Attacking Soaring Health Care Costs: How One University Controls Health Care Costs.

ERIC Educational Resources Information Center

Clarke, Susan S.

1993-01-01

Health care costs at Rensselaer Polytechnic Institute (New York) were projected to double between 1986 and 1990. The university has met cost-reduction goals through varied approaches, planned future cuts in overall costs by studying its employee population and is working toward a flexible plan for diverse health care needs. (MSE)

47 CFR 27.1180 - The cost-sharing formula.

Code of Federal Regulations, 2010 CFR

2010-10-01

...); towers and/or modifications; back-up power equipment; monitoring or control equipment; engineering costs (design/path survey); installation; systems testing; FCC filing costs; site acquisition and civil works... as equipment and engineering expenses. There is no cap on the actual costs of relocation. (c) An AWS...

Does self-management for return to work increase the effectiveness of vocational rehabilitation for chronic compensated musculoskeletal disorders? - Protocol for a randomised controlled trial

PubMed Central

2010-01-01

Background Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation. Methods/Design The research plan contains mixed methodology consisting of a single blind randomised controlled trial, an economic evaluation and qualitative research. Participants (n = 366) are volunteers with compensated musculoskeletal disorders of 3 months to 3 years in duration who were working at the time of the injury/onset of the chronic disorder. The trial tests the effectiveness of usual vocational rehabilitation plus the Chronic Disease Self-Management Program (CDSMP) to which two additional and newly-developed modules have been added, against vocational rehabilitation alone (control) The modules added to the CDSMP focus on how to navigate through compensation systems and manage the return to work process, and aim to be relevant to those in a vocational rehabilitation setting. The primary outcome of this study is readiness for return to work which will be evaluated using the Readiness for Return-to-Work scale. Secondary outcomes include return to work status, health efficacy (heiQ™ questionnaire) and general health status (SF-12v2® Health Survey). Measures will be taken at baseline, immediately post-intervention and at 6- and 12- months post-intervention by an independent assessor. An economic evaluation will compare the costs and outcomes between the intervention and control groups in terms of cost-effectiveness and a partial cost-benefit or cost analysis. The impact of the intervention will also be evaluated qualitatively, in terms of its acceptability to stakeholders. Discussion This article describes the protocol for a single blind randomised controlled trial with a one year follow-up. The results will provide evidence for the addition or not of self-management training within vocational rehabilitation for chronic compensated musculoskeletal disorders. Trial Registration Australia and New Zealand Clinical Trials Registry ACTRN12609000843257 PMID:20534168

Vaccination and treatment as control interventions in an infectious disease model with their cost optimization

NASA Astrophysics Data System (ADS)

Kumar, Anuj; Srivastava, Prashant K.

2017-03-01

In this work, an optimal control problem with vaccination and treatment as control policies is proposed and analysed for an SVIR model. We choose vaccination and treatment as control policies because both these interventions have their own practical advantage and ease in implementation. Also, they are widely applied to control or curtail a disease. The corresponding total cost incurred is considered as weighted combination of costs because of opportunity loss due to infected individuals and costs incurred in providing vaccination and treatment. The existence of optimal control paths for the problem is established and guaranteed. Further, these optimal paths are obtained analytically using Pontryagin's Maximum Principle. We analyse our results numerically to compare three important strategies of proposed controls, viz.: vaccination only; with both treatment and vaccination; and treatment only. We note that first strategy (vaccination only) is less effective as well as expensive. Though, for a highly effective vaccine, vaccination alone may also work well in comparison with treatment only strategy. Among all the strategies, we observe that implementation of both treatment and vaccination is most effective and less expensive. Moreover, in this case the infective population is found to be relatively very low. Thus, we conclude that the comprehensive effect of vaccination and treatment not only minimizes cost burden due to opportunity loss and applied control policies but also keeps a tab on infective population.

Improvements and new concepts for traffic control in work zones. Volume 4, Speed control in work zones

DOT National Transportation Integrated Search

1985-09-01

Tile objective of the research was to determine or develop effective methods of s1owing traffic to an acceptable speed in work zones. Factors considered in the study included cost, motorist and worker safety, institutional constraints, and probabilit...

33 CFR 203.47 - Modifications to non-Federal flood control works.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DISASTER PROCEDURES Rehabilitation Assistance for Flood Control Works Damaged by Flood or Coastal Storm... Federal construction cost of rehabilitation to preflood level of protection, or $100,000, whichever is... only in cash. In-kind services are not permitted for modification work. (b) Protection of additional...

33 CFR 203.47 - Modifications to non-Federal flood control works.

Code of Federal Regulations, 2014 CFR

2014-07-01

... DISASTER PROCEDURES Rehabilitation Assistance for Flood Control Works Damaged by Flood or Coastal Storm... Federal construction cost of rehabilitation to preflood level of protection, or $100,000, whichever is... only in cash. In-kind services are not permitted for modification work. (b) Protection of additional...

33 CFR 203.47 - Modifications to non-Federal flood control works.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DISASTER PROCEDURES Rehabilitation Assistance for Flood Control Works Damaged by Flood or Coastal Storm... Federal construction cost of rehabilitation to preflood level of protection, or $100,000, whichever is... only in cash. In-kind services are not permitted for modification work. (b) Protection of additional...

33 CFR 203.47 - Modifications to non-Federal flood control works.

Code of Federal Regulations, 2012 CFR

2012-07-01

... DISASTER PROCEDURES Rehabilitation Assistance for Flood Control Works Damaged by Flood or Coastal Storm... Federal construction cost of rehabilitation to preflood level of protection, or $100,000, whichever is... only in cash. In-kind services are not permitted for modification work. (b) Protection of additional...

33 CFR 203.47 - Modifications to non-Federal flood control works.

Code of Federal Regulations, 2013 CFR

2013-07-01

... DISASTER PROCEDURES Rehabilitation Assistance for Flood Control Works Damaged by Flood or Coastal Storm... Federal construction cost of rehabilitation to preflood level of protection, or $100,000, whichever is... only in cash. In-kind services are not permitted for modification work. (b) Protection of additional...

Cost and Return on Investment of a Work-Family Intervention in the Extended Care Industry: Evidence From the Work, Family, and Health Network.

PubMed

Dowd, William N; Bray, Jeremy W; Barbosa, Carolina; Brockwood, Krista; Kaiser, David J; Mills, Michael J; Hurtado, David A; Wipfli, Brad

2017-10-01

To estimate the cost and return on investment (ROI) of an intervention targeting work-family conflict (WFC) in the extended care industry. Costs to deliver the intervention during a group-randomized controlled trial were estimated, and data on organizational costs-presenteeism, health care costs, voluntary termination, and sick time-were collected from interviews and administrative data. Generalized linear models were used to estimate the intervention's impact on organizational costs. Combined, these results produced ROI estimates. A cluster-robust confidence interval (CI) was estimated around the ROI estimate. The per-participant cost of the intervention was $767. The ROI was -1.54 (95% CI: -4.31 to 2.18). The intervention was associated with a $668 reduction in health care costs (P < 0.05). This paper builds upon and expands prior ROI estimation methods to a new setting.

Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea.

PubMed

Buono, Jessica L; Carson, Robyn T; Flores, Natalia M

2017-02-14

Irritable bowel syndrome (IBS) affects 10-15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population. Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics. In total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p < 0.001; mean PCS: 47.29 vs. 50.67; p < 0.001; mean SF-6D: 0.677 vs. 0.741; p < 0.001) and greater absenteeism (5.1% vs. 2.9%; p = 0.004), presenteeism (17.9% vs. 11.3%; p < 0.001), overall work productivity loss (20.7% vs. 13.2%; p < 0.001), and activity impairment (29.6% vs. 18.9%; p < 0.001). Respondents with IBS-D also incurred an estimated $2486 more in indirect costs ($7008 vs. $4522; p < 0.001). Compared with controls, IBS-D is associated with significantly lower HRQoL, greater impairments in work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.

Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness

PubMed Central

Driessen, Maurice T; Anema, Johannes R; Proper, Karin I; Bongers, Paulien M; Beek, Allard J van der

2008-01-01

Background Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP among workers. Methods In a randomised controlled trial (RCT), a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline. The departments consisting of about 150 workers are pre-stratified and randomised. The control departments receive usual practice and the intervention departments receive PE. Within each intervention department a working group is formed including eight workers, a representative of the management, and an occupational health and safety coordinator. During a one day meeting, the working group follows the steps of PE in which the most important risk factors for LBP and NP, and the most adequate ergonomic measures are identified on the basis of group consensus. The implementation of ergonomic measures at the department is performed by the working group. To improve the implementation process, so-called 'ergocoaches' are trained. The primary outcome measure is an episode of LBP and NP. Secondary outcome measures are actual use of ergonomic measures, physical workload, psychosocial workload, intensity of pain, general health status, sick leave, and work productivity. The cost-effectiveness analysis is performed from the societal and company perspective. Outcome measures are assessed using questionnaires at baseline and after 6 and 12 months. Data on the primary outcome as well as on intensity of pain, sick leave, work productivity, and health care costs are collected every 3 months. Discussion Prevention of LBP and NP is beneficial for workers, employers, and society. If the intervention is proven (cost-)effective, the intervention can have a major impact on LBP and NP prevention and, thereby, on work disability prevention. Results are expected in 2010. Trial registration ISRCTN27472278 PMID:18959799

Imputing at-work productivity loss using results of a randomized controlled trial comparing tapentadol extended release and oxycodone controlled release for osteoarthritis pain.

PubMed

Lerner, Debra; Chang, Hong; Rogers, William H; Benson, Carmela; Chow, Wing; Kim, Myoung S; Biondi, David

2012-08-01

: To determine the impact of tapentadol extended release (ER) versus placebo or oxycodone controlled release (CR) on the work productivity of adults with chronic moderate to severe knee osteoarthritis pain. : Using clinical trial data on pain outcomes, a validated methodology imputed treatment group differences in at-work productivity and associated differences in productivity costs (assuming a $100,000 annual salary per participant). : Imputed improvements in at-work productivity were significantly greater for tapentadol ER compared with either placebo (mean, 1.96% vs 1.51%; P = 0.001) or oxycodone CR (mean, 1.96% vs 1.40%; P < 0.001). Mean net savings per participant were $450 (P < 0.01) for tapentadol ER versus placebo and $560 (P = 0.001) for tapentadol ER versus oxycodone CR. : Effective osteoarthritis pain treatment also may help employees to function better at work and reduce their employers' productivity costs.

47 CFR 27.1164 - The cost-sharing formula.

Code of Federal Regulations, 2013 CFR

2013-10-01

...); installation; systems testing; FCC filing costs; site acquisition and civil works; zoning costs; training... upgrades for interference control; power plant upgrade (if required); electrical grounding systems; Heating Ventilation and Air Conditioning (HVAC) (if required); alternate transport equipment; and leased facilities...

More Colleges Tighten Benefit Programs to Meet Big Rise in Health-Insurance Costs.

ERIC Educational Resources Information Center

Magner, Denise K.

1992-01-01

Increases in costs to colleges and universities for employee health insurance have risen as much as 20 to 30 percent annually, requiring adjustments to control costs, a new philosophy of sharing costs with employees, increased proportions of payroll (now 6.1 percent) going for health care costs, and reductions in work force size. (DB)

Cost effectiveness of tobacco control policies in Vietnam: the case of population-level interventions.

PubMed

Higashi, Hideki; Truong, Khoa D; Barendregt, Jan J; Nguyen, Phuong K; Vuong, Mai L; Nguyen, Thuy T; Hoang, Phuong T; Wallace, Angela L; Tran, Tien V; Le, Cuong Q; Doran, Christopher M

2011-05-01

Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries. The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam. Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis. All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e.

A Study of the Relationship between User Attitudes and the Success of the MAJCOM and AFRCE Work Information Management System.

DTIC Science & Technology

1984-09-01

subsystems including labor reporting, Prime BEEF (Base Engineer Emergency Forces) composition, work order control, material control, cost accounting...AirComan IL ARCE BallsticLangey AB,24 Misl Supr)-FC Norton AF CA ( Estr Region) - AFRCE (United Kingdom) Ruislip AB UK UntdSae0i Fre nErp * Ramstein AB...Air Force personnel and minimize information burden on users, providers, and handlers, thereby reducing the costs, labor and intensiveness, and time

Illness-associated productivity costs among women with employer-sponsored insurance and newly diagnosed breast cancer.

PubMed

Meadows, Eric S; Johnston, Stephen S; Cao, Zhun; Foley, Kathleen A; Pohl, Gerhardt M; Johnston, Joseph A; Ramsey, Scott D

2010-04-01

Determine lost work time and job attrition for incident breast cancer (BC). The cases were employed women, aged 18 to 64, with BC identified by a validated algorithm between 1999 and 2005, from claims (MarketScan) and attendance databases. Controls without cancer were matched 3:1 on age, comorbidity, and index year. First-year mean disability days were 60 (cases, N = 880) versus 5 (controls, N = 2640) (P < 0.001). The first-year disability costs were $4900 for cases versus $385 for controls (P < 0.001). In years 2 through 4, the disability days and associated costs were similar for the cases versus controls. After 4 years, 56.4% of cases were still enrolled in the employer-sponsored insurance programs compared to 6.5% of controls (P < 0.001). The lost work associated with BC is substantial in the first year after diagnosis. Employee retention is much higher for BC cases versus controls.

Army Corps of Engineers: Cost Increases in Flood Control Projects and Improving Communication with Nonfederal Sponsors

DTIC Science & Technology

2013-12-01

such poor condition that it had to have major rehabilitation work performed. Work to fix the deteriorated tunnel cost $10 million more than had...originally been estimated.19 Corps officials on the Little Calumet project said during construction they encountered a former landfill along one portion

Working memory costs of task switching.

PubMed

Liefooghe, Baptist; Barrouillet, Pierre; Vandierendonck, André; Camos, Valérie

2008-05-01

Although many accounts of task switching emphasize the importance of working memory as a substantial source of the switch cost, there is a lack of evidence demonstrating that task switching actually places additional demands on working memory. The present study addressed this issue by implementing task switching in continuous complex span tasks with strictly controlled time parameters. A series of 4 experiments demonstrate that recall performance decreased as a function of the number of task switches and that the concurrent load of item maintenance had no influence on task switching. These results indicate that task switching induces a cost on working memory functioning. Implications for theories of task switching, working memory, and resource sharing are addressed.

Productivity loss due to absenteeism and presenteeism by different instruments in patients with RA and subjects without RA.

PubMed

Braakman-Jansen, Louise M A; Taal, Erik; Kuper, Ina H; van de Laar, Mart A F J

2012-02-01

To explore the impact of at-work productivity loss on the total productivity cost by different instruments in patients recently diagnosed with RA and controls without RA. Cross-sectional data were collected from outpatients with RA between December 2007 and February 2008. The control group was formed by subjects without RA matched on age and gender. Absenteeism and presenteeism were estimated by the Quantity and Quality (QQ) Questionnaire, Work Productivity and Activity Impairment Questionnaire General Health V2.0 (WPAI-GH) and Health and Labor Questionnaire (HLQ) questionnaires. Differences between groups were tested by Mann-Whitney U-test. Costs were valued by the human capital approach. Data were available from 62 patients with a paid job and 61 controls. QQ- and WPAI-GH scores of presenteeism were moderately correlated (r = 0.61) while the HLQ presenteeism score correlated poorly with the other instruments (r = 0.34). The contribution of presenteeism on total productivity costs was estimated at ∼70% in the RA group. The mean costs per person per week due to presenteeism varied between €79 and €318 per week in the RA group, dependent on the instrument used. The costs due to presenteeism were about two to four times higher in the RA group compared with the control group. This study indicates that the impact of presenteeism on the total productivity costs in patients with RA is high. However, work productivity in individuals without RA was not optimal either, which implies a risk of overestimation of cost when a normal score is not taken into account. Finally, different presenteeism instruments lead to different results.

"Employment and arthritis: making it work" a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).

PubMed

Carruthers, Erin C; Rogers, Pamela; Backman, Catherine L; Goldsmith, Charles H; Gignac, Monique A; Marra, Carlo; Village, Judy; Li, Linda C; Esdaile, John M; Lacaille, Diane

2014-07-21

Arthritis and musculoskeletal conditions are the leading cause of long-term work disability (WD), an outcome with a major impact on quality of life and a high cost to society. The importance of decreased at-work productivity has also recently been recognized. Despite the importance of these problems, few interventions have been developed to reduce the impact of arthritis on employment. We have developed a novel intervention called "Making It Work", a program to help people with inflammatory arthritis (IA) deal with employment issues, prevent WD and improve at-work productivity. After favorable results in a proof-of-concept study, we converted the program to a web-based format for broader dissemination and improved accessibility. The objectives of this study are: 1) to evaluate in a randomized controlled trial (RCT) the effectiveness of the program at preventing work cessation and improving at-work productivity; 2) to perform a cost-utility analysis of the intervention. 526 participants with IA will be recruited from British Columbia, Alberta, and Ontario in Canada. The intervention consists of a) 5 online group sessions; b) 5 web-based e-learning modules; c) consultations with an occupational therapist for an ergonomic work assessment and a vocational rehabilitation counselor. Questionnaires will be administered online at baseline and every 6 months to collect information about demographics, disease measures, costs, work-related risk factors for WD, quality of life, and work outcomes. Primary outcomes include at-work productivity and time to work cessation of > 6 months for any reason. Secondary outcomes include temporary work cessation, number of days missed from work per year, reduction in hours worked per week, quality adjusted life year for the cost utility analysis, and changes from baseline in employment risk factors. Analysis of Variance will evaluate the intervention's effect on at-work productivity, and multivariable Cox regression models will estimate the risk of work cessation associated with the intervention after controlling for risk factors for WD and other important predictors imbalanced at baseline. This program fills an important gap in arthritis health services and addresses an important and costly problem. Knowledge gained from the RCT will be useful to health care professionals, policy planners and arthritis stakeholders. ClinicalTrials.gov NCT01852851; registered April 13, 2012; first participant randomized on July 6, 2013.

Return to work of workers without a permanent employment contract, sick-listed due to a common mental disorder: design of a randomised controlled trial.

PubMed

Lammerts, Lieke; Vermeulen, Sylvia J; Schaafsma, Frederieke G; van Mechelen, Willem; Anema, Johannes R

2014-06-12

Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job.The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual. The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months.The program strongly involves the sick-listed worker in the identification of obstacles for return to work and possible solutions, resulting in a consensus based action plan. This plan will be used as a starting point for the search of suitable competitive employment with support of a rehabilitation agency. During this process the insurance physician of the sick-listed worker contacts other caregivers to promote integrated care.Workers eligible to participate in this study have no permanent employment contract, have applied for a sickness benefit at the Dutch Social Security Agency and are sick-listed between two and fourteen weeks due to mental health problems.The primary outcome measure is the duration until first sustainable return to work in a competitive job. Outcomes are measured at baseline and after three, six, nine and twelve months. If the participatory supportive return to work program proves to be cost-effective, the social security system, the sick-listed worker and society as a whole will benefit. A cost-effective return to work program will lead to a reduction of costs related to sickness absence. For the sick-listed worker a cost-effective program results in earlier sustainable return to work, which can be associated with both social and health benefits. The trial registration number and date is NTR3563, August 7, 2012.

Return to work of workers without a permanent employment contract, sick-listed due to a common mental disorder: design of a randomised controlled trial

PubMed Central

2014-01-01

Background Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job. The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual. Methods/Design The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months. The program strongly involves the sick-listed worker in the identification of obstacles for return to work and possible solutions, resulting in a consensus based action plan. This plan will be used as a starting point for the search of suitable competitive employment with support of a rehabilitation agency. During this process the insurance physician of the sick-listed worker contacts other caregivers to promote integrated care. Workers eligible to participate in this study have no permanent employment contract, have applied for a sickness benefit at the Dutch Social Security Agency and are sick-listed between two and fourteen weeks due to mental health problems. The primary outcome measure is the duration until first sustainable return to work in a competitive job. Outcomes are measured at baseline and after three, six, nine and twelve months. Discussion If the participatory supportive return to work program proves to be cost-effective, the social security system, the sick-listed worker and society as a whole will benefit. A cost-effective return to work program will lead to a reduction of costs related to sickness absence. For the sick-listed worker a cost-effective program results in earlier sustainable return to work, which can be associated with both social and health benefits. Trial registration The trial registration number and date is NTR3563, August 7, 2012. PMID:24919561

A health system program to reduce work disability related to musculoskeletal disorders.

PubMed

Abásolo, Lydia; Blanco, Margarita; Bachiller, Javier; Candelas, Gloria; Collado, Paz; Lajas, Cristina; Revenga, Marcelino; Ricci, Patricia; Lázaro, Pablo; Aguilar, Maria Dolores; Vargas, Emilio; Fernández-Gutiérrez, Benjamín; Hernández-García, César; Carmona, Loreto; Jover, Juan A

2005-09-20

Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product. To evaluate whether a population-based clinical program offered to patients with recent-onset work disability caused by MSDs is cost-effective. Randomized, controlled intervention study. The inclusion and follow-up periods each lasted 12 months. Three health districts in Madrid, Spain. All patients with MSD-related temporary work disability in 1998 and 1999. The control group received standard primary care management, with referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties. Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis. 1,077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16,297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (mean, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, 6.00 dollars had to be invested in the program. Each dollar invested generated a benefit of 11.00 dollars. The program's net benefit was in excess of 5 million dollars. The study was unblinded. Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.

Remembering to Prepare: The Benefits (and Costs) of High Working Memory Capacity

ERIC Educational Resources Information Center

Richmond, Lauren L.; Redick, Thomas S.; Braver, Todd S.

2015-01-01

The dual mechanisms of control framework postulates that cognitive control can operate in 2 distinct modes: a "proactive" preparatory mode and a "reactive" wait-and-see mode. Importantly, the 2 modes are associated with both costs and benefits in cognitive performance. Here we explore this framework, in terms of its…

Adherence to infection control guidelines in surgery on MRSA positive patients : A cost analysis.

PubMed

Saegeman, V; Schuermans, A

2016-09-01

In surgical units, similar to other healthcare departments, guidelines are used to curb transmission of methicillin resistant Staphylococcus aureus (MRSA). The aim of this study was to calculate the extra costs for material and extra working hours for compliance to MRSA infection control guidelines in the operating rooms of a University Hospital. The study was based on observations of surgeries on MRSA positive patients. The average cost per surgery was calculated utilizing local information on unit costs. Robustness of the calculations was evaluated with a sensitivity analysis. The total extra costs of adherence to MRSA infection control guidelines averaged € 340.46 per surgical procedure (range € 207.76- € 473.15). A sensitivity analysis based on a standardized operating room hourly rate reached a cost of € 366.22. The extra costs of adherence to infection control guidelines are considerable. To reduce costs, the logistical planning of surgeries could be improved by for instance a dedicated room.

Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial.

PubMed

Flood, Chris; Mugford, Miranda; Stewart, Sandra; Harvey, Ian; Poland, Fiona; Lloyd-Smith, Walter

2005-01-01

To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life. Cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves. There were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case 542 pounds, 95% CI 434-1,519 pounds). Mean total costs of care per participant were 4,379 pounds and 3,837 pounds for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of 14,000 pounds per quality-adjusted life year (QALY). The probability of such an outcome was <50%. From a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home.

Work productivity and activity impairment in gastroesophageal reflux disease in Korean full-time employees: a multicentre study.

PubMed

Shin, Woon Geon; Kim, Heung Up; Kim, Sang Gyun; Kim, Gwang Ha; Shim, Ki-Nam; Kim, Jeong Wook; Kim, Jin Il; Kim, Jae Gyu; Kim, Jae J; Yim, Da-Hae; Park, Sue K; Park, Soo-Heon

2012-04-01

The costs of gastroesophageal reflux disease have not been assessed in Asia, even though the prevalence of gastroesophageal reflux disease is gradually increasing. We evaluated work presenteeism and absenteeism as indirect costs of gastroesophageal reflux disease in Korea. This was a cross-sectional and multicentre study using patient-reported outcome instruments. A total of 1009 full-time employees who visited the gastrointestinal department for any reason (281 patients with gastroesophageal reflux disease and 728 controls) were included. Main outcomes were presenteeism and absenteeism measured as work productivity loss and monetary cost per week. Absenteeism and presenteeism were significantly higher in the gastroesophageal reflux disease than the control group (1.49% vs. 0.46%, P=0.0010; 34.13% vs. 9.23%, P<0.0001). Loss of work productivity was significantly greater in the gastroesophageal reflux disease than the control group (33.09% vs. 9.02%; P<0.0001). This loss of work productivity difference between the two groups represented an additional productivity loss of 11.7h/week in the gastroesophageal reflux disease group compared with the control group. Assuming average hourly wages of $14.12, the weekly burden of gastroesophageal reflux disease reached $165.07 per person. Gastroesophageal reflux disease was associated with substantial work productivity loss, mainly due to presenteeism rather than absenteeism, in Korean full-time employees. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study

PubMed Central

2012-01-01

Background Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. Methods/design This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients’ supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. Discussion Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. Trial registration number NTR2886 PMID:22747949

An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study.

PubMed

van Vilsteren, Myrthe; Boot, Cécile R L; Steenbeek, Romy; van Schaardenburg, Dirkjan; Voskuyl, Alexandre E; Anema, Johannes R

2012-07-02

Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients' supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. NTR2886.

E-learning: controlling costs and increasing value.

PubMed

Walsh, Kieran

2015-04-01

E-learning now accounts for a substantial proportion of medical education provision. This progress has required significant investment and this investment has in turn come under increasing scrutiny so that the costs of e-learning may be controlled and its returns maximised. There are multiple methods by which the costs of e-learning can be controlled and its returns maximised. This short paper reviews some of those methods that are likely to be most effective and that are likely to save costs without compromising quality. Methods might include accessing free or low-cost resources from elsewhere; create short learning resources that will work on multiple devices; using open source platforms to host content; using in-house faculty to create content; sharing resources between institutions; and promoting resources to ensure high usage. Whatever methods are used to control costs or increase value, it is most important to evaluate the impact of these methods.

Optimization of Highway Work Zone Decisions Considering Short-Term and Long-Term Impacts

DTIC Science & Technology

2010-01-01

strategies which can minimize the one-time work zone cost. Considering the complex and combinatorial nature of this optimization problem, a heuristic...combination of lane closure and traffic control strategies which can minimize the one-time work zone cost. Considering the complex and combinatorial nature ...zone) NV # the number of vehicle classes NPV $ Net Present Value p’(t) % Adjusted traffic diversion rate at time t p(t) % Natural diversion rate

Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

PubMed

Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

2008-04-01

Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

75 FR 11621 - Agency Information Collection Activities: Notice of Request for Extension of Currently Approved...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-11

... costs incurred for adjusting their facilities. The railroad companies must have a system for recording labor, materials, supplies, and equipment costs incurred when undertaking the necessary railroad work...: Developing and Recording Costs for Railroad Adjustments. OMB Control Number: 2125-0521. Background: Under 23...

Cost Benefit Analysis and Other Fun and Games.

ERIC Educational Resources Information Center

White, Herbert S.

1985-01-01

Discussion of application of cost benefit analysis (CBA) accounting techniques to libraries highlights user willingness to be charged for services provided, reasons why CBA will not work in library settings, libraries and budgets, cost distribution on basis of presumed or expected use, implementation of information-seeking behavior control, and…

Mini-intervention for subacute low back pain: a randomized controlled trial.

PubMed

Karjalainen, Kaija; Malmivaara, Antti; Pohjolainen, Timo; Hurri, Heikki; Mutanen, Pertti; Rissanen, Pekka; Pahkajärvi, Helena; Levon, Heikki; Karpoff, Hanna; Roine, Risto

2003-03-15

Randomized controlled trial. To investigate the effectiveness and costs of a mini-intervention, provided in addition to the usual care, and the incremental effect of a work site visit for patients with subacute disabling low back pain. There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain. A total of 164 patients with subacute low back pain were randomized to a mini-intervention group (A), a work site visit group (B), or a usual care group (C). Groups A (n = 56) and B (n = 51) underwent one assessment by a physician plus a physiotherapist. Group B received a work site visit in addition. Group C served as controls (n = 57) and was treated in municipal primary health care. All patients received a leaflet on back pain. Pain, disability, specific and generic health-related quality of life, satisfaction with care, days on sick leave, and use and costs of health care consumption were measured at 3-, 6-, and 12-month follow-ups. During follow-up, fewer subjects had daily pain in Groups A and B than in Group C (Group A Group C, = 0.002; Group B Group C, = 0.030). In Group A, pain was less bothersome (Group A Group C, = 0.032) and interfered less with daily life (Group A Group C, = 0.040) than among controls. Average days on sick leave were 19 in Group A, 28 in Group B, and 41 in Group C (Group A Group C, = 0.019). Treatment satisfaction was better in the intervention groups than among the controls, and costs were lowest in the mini-intervention group. Mini-intervention reduced daily back pain symptoms and sickness absence, improved adaptation to pain and patient satisfaction among patients with subacute low back pain, without increasing health care costs. A work site visit did not increase effectiveness.

U.S. Air Force Research Laboratory's Need for Flow Physics and Control With Applications Involving Aero-Optics and Weapon Bay Cavities

NASA Technical Reports Server (NTRS)

Schmit, Ryan

2010-01-01

To develop New Flow Control Techniques: a) Knowledge of the Flow Physics with and without control. b) How does Flow Control Effect Flow Physics (What Works to Optimize the Design?). c) Energy or Work Efficiency of the Control Technique (Cost - Risk - Benefit Analysis). d) Supportability, e.g. (size of equipment, computational power, power supply) (Allows Designer to include Flow Control in Plans).

The long-term impact of employment on mental health service use and costs for persons with severe mental illness.

PubMed

Bush, Philip W; Drake, Robert E; Xie, Haiyi; McHugo, Gregory J; Haslett, William R

2009-08-01

Stable employment promotes recovery for persons with severe mental illness by enhancing income and quality of life, but its impact on mental health costs has been unclear. This study examined service cost over ten years among participants in a co-occurring disorders study. Latent-class growth analysis of competitive employment identified trajectory groups. The authors calculated annual costs of outpatient services and institutional stays for 187 participants and examined group differences in ten-year utilization and cost. A steady-work group (N=51) included individuals whose work hours increased rapidly and then stabilized to average 5,060 hours per person over ten years. A late-work group (N=57) and a no-work group (N=79) did not differ significantly in utilization or cost outcomes, so they were combined into a minimum-work group (N=136). More education, a bipolar disorder diagnosis (versus schizophrenia or schizoaffective disorder), work in the past year, and lower scores on the expanded Brief Psychiatric Rating Scale predicted membership in the steady-work group. These variables were controlled for in the outcomes analysis. Use of outpatient services for the steady-work group declined at a significantly greater rate than it did for the minimum-work group, while institutional (hospital, jail, or prison) stays declined for both groups without a significant difference. The average cost per participant for outpatient services and institutional stays for the minimum-work group exceeded that of the steady-work group by $166,350 over ten years. Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation.

Minimizing communication cost among distributed controllers in software defined networks

NASA Astrophysics Data System (ADS)

Arlimatti, Shivaleela; Elbreiki, Walid; Hassan, Suhaidi; Habbal, Adib; Elshaikh, Mohamed

2016-08-01

Software Defined Networking (SDN) is a new paradigm to increase the flexibility of today's network by promising for a programmable network. The fundamental idea behind this new architecture is to simplify network complexity by decoupling control plane and data plane of the network devices, and by making the control plane centralized. Recently controllers have distributed to solve the problem of single point of failure, and to increase scalability and flexibility during workload distribution. Even though, controllers are flexible and scalable to accommodate more number of network switches, yet the problem of intercommunication cost between distributed controllers is still challenging issue in the Software Defined Network environment. This paper, aims to fill the gap by proposing a new mechanism, which minimizes intercommunication cost with graph partitioning algorithm, an NP hard problem. The methodology proposed in this paper is, swapping of network elements between controller domains to minimize communication cost by calculating communication gain. The swapping of elements minimizes inter and intra communication cost among network domains. We validate our work with the OMNeT++ simulation environment tool. Simulation results show that the proposed mechanism minimizes the inter domain communication cost among controllers compared to traditional distributed controllers.

Working memory in social anxiety disorder: better manipulation of emotional versus neutral material in working memory.

PubMed

Yoon, K Lira; Kutz, Amanda M; LeMoult, Joelle; Joormann, Jutta

2017-12-01

Individuals with social anxiety disorder (SAD) engage in post-event processing, a form of perseverative thinking. Given that deficits in working memory might underlie perseverative thinking, we examined working memory in SAD with a particular focus on the effects of stimulus valence. SAD (n = 31) and healthy control (n = 20) participants either maintained (forward trials) or reversed (backward trials) in working memory the order of four emotional or four neutral pictures, and we examined sorting costs, which reflect the extent to which performance deteriorated on the backward trials compared to the forward trials. Emotionality of stimuli affected performance of the two groups differently. Whereas control participants exhibited higher sorting costs for emotional stimuli compared to neutral stimuli, SAD participants exhibited the opposite pattern. Greater attention to emotional stimuli in SAD might facilitate the processing of emotional (vs. neutral) stimuli in working memory.

The Role of Working Memory Capacity and Interference Resolution Mechanisms in Task Switching

PubMed Central

Pettigrew, Corinne; Martin, Randi C.

2015-01-01

Theories of task switching have emphasized a number of control mechanisms that may support the ability to flexibly switch between tasks. The present study examined the extent to which individual differences in working memory (WM) capacity and two measures of interference resolution, response-distractor inhibition and resistance to proactive interference (PI), account for variability in task switching, including global costs, local costs, and N-2 repetition costs. 102 young and 60 older adults were tested on a battery of tasks. Composite scores were created for WM capacity, response-distractor inhibition, and resistance to PI; shifting was indexed by rate residual scores which combine response time and accuracy and account for individual differences in processing speed. Composite scores served as predictors of task switching. WM was significantly related to global switch costs. While resistance to PI and WM explained some variance in local costs, these effects did not reach significance. In contrast, none of the control measures explained variance in N-2 repetition costs. Furthermore, age effects were only evident for N-2 repetition costs, with older adults demonstrating larger costs than young adults. Results are discussed within the context of theoretical models of task switching. PMID:26594895

The role of working memory capacity and interference resolution mechanisms in task switching.

PubMed

Pettigrew, Corinne; Martin, Randi C

2016-12-01

Theories of task switching have emphasized a number of control mechanisms that may support the ability to flexibly switch between tasks. The present study examined the extent to which individual differences in working memory (WM) capacity and two measures of interference resolution, response-distractor inhibition and resistance to proactive interference (PI), account for variability in task switching, including global costs, local costs, and N-2 repetition costs. A total of 102 young and 60 older adults were tested on a battery of tasks. Composite scores were created for WM capacity, response-distractor inhibition, and resistance to PI; shifting was indexed by rate residual scores, which combine response time and accuracy and account for individual differences in processing speed. Composite scores served as predictors of task switching. WM was significantly related to global switch costs. While resistance to PI and WM explained some variance in local costs, these effects did not reach significance. In contrast, none of the control measures explained variance in N-2 repetition costs. Furthermore, age effects were only evident for N-2 repetition costs, with older adults demonstrating larger costs than young adults. Results are discussed within the context of theoretical models of task switching.

Performance measurement: A tool for program control

NASA Technical Reports Server (NTRS)

Abell, Nancy

1994-01-01

Performance measurement is a management tool for planning, monitoring, and controlling as aspects of program and project management--cost, schedule, and technical requirements. It is a means (concept and approach) to a desired end (effective program planning and control). To reach the desired end, however, performance measurement must be applied and used appropriately, with full knowledge and recognition of its power and of its limitations--what it can and cannot do for the project manager. What is the potential of this management tool? What does performance measurement do that a traditional plan vs. actual technique cannot do? Performance measurement provides an improvement over the customary comparison of how much money was spent (actual cost) vs. how much was planned to be spent based on a schedule of activities (work planned). This commonly used plan vs. actual comparison does not allow one to know from the numerical data if the actual cost incurred was for work intended to be done.

[Cost-benefit analysis of primary prevention programs for mental health at the workplace in Japan].

PubMed

Yoshimura, Kensuke; Kawakami, Norito; Tsusumi, Akizumi; Inoue, Akiomi; Kobayashi, Yuka; Takeuchi, Ayano; Fukuda, Takashi

2013-01-01

To determine the cost-benefits of primary prevention programs for mental health at the workplace, we conducted a meta-analysis of published studies in Japan. We searched the literature, published as of 16 November 2011, using the Pubmed database and relevant key words. The inclusion criteria were: conducted in the workplace in Japan; primary prevention focus; quasi-experimental studies or controlled trials; and outcomes including absenteeism or presenteeism. Four studies were identified: one participatory work environment improvement, one individual-oriented stress management, and two supervisor education programs. Costs and benefits in yen were estimated for each program, based on the description of the programs in the literature, and additional information from the authors. The benefits were estimated based on each program's effect on work performance (measured using the WHO Health and Work Performance Questionnaire in all studies), as well as sick leave days, if available. The estimated relative increase in work performance (%) in the intervention group compared to the control group was converted into labor cost using the average bonus (18% of the total annual salary) awarded to employees in Japan as a base. Sensitive analyses were conducted using different models of time-trend of intervention effects and 95% confidence limits of the relative increase in work performance. For the participatory work environment improvement program, the cost was estimated as 7,660 yen per employee, and the benefit was 15,200-22,800 yen per employee. For the individual-oriented stress management program, the cost was 9,708 yen per employee, and the benefit was 15,200-22,920 yen per employee. For supervisor education programs, the costs and benefits were respectively 5,209 and 4,400-6,600 yen per employee, in one study, 2,949 and zero yen per employee in the other study. The 95% confidence intervals were wide for all these studies. For the point estimates based on these cases, the participatory work environment improvement program and the individual-oriented stress management program showed better cost-benefits. For the supervisor education programs, the costs were almost equal to or greater than the benefits. The results of the present study suggest these primary prevention programs for mental health at the workplace are economically advantageous to employers. Because the 95% confidence intervals were wide, further research is needed to clarify if these interventions yield statistically significant cost-benefits.

Impact and cost-effectiveness of a comprehensive Schistosomiasis japonica control program in the Poyang Lake region of China.

PubMed

Yu, Qing; Zhao, Geng-Ming; Hong, Xian-Lin; Lutz, Eric A; Guo, Jia-Gang

2013-11-28

Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003-2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%-544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%-1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence.

Impact and Cost-Effectiveness of a Comprehensive Schistosomiasis japonica Control Program in the Poyang Lake Region of China

PubMed Central

Yu, Qing; Zhao, Geng-Ming; Hong, Xian-Lin; Lutz, Eric A.; Guo, Jia-Gang

2013-01-01

Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003–2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%–544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%–1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence. PMID:24287861

The Inactivation Principle: Mathematical Solutions Minimizing the Absolute Work and Biological Implications for the Planning of Arm Movements

PubMed Central

Berret, Bastien; Darlot, Christian; Jean, Frédéric; Pozzo, Thierry; Papaxanthis, Charalambos; Gauthier, Jean Paul

2008-01-01

An important question in the literature focusing on motor control is to determine which laws drive biological limb movements. This question has prompted numerous investigations analyzing arm movements in both humans and monkeys. Many theories assume that among all possible movements the one actually performed satisfies an optimality criterion. In the framework of optimal control theory, a first approach is to choose a cost function and test whether the proposed model fits with experimental data. A second approach (generally considered as the more difficult) is to infer the cost function from behavioral data. The cost proposed here includes a term called the absolute work of forces, reflecting the mechanical energy expenditure. Contrary to most investigations studying optimality principles of arm movements, this model has the particularity of using a cost function that is not smooth. First, a mathematical theory related to both direct and inverse optimal control approaches is presented. The first theoretical result is the Inactivation Principle, according to which minimizing a term similar to the absolute work implies simultaneous inactivation of agonistic and antagonistic muscles acting on a single joint, near the time of peak velocity. The second theoretical result is that, conversely, the presence of non-smoothness in the cost function is a necessary condition for the existence of such inactivation. Second, during an experimental study, participants were asked to perform fast vertical arm movements with one, two, and three degrees of freedom. Observed trajectories, velocity profiles, and final postures were accurately simulated by the model. In accordance, electromyographic signals showed brief simultaneous inactivation of opposing muscles during movements. Thus, assuming that human movements are optimal with respect to a certain integral cost, the minimization of an absolute-work-like cost is supported by experimental observations. Such types of optimality criteria may be applied to a large range of biological movements. PMID:18949023

Using activity-based costing to track resource use in group practices.

PubMed

Zeller, T L; Siegel, G; Kaciuba, G; Lau, A H

1999-09-01

Research shows that understanding how resources are consumed can help group practices control costs. An American Academy of Orthopaedic Surgeons study used an activity-based costing (ABC) system to measure how resources are consumed in providing medical services. Teams of accounting professors observed 18 diverse orthopedic surgery practices. The researchers identified 17 resource-consuming business processes performed by nonphysician office staff. They measured resource consumption by assigning costs to each process according to how much time is spent on related work activities. When group practices understand how their resources are being consumed, they can reduce costs and optimize revenues by making adjustments in how administrative and clinical staff work.

Working and waiting for better rewards: self-control in two monkey species (Cebus apella and Macaca mulatta).

PubMed

Evans, Theodore A; Perdue, Bonnie M; Parrish, Audrey E; Beran, Michael J

2014-03-01

Self-control is typically defined as choosing a greater, delayed reward over a lesser, more immediate reward. However, in nature, there are other costs besides delay associated with obtaining the greatest outcome including increased effort, potential punishment, and low probability of reward. Effort is an interesting case because it sometimes impairs self-control, by acting as an additional cost, and at other times facilitates self-control, by distracting one from impulsive options. Additionally, different species may perform differently in effortful self-control tasks, based on their natural ecology. To gain insight into these aspects of self-control behavior, we examined capuchin monkeys' and rhesus monkeys' self-control in separate working and waiting choice tasks. We hypothesized that capuchins would show greater self-control in the working task, given their naturally higher activity level, whereas rhesus would perform similarly in both tasks. Rhesus performed as predicted, whereas contrary to our hypothesis, capuchins exhibited lesser performance in the working task. Nonetheless, these results may still stem from inherent species differences interacting with details of the methodology. Capuchins, being highly energetic and social monkeys, may have divided their energy and attention between the working task and other elements of the test environment such as visible group mates or manipulanda. Copyright © 2014 Elsevier B.V. All rights reserved.

Estimating the cost of sea lice to salmon aquaculture in eastern Canada.

PubMed Central

Mustafa, A; Rankaduwa, W; Campbell, P

2001-01-01

Parasitic sea lice are serious problems in aquaculture. The true cost of these parasites is unknown. We demonstrate the economic burden imposed by sea lice, so that researchers, aquatic specialists, and policy makers can approximate the economic cost of this problem and work towards developing alternative control methods. PMID:11195524

Costs and outcome for serious hand and arm injuries during the first year after trauma - a prospective study.

PubMed

Rosberg, Hans-Eric; Carlsson, Katarina Steen; Cederlund, Ragnhild I; Ramel, Eva; Dahlin, Lars B

2013-05-24

To study costs and outcome for serious hand and arm injuries during the first year after the trauma. In patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work. The majority of the 45 included patients (median 42 years 16-64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age >50 years (+52%), injury at work (+40%) and partial labour market activity (+66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury]. Despite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure.

Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves. Results of a randomised controlled trial.

PubMed

Byford, S; Harrington, R; Torgerson, D; Kerfoot, M; Dyer, E; Harrington, V; Woodham, A; Gill, J; McNiven, F

1999-01-01

Little evidence exists regarding the effectiveness or cost-effectiveness of alternative treatment services in the field of child and adolescent psychiatry. To assess the cost-effectiveness of a home-based social work intervention for young people who have deliberately poisoned themselves. Children aged < or = 16 years, referred to child mental health teams with a diagnosis of deliberate self-poisoning were randomly allocated to either routine care (n = 77) or routine care plus the social work intervention (n = 85). Clinical and resource-use data were assessed over six months from the date of trial entry. No significant differences were found between the two groups in terms of the main outcome measures or costs. In a sub-group of children without major depression, suicidal ideation was significantly lower in the intervention group at the six-month follow-up (P = 0.01), with no significant differences in cost. A family-based social work intervention for children and adolescents who have deliberately poisoned themselves is as cost-effective as routine care alone.

Digital vs. conventional implant prosthetic workflows: a cost/time analysis.

PubMed

Joda, Tim; Brägger, Urs

2015-12-01

The aim of this prospective cohort trial was to perform a cost/time analysis for implant-supported single-unit reconstructions in the digital workflow compared to the conventional pathway. A total of 20 patients were included for rehabilitation with 2 × 20 implant crowns in a crossover study design and treated consecutively each with customized titanium abutments plus CAD/CAM-zirconia-suprastructures (test: digital) and with standardized titanium abutments plus PFM-crowns (control conventional). Starting with prosthetic treatment, analysis was estimated for clinical and laboratory work steps including measure of costs in Swiss Francs (CHF), productivity rates and cost minimization for first-line therapy. Statistical calculations were performed with Wilcoxon signed-rank test. Both protocols worked successfully for all test and control reconstructions. Direct treatment costs were significantly lower for the digital workflow 1815.35 CHF compared to the conventional pathway 2119.65 CHF [P = 0.0004]. For subprocess evaluation, total laboratory costs were calculated as 941.95 CHF for the test group and 1245.65 CHF for the control group, respectively [P = 0.003]. The clinical dental productivity rate amounted to 29.64 CHF/min (digital) and 24.37 CHF/min (conventional) [P = 0.002]. Overall, cost minimization analysis exhibited an 18% cost reduction within the digital process. The digital workflow was more efficient than the established conventional pathway for implant-supported crowns in this investigation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Concepts for Life Cycle Cost Control Required to Achieve Space Transportation Affordability and Sustainability

NASA Technical Reports Server (NTRS)

Rhodes, Russel E.; Zapata, Edgar; Levack, Daniel J. H.; Robinson, John W.; Donahue, Benjamin B.

2009-01-01

Cost control must be implemented through the establishment of requirements and controlled continually by managing to these requirements. Cost control of the non-recurring side of life cycle cost has traditionally been implemented in both commercial and government programs. The government uses the budget process to implement this control. The commercial approach is to use a similar process of allocating the non-recurring cost to major elements of the program. This type of control generally manages through a work breakdown structure (WBS) by defining the major elements of the program. If the cost control is to be applied across the entire program life cycle cost (LCC), the approach must be addressed very differently. A functional breakdown structure (FBS) is defined and recommended. Use of a FBS provides the visibifity to allow the choice of an integrated solution reducing the cost of providing many different elements of like function. The different functional solutions that drive the hardware logistics, quantity of documentation, operational labor, reliability and maintainability balance, and total integration of the entire system from DDT&E through the life of the program must be fully defined, compared, and final decisions made among these competing solutions. The major drivers of recurring cost have been identified and are presented and discussed. The LCC requirements must be established and flowed down to provide control of LCC. This LCC control will require a structured rigid process similar to the one traditionally used to control weight/performance for space transportation systems throughout the entire program. It has been demonstrated over the last 30 years that without a firm requirement and methodically structured cost control, it is unlikely that affordable and sustainable space transportation system LCC will be achieved.

The economic impact of GERD and PUD: examination of direct and indirect costs using a large integrated employer claims database.

PubMed

Joish, Vijay N; Donaldson, Gary; Stockdale, William; Oderda, Gary M; Crawley, Joseph; Sasane, Rahul; Joshua-Gotlib, Sandra; Brixner, Diana I

2005-04-01

The objective of this study was to examine the relationship of work loss associated with gastro- the relationship of work loss associated with gastro- the relationship of work loss associated with gastro-esophageal reflux disease (GERD) and peptic ulcer disease (GERD) and peptic ulcer disease (PUD) in a large population of employed individuals in the United States (US) and quantify the individuals in the United States (US) and quantify the economic impact of these diseases to the employer. A proprietary database that contained work place absence, disability and workers' compensation data in addition to prescription drug and medical claims was used to answer the objectives. Employees with a medical claim with an ICD-9 code for GERD or PUD were identified from 1 January 1997 to 31 December 2000. A cohort of controls was identified for the same time period using the method of frequency matching on age, gender, industry type, occupational status, and employment status. Work absence rates and health care costs were compared between the groups after adjusting for demo graphic, and employment differences using analysis of covariance models. There were significantly lower (p < 0.05) prescription, and outpatient costs in the controls compared to the disease groups, although the eta-square values were very low. The mean work absence attributed to sick days was 2.8 (+/- 2.3) for controls, 3.4 (+/- 2.5) for GERD, 3.2 (+/- 2.6) for PUD, and 3.2 (+/- 2.3) days for GERD + PUD. For work loss, a significantly higher (p < 0.05) rate of adjusted all-cause absenteeism and sickness-related absenteeism were observed between the disease groups versus the controls. In particular, controls had an average of 1.2 to 1.6 days and 0.4 to 0.6 lower all-cause and sickness-related absenteeism compared to the disease groups. The incremental economic impact projected to a hypothetical employed population was estimated to be $3441 for GERD, $1374 for PUD, and $4803 for GERD + PUD per employee per year compared to employees without these diseases. Direct medical cost and work absence in employees with GERD, PUD and GERD + PUD represent a significant burden to employees and employers.

Cost-effectiveness of a vocational enablement protocol for employees with hearing impairment; design of a randomized controlled trial

PubMed Central

2012-01-01

Background Hearing impairment at the workplace, and the resulting psychosocial problems are a major health problem with substantial costs for employees, companies, and society. Therefore, it is important to develop interventions to support hearing impaired employees. The objective of this article is to describe the design of a randomized controlled trial evaluating the (cost-) effectiveness of a Vocational Enablement Protocol (VEP) compared with usual care. Methods/Design Participants will be selected with the 'Hearing and Distress Screener'. The study population will consist of 160 hearing impaired employees. The VEP intervention group will be compared with usual care. The VEP integrated care programme consists of a multidisciplinary assessment of auditory function, work demands, and personal characteristics. The goal of the intervention is to facilitate participation in work. The primary outcome measure of the study is 'need for recovery after work'. Secondary outcome measures are coping with hearing impairment, distress, self-efficacy, psychosocial workload, job control, general health status, sick leave, work productivity, and health care use. Outcome measures will be assessed by questionnaires at baseline, and 3, 6, 9, and 12 months after baseline. The economic evaluation will be performed from both a societal and a company perspective. A process evaluation will also be performed. Discussion Interventions addressing occupational difficulties of hearing impaired employees are rare but highly needed. If the VEP integrated care programme proves to be (cost-) effective, the intervention can have an impact on the well-being of hearing impaired employees, and thereby, on the costs for the company as well for the society. Trial registration Netherlands Trial Register (NTR): NTR2782 PMID:22380920

Insecticide Resistance and Malaria Vector Control: The Importance of Fitness Cost Mechanisms in Determining Economically Optimal Control Trajectories

PubMed Central

Brown, Zachary S.; Dickinson, Katherine L.; Kramer, Randall A.

2014-01-01

The evolutionary dynamics of insecticide resistance in harmful arthropods has economic implications, not only for the control of agricultural pests (as has been well studied), but also for the control of disease vectors, such as malaria-transmitting Anopheles mosquitoes. Previous economic work on insecticide resistance illustrates the policy relevance of knowing whether insecticide resistance mutations involve fitness costs. Using a theoretical model, this article investigates economically optimal strategies for controlling malaria-transmitting mosquitoes when there is the potential for mosquitoes to evolve resistance to insecticides. Consistent with previous literature, we find that fitness costs are a key element in the computation of economically optimal resistance management strategies. Additionally, our models indicate that different biological mechanisms underlying these fitness costs (e.g., increased adult mortality and/or decreased fecundity) can significantly alter economically optimal resistance management strategies. PMID:23448053

43 CFR 45.73 - How will the bureau analyze a proposed alternative and formulate its modified condition or...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., distribution, cost, and use; (2) Flood control; (3) Navigation; (4) Water supply; (5) Air quality; and (6..., including: (1) Any evidence on the implementation costs or operational impacts for electricity production of...) Cost significantly less to implement; or (ii) Result in improved operation of the project works for...

The Humanistic and Economic Burden of Narcolepsy.

PubMed

Flores, Natalia M; Villa, Kathleen F; Black, Jed; Chervin, Ronald D; Witt, Edward A

2016-03-01

To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy. © 2016 American Academy of Sleep Medicine.

Extracting Work from Quantum Measurement in Maxwell's Demon Engines

NASA Astrophysics Data System (ADS)

Elouard, Cyril; Herrera-Martí, David; Huard, Benjamin; Auffèves, Alexia

2017-06-01

The essence of both classical and quantum engines is to extract useful energy (work) from stochastic energy sources, e.g., thermal baths. In Maxwell's demon engines, work extraction is assisted by a feedback control based on measurements performed by a demon, whose memory is erased at some nonzero energy cost. Here we propose a new type of quantum Maxwell's demon engine where work is directly extracted from the measurement channel, such that no heat bath is required. We show that in the Zeno regime of frequent measurements, memory erasure costs eventually vanish. Our findings provide a new paradigm to analyze quantum heat engines and work extraction in the quantum world.

Investigate Methods of Improving Production Throughput in a Shipyard (The National Shipbuilding Research Program)

DTIC Science & Technology

1995-09-01

New Global Competition” ...10 “New Systems for Process Control and Product Costing ” . . . 11 “Performance Measurement Systems for the Future”, should...Selected Highlights: Page 53-World Class - Definition and applicable discussions. “Its clear that yesterdays cost systems don’t work in todays...Why conventional cost systems fail Indirect, No information about activities, Too late. Plant activities only, Inaccurate product costs , No customer

The effect of accountable care organizations on oncology practice.

PubMed

Shulman, Lawrence N

2014-01-01

Cancer care accounts for a significant portion of the rise in health care costs, and therefore, as national efforts escalate to control cost, cancer care will be a focus of concern. Cost increases in cancer care are related to many factors, including increasing cancer incidence in an aging population, the introduction of new high-cost therapeutics, and the high cost of end-of-life care. Accountable care organizations (ACOs) have been one of the major efforts directed at controlling health care costs. How cancer care will fit into the rubric of ACOs is not entirely clear but will certainly evolve over the coming years. The oncology profession has the opportunity to play a role in this evolution or could leave the evolution to others driving the process, such as the Centers for Medicare and Medicaid Services (CMS), private payers, and ACOs. Ideally all parties will work together to provide a construct for high-value, high-quality care for patients with cancer while contributing to cost control in overall health care.

Towards canine rabies elimination: Economic comparisons of three project sites.

PubMed

Elser, J L; Hatch, B G; Taylor, L H; Nel, L H; Shwiff, S A

2018-02-01

An appreciation of the costs of implementing canine rabies control in different settings is important for those planning new or expanded interventions. Here we compare the costs of three canine rabies control projects in South Africa, the Philippines and Tanzania to identify factors that influence the overall costs of rabies control efforts. There was considerable variation in the cost of vaccinating each dog, but across the sites these were lower where population density was higher, and later in the projects when dog vaccination coverage was increased. Transportation costs comprised a much higher proportion of total costs in rural areas and where house-to-house vaccination campaigns were necessary. The association between the cost of providing PEP and human population density was less clear. The presence of a pre-existing national rabies management programme had a marked effect on keeping infrastructure and equipment costs for the project low. Finally, the proportion of the total costs of the project provided by the external donor was found to be low for the projects in the Philippines and South Africa, but likely covered close to the complete costs of the project in Tanzania. The detailed economic evaluation of three recent large-scale rabies control pilot projects provides the opportunity to examine economic costs across these different settings and to identify factors influencing rabies control costs that could be applied to future projects. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

The Psychological Cost of Making Control Responses in the Nonstereotype Direction.

PubMed

Chan, Alan H S; Hoffmann, Errol R

2016-12-01

The aim of this study was to develop a scale for the "psychological cost" of making control responses in the nonstereotype direction. Wickens, Keller, and Small suggested values for the psychological cost arising from having control/display relationships that were not in the common stereotype directions. We provide values of such costs specifically for these situations. Working from data of Chan and Hoffmann for 168 combinations of display location, control type, and display movement direction, we define values for the cost and compare these with the suggested values of Wickens et al.'s Frame of Reference Transformation Tool (FORT) model. We found marked differences between the values of the FORT model and the data of our experiments. The differences arise largely from the effects of the Worringham and Beringer visual field principle not being adequately considered in the previous research. A better indication of the psychological cost for use of incorrect control/display stereotypes is given. It is noted that these costs are applicable only to the factor of stereotype strength and not other factors considered in the FORT model. Effects of having controls and displays that are not arranged to operate with population expectancies can be readily determined from the data in this paper. © 2016, Human Factors and Ergonomics Society.

Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

PubMed

Iles, Ross Anthony; Wyatt, M; Pransky, G

2012-12-01

This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

Stakeholder benefit from depression disease management: differences by rurality?

PubMed

Xu, Stanley; Rost, Kathryn; Dong, Fran; Dickinson, L Miriam

2011-01-01

Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two proposed stakeholders (health plans and employer purchasers) economically benefit from depression care management (reduced outpatient utilization and work costs, respectively) in two delivery systems (rural and urban). This study examined the main and differential effects of depression care management on outpatient utilization and work costs over 24 months in a preplanned secondary analysis of 479 depressed patients from rural and urban primary care practices in a randomized controlled trial. Over 24 months, the intervention did not significantly reduce outpatient utilization costs in the entire cohort (-$191, 95% confidence interval (CI)=-$2,083 to $1,647), but it did decrease work costs (-$1,970, 95% CI=-$3,934 to -$92). While not statistically significant, rural-urban differences in work costs were in the same direction, while rural-urban differences in utilization costs differed in direction. These findings provide preliminary evidence that employers who elect to cover depression care management costs should receive comparable economic benefits in the rural and urban employees they insure. Given the limited sample size, further research may be needed to determine whether health plans who elect to cover depression care management costs will receive comparable economic benefits in the rural and urban enrollees they insure.

Economic costs of outbreaks of acute viral gastroenteritis due to norovirus in Catalonia (Spain), 2010-2011.

PubMed

Navas, Encarna; Torner, Nuria; Broner, Sonia; Godoy, Pere; Martínez, Ana; Bartolomé, Rosa; Domínguez, Angela

2015-10-01

To determine the direct and indirect costs of outbreaks of acute viral gastroenteritis (AVG) due to norovirus in closed institutions (hospitals, social health centers or nursing homes) and the community in Catalonia in 2010-11. Information on outbreaks were gathered from the reports made by epidemiological surveillance units. Direct costs (medical visits, hospital stays, drug treatment, sample processing, transport, diagnostic tests, monitoring and control of the outbreaks investigated) and indirect costs (lost productivity due to work absenteeism, caregivers time and working hours lost due to medical visits) were calculated. Twenty-seven outbreaks affecting 816 people in closed institutions and 74 outbreaks affecting 1,940 people in the community were detected. The direct and indirect costs of outbreaks were € 131,997.36 (€ 4,888.79 per outbreak) in closed institutions and € 260,557.16 (€ 3,521.04 per outbreak) in community outbreaks. The cost per case was € 161.76 in outbreaks in closed institutions and € 134.31 in community outbreaks. The main costs were surveillance unit monitoring (€ 116,652.93), laboratory diagnoses (€ 119,950.95), transport of samples (€ 69,970.90), medical visits (€ 25,250.50) and hospitalization (€ 13,400.00). The cost of outbreaks of acute viral gastroenteritis due to norovirus obtained in this study was influenced by the number of people affected and the severity of the outbreak, which determined hospitalizations and work absenteeism. Urgent reporting of outbreaks would allow the implementation of control measures that could reduce the numbers affected and the duration of the illness and thus the costs derived from them.

Spacelab Mission Implementation Cost Assessment (SMICA)

NASA Technical Reports Server (NTRS)

Guynes, B. V.

1984-01-01

A total savings of approximately 20 percent is attainable if: (1) mission management and ground processing schedules are compressed; (2) the equipping, staffing, and operating of the Payload Operations Control Center is revised, and (3) methods of working with experiment developers are changed. The development of a new mission implementation technique, which includes mission definition, experiment development, and mission integration/operations, is examined. The Payload Operations Control Center is to relocate and utilize new computer equipment to produce cost savings. Methods of reducing costs by minimizing the Spacelab and payload processing time during pre- and post-mission operation at KSC are analyzed. The changes required to reduce costs in the analytical integration process are studied. The influence of time, requirements accountability, and risk on costs is discussed. Recommendation for cost reductions developed by the Spacelab Mission Implementation Cost Assessment study are listed.

Value Engineering. "A Working Tool for Cost Control in the Design of Educational Facilities."

ERIC Educational Resources Information Center

Lawrence, Jerry

Value Engineering (VE) is a cost optimizing technique used to analyze design quality and cost-effectiveness. The application of VE procedures to the design and construction of school facilities has been adopted by the state of Washington. By using VE, the optimum value for every life cycle dollar spent on a facility is obtained by identifying not…

Study protocol: the effectiveness and cost effectiveness of an employer-led intervention to increase walking during the daily commute: the Travel to Work randomised controlled trial.

PubMed

Audrey, Suzanne; Cooper, Ashley R; Hollingworth, William; Metcalfe, Chris; Procter, Sunita; Davis, Adrian; Campbell, Rona; Gillison, Fiona; Rodgers, Sarah E

2015-02-18

Physical inactivity increases the risk of many chronic diseases including coronary heart disease, type 2 diabetes and some cancers. It is recommended that adults should undertake at least 150 minutes of moderate intensity physical activity throughout the week but many adults do not achieve this. An opportunity for working adults to accumulate the recommended activity levels is through the daily commute. Employees will be recruited from workplaces in south-west England and south Wales. In the intervention arm, workplace Walk-to-Work promoters will be recruited and trained. Participating employees will receive Walk-to-Work materials and support will be provided through four contacts from the promoters over 10 weeks. Workplaces in the control arm will continue with their usual practice. The intervention will be evaluated by a cluster randomized controlled trial including economic and process evaluations. The primary outcome is daily minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes are: overall physical activity; sedentary time; modal shift away from private car use during the commute; and physical activity/MVPA during the commute. Accelerometers, GPS receivers and travel diaries will be used at baseline and one year follow-up. Questionnaires will be used at baseline, immediately post intervention, and one year follow-up. The process evaluation will examine the context, delivery and response to the intervention from the perspectives of employers, Walk-to-Work promoters and employees using questionnaires, descriptive statistics, fieldnotes and interviews. A cost-consequence study will include employer, employee and health service costs and outcomes. Time and consumables used in implementing the intervention will be measured. Journey time, household commuting costs and expenses will be recorded using travel diaries to estimate costs to employees. Presenteeism, absenteeism, employee wellbeing and health service use will be recorded. Compared with other forms of physical activity, walking is a popular, familiar and convenient, and the main option for increasing physical activity in sedentary populations. To our knowledge, this is the first full-scale randomised controlled trial to objectively measure (using accelerometers and GPS receivers) the effectiveness of a workplace intervention to promote walking during the commute to and from work. ISRCTN15009100 (10 December 2014).

Impaired Contingent Attentional Capture Predicts Reduced Working Memory Capacity in Schizophrenia

PubMed Central

Mayer, Jutta S.; Fukuda, Keisuke; Vogel, Edward K.; Park, Sohee

2012-01-01

Although impairments in working memory (WM) are well documented in schizophrenia, the specific factors that cause these deficits are poorly understood. In this study, we hypothesized that a heightened susceptibility to attentional capture at an early stage of visual processing would result in working memory encoding problems. 30 patients with schizophrenia and 28 demographically matched healthy participants were presented with a search array and asked to report the orientation of the target stimulus. In some of the trials, a flanker stimulus preceded the search array that either matched the color of the target (relevant-flanker capture) or appeared in a different color (irrelevant-flanker capture). Working memory capacity was determined in each individual using the visual change detection paradigm. Patients needed considerably more time to find the target in the no-flanker condition. After adjusting the individual exposure time, both groups showed equivalent capture costs in the irrelevant-flanker condition. However, in the relevant-flanker condition, capture costs were increased in patients compared to controls when the stimulus onset asynchrony between the flanker and the search array was high. Moreover, the increase in relevant capture costs correlated negatively with working memory capacity. This study demonstrates preserved stimulus-driven attentional capture but impaired contingent attentional capture associated with low working memory capacity in schizophrenia. These findings suggest a selective impairment of top-down attentional control in schizophrenia, which may impair working memory encoding. PMID:23152783

Impaired contingent attentional capture predicts reduced working memory capacity in schizophrenia.

PubMed

Mayer, Jutta S; Fukuda, Keisuke; Vogel, Edward K; Park, Sohee

2012-01-01

Although impairments in working memory (WM) are well documented in schizophrenia, the specific factors that cause these deficits are poorly understood. In this study, we hypothesized that a heightened susceptibility to attentional capture at an early stage of visual processing would result in working memory encoding problems. 30 patients with schizophrenia and 28 demographically matched healthy participants were presented with a search array and asked to report the orientation of the target stimulus. In some of the trials, a flanker stimulus preceded the search array that either matched the color of the target (relevant-flanker capture) or appeared in a different color (irrelevant-flanker capture). Working memory capacity was determined in each individual using the visual change detection paradigm. Patients needed considerably more time to find the target in the no-flanker condition. After adjusting the individual exposure time, both groups showed equivalent capture costs in the irrelevant-flanker condition. However, in the relevant-flanker condition, capture costs were increased in patients compared to controls when the stimulus onset asynchrony between the flanker and the search array was high. Moreover, the increase in relevant capture costs correlated negatively with working memory capacity. This study demonstrates preserved stimulus-driven attentional capture but impaired contingent attentional capture associated with low working memory capacity in schizophrenia. These findings suggest a selective impairment of top-down attentional control in schizophrenia, which may impair working memory encoding.

Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

PubMed Central

2014-01-01

Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669. PMID:25012813

Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669).

PubMed

Bishop, Annette; Wynne-Jones, Gwenllian; Lawton, Sarah A; van der Windt, Danielle; Main, Chris; Sowden, Gail; Burton, A Kim; Lewis, Martyn; Jowett, Sue; Sanders, Tom; Hay, Elaine M; Foster, Nadine E

2014-07-10

Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Current Controlled Trials ISRCTN52269669.

A cost-analysis of complex workplace nutrition education and environmental dietary modification interventions.

PubMed

Fitzgerald, Sarah; Kirby, Ann; Murphy, Aileen; Geaney, Fiona; Perry, Ivan J

2017-01-09

The workplace has been identified as a priority setting to positively influence individuals' dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer's perspective. Cost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace. The combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist's time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs). Within multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions. Current Controlled Trials: ISRCTN35108237 . Date of registration: The trial was retrospectively registered on 02/07/2013.

Improvement of General Electric’s Chilled Ammonia Process with the use of Membrane Technology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Muraskin, Dave; Dube, Sanjay; Baburao, Barath

General Electric Environmental Control Solutions (formerly Alstom Power Environmental Control Systems) set out to complete the Phase 1 award requirements for a Phase II renewal application for their project selected under DOE-FOA-0001190 “Small and Large Scale Pilots for Reducing the Cost of CO 2 Capture and Compression”. The project focus was to implement several improvement concepts utilizing membrane technology at the recipient’s Chilled Ammonia Process (CAP) CO 2 capture large-scale pilot plant. The goal was to lower the overall cost of technology. During the development of costs for the preliminary techno-economic assessment (TEA), it became clear that the capital andmore » operating costs of this concept were not economically attractive. All work related to a Phase II renewal application at that point was halted as GE made the decision not to submit a Phase II renewal application. Discussions with DOE resulted in a path towards useful information produced from the design and cost work already completed on the project. With the reverse osmosis (RO) unit providing most of the cost issues, GE would provide a sensitivity analysis of the RO unit with respect to project cost. This information would be included with the Techno-Economic Analysis along with the Technology Gap Analysis.« less

Perceived work ability, quality of life, and fatigue in patients with rheumatoid arthritis after a 6-month course of TNF inhibitors: prospective intervention study and partial economic evaluation.

PubMed

Hoving, J L; Bartelds, G M; Sluiter, J K; Sadiraj, K; Groot, I; Lems, W F; Dijkmans, B A C; Wijbrandts, C A; Tak, P P; Nurmohamed, M T; Voskuyl, A E; Frings-Dresen, M H W

2009-01-01

The objective of this exploratory study was to evaluate the effects and costs of a 6-month course of tumour necrosis factor (TNF) inhibitors on work ability, quality of life, and fatigue in patients with rheumatoid arthritis (RA). In this prospective single-arm intervention study 59 consecutive patients of working age with established RA were recruited from an outpatient clinic in Amsterdam, the Netherlands. All patients received fortnightly subcutaneous injections of 40 mg adalimumab. The three outcomes at baseline and 6 months were: perceived work ability [Work Ability Index (WAI)], quality of life [Rheumatoid Arthritis Quality of Life instrument (RAQoL)], and fatigue [Checklist Individual Strength (CIS), Need for Recovery (NFR) scale]. Cost data of the preceding 6 months were collected using a self-administered patient questionnaire at baseline and follow-up. At 6 months, all outcomes showed a statistically significant improvement in mean scores from baseline, ranging from 10.0% (WAI), to 11.7% (RAQoL), to 15% (NFR) (subgroup paid work, n = 26). The total mean costs showed a twofold increase in mean costs per week per patient [difference EUR 169, 95% confidence interval (CI) EUR 113-226]. In this short-term exploratory evaluation, a 6-month course of TNF inhibitors improved work ability and quality of life, and reduced fatigue in patients with established RA. These effects are associated with an increase in total healthcare costs, attributable to the costs of TNF inhibitors. Randomized controlled trials with a longer follow-up are needed to show a long-term effect on work disability and the potential cost-effectiveness of TNF inhibitors.

Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial

PubMed Central

2012-01-01

Background Distance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective. Methods A randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m2). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves. Results At two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes. Conclusions Neither intervention mode was proven to be cost-effective compared to self-help. Trial registration ISRCTN04265725 PMID:22967224

40 CFR 35.937-3 - Evaluation of qualifications.

Code of Federal Regulations, 2012 CFR

2012-07-01

... bodies, and with private industry, including such factors as control of costs, quality of work, and ability to meet schedules; (3) The candidate's capacity to perform the work (including any specialized... ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-3...

40 CFR 35.937-3 - Evaluation of qualifications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... bodies, and with private industry, including such factors as control of costs, quality of work, and ability to meet schedules; (3) The candidate's capacity to perform the work (including any specialized... ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-3...

40 CFR 35.937-3 - Evaluation of qualifications.

Code of Federal Regulations, 2013 CFR

2013-07-01

... bodies, and with private industry, including such factors as control of costs, quality of work, and ability to meet schedules; (3) The candidate's capacity to perform the work (including any specialized... ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-3...

40 CFR 35.937-3 - Evaluation of qualifications.

Code of Federal Regulations, 2014 CFR

2014-07-01

... bodies, and with private industry, including such factors as control of costs, quality of work, and ability to meet schedules; (3) The candidate's capacity to perform the work (including any specialized... ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-3...

Test Program for Assessing Vulnerability of Industrial Equipment to Nuclear Air Blast.

DTIC Science & Technology

1983-10-01

PROJECT. TASK 4Scientific Servic, Inc. AREA & WORK UNIT NUMBERS 517 East Bayshore Work Unit 1124F Redwood City, CA 94063___ __________ 11. CONTROLLING ...vulnerability, but perhaps less expensive, to be selected and substituted, with an eye to cost control . 5. MODELING AND SCALING CONSIDERATIONS Reiterating...behavior and properties of the test items and Interfaces that control behavior (e4g., test objects/flow field, test objects/interfacing surface of

Burden of fibromyalgia and comparisons with osteoarthritis in the workforce.

PubMed

Kleinman, Nathan; Harnett, James; Melkonian, Arthur; Lynch, Wendy; Kaplan-Machlis, Barbara; Silverman, Stuart L

2009-12-01

To calculate the fibromyalgia (FM) burden of illness (BOI) from the employer perspective and to compare annual prevalence, work output, absence, and health benefit costs of employees with FM versus osteoarthritis (OA). Retrospective regression model analysis comparing objective work output, total health benefit (health care, prescription drug, sick leave, disability, workers' compensation) costs, and absence days for FM, versus OA and NoFM cohorts, while controlling for differences in patient characteristics. FM prevalence was 0.73%; OA 0.90%. Total health benefit costs for FM were $8452 versus $11,253 (P < 0.0001) for OA and $4013 (P < 0.0001) for NoFM, with BOI = $4439. Total absence days were 16.8 versus 19.8 (P < 0.0001) and 6.4 (P < 0.0001), respectively. FM had significantly lower annual work output than NoFM (19.5%, P = 0.003) but comparable with OA. FM places a significant cost, absence, and productivity burden on employers.

Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial

PubMed Central

van Oostrom, Sandra H; Anema, Johannes R; Terluin, Berend; de Vet, Henrica CW; Knol, Dirk L; van Mechelen, Willem

2008-01-01

Background Considering the high costs of sick leave and the consequences of sick leave for employees, an early return-to-work of employees with mental disorders is very important. Therefore, a workplace intervention is developed based on a successful return-to-work intervention for employees with low back pain. The objective of this paper is to present the design of a randomized controlled trial evaluating the cost-effectiveness of the workplace intervention compared with usual care for sick-listed employees with common mental disorders. Methods The study is designed as a randomized controlled trial with a follow-up of one year. Employees eligible for this study are on sick leave for 2 to 8 weeks with common mental disorders. The workplace intervention will be compared with usual care. The workplace intervention is a stepwise approach that aims to reach consensus about a return-to-work plan by active participation and strong commitment of both the sick-listed employee and the supervisor. Outcomes will be assessed at baseline, 3, 6, 9 and 12 months. The primary outcome of this study is lasting return-to-work, which will be acquired from continuous registration systems of the companies after the follow-up. Secondary outcomes are total number of days of sick leave during the follow-up, severity of common mental disorders, coping style, job content, and attitude, social influence, and self-efficacy determinants. Cost-effectiveness will be evaluated from the societal perspective. A process evaluation will also be conducted. Discussion Return-to-work is difficult to discuss in the workplace for sick-listed employees with mental disorders and their supervisors. Therefore, this intervention offers a unique opportunity for the sick-listed employee and the supervisor to discuss barriers for return-to-work. Results of this study will possibly contribute to improvement of disability management for sick-listed employees with common mental disorders. Results will become available in 2009. Trial registration ISRCTN92307123 PMID:18194525

How Much Is Too Much? Controlling Administrative Costs through Effective Oversight. A Guide for Higher Education Trustees

ERIC Educational Resources Information Center

Alacbay, Armand; Barden, Danielle

2017-01-01

With recent research from the Institute for Higher Education Policy showing that college is unaffordable for as many as 70% of working- and middle-class students, concerns about college costs are mounting. The cost of operating an institution of higher education, with very few exceptions, is reflected in the price of attendance that students,…

Prosthetic design directives: Low-cost hands within reach.

PubMed

Jones, G K; Rosendo, A; Stopforth, R

2017-07-01

Although three million people around the world suffer from the lack of one or both upper limbs 80% of this number is located within developing countries. While prosthetic prices soar with technology 3D printing and low cost electronics present a sensible solution for those that cannot afford expensive prosthetics. The electronic and control design of a low-cost prosthetic hand, the Touch Hand II, is discussed. This paper shows that sensorless techniques can be used to reduce design complexities, costs, and provide easier access to the electronics. A closing and opening finite state machine (COFSM) was developed to handle the actuated digit joint control state and a supervisory switching control scheme, used for speed and grip strength control. Three torque and speed settings were created to be preset for specific grasps. The hand was able to replicate ten frequently used grasps and grip some common objects. Future work is necessary to enable a user to control it with myoelectric signals (MESs) and to solve operational problems related to electromagnetic interference (EMI).

Managing psychotropic drug costs: will formularies work?

PubMed

Huskamp, Haiden A

2003-01-01

Payers of pharmaceutical benefits are increasingly turning to drug formularies in an attempt to control rising pharmacy costs, including those for psychotropic drugs. In this paper I examine several issues that policymakers should consider when addressing formulary design for psychotropic drugs: heterogeneity within mental health disorders and limited information about treatment effectiveness for individual patients; the potential for plans to try to use formularies to avoid adverse selection and implications for psychotropic coverage; the interaction of Medicaid formulary policy and manufacturers' incentives for psychotropic innovation; and incentives created by mental health institutions that decrease formularies' potential effectiveness in controlling psychotropic drug costs.

Supported employment: cost-effectiveness across six European sites

PubMed Central

Knapp, Martin; Patel, Anita; Curran, Claire; Latimer, Eric; Catty, Jocelyn; Becker, Thomas; Drake, Robert E; Fioritti, Angelo; Kilian, Reinhold; Lauber, Christoph; Rössler, Wulf; Tomov, Toma; van Busschbach, Jooske; Comas-Herrera, Adelina; White, Sarah; Wiersma, Durk; Burns, Tom

2013-01-01

A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment. PMID:23471803

Automated generation of weld path trajectories.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sizemore, John M.; Hinman-Sweeney, Elaine Marie; Ames, Arlo Leroy

2003-06-01

AUTOmated GENeration of Control Programs for Robotic Welding of Ship Structure (AUTOGEN) is software that automates the planning and compiling of control programs for robotic welding of ship structure. The software works by evaluating computer representations of the ship design and the manufacturing plan. Based on this evaluation, AUTOGEN internally identifies and appropriately characterizes each weld. Then it constructs the robot motions necessary to accomplish the welds and determines for each the correct assignment of process control values. AUTOGEN generates these robot control programs completely without manual intervention or edits except to correct wrong or missing input data. Most shipmore » structure assemblies are unique or at best manufactured only a few times. Accordingly, the high cost inherent in all previous methods of preparing complex control programs has made robot welding of ship structures economically unattractive to the U.S. shipbuilding industry. AUTOGEN eliminates the cost of creating robot control programs. With programming costs eliminated, capitalization of robots to weld ship structures becomes economically viable. Robot welding of ship structures will result in reduced ship costs, uniform product quality, and enhanced worker safety. Sandia National Laboratories and Northrop Grumman Ship Systems worked with the National Shipbuilding Research Program to develop a means of automated path and process generation for robotic welding. This effort resulted in the AUTOGEN program, which has successfully demonstrated automated path generation and robot control. Although the current implementation of AUTOGEN is optimized for welding applications, the path and process planning capability has applicability to a number of industrial applications, including painting, riveting, and adhesive delivery.« less

Effectiveness of guideline-based care by occupational physicians on the return-to-work of workers with common mental disorders: design of a cluster-randomised controlled trial.

PubMed

van Beurden, Karlijn M; Brouwers, Evelien P M; Joosen, Margot C W; Terluin, Berend; van der Klink, Jac J L; van Weeghel, Jaap

2013-03-06

Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders. This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor, and the extent of guideline adherence. If the results show that guideline-based care in fact leads to faster and sustainable return-to-work, this study will contribute to lowering personal, societal and financial costs. ISRCTN86605310.

Effectiveness of guideline-based care by occupational physicians on the return-to-work of workers with common mental disorders: design of a cluster-randomised controlled trial

PubMed Central

2013-01-01

Background Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders. Methods/design This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor, and the extent of guideline adherence. Discussion If the results show that guideline-based care in fact leads to faster and sustainable return-to-work, this study will contribute to lowering personal, societal and financial costs. Trial registration ISRCTN86605310 PMID:23496948

Estimating airline operating costs

NASA Technical Reports Server (NTRS)

Maddalon, D. V.

1978-01-01

A review was made of the factors affecting commercial aircraft operating and delay costs. From this work, an airline operating cost model was developed which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model, similar in some respects to the standard Air Transport Association of America (ATA) Direct Operating Cost Model, permits estimates of aircraft-related costs not now included in the standard ATA model (e.g., aircraft service, landing fees, flight attendants, and control fees). A study of the cost of aircraft delay was also made and a method for estimating the cost of certain types of airline delay is described.

Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

PubMed

de la Torre-Díez, Isabel; López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

2015-02-01

A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

Dynamic Programming and Error Estimates for Stochastic Control Problems with Maximum Cost

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bokanowski, Olivier, E-mail: boka@math.jussieu.fr; Picarelli, Athena, E-mail: athena.picarelli@inria.fr; Zidani, Hasnaa, E-mail: hasnaa.zidani@ensta.fr

2015-02-15

This work is concerned with stochastic optimal control for a running maximum cost. A direct approach based on dynamic programming techniques is studied leading to the characterization of the value function as the unique viscosity solution of a second order Hamilton–Jacobi–Bellman (HJB) equation with an oblique derivative boundary condition. A general numerical scheme is proposed and a convergence result is provided. Error estimates are obtained for the semi-Lagrangian scheme. These results can apply to the case of lookback options in finance. Moreover, optimal control problems with maximum cost arise in the characterization of the reachable sets for a system ofmore » controlled stochastic differential equations. Some numerical simulations on examples of reachable analysis are included to illustrate our approach.« less

Health Outcomes and Costs of Social Work Services: A Systematic Review.

PubMed

Steketee, Gail; Ross, Abigail M; Wachman, Madeline K

2017-12-01

Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession's person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using "social work" AND "cost" and "health" for trials published from 1990 to 2017. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential.

The effects of a controlled energy storage and return prototype prosthetic foot on transtibial amputee ambulation

PubMed Central

Segal, Ava D.; Zelik, Karl E.; Klute, Glenn K.; Morgenroth, David C.; Hahn, Michael E.; Orendurff, Michael S.; Adamczyk, Peter G.; Collins, Steven H.; Kuo, Arthur D.; Czerniecki, Joseph M.

2015-01-01

The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. PMID:22100728

The effects of a controlled energy storage and return prototype prosthetic foot on transtibial amputee ambulation.

PubMed

Segal, Ava D; Zelik, Karl E; Klute, Glenn K; Morgenroth, David C; Hahn, Michael E; Orendurff, Michael S; Adamczyk, Peter G; Collins, Steven H; Kuo, Arthur D; Czerniecki, Joseph M

2012-08-01

The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. Published by Elsevier B.V.

Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania.

PubMed

Ngalesoni, Frida; Ruhago, George; Mayige, Mary; Oliveira, Tiago Cravo; Robberstad, Bjarne; Norheim, Ole Frithjof; Higashi, Hideki

2017-01-01

Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government's ability to implement these interventions.

Costs associated with workdays lost and utilization of health care resources because of asthma in daily clinical practice in Spain.

PubMed

Ojeda, P; Sanz de Burgoa, V

2013-01-01

Asthma is associated with high indirect costs due to lower work productivity and higher absenteeism and presenteeism. To study loss of productivity measured using the lost workday equivalent (LWDE) index and health care utilization in asthmatics depending on age, geographical location, time period, severity, and level of asthma control. In this cross-sectional, observational, epidemiological multicenter study, 120 allergists nationwide were asked to select asthmatic patients aged 18 to 65 years who were evenly distributed according to the 4 levels of asthma severity (Global Initiative on Asthma) during 3 different seasons. The participants collected sociodemographic data, spirometry values, Asthma Control Test (ACT) score, health care utilization data, perceived stress according to the Impact on Work Productivity Index (IMPALA, indice del Impacto de la Enfermedad en la Productividad Laboral), and score on the Sheehan disability scale. The LWDE index was used to measure the number of workdays lost and the number of workdays with asthma symptoms combined with the percentage for average performance at work. The study sample comprised 1098 patients (58.7% females; 48.5% aged 18-40 and 51.5% aged 41-65). According to the ACT score, disease was uncontrolled in 57.6% of patients, well controlled in 32.8%, and totally controlled in 9.6%. The mean cost due to workdays lost was Euro 285.81/patient/mo (95% CI, Euro 252.71-318.92). Indirect costs were significantly higher in older patients (41-65 years, Euro 405.08; 95% CI, 348.97-461.19), patients with more severe disease (Euro 698.95; 95% CI, 588.63-809.27), and patients with more poorly controlled asthma (Euro 466.86; 95% CI, Euro 414.39-519.33). The average cost of health care units per patient for each 3-month period was Euro1317.30 (95% CI, Euro 1151.34-Euro 1483.26). Indirect costs were significantly higher in older patients (Euro 2104.00 in patients aged 18-40 vs Euro 3301.55 in patients aged 41-65), in northern and central regions, in severe disease (Euro 2921.63), and in more poorly controlled asthma (Euro 1799.42). Our findings could prove useful for physicians and health care providers.

Cost-effectiveness of a distance lifestyle counselling programme among overweight employees from a company perspective, ALIFE@Work: a randomized controlled trial.

PubMed

Gussenhoven, A H M; van Wier, M F; Bosmans, J E; Dekkers, J C; van Mechelen, W

2013-01-01

The objective of this study was to determine whether a lifestyle intervention with individual counselling was cost-effective for reducing body weight compared with usual care from a company perspective. Overweight employees were recruited and randomly assigned to the intervention groups, either phone or Internet, or the control group. The intervention was based on a cognitive behavioural approach and addressed physical activity and diet. Self-reported body weight was collected at baseline and 12 months follow-up. Intervention costs and costs of sick leave days based on gross and net lost productivity days (GLPDs/NLPDs) obtained from the participating companies were calculated. Missing data were imputed using multiple imputation techniques. Uncertainty surrounding the differences in costs and the incremental cost-effectiveness ratios (ICER) was estimated by bootstrapping techniques, and presented on cost-effectiveness planes and cost-effectiveness acceptability curves. No statistically significant differences in total costs were found between the intervention groups and control group, though mean total costs in both intervention groups tended to be higher than those in the control group. The ICER of the Internet group compared with the control group was €59 per kilogram of weight loss based on GLPD costs. The probability of cost effectiveness of the Internet intervention was 45% at a willingness-to-pay of €0 per extra kilogram weight loss and 75% at a willingness-to-pay of €1500 per extra kilogram body weight loss. Comparable results were found for the phone intervention. The intervention was not cost effective in comparison with usual care from the company perspective. Due to the large amount of missing data, it is not possible to draw firm conclusions.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

The Application of Quantity Discounts in Army Procurements (Field Test).

DTIC Science & Technology

1980-04-01

Work Directive (PWD). d. The amended PWD is forwarded to the Procurement and Production (PP) control where quantity increments and delivery schedules are...counts on 97 Army Stock Fund small purchases (less than $10,000) and received 10 I be * 0p cebe * )~ Cb 111 cost effective discounts on 46 or 47.4% of...discount but the computed annualized cost for the QD increment was larger than the computed annualized cost for the EOQ, this was not a cost effective

Resource Use and Costs of Dengue: Analysis of Data from Phase III Efficacy Studies of a Tetravalent Dengue Vaccine.

PubMed

El Fezzazi, Hanna; Branchu, Marie; Carrasquilla, Gabriel; Pitisuttithum, Punnee; Perroud, Ana Paula; Frago, Carina; Coudeville, Laurent

2017-12-01

A tetravalent dengue vaccine (CYD-TDV) has recently been approved in 12 countries in southeast Asia and Latin America for individuals aged 9-45 years or 9-60 years (age indication approvals vary by country) living in endemic areas. Data on utilization of medical and nonmedical resources as well as time lost from school and work were collected during the active phase of two phase III efficacy studies performed in 10 countries in the Asia-Pacific region and Latin America (NCT01373281; NCT01374516). We compared dengue-related resource utilization and costs among vaccinated and nonvaccinated participants. Country-specific unit costs were derived from available literature. There were 901 virologically confirmed dengue episodes among participants aged ≥ 9 years ( N = 25,826): corresponding to 373 episodes in the CYD-TDV group ( N = 17,230) and 528 episodes in the control group ( N = 8,596). Fewer episodes in the CYD-TDV group resulted in hospitalization than in the control group (7.0% versus 13.3%; P = 0.002), but both had a similar average length of stay of 4 days. Overall, a two-thirds reduction in resource consumption and missed school/work days was observed in the CYD-TDV group relative to the control group. The estimated direct and indirect cost (2014 I$) associated with dengue episodes per participant in the CYD-TDV group was 73% lower than in the control group (I$6.72 versus I$25.08); representing a saving of I$I8.36 (95% confidence interval [CI]:17.05-19.78) per participant with vaccination. This is the first study providing information on dengue costs among vaccinated individuals and direct confirmation that vaccination has the potential to reduce dengue illness costs.

Resource Use and Costs of Dengue: Analysis of Data from Phase III Efficacy Studies of a Tetravalent Dengue Vaccine

PubMed Central

El Fezzazi, Hanna; Branchu, Marie; Carrasquilla, Gabriel; Pitisuttithum, Punnee; Perroud, Ana Paula; Frago, Carina; Coudeville, Laurent

2017-01-01

Abstract. A tetravalent dengue vaccine (CYD-TDV) has recently been approved in 12 countries in southeast Asia and Latin America for individuals aged 9–45 years or 9–60 years (age indication approvals vary by country) living in endemic areas. Data on utilization of medical and nonmedical resources as well as time lost from school and work were collected during the active phase of two phase III efficacy studies performed in 10 countries in the Asia-Pacific region and Latin America (NCT01373281; NCT01374516). We compared dengue-related resource utilization and costs among vaccinated and nonvaccinated participants. Country-specific unit costs were derived from available literature. There were 901 virologically confirmed dengue episodes among participants aged ≥ 9 years (N = 25,826): corresponding to 373 episodes in the CYD-TDV group (N = 17,230) and 528 episodes in the control group (N = 8,596). Fewer episodes in the CYD-TDV group resulted in hospitalization than in the control group (7.0% versus 13.3%; P = 0.002), but both had a similar average length of stay of 4 days. Overall, a two-thirds reduction in resource consumption and missed school/work days was observed in the CYD-TDV group relative to the control group. The estimated direct and indirect cost (2014 I$) associated with dengue episodes per participant in the CYD-TDV group was 73% lower than in the control group (I$6.72 versus I$25.08); representing a saving of I$I8.36 (95% confidence interval [CI]:17.05–19.78) per participant with vaccination. This is the first study providing information on dengue costs among vaccinated individuals and direct confirmation that vaccination has the potential to reduce dengue illness costs. PMID:29141713

Voltage control in Z-source inverter using low cost microcontroller for undergraduate approach

NASA Astrophysics Data System (ADS)

Zulkifli, Shamsul Aizam; Sewang, Mohd Rizal; Salimin, Suriana; Shah, Noor Mazliza Badrul

2017-09-01

This paper is focussing on controlling the output voltage of Z-Source Inverter (ZSI) using a low cost microcontroller with MATLAB-Simulink that has been used for interfacing the voltage control at the output of ZSI. The key advantage of this system is the ability of a low cost microcontroller to process the voltage control blocks based on the mathematical equations created in MATLAB-Simulink. The Proportional Integral (PI) control equations are been applied and then, been downloaded to the microcontroller for observing the changes on the voltage output regarding to the changes on the reference on the PI. The system has been simulated in MATLAB and been verified with the hardware setup. As the results, the Raspberry Pi and Arduino that have been used in this work are able to respond well when there is a change of ZSI output. It proofed that, by applying/introducing this method to student in undergraduate level, it will help the student to understand more on the process of the power converter combine with a control feedback function that can be applied at low cost microcontroller.

Workplace involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions.

PubMed

Carroll, Christopher; Rick, Jo; Pilgrim, Hazel; Cameron, Jackie; Hillage, Jim

2010-01-01

Long-term sickness absence among workers is a major problem in industrialised countries. The aim of the review is to determine whether interventions involving the workplace are more effective and cost-effective at helping employees on sick leave return to work than those that do not involve the workplace at all. A systematic review of controlled intervention studies and economic evaluations. Sixteen electronic databases and grey literature sources were searched, and reference and citation tracking was performed on included publications. A narrative synthesis was performed. Ten articles were found reporting nine trials from Europe and Canada, and four articles were found evaluating the cost-effectiveness of interventions. The population in eight trials suffered from back pain and related musculoskeletal conditions. Interventions involving employees, health practitioners and employers working together, to implement work modifications for the absentee, were more consistently effective than other interventions. Early intervention was also found to be effective. The majority of trials were of good or moderate quality. Economic evaluations indicated that interventions with a workplace component are likely to be more cost effective than those without. Stakeholder participation and work modification are more effective and cost effective at returning to work adults with musculoskeletal conditions than other workplace-linked interventions, including exercise.

Small size transformer provides high power regulation with low ripple and maximum control

NASA Technical Reports Server (NTRS)

Manoli, R.; Ulrich, B. R.

1971-01-01

Single, variable, transformer/choke device does work of several. Technique reduces drawer assembly physical size and design and manufacturing cost. Device provides power, voltage current and impedance regulation while maintaining maximum control of linearity and ensuring extremely low ripple. Nulling is controlled to very fine degree.

The Humanistic and Economic Burden of Narcolepsy

PubMed Central

Flores, Natalia M.; Villa, Kathleen F.; Black, Jed; Chervin, Ronald D.; Witt, Edward A.

2016-01-01

Study Objectives: To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss–through comparison of patients to matched controls. Methods: This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Results: Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). Conclusions: These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy. Citation: Flores NM, Villa KF, Black J, Chervin RD, Witt EA. The humanistic and economic burden of narcolepsy. J Clin Sleep Med 2016;12(3):401–407. PMID:26518705

Log in and breathe out: efficacy and cost-effectiveness of an online sleep training for teachers affected by work-related strain--study protocol for a randomized controlled trial.

PubMed

Thiart, Hanne; Lehr, Dirk; Ebert, David Daniel; Sieland, Bernhard; Berking, Matthias; Riper, Heleen

2013-06-11

Insomnia and work-related stress often co-occur. Both are associated with personal distress and diminished general functioning, as well as substantial socio-economic costs due to, for example, reduced productivity at the work place and absenteeism. Insomnia complaints by people experiencing work-related stress are correlated with a deficient cognitive detachment from work. Diffuse boundaries between work and private life can additionally complicate the use of recreational activities that facilitate cognitive detachment.Cognitive behavioral therapy for insomnia is effective but rarely implemented. Internet-based cognitive behavioral therapy for insomnia could potentially reduce this deficit given its demonstrated effectiveness. Less is known, however, about the efficacy of internet-based cognitive behavioral therapy for insomnia in populations affected by high work stress. Thus, the aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed, guided online training which is based on Cognitive Behavioral Therapy for insomnia and tailored to teachers affected by occupational stress. In a two-arm randomized controlled trial (N = 128), the effects of a guided online sleep training will be compared to a waitlist-control condition. German teachers with significant clinical insomnia complaints (Insomnia Severity Index ≥ 15) and work-related rumination (Irritation Scale, subscale Cognitive Irritation ≥ 15) will be included in the study. The primary outcome measure will be insomnia severity. Additionally, an economic evaluation from a societal perspective will be conducted. Data from the intention-to-treat sample will be analyzed two and six months after randomization. To the best of our knowledge, this is the first study to evaluate an online sleep training tailored to a specific population with work stress, that is, teachers. If this type of intervention is effective, it could reduce the paucity of cognitive behavioral therapy for insomnia and augment the support for teachers in coping with their insomnia problems. German Clinical Trial Register (DRKS): DRKS00004700.

The impact of hepatitis C on labor force participation, absenteeism, presenteeism and non-work activities.

PubMed

DiBonaventura, Marco daCosta; Wagner, Jan-Samuel; Yuan, Yong; L'Italien, Gilbert; Langley, Paul; Ray Kim, W

2011-01-01

Between 2.7 and 3.9 million people are currently infected with the hepatitis C virus (HCV) in the United States. Although many studies have investigated the impact of HCV on direct healthcare costs, few studies have estimated the indirect costs associated with the virus using a nationally-representative dataset. Using data from the 2009 United States (US) National Health and Wellness Survey, patients who reported a hepatitis C diagnosis (n = 695) were compared to controls on labor force participation, productivity loss, and activity impairment after adjusting for demographics, health risk behaviors, and comorbidities. All analyses applied sampling weights to project to the population. Patients with HCV were significantly less likely to be in the labor force than controls and reported significantly higher levels of absenteeism (4.88 vs. 3.03%), presenteeism (16.69 vs. 13.50%), overall work impairment (19.40 vs.15.35%), and activity impairment (25.01 vs. 21.78%). A propensity score matching methodology replicated many of these findings. While much of the work on HCV has focused on direct costs, our results suggest indirect costs should not be ignored when quantifying the societal burden of HCV. To our knowledge, this is the first study which has utilized a large, nationally-representative data source for identifying the impact of HCV on labor force participation and work and activity impairment using both a propensity-score matching and a regression modeling framework. All data were patient-reported (including HCV diagnosis and work productivity), which could have introduced some subjective biases.

Impact of Uncertainty from Load-Based Reserves and Renewables on Dispatch Costs and Emissions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Bowen; Maroukis, Spencer D.; Lin, Yashen

2016-11-21

Aggregations of controllable loads are considered to be a fast-responding, cost-efficient, and environmental-friendly candidate for power system ancillary services. Unlike conventional service providers, the potential capacity from the aggregation is highly affected by factors like ambient conditions and load usage patterns. Previous work modeled aggregations of controllable loads (such as air conditioners) as thermal batteries, which are capable of providing reserves but with uncertain capacity. A stochastic optimal power flow problem was formulated to manage this uncertainty, as well as uncertainty in renewable generation. In this paper, we explore how the types and levels of uncertainty, generation reserve costs, andmore » controllable load capacity affect the dispatch solution, operational costs, and CO2 emissions. We also compare the results of two methods for solving the stochastic optimization problem, namely the probabilistically robust method and analytical reformulation assuming Gaussian distributions. Case studies are conducted on a modified IEEE 9-bus system with renewables, controllable loads, and congestion. We find that different types and levels of uncertainty have significant impacts on dispatch and emissions. More controllable loads and less conservative solution methodologies lead to lower costs and emissions.« less

2016 reflections on the favorable cost-benefit of lung cancer screening

PubMed Central

Dieguez, Gabriela

2016-01-01

This article gives a basic background on the confusing and often politicized topic of cost-benefit analysis in healthcare, using lung cancer screening as a case study. The authors are actuaries who work with the insurance industry, where real-world data is used to produce audited financial figures; other disciplines which work with cost-benefit analysis include those academic disciplines where randomized controlled trials may be perceived as the gold standard of evidence. In recent years, the finance and academic sectors of healthcare have begun to converge, as academic disciplines have come to increasingly appreciate real-world data, and insurers increasingly appreciate classical evidence-based medicine. Nevertheless, the variation of results in cost-benefit analyses for particular treatments can be bewildering to medical experts unfamiliar with real-world healthcare financing. PMID:27195273

7 CFR 1781.4 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... improvement. (d) RC&D measure plan. A plan document for a land area, directly controlled or under the... area. (f) Watershed works of improvement. Structural, nonstructural, and land treatment measures... costs of installing WS works of improvement or RCD measures by the Federal Government and by sponsoring...

7 CFR 1781.4 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... improvement. (d) RC&D measure plan. A plan document for a land area, directly controlled or under the... area. (f) Watershed works of improvement. Structural, nonstructural, and land treatment measures... costs of installing WS works of improvement or RCD measures by the Federal Government and by sponsoring...

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation.

PubMed

Noben, Cindy; Evers, Silvia; Genabeek, Joost van; Nijhuis, Frans; de Rijk, Angelique

2017-04-01

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

Design of a Low-Cost Air Levitation System for Teaching Control Engineering.

PubMed

Chacon, Jesus; Saenz, Jacobo; Torre, Luis de la; Diaz, Jose Manuel; Esquembre, Francisco

2017-10-12

Air levitation is the process by which an object is lifted without mechanical support in a stable position, by providing an upward force that counteracts the gravitational force exerted on the object. This work presents a low-cost lab implementation of an air levitation system, based on open solutions. The rapid dynamics makes it especially suitable for a control remote lab. Due to the system's nature, the design can be optimized and, with some precision trade-off, kept affordable both in cost and construction effort. It was designed to be easily adopted to be used as both a remote lab and as a hands-on lab.

[Actual conditions of occupational health administration of small-scale enterprises in Japan: (II). Occupational health controls for hazardous and musculo-skeletally stressful working factors].

PubMed

Kumagai, S; Hirata, M; Tabuchi, T; Tainaka, H; Andoh, K; Oda, H

2000-09-01

In order to clarify the actual condition of occupational health management for hazardous and musculo-skeletally stressful work factors in small-scale enterprises (SSEs) in Japan, a questionnaire survey was conducted in an area near Osaka city. The hazardous work factors examined were dust, organic solvents, lead, specified chemical substances, anoxia, noise, hand-arm vibration, ionizing radiation, high and low temperatures, and high air pressure. The musculo-skeletally stressful work factors examined were VDT work, prolonged standing, unnatural postures, handling of heavy weights, and stress on neck, shoulders and arms. The number of SSEs that replied to the questionnaire was 765 (recovery rate: 69.3%). Enterprises with noise, dust, hand-arm vibration and organic solvents numbered 14.0%, 10.7%, 6.9% and 6.4%, respectively, and those with other hazardous factors numbered less than 3%. Special medical examinations and working environment measurements for hazardous factors were conducted in 0.0% to 26.7% and 0.0% to 13.3%, respectively, of the enterprises. Working environment controls were conducted in 0.0% to 40.2%. Enterprises with prolonged standing and VDT work, were 42.0% and 35.8%, whereas those with other stressful factors were approximately 30%. Special medical examinations for musculo-skeletally stressful factors were conducted in 3.0% to 5.1% of the enterprises, and work controls were conducted in 20.4% to 25.3%. Non execution of the special medical examinations and working environment measurements were mainly due to "lack of knowledge of the law (19.7% and 30.2%)" and "lack of time to perform (16.0% and 23.3%)". Non execution of the controls for the hazardous work factors was due to "lack of knowledge as to how to control (9.0%)", "high costs (7.4%)", "lack of time to perform (6.4%)" and "absence of a suitable adviser (5.9%)". Non execution of the controls for stressful work factors was due to "lack of knowledge as to how to control (15.6%)" and "lack of time to perform (10.2%)". Consequently, as a result of the survey, it was suggested that it is necessary to enlighten the employers of SEEs as to the importance of occupational health controls. It is also necessary to propose low-cost, feasible control methods.

Costs and benefits linked to developments in cognitive control.

PubMed

Blackwell, Katharine A; Munakata, Yuko

2014-03-01

Developing cognitive control over one's thoughts, emotions, and actions is a fundamental process that predicts important life outcomes. Such control begins in infancy, and shifts during development from a predominantly reactive form (e.g. retrieving task-relevant information when needed) to an increasingly proactive form (e.g. maintaining task-relevant information in anticipation of needing it). While such developments are generally viewed as adaptive, cognitive abilities can also involve trade-offs, such that the benefits of developing increasingly proactive control may come with associated costs. In two experiments, we test for such cognitive trade-offs in children who are transitioning to proactive control. We find that proactive control predicts expected benefits in children's working memory, but is also associated with predicted costs in disproportionately slowing children under conditions of distraction. These findings highlight unique advantages and disadvantages of proactive and reactive control, and suggest caution in attempting to alter their balance during development. © 2013 John Wiley & Sons Ltd.

Coal gasification systems engineering and analysis. Appendix H: Work breakdown structure

NASA Technical Reports Server (NTRS)

1980-01-01

A work breakdown structure (WBS) is presented which encompasses the multiple facets (hardware, software, services, and other tasks) of the coal gasification program. The WBS is shown to provide the basis for the following: management and control; cost estimating; budgeting and reporting; scheduling activities; organizational structuring; specification tree generation; weight allocation and control; procurement and contracting activities; and serves as a tool for program evaluation.

Metabolic cost and mechanical work for the step-to-step transition in walking after successful total ankle arthroplasty.

PubMed

Doets, H Cornelis; Vergouw, David; Veeger, H E J Dirkjan; Houdijk, Han

2009-12-01

The aim of this study was to investigate whether impaired ankle function after total ankle arthroplasty (TAA) affects the mechanical work during the step-to-step transition and the metabolic cost of walking. Respiratory and force plate data were recorded in 11 patients and 11 healthy controls while they walked barefoot at a fixed walking speed (FWS, 1.25 m/s) and at their self-selected speed (SWS). At FWS metabolic cost of transport was 28% higher for the TAA group, but at SWS there was no significant increase. During the step-to-step transition, positive mechanical work generated by the trailing TAA leg was lower and negative mechanical work in the leading intact leg was larger. Despite the increase in mechanical work dissipation during double support, no significant differences in total mechanical work were found over a complete stride. This might be a result of methodological limitations of calculating mechanical work. Nevertheless, mechanical work dissipated during the step-to-step transition at FWS correlated significantly with metabolic cost of transport: r=.540. It was concluded that patients after successful TAA still experienced an impaired lower leg function, which contributed to an increase in mechanical energy dissipation during the step-to-step transition, and to an increase in the metabolic demand of walking. 2009 Elsevier B.V. All rights reserved.

Freeform Fluidics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Love, Lonnie J; Richardson, Bradley S; Lind, Randall F

This work explores the integration of miniaturized fluid power and additive manufacturing. Oak Ridge National Laboratory (ORNL) has been developing an approach to miniaturized fluidic actuation and control that enables high dexterity, low cost and a pathway towards energy efficiency. Previous work focused on mesoscale digital control valves (high pressure, low flow) and the integration of actuation and fluid passages directly with the structure. The primary application being fluid powered robotics. The fundamental challenge was part complexity. Additive manufacturing technologies (E-Beam, Laser and Ultrasonic deposition) enable freeform manufacturing using conventional metal alloys with excellent mechanical properties. The combination of thesemore » two technologies (miniaturized fluid power and additive manufacturing) can enable a paradigm shift in fluid power, increasing efficiency while simultaneously reducing weight, size, complexity and cost.« less

The Cost of Education Index: Measurement of Price Differences of Education Personnel Among New York State School Districts. Working Paper in Education Finance No. 26.

ERIC Educational Resources Information Center

Wendling, Wayne

This report is divided into four sections. Section 1 is a short discussion of the economic theory underlying the construction of the cost of education index and an example of how the index is calculated. Also presented are descriptions of the factors included in the statistical analysis to control for quality, quantity, and cost differences and…

"A manager in the minds of doctors:" a comparison of new modes of control in European hospitals.

PubMed

Kuhlmann, Ellen; Burau, Viola; Correia, Tiago; Lewandowski, Roman; Lionis, Christos; Noordegraaf, Mirko; Repullo, Jose

2013-07-02

Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) 'integrated' control with high levels of coordination and coherent patterns for cost and quality controls; (2) 'partly integrated' control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) 'fragmented' control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Our comparison highlights how organisations matter and brings the crucial relevance of 'coordination' of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.

The effect of 90 day administration of a high dose vitamin B-complex on work stress.

PubMed

Stough, Con; Scholey, Andrew; Lloyd, Jenny; Spong, Jo; Myers, Stephen; Downey, Luke A

2011-10-01

Occupational stress is increasing in Western societies and the impact is significant at a personal, organisational and community level. The present study examined for the first time the efficacy of 3 months administration of two forms of high dose vitamin B complex on mood and psychological strain associated with chronic work stress. Sixty participants completed the 3-month, double-blind, randomised, placebo-controlled trial in which personality, work demands, mood, anxiety and strain were assessed. After individual differences in personality and work demands were statistically controlled, the vitamin B complex treatment groups reported significantly lower personal strain and a reduction in confusion and depressed/dejected mood after 12 weeks. There were no treatment-related changes in other measures of mood and anxiety. The results of the study are consistent with two previous studies examining multivitamin supplementation and personal (non-work) feelings of strain and suggestive of significant decreases in the experience of workplace stress after 90 day supplementation of a B multivitamin. Given the direct and indirect costs of workplace stress, these findings point to the utility of a cost-effective treatment for the mood and psychological strain effects of occupational stress. These findings may have important personal health, organisational and societal outcomes given the rising cost and incidence of workplace stress. Copyright © 2011 John Wiley & Sons, Ltd.

The economic consequences of irritable bowel syndrome: a US employer perspective.

PubMed

Leong, Stephanie A; Barghout, Victoria; Birnbaum, Howard G; Thibeault, Crystal E; Ben-Hamadi, Rym; Frech, Feride; Ofman, Joshua J

2003-04-28

The objective of this study was to measure the direct costs of treating irritable bowel syndrome (IBS) and the indirect costs in the workplace. This was accomplished through retrospective analysis of administrative claims data from a national Fortune 100 manufacturer, which includes all medical, pharmaceutical, and disability claims for the company's employees, spouses/dependents, and retirees. Patients with IBS were identified as individuals, aged 18 to 64 years, who received a primary code for IBS or a secondary code for IBS and a primary code for constipation or abdominal pain between January 1, 1996, and December 31, 1998. Of these patients with IBS, 93.7% were matched based on age, sex, employment status, and ZIP code to a control population of beneficiaries. Direct and indirect costs for patients with IBS were compared with those of matched controls. The average total cost (direct plus indirect) per patient with IBS was 4527 dollars in 1998 compared with 3276 dollars for a control beneficiary (P<.001). The average physician visit costs were 524 dollars and 345 dollars for patients with IBS and controls, respectively (P<.001). The average outpatient care costs to the employer were 1258 dollars and 742 dollars for patients with IBS and controls, respectively (P<.001). Medically related work absenteeism cost the employer 901 dollars on average per employee treated for IBS compared with 528 dollars on average per employee without IBS (P<.001). Irritable bowel syndrome is a significant financial burden on the employer that arises from an increase in direct and indirect costs compared with the control group.

Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania

PubMed Central

Ngalesoni, Frida; Ruhago, George; Mayige, Mary; Oliveira, Tiago Cravo; Robberstad, Bjarne; Norheim, Ole Frithjof; Higashi, Hideki

2017-01-01

Background Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. Aims We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. Materials and methods A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. Results Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. Conclusions Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government’s ability to implement these interventions. PMID:28767722

Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review

PubMed Central

López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

2015-01-01

Abstract Objective: A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Materials and Methods: Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as “cost-utility” OR “cost utility” AND “telemedicine,” “cost-effectiveness” OR “cost effectiveness” AND “mobile health,” etc. In the articles searched, there were no limitations in the publication date. Results: The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. Conclusions: There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures. PMID:25474190

Early magnetic resonance imaging in acute knee injury: a cost analysis.

PubMed

Patel, Nirav K; Bucknill, Andrew; Ahearne, David; Denning, Janet; Desai, Kailash; Watson, Martin

2012-06-01

Acute knee injury is common, and MRI is often only used when non-operative management fails because of limited availability. We investigated whether early MRI in acute knee injury is more clinically and cost-effective compared to conventional physiotherapy and reassessment. All patients with acute indirect soft tissue knee injury referred to fracture clinic were approached. Recruited patients were randomised to either the MRI group: early MRI within 2 weeks or the control group: conventional management with physiotherapy. Patients were assessed in clinic initially, at 2 weeks and 3 months post-injury. Management costs were calculated for all patients until surgical treatment or discharge. Forty-six patients were recruited: 23 in the MRI and 23 in the control group. Male sex and mean age were similar in the two groups. The total management cost of the MRI group was £16,127 and control group was £16,170, with a similar mean cost per patient (NS). The MRI group had less mean physiotherapy (2.5 ± 1.9 vs. 5.1 ± 3.5, p < 0.01) and outpatient appointments (NS). Median time to surgery and time off work was less in the MRI group (NS). The MRI group had less pain (p < 0.05), less activity limitation (p = 0.04) and better satisfaction (p = 0.04). Early MRI in acute knee injury facilitates faster diagnosis and management of internal derangement at a cost comparable to conventional treatment. Moreover, patients had significantly less time off work with improved pain, activity limitation and satisfaction scores. II.

Labor market productivity costs for caregivers of children with spina bifida: a population-based analysis.

PubMed

Tilford, John M; Grosse, Scott D; Goodman, Allen C; Li, Kemeng

2009-01-01

Caregiver productivity costs are an important component of the overall cost of care for individuals with birth defects and developmental disabilities, yet few studies provide estimates for use in economic evaluations. This study estimates labor market productivity costs for caregivers of children and adolescents with spina bifida. Case families were recruited from a state birth defects registry in Arkansas. Primary caregivers of children with spina bifida (N = 98) reported their employment status in the past year and demographic characteristics. Controls were abstracted from the Current Population Survey covering the state of Arkansas for the same time period (N = 416). Estimates from regression analyses of labor market outcomes were used to calculate differences in hours worked per week and lifetime costs. Caregivers of children with spina bifida worked an annual average of 7.5 to 11.3 hours less per week depending on the disability severity. Differences in work hours by caregivers of children with spina bifida translated into lifetime costs of $133,755 in 2002 dollars using a 3% discount rate and an age- and sex-adjusted earnings profile. Including caregivers' labor market productivity costs in prevention effectiveness estimates raises the net cost savings per averted case of spina bifida by 48% over the medical care costs alone. Information on labor market productivity costs for caregivers can be used to better inform economic evaluations of prevention and treatment strategies for spina bifida. Cost-effectiveness calculations that omit caregiver productivity costs substantially overstate the net costs of the intervention and underestimate societal value.

Design of a trial-based economic evaluation on the cost-effectiveness of employability interventions among work disabled employees or employees at risk of work disability: The CASE-study

PubMed Central

2012-01-01

Background In the Netherlands, absenteeism and reduced productivity due to work disability lead to high yearly costs reaching almost 5% of the gross national product. To reduce the economic burden of sick leave and reduced productivity, different employability interventions for work-disabled employees or employees at risk of work disability have been developed. Within this study, called 'CASE-study' (Cost-effectiveness Analysis of Sustainable Employability), five different employability interventions directed at work disabled employees with divergent health complaints will be analysed on their effectiveness and cost-effectiveness. This paper describes a consistent and transparent methodological design to do so. Methods/design Per employability intervention 142 participants are needed whereof approximately 66 participants receiving the intervention will be compared with 66 participants receiving usual care. Based on the intervention-specific characteristics, a randomized control trial or a quasi-experiment with match-criteria will be conducted. Notwithstanding the study design, eligible participants will be employees aged 18 to 63, working at least 12 h per week, and at risk of work disability, or already work-disabled due to medical restrictions. The primary outcome will be the duration of sick leave. Secondary outcomes are health status and quality of life. Outcomes will be assessed at baseline and then 6, 12 and 18 months later. Economic costs will consist of healthcare costs and cost of lost production due to work disability, and will be evaluated from a societal perspective. Discussion The CASE-study is the first to conduct economic evaluations of multiple different employability interventions based on a similar methodological framework. The cost-effectiveness results for every employability intervention will be published in 2014, but the methods, strengths and weaknesses of the study protocol are discussed in this paper. To contribute to treatment options in occupational health practice and enable the development of guidelines on how to conduct economic evaluation better suited to this field; this paper provides an important first step. Trial registration Four trials involved in the CASE-study are registered with the Netherlands Trial Registry: Care for Work (NTR2886), Health and Motion (NTR3111), Guidance to Excel in Return to Work (NTR3151), Care for Companies/Second Care (NTR3136). PMID:22257557

Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis.

PubMed

Noben, Cindy; Vilsteren, Myrthe van; Boot, Cécile; Steenbeek, Romy; Schaardenburg, Dirkjan van; Anema, Johannes R; Evers, Silvia; Nijhuis, Frans; Rijk, Angelique de

2017-05-25

Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity. Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings. At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings. The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs.

Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis

PubMed Central

Noben, Cindy; van Vilsteren, Myrthe; Boot, Cécile; Steenbeek, Romy; van Schaardenburg, Dirkjan; Anema, Johannes R.; Evers, Silvia; Nijhuis, Frans; de Rijk, Angelique

2017-01-01

Objectives: Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity. Methods: Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings. Results: At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings. Discussion: The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs. PMID:28381814

Open Learning: Resource Allocation and Control. Coombe Lodge Working Paper. Information Bank Number 1610.

ERIC Educational Resources Information Center

Latcham, Jack

In an effort to demonstrate that open learning can be accommodated within existing funding mechanisms in British colleges of further and higher education, this paper discusses issues concerned with determining the cost of Flexistudy and open learning delivery systems. After a review of the difficulties of estimating precisely the costs of various…

Volumetric calculation using low cost unmanned aerial vehicle (UAV) approach

NASA Astrophysics Data System (ADS)

Rahman, A. A. Ab; Maulud, K. N. Abdul; Mohd, F. A.; Jaafar, O.; Tahar, K. N.

2017-12-01

Unmanned Aerial Vehicles (UAV) technology has evolved dramatically in the 21st century. It is used by both military and general public for recreational purposes and mapping work. Operating cost for UAV is much cheaper compared to that of normal aircraft and it does not require a large work space. The UAV systems have similar functions with the LIDAR and satellite images technologies. These systems require a huge cost, labour and time consumption to produce elevation and dimension data. Measurement of difficult objects such as water tank can also be done by using UAV. The purpose of this paper is to show the capability of UAV to compute the volume of water tank based on a different number of images and control points. The results were compared with the actual volume of the tank to validate the measurement. In this study, the image acquisition was done using Phantom 3 Professional, which is a low cost UAV. The analysis in this study is based on different volume computations using two and four control points with variety set of UAV images. The results show that more images will provide a better quality measurement. With 95 images and four GCP, the error percentage to the actual volume is about 5%. Four controls are enough to get good results but more images are needed, estimated about 115 until 220 images. All in all, it can be concluded that the low cost UAV has a potential to be used for volume of water and dimension measurement.

The impact of precancerous cervical lesions on functioning at work and work productivity.

PubMed

Lerner, Debra; Parsons, Susan K; Justicia-Linde, Faye; Chelmow, David; Chang, Hong; Rogers, William H; Greenhill, Annabel M; Perch, Katherine; Kruzikas, Denise

2010-09-01

To assess the work performance and productivity impact of human papillomavirus (HPV). A cross-sectional study compared 94 employed women with clinically significant HPV-related cervical lesions with 118 healthy controls. Data were collected by self-administered web-based questionnaire. At-work performance limitations and productivity loss (presenteeism) and absenteeism were measured. Univariate and multivariate case-control group and clinical subgroup differences were tested. Based on adjusted mean scores, the HPV group had significantly more at-work limitations and productivity loss than controls (P = 0.009), higher absence rates (P = 0.002), and significantly more productivity loss because of absences (P = 0.007). At-work limitations varied in association with martial status (P = 0.025); at-work productivity loss was associated with years of education (P = 0.039). HPV is costly for working women, their employers, and the economy.

Migraine Nurses in Primary Care: Costs and Benefits.

PubMed

van den Berg, Jan S P; Steiner, Timothy J; Veenstra, Petra J L; Kollen, Boudewijn J

2017-09-01

We examined the costs and benefits of introducing migraine nurses into primary care. Migraine is one of the most costly neurological diseases. We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with <50% productivity at work due to migraine, and notional costs related to lost days of household activities or days of <50% household productivity. Analysis was conducted from the payer's perspective. After 9 months the direct costs were €281.11 in the control group against €332.23 in the intervention group (mean difference -51.12; 95% CI: -113.20-15.56; P = .134); the indirect costs were €1985.51 in the control group against €1631.75 in the intervention group (mean difference 353.75; 95% CI: -355.53-1029.82; P = .334); and total costs were €2266.62 in the control group, against €1963.99 in the intervention group (mean difference 302.64; 95% CI: -433.46-1001.27; P = .438). When costs attributable to lost household productivity were included, total costs increased to €6076.62 in the control group and €5048.15 in the intervention group (mean difference 1028.47; 95% CI: -590.26-2603.67; P = .219). Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile. © 2017 American Headache Society.

Cost and benefits design optimization model for fault tolerant flight control systems

NASA Technical Reports Server (NTRS)

Rose, J.

1982-01-01

Requirements and specifications for a method of optimizing the design of fault-tolerant flight control systems are provided. Algorithms that could be used for developing new and modifying existing computer programs are also provided, with recommendations for follow-on work.

Making the Net More Intelligent.

ERIC Educational Resources Information Center

Somers, Doug

1998-01-01

Discusses how service providers can address the challenge of costs and the need for attractive services valuable to business customers. Focuses on Internet service control; applying intelligent networking features to the internet working services dilemma; and providing access control over network-based applications for Internet virtual private…

Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial.

PubMed

Heber, Elena; Ebert, David Daniel; Lehr, Dirk; Nobis, Stephanie; Berking, Matthias; Riper, Heleen

2013-07-15

Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees. The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α = .05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen's Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol. The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a preventative, economical stress-management tool will be conceivable. The strengths and limitations of the present study are discussed. German Register of Clinical Studies (DRKS): DRKS00004749.

Development of a Hot Working Steel Based on a Controlled Gas-Metal-Reaction

NASA Astrophysics Data System (ADS)

Ritzenhoff, Roman; Gharbi, Mohammad Malekipour

As a result of cost sensitiveness, the demand on hot working steels with advanced characteristics and properties are ascending. We have used a controlled gas-metal-reaction in a P-ESR furnace to produce high quality hot working steel. These types of materials are also known as High Nitrogen Steels (HNS). An overview of the development in a pressurized induction furnace to the final industrial scale using P-ESR will be provided. Different heat treatment strategies are conducted and their effect on mechanical properties is investigated.

Workforce flexibility - in defence of professional healthcare work.

PubMed

Wise, Sarah; Duffield, Christine; Fry, Margaret; Roche, Michael

2017-06-19

Purpose The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity. Design/methodology/approach The paper uses the Weberian tool of "ideal types". Key workforce reforms are held against Atkinson's model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control. Findings Appeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy. Originality/value The paper questions the conventional conception of "the problem" of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.

20 CFR 416.976 - Impairment-related work expenses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... work, we will deduct payments you make toward its cost. (5) Payments for drugs and medical services. (i) If you must use drugs or medical services (including diagnostic procedures) to control your impairment(s), the payments you make for them may be deducted. The drugs or services must be prescribed (or...

33 CFR 203.50 - Nonstructural alternatives to rehabilitation of flood control works.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL... expenditures. Exclusive of the costs of investigation, report preparation, engineering and design work, and...'s request for an NSAP, whichever is earlier, if insufficient progress is being made to develop and...

33 CFR 203.50 - Nonstructural alternatives to rehabilitation of flood control works.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL... expenditures. Exclusive of the costs of investigation, report preparation, engineering and design work, and...'s request for an NSAP, whichever is earlier, if insufficient progress is being made to develop and...

33 CFR 203.50 - Nonstructural alternatives to rehabilitation of flood control works.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL... expenditures. Exclusive of the costs of investigation, report preparation, engineering and design work, and...'s request for an NSAP, whichever is earlier, if insufficient progress is being made to develop and...

33 CFR 203.50 - Nonstructural alternatives to rehabilitation of flood control works.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE EMERGENCY EMPLOYMENT OF ARMY AND OTHER RESOURCES, NATURAL... expenditures. Exclusive of the costs of investigation, report preparation, engineering and design work, and...'s request for an NSAP, whichever is earlier, if insufficient progress is being made to develop and...

Better health at work? An evaluation of the effects and cost-benefits of a structured workplace health improvement programme in reducing sickness absence.

PubMed

Braun, T; Bambra, C; Booth, M; Adetayo, K; Milne, E

2015-03-01

This paper presents the results of an evaluation of the Better Health at Work Award-a structured regional workplace health programme which combined changes to the work environment with lifestyle interventions. Baseline and follow-up data on sickness-absence rates and programme costs were collected retrospectively via a web survey of all participating organizations. Changes over time were calculated using 95% confidence intervals of the mean, supplemented by hypothesis testing using a t-test. The indicative cost-benefits of the intervention were also calculated. Participation was associated with a mean reduction in sickness absence of 0.26-1.6 days per employee per year depending on the length and level of participation in the programme. The estimated cost for the programme was £3 per sickness-absence day saved. These results suggest that the Better Health at Work Award could be a cost-effective way of improving health and reducing sickness absence particularly in the public sector. However, controlled evaluations of future interventions are needed. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Unmanned Aerial Vehicles unique cost estimating requirements

NASA Astrophysics Data System (ADS)

Malone, P.; Apgar, H.; Stukes, S.; Sterk, S.

Unmanned Aerial Vehicles (UAVs), also referred to as drones, are aerial platforms that fly without a human pilot onboard. UAVs are controlled autonomously by a computer in the vehicle or under the remote control of a pilot stationed at a fixed ground location. There are a wide variety of drone shapes, sizes, configurations, complexities, and characteristics. Use of these devices by the Department of Defense (DoD), NASA, civil and commercial organizations continues to grow. UAVs are commonly used for intelligence, surveillance, reconnaissance (ISR). They are also use for combat operations, and civil applications, such as firefighting, non-military security work, surveillance of infrastructure (e.g. pipelines, power lines and country borders). UAVs are often preferred for missions that require sustained persistence (over 4 hours in duration), or are “ too dangerous, dull or dirty” for manned aircraft. Moreover, they can offer significant acquisition and operations cost savings over traditional manned aircraft. Because of these unique characteristics and missions, UAV estimates require some unique estimating methods. This paper describes a framework for estimating UAV systems total ownership cost including hardware components, software design, and operations. The challenge of collecting data, testing the sensitivities of cost drivers, and creating cost estimating relationships (CERs) for each key work breakdown structure (WBS) element is discussed. The autonomous operation of UAVs is especially challenging from a software perspective.

Economic Evaluation of a Worksite Obesity Prevention and Intervention Trial among Hotel Workers in Hawaii

PubMed Central

Meenan, Richard T.; Vogt, Thomas M.; Williams, Andrew E.; Stevens, Victor J.; Albright, Cheryl L.; Nigg, Claudio

2010-01-01

Objective Economic evaluation of Work, Weight, and Wellness (3W), a two-year randomized trial of a weight loss program delivered through Hawaii hotel worksites. Methods Business case analysis from hotel perspective. Program resources were micro-costed (2008 dollars). Program benefits were reduced medical costs, fewer absences, and higher productivity. Primary outcome was discounted 24-month net present value (NPV). Results Control program cost $222K to implement over 24 months ($61 per participant), intervention program cost $1.12M ($334). Including overweight participants (body mass index > 25), discounted control NPV was −$217K; −$1.1M for intervention program. Presenteeism improvement of 50% combined with baseline 10% productivity shortfall required to generate positive 24-month intervention NPV. Conclusions 3W’s positive clinical outcomes did not translate into immediate economic benefit for participating hotels, although modest cost savings were observed in the trial’s second year. PMID:20061889

Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669).

PubMed

Wynne-Jones, Gwenllian; Artus, Majid; Bishop, Annette; Lawton, Sarah A; Lewis, Martyn; Jowett, Sue; Kigozi, Jesse; Main, Chris; Sowden, Gail; Wathall, Simon; Burton, A Kim; van der Windt, Danielle A; Hay, Elaine M; Foster, Nadine E

2017-10-30

Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work <6 months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n = 158) had fewer days work absence compared with the control arm (n = 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99), P = 0·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Job demand-control and job stress at work: A cross-sectional study among prison staff

PubMed Central

Akbari, Jafar; Akbari, Rouhollah; Shakerian, Mahnaz; Mahaki, Behzad

2017-01-01

Introduction: Job stress can impose significant costs to the workplaces and organizations due to some issues such as absenteeism, less productivity, and medical costs. Job overload and lack of decision latitude can lead to job stress. The current study aimed to investigate the job demands and control as predictor of job stress and its relationship, with some of the demographic characteristics of Iranian prison staff. Materials and Methods: This study was performed on 171 male employees working in four prisons located in Ilam, Iran. The sampling method was census and all four prisons’ staff were selected to respond the Job Content Questionnaires. Finally, the data were analyzed using t-test or independent samples test as well as SPSS 20. Results: The highest amount of job demand (mean = 21.28) and the lowest amount of job control on average (9.76) were reported by those staff working in Darehshahr prison. There was also a significant relationship between job post and job control among the prison staff (β = −0.375, P = 0.001). Conclusion: The level of job stress reported by prison staff was high in this study mainly caused by high job demand and low job control, especially in Darehshahr prison staff. PMID:28546980

Is the metabolic cost of walking higher in people with diabetes?

PubMed

Petrovic, M; Deschamps, K; Verschueren, S M; Bowling, F L; Maganaris, C N; Boulton, A J M; Reeves, N D

2016-01-01

People with diabetes walk slower and display biomechanical gait alterations compared with controls, but it remains unknown whether the metabolic cost of walking (CoW) is elevated. The aim of this study was to investigate the CoW and the lower limb concentric joint work as a major determinant of the CoW, in patients with diabetes and diabetic peripheral neuropathy (DPN). Thirty-one nondiabetic controls (Ctrl), 22 diabetic patients without peripheral neuropathy (DM), and 14 patients with moderate/severe DPN underwent gait analysis using a motion analysis system and force plates and treadmill walking using a gas analyzer to measure oxygen uptake. The CoW was significantly higher particularly in the DPN group compared with controls and also in the DM group (at selected speeds only) compared with controls, across a range of matched walking speeds. Despite the higher CoW in patients with diabetes, concentric lower limb joint work was significantly lower in DM and DPN groups compared with controls. The higher CoW is likely due to energetic inefficiencies associated with diabetes and DPN reflecting physiological and biomechanical characteristics. The lower concentric joint work in patients with diabetes might be a consequence of kinematic gait alterations and may represent a natural strategy aimed at minimizing the CoW. Copyright © 2016 the American Physiological Society.

Lidar-Enhanced Wind Turbine Control: Past, Present, and Future: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scholbrock, Andrew; Fleming, Paul; Wright, Alan

2016-07-01

This paper will look at the development of lidar-enhanced controls and how they have been used for turbine load reduction with pitch actuation, as well as increased energy production with improved yaw control. Ongoing work will also be discussed to show that combining pitch and torque control using feedforward nonlinear model predictive control can lead to both reduced loads and increased energy production. Future work is also proposed on extending individual wind turbine controls to the wind plant level and determining how lidars can be used for control methods to further lower the cost of wind energy by minimizing wakemore » impacts in a wind farm.« less

Guidance for Efficient Small Animal Imaging Quality Control.

PubMed

Osborne, Dustin R; Kuntner, Claudia; Berr, Stuart; Stout, David

2017-08-01

Routine quality control is a critical aspect of properly maintaining high-performance small animal imaging instrumentation. A robust quality control program helps produce more reliable data both for academic purposes and as proof of system performance for contract imaging work. For preclinical imaging laboratories, the combination of costs and available resources often limits their ability to produce efficient and effective quality control programs. This work presents a series of simplified quality control procedures that are accessible to a wide range of preclinical imaging laboratories. Our intent is to provide minimum guidelines for routine quality control that can assist preclinical imaging specialists in setting up an appropriate quality control program for their facility.

Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome

PubMed Central

González López-Valcárcel, Beatriz; Librero, Julián; García-Sempere, Aníbal; Peña, Luz María; Bauer, Sofía; Puig-Junoy, Jaume; Oliva, Juan; Peiró, Salvador; Sanfélix-Gimeno, Gabriel

2017-01-01

Objectives Cost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia. Methods Population-based retrospective cohort of 10 563 patients discharged alive after an ACS in 2009–2011. We examined a control group (low-income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance and middle-income to high-income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period. Results Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACE inhibitor or an angiotensin II receptor blocker (ACEI/ARB) and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence, respectively, p<0.01 for both). Adherence to statins decreased for the middle-income to high-income group as compared with the control group (7.8% increase of non-adherence, p<0.01). These effects seemed temporary. Conclusions Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost sharing. PMID:28249992

Continuing to Confront COPD International Patient Survey: Economic Impact of COPD in 12 Countries.

PubMed

Foo, Jason; Landis, Sarah H; Maskell, Joe; Oh, Yeon-Mok; van der Molen, Thys; Han, MeiLan K; Mannino, David M; Ichinose, Masakazu; Punekar, Yogesh

2016-01-01

The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD. This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation), contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct and indirect costs estimated the total societal costs per patient. The annual direct costs of COPD ranged from $504 (South Korea) to $9,981 (USA), with inpatient hospitalisations (5 countries) and home oxygen therapy (3 countries) being the key drivers of direct costs. The proportion of patients completely prevented from working due to their COPD ranged from 6% (Italy) to 52% (USA and UK) with 8 countries reporting this to be ≥20%. Total societal costs per patient varied widely from $1,721 (Russia) to $30,826 (USA) but a consistent pattern across countries showed greater costs among those with increased burden of COPD (symptoms, health status and more severe disease) and a greater number of comorbidities. The economic burden of COPD is considerable across countries, and requires targeted resources to optimise COPD management encompassing the control of symptoms, prevention of exacerbations and effective treatment of comorbidities. Strategies to allow COPD patients to remain in work are important for addressing the substantial wider societal costs.

Design of a Low-Cost Air Levitation System for Teaching Control Engineering

PubMed Central

Chacon, Jesus; Saenz, Jacobo; de la Torre, Luis; Diaz, Jose Manuel; Esquembre, Francisco

2017-01-01

Air levitation is the process by which an object is lifted without mechanical support in a stable position, by providing an upward force that counteracts the gravitational force exerted on the object. This work presents a low-cost lab implementation of an air levitation system, based on open solutions. The rapid dynamics makes it especially suitable for a control remote lab. Due to the system’s nature, the design can be optimized and, with some precision trade-off, kept affordable both in cost and construction effort. It was designed to be easily adopted to be used as both a remote lab and as a hands-on lab. PMID:29023381

Lidar-Enhanced Wind Turbine Control: Past, Present, and Future

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scholbrock, Andrew; Fleming, Paul; Schlipf, David

The main challenges in harvesting energy from the wind arise from the unknown incoming turbulent wind field. Balancing the competing interests of reduction in structural loads and increasing energy production is the goal of a wind turbine controller to reduce the cost of producing wind energy. Conventional wind turbines use feedback methods to optimize these goals, reacting to wind disturbances after they have already impacted the wind turbine. Lidar sensors offer a means to provide additional inputs to a wind turbine controller, enabling new techniques to improve control methods, allowing a controller to actuate a wind turbine in anticipation ofmore » an incoming wind disturbance. This paper will look at the development of lidar-enhanced controls and how they have been used for various turbine load reductions with pitch actuation, as well as increased energy production with improved yaw control. Ongoing work will also be discussed to show that combining pitch and torque control using feedforward nonlinear model predictive control can lead to both reduced loads and increased energy production. Future work is also proposed on extending individual wind turbine controls to the wind plant level and determining how lidars can be used for control methods to further lower the cost of wind energy by minimizing wake impacts in a wind farm.« less

Impulsive Control for Continuous-Time Markov Decision Processes: A Linear Programming Approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dufour, F., E-mail: dufour@math.u-bordeaux1.fr; Piunovskiy, A. B., E-mail: piunov@liv.ac.uk

2016-08-15

In this paper, we investigate an optimization problem for continuous-time Markov decision processes with both impulsive and continuous controls. We consider the so-called constrained problem where the objective of the controller is to minimize a total expected discounted optimality criterion associated with a cost rate function while keeping other performance criteria of the same form, but associated with different cost rate functions, below some given bounds. Our model allows multiple impulses at the same time moment. The main objective of this work is to study the associated linear program defined on a space of measures including the occupation measures ofmore » the controlled process and to provide sufficient conditions to ensure the existence of an optimal control.« less

Do Zero-Cost Workers’ Compensation Medical Claims Really Have Zero Costs?

PubMed Central

Asfaw, Abay; Rosa, Roger; Mao, Rebecca

2015-01-01

Objective Previous research suggests that non–workers’ compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs. Methods Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments. Results Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims. Conclusion Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year. PMID:24316724

Randomized Controlled Trial of Adding Telephone Follow-Up to an Occupational Rehabilitation Program to Increase Work Participation.

PubMed

Hara, Karen Walseth; Bjørngaard, Johan Håkon; Brage, Søren; Borchgrevink, Petter Christian; Halsteinli, Vidar; Stiles, Tore Charles; Johnsen, Roar; Woodhouse, Astrid

2018-06-01

Purpose Transfer from on-site rehabilitation to the participant's daily environment is considered a weak link in the rehabilitation chain. The main objective of this study is to see if adding boosted telephone follow-up directly after completing an occupational rehabilitation program effects work participation. Methods A randomized controlled study included participants with chronic pain, chronic fatigue or common mental disorders on long-term sick leave. After completing 3½ weeks of acceptance and commitment therapy based occupational rehabilitation, participants were randomized to boosted follow-up or a control group before returning to their daily environment. The intervention was delivered over 6 months by on-site RTW coordinators mainly via telephone. Primary outcome was RTW categorized as participation in competitive work ≥1 day per week on average over 8 weeks. Results There were 213 participants of mean age 42 years old. Main diagnoses of sick leave certification were mental disorders (38%) and musculoskeletal disorders (30%). One year after discharge the intervention group had 87% increased odds (OR 1.87, 95% confidence interval 1.06-3.31, p = 0.031), of (re)entry to competitive work ≥1 day per week compared with the controls, with similar positive results for sensitivity analysis of participation half time (≥2.5 days per week). The cost of boosted follow-up was 390.5 EUR per participant. Conclusion Participants receiving boosted RTW follow-up had higher (re)entry to competitive work ≥1 day per week at 1 year when compared to the control group. Adding low-cost boosted follow-up by telephone after completing an occupational rehabilitation program augmented the effect on return-to-work.

Impact of dry eye on work productivity.

PubMed

Yamada, Masakazu; Mizuno, Yoshinobu; Shigeyasu, Chika

2012-01-01

The purpose of this study was to evaluate the impact of dry eye on work productivity of office workers, especially in terms of presenteeism. A total of 396 individuals aged ≥20 years (258 men and 138 women, mean age 43.4 ± 13.0 years) were recruited through an online survey. Data from 355 responders who did not have missing values were included in the analysis. They were classified into the following four groups according to the diagnostic status and subjective symptoms of dry eye: a definite dry eye group; a marginal dry eye group; a self-reported dry eye group; and a control group. The impact of dry eye on work productivity was evaluated using the Japanese version of the Work Limitations Questionnaire. The cost of work productivity loss associated with dry eye and the economic benefits of providing treatment for dry eye were also assessed. The degree of work performance loss was 5.65% in the definite dry eye group, 4.37% in the marginal dry eye group, 6.06% in the self-reported dry eye group, and 4.27% in the control group. Productivity in the self-reported dry eye group was significantly lower than that in the control group (P < 0.05). The annual cost of work productivity loss associated with dry eye was estimated to be USD 741 per person. Dry eye impairs work performance among office workers, which may lead to a substantial loss to industry. Management of symptoms of dry eye by providing treatment may contribute to improvement in work productivity.

Using the Community College to Control College Costs: How Much Cheaper Is It?

ERIC Educational Resources Information Center

Romano, Richard M.; Djajalaksana, Yenni M.

2011-01-01

Data from NCES indicate that it is two to three times more expensive to educate a student at a public four-year college than at a community college. These figures exaggerate the difference between the two when you calculate the costs of the first two years of education for students working on a bachelor's degree. Using modified Integrated…

A Behavioral Measure of Costly Helping: Replicating and Extending the Association with Callous Unemotional Traits in Male Adolescents

PubMed Central

Sakai, Joseph T.; Dalwani, Manish S.; Mikulich-Gilbertson, Susan K.; McWilliams, Shannon K.; Raymond, Kristen M.; Crowley, Thomas J.

2016-01-01

Background Some conduct-disordered youths have high levels of callous unemotional traits and meet the DSM-5’s “with limited prosocial emotions” (LPE) specifier. These youths often do aggressive, self-benefitting acts that cost others. We previously developed a task, the AlAn’s game, which asks participants to repeatedly decide whether to accept or reject offers in which they will receive money but a planned charity donation will be reduced. In our prior work, more "costly helping" (i.e., rejecting the offered money and protecting the donation) was associated with lower callous unemotional traits. Here we extend that prior work in a larger sample of adolescent male patients with serious conduct problems and controls, and test whether this association is mediated specifically by a Moral Elevation response (i.e., a positive emotional response to another’s act of virtue). Methods The adolescent male participants were: 45 patients (23 with LPE) and 26 controls, who underwent an extensive phenotypic assessment including a measure of Moral Elevation. About 1 week later participants played the AlAn’s game. Results All AlAn’s game outcomes demonstrated significant group effects: (1) money taken for self (p = 0.02); (2) money left in the charitable donation (p = 0.03); and, (3) costly helping (p = 0.047). Controls took the least money and did the most costly helping, while patients with LPE took the most money and did the least costly helping. Groups also significantly differed in post-stimulus Moral Elevation scores (p = 0.005). Exploratory analyses supported that the relationship between callous unemotional traits and costly helping on the AlAn’s game may be mediated in part by differences in Moral Elevation. Conclusions The AlAn's game provides a standardized behavioral measure associated with callous unemotional traits. Adolescents with high levels of callous unemotional traits engage in fewer costly helping behaviors, and those differences may be related to blunting of positive emotional responses. PMID:26977935

Energetic costs of producing muscle work and force in a cyclical human bouncing task

PubMed Central

Kuo, Arthur D.

2011-01-01

Muscles expend energy to perform active work during locomotion, but they may also expend significant energy to produce force, for example when tendons perform much of the work passively. The relative contributions of work and force to overall energy expenditure are unknown. We therefore measured the mechanics and energetics of a cyclical bouncing task, designed to control for work and force. We hypothesized that near bouncing resonance, little work would be performed actively by muscle, but the cyclical production of force would cost substantial metabolic energy. Human subjects (n = 9) bounced vertically about the ankles at inversely proportional frequencies (1–4 Hz) and amplitudes (15–4 mm), such that the overall rate of work performed on the body remained approximately constant (0.30 ± 0.06 W/kg), but the forces varied considerably. We used parameter identification to estimate series elasticity of the triceps surae tendon, as well as the work performed actively by muscle and passively by tendon. Net metabolic energy expenditure for bouncing at 1 Hz was 1.15 ± 0.31 W/kg, attributable mainly to active muscle work with an efficiency of 24 ± 3%. But at 3 Hz (near resonance), most of the work was performed passively, so that active muscle work could account for only 40% of the net metabolic rate of 0.76 ± 0.28 W/kg. Near resonance, a cost for cyclical force that increased with both amplitude and frequency of force accounted for at least as much of the total energy expenditure as a cost for work. Series elasticity reduces the need for active work, but energy must still be expended for force production. PMID:21212245

One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs

PubMed Central

Maben, Jill; Penfold, Clarissa; Simon, Michael; Anderson, Janet E; Robert, Glenn; Pizzo, Elena; Hughes, Jane; Murrells, Trevor; Barlow, James

2016-01-01

Background and objectives There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods Mixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. Results Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. Conclusions Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. PMID:26408568

Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial.

PubMed

Vermeulen, Sylvia J; Anema, Johannes R; Schellart, Antonius J M; van Mechelen, Willem; van der Beek, Allard J

2010-03-28

Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System. NTR1047.

Costs for a health coaching intervention for chronic care management.

PubMed

Wagner, Todd H; Willard-Grace, Rachel; Chen, Ellen; Bodenheimer, Thomas; Thom, David H

2016-04-01

Health coaches can help patients gain knowledge, skills, and confidence to manage their chronic conditions. Coaches may be particularly valuable in resource-poor settings, but they are not typically reimbursed by insurance, raising questions about their budgetary impact. The Health Coaching in Primary Care (HCPC) study was a randomized controlled trial that showed health coaches were effective at helping low-income patients improve control of their type 2 diabetes, hypertension, and/or hyperlipidemia at 12 months compared with usual care. We estimated the cost of employing 3 health coaches and mapped these costs to participants. We tested whether the added costs of the coaches were offset by any savings in healthcare utilization within 1 year. Healthcare utilization data were obtained from 5 sources. Multivariate models assessed differences in costs at 1 year controlling for baseline characteristics. Coaches worked an average of 9 hours with each participant over the length of the study. On average, the health coach intervention cost $483 per participant per year. The average healthcare costs for the coaching group was $3207 compared with $3276 for the control group (P = .90). There was no evidence that the coaching intervention saved money at 1 year. Health coaches have been shown to improve clinical outcomes related to chronic disease management. We found that employing health coaches adds an additional cost of $483 per patient per year. The data do not suggest that health coaches pay for themselves by reducing healthcare utilization in the first year.

33 CFR 241.2 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FLOOD CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.2 Applicability. This... Commands and District Commands of the Corps of Engineers having Civil Works Responsibilities. [60 FR 5133...

33 CFR 241.2 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... FLOOD CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.2 Applicability. This... Commands and District Commands of the Corps of Engineers having Civil Works Responsibilities. [60 FR 5133...

33 CFR 241.2 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... FLOOD CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.2 Applicability. This... Commands and District Commands of the Corps of Engineers having Civil Works Responsibilities. [60 FR 5133...

33 CFR 241.2 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... FLOOD CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.2 Applicability. This... Commands and District Commands of the Corps of Engineers having Civil Works Responsibilities. [60 FR 5133...

Allocating physicians' overhead costs to services: an econometric/accounting-activity based-approach.

PubMed

Peden, Al; Baker, Judith J

2002-01-01

Using the optimizing properties of econometric analysis, this study analyzes how physician overhead costs (OC) can be allocated to multiple activities to maximize precision in reimbursing the costs of services. Drawing on work by Leibenstein and Friedman, the analysis also shows that allocating OC to multiple activities unbiased by revenue requires controlling for revenue when making the estimates. Further econometric analysis shows that it is possible to save about 10 percent of OC by paying only for those that are necessary.

Efficacy and cost-effectiveness of minimal guided and unguided internet-based mobile supported stress-management in employees with occupational stress: a three-armed randomised controlled trial.

PubMed

Ebert, David Daniel; Lehr, Dirk; Smit, Filip; Zarski, Anna-Carlotta; Riper, Heleen; Heber, Elena; Cuijpers, Pim; Berking, Matthias

2014-08-07

Internet- and mobile based stress-management interventions (iSMI) may be an effective means to address the negative consequences of occupational stress. However, available results from randomised controlled trials are conflicting. Moreover, it is yet not clear whether guided or unguided self-help iSMI provide better value for money. Internet-based mental health interventions without guidance are often much less effective than interventions including at least some guidance from a professional. However, direct comparisons in randomised controlled trials are scarce and, to the best of our knowledge, the comparative (cost)-effectiveness of guided vs. unguided iSMI has not yet been studied. Hence, this study investigates the acceptability and (cost-) effectiveness of minimal guided and unguided iSMI in employees with heightened levels of perceived stress. A three-armed randomised controlled trial (RCT) will be conducted to compare a minimal guided and unguided iSMI with a waiting list control condition (WLC). Both active conditions are based on the same iSMI, i.e. GET.ON Stress, and differ only with regard to the guidance format. Employees with heightened levels of perceived stress (PSS ≥ 22) will be randomised to one of three conditions. Primary outcome will be comparative changes in perceived stress (PSS). Secondary outcomes include changes in self-reported depression, work-engagement, presenteeism and absenteeism. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective, including both direct medical costs and costs related to productivity losses. In addition, a cost-benefit analysis will be conducted from the employer's perspective. Incremental net-benefit regression analyses will address the question if there are any baseline factors (i.e. subgroups of employees) associated with particularly favorable cost-effectiveness when the experimental intervention is offered. Assessments take place at baseline, 7 weeks post-treatment and 6 months after randomisation. Online-based (guided) self-help interventions could be an acceptable, effective and economically sustainable approach to offer evidence-based intervention alternatives to reduce the negative consequences associated with work-related stress. This study evaluates the (cost-) effectiveness of two versions of an iSMI, minimal guided and unguided iSMI. Thus, the present study will further enhance the evidence-base for iSMI and provide valuable information about the optimal balance between outcome and economic costs. German Clinical Trial Registration (DRKS): DRKS00005687.

Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic asthma.

PubMed

Brazier, Peter; Schauer, Uwe; Hamelmann, Eckard; Holmes, Steve; Pritchard, Clive; Warner, John O

2016-01-01

Chronic asthma is a significant burden for individual sufferers, adversely impacting their quality of working and social life, as well as being a major cost to the National Health Service (NHS). Temperature-controlled laminar airflow (TLA) therapy provides asthma patients at BTS/SIGN step 4/5 an add-on treatment option that is non-invasive and has been shown in clinical studies to improve quality of life for patients with poorly controlled allergic asthma. The objective of this study was to quantify the cost-effectiveness of TLA (Airsonett AB) technology as an add-on to standard asthma management drug therapy in the UK. The main performance measure of interest is the incremental cost per quality-adjusted life year (QALY) for patients using TLA in addition to usual care versus usual care alone. The incremental cost of TLA use is based on an observational clinical study monitoring the incidence of exacerbations with treatment valued using NHS cost data. The clinical effectiveness, used to derive the incremental QALY data, is based on a randomised double-blind placebo-controlled clinical trial comprising participants with an equivalent asthma condition. For a clinical cohort of asthma patients as a whole, the incremental cost-effectiveness ratio (ICER) is £8998 per QALY gained, that is, within the £20 000/QALY cost-effectiveness benchmark used by the National Institute for Health and Care Excellence (NICE). Sensitivity analysis indicates that ICER values range from £18 883/QALY for the least severe patients through to TLA being dominant, that is, cost saving as well as improving quality of life, for individuals with the most severe and poorly controlled asthma. Based on our results, Airsonett TLA is a cost-effective addition to treatment options for stage 4/5 patients. For high-risk individuals with more severe and less well controlled asthma, the use of TLA therapy to reduce incidence of hospitalisation would be a cost saving to the NHS.

Minimum specific cost control of technological processes realized in a living objects-containing microenvironment.

PubMed

Amelkin, Alexander A; Blagoveschenskaya, Margarita M; Lobanov, Yury V; Amelkin, Anatoly K

2003-01-01

The purpose of the present work is to work out an approach for the development of software and the choice of hardware structures when designing subsystems for automatic control of technological processes realized in living objects containing limited space (microenvironment). The subsystems for automatic control of the microenvironment (SACME) under development use the Devices for Air Prophylactic Treatment, Aeroionization, and Purification (DAPTAP) as execution units for increasing the level of safety and quality of agricultural raw material and foodstuffs, for reducing the losses of agricultural produce during storage and cultivation, as well as for intensifying the processes of activation of agricultural produce and industrial microorganisms. A set of interconnected SACMEs works within the framework of a general microenvironmental system (MES). In this research, the population of baker's yeast is chosen as a basic object of control under the industrial fed-batch cultivation in a bubbling bioreactor. This project is an example of a minimum cost automation approach. The microenvironment optimal control problem for baker's yeast cultivation is reduced from a profit maximum to the maximization of overall yield by the reason that the material flow-oriented specific cost correlates closely with the reciprocal value of the overall yield. Implementation of the project partially solves a local sustainability problem and supports a balance of microeconomical, microecological and microsocial systems within a technological subsystem realized in a microenvironment maintaining an optimal value of economical criterion (e.g. minimum material, flow-oriented specific cost) and ensuring: (a) economical growth (profit increase, raw material saving); (b) high security, safety and quality of agricultural raw material during storage process and of food produce during a technological process; elimination of the contact of gaseous harmful substances with a subproduct during various technological stages; (c) improvement of labour conditions for industrial personnel from an ecological point of view (positive effect of air aeroionization and purification on human organism promoting strengthened health and an increase in life duration, pulverent and gaseous chemical and biological impurity removal). An alternative aspect of a controlled living microenvironment forming is considered.

Patient-controlled analgesia versus intramuscular analgesic therapy.

PubMed

Smythe, M; Loughlin, K; Schad, R F; Lucarroti, R L

1994-06-01

The pharmacy and nursing time requirements, quality of postoperative pain control, and cost of patient-controlled analgesia (PCA) and intramuscular (i.m.) analgesic therapy were studied. All timings were conducted with a stopwatch on a single nursing unit that primarily receives gynecologic surgery patients. The various work elements involved in each type of therapy were timed individually. Both quality of analgesia and cost were evaluated in a prospective, randomized study in hysterectomy patients. I.M. patients received meperidine hydrochloride 75-100 mg every three to four hours as needed. PCA patients had access to morphine sulfate 1 mg or meperidine hydrochloride 10 mg, with a six-minute lockout period. The patients scored their pain every four hours. Direct costs for PCA were calculated as drug cost plus tubing cost plus form cost plus maintenance cost plus depreciation cost. Direct costs for i.m. therapy consisted of the cost of drugs. The total mean nursing time per patient was 16.9 minutes for PCA and 10.7 minutes for i.m. therapy. Pharmacy time per patient was 5.1 minutes longer for PCA than for i.m. therapy. Thirty-six hysterectomy patients (17 i.m. and 19 PCA) were enrolled in the study of pain control and cost. Among i.m. patients, 64% of the pain scores were mild or worse, compared with 40% for PCA patients. The median pain scores were moderate for i.m. patients and mild for PCA patients. Scores tended to be lower for PCA patients at 16 and 20 hours. Although equal numbers of patients in the two groups experienced nausea, i.m. patients needed more doses of antiemetics than PCA patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Would Consolidation of Army Software Engineering Organizations Help to Control Software Costs for Current and Future Systems

DTIC Science & Technology

2015-04-16

Specific to Work and Organization .................................................................... 32 Summary of Questions Specific to Work and...Limitations include assumptions that the work identified in the software center’s 6 mission and functions manual (10-1; CECOM, 2011) as well as in public...that produced RDECOM. The focus was on the movement of positions based on the position job series, not on the work that was actually being performed

Log in and breathe out: efficacy and cost-effectiveness of an online sleep training for teachers affected by work-related strain - study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Insomnia and work-related stress often co-occur. Both are associated with personal distress and diminished general functioning, as well as substantial socio-economic costs due to, for example, reduced productivity at the work place and absenteeism. Insomnia complaints by people experiencing work-related stress are correlated with a deficient cognitive detachment from work. Diffuse boundaries between work and private life can additionally complicate the use of recreational activities that facilitate cognitive detachment. Cognitive behavioral therapy for insomnia is effective but rarely implemented. Internet-based cognitive behavioral therapy for insomnia could potentially reduce this deficit given its demonstrated effectiveness. Less is known, however, about the efficacy of internet-based cognitive behavioral therapy for insomnia in populations affected by high work stress. Thus, the aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed, guided online training which is based on Cognitive Behavioral Therapy for insomnia and tailored to teachers affected by occupational stress. Methods/Design In a two-arm randomized controlled trial (N = 128), the effects of a guided online sleep training will be compared to a waitlist-control condition. German teachers with significant clinical insomnia complaints (Insomnia Severity Index ≥15) and work-related rumination (Irritation Scale, subscale Cognitive Irritation ≥15) will be included in the study. The primary outcome measure will be insomnia severity. Additionally, an economic evaluation from a societal perspective will be conducted. Data from the intention-to-treat sample will be analyzed two and six months after randomization. Discussion To the best of our knowledge, this is the first study to evaluate an online sleep training tailored to a specific population with work stress, that is, teachers. If this type of intervention is effective, it could reduce the paucity of cognitive behavioral therapy for insomnia and augment the support for teachers in coping with their insomnia problems. Trial registration German Clinical Trial Register (DRKS): DRKS00004700 PMID:23759035

Integration of vehicle yaw stabilisation and rollover prevention through nonlinear hierarchical control allocation

NASA Astrophysics Data System (ADS)

Alberding, Matthäus B.; Tjønnås, Johannes; Johansen, Tor A.

2014-12-01

This work presents an approach to rollover prevention that takes advantage of the modular structure and optimisation properties of the control allocation paradigm. It eliminates the need for a stabilising roll controller by introducing rollover prevention as a constraint on the control allocation problem. The major advantage of this approach is the control authority margin that remains with a high-level controller even during interventions for rollover prevention. In this work, the high-level control is assigned to a yaw stabilising controller. It could be replaced by any other controller. The constraint for rollover prevention could be replaced by or extended to different control objectives. This work uses differential braking for actuation. The use of additional or different actuators is possible. The developed control algorithm is computationally efficient and suitable for low-cost automotive electronic control units. The predictive design of the rollover prevention constraint does not require any sensor equipment in addition to the yaw controller. The method is validated using an industrial multi-body vehicle simulation environment.

20 CFR 404.1576 - Impairment-related work expenses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... enable you to work, we will deduct payments you make toward its cost. (5) Payments for drugs and medical services. (i) If you must use drugs or medical services (including diagnostic procedures) to control your impairment(s) the payments you make for them may be deducted. The drugs or services must be prescribed (or...

Effectiveness of a Hospital-Based Work Support Intervention for Female Cancer Patients – A Multi-Centre Randomised Controlled Trial

PubMed Central

Tamminga, Sietske J.; Verbeek, Jos H. A. M.; Bos, Monique M. E. M.; Fons, Guus; Kitzen, Jos J. E. M.; Plaisier, Peter W.; Frings-Dresen, Monique H. W.; de Boer, Angela G. E. M.

2013-01-01

Objective One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre randomised controlled trial. Methods Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. Results Return-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-to-work was 194 days (range 14–435) versus 192 days (range 82–465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64–1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. Conclusion The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of the intervention are useful and which elements need improvement. Trial Registration Nederlands Trial Register (NTR) 1658 PMID:23717406

Health Outcomes and Costs of Social Work Services: A Systematic Review

PubMed Central

Ross, Abigail M.; Wachman, Madeline K.

2017-01-01

Background. Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession’s person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. Objectives. To systematically review international studies of the effect of social work–involved health services on health and economic outcomes. Search Methods. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017. Selection Criteria. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Data Collection and Analysis. Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Main Results. Average study quality was fair. Studies of 7 social work–led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Conclusions. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential. PMID:29236534

Optimal spacecraft attitude control using collocation and nonlinear programming

NASA Astrophysics Data System (ADS)

Herman, A. L.; Conway, B. A.

1992-10-01

Direct collocation with nonlinear programming (DCNLP) is employed to find the optimal open-loop control histories for detumbling a disabled satellite. The controls are torques and forces applied to the docking arm and joint and torques applied about the body axes of the OMV. Solutions are obtained for cases in which various constraints are placed on the controls and in which the number of controls is reduced or increased from that considered in Conway and Widhalm (1986). DCLNP works well when applied to the optimal control problem of satellite attitude control. The formulation is straightforward and produces good results in a relatively small amount of time on a Cray X/MP with no a priori information about the optimal solution. The addition of joint acceleration to the controls significantly reduces the control magnitudes and optimal cost. In all cases, the torques and acclerations are modest and the optimal cost is very modest.

The opportunity cost of time modulates cognitive effort.

PubMed

Otto, A Ross; Daw, Nathaniel D

2018-05-08

A spate of recent work demonstrates that humans seek to avoid the expenditure of cognitive effort, much like physical effort or economic resources. Less is clear, however, about the circumstances dictating how and when people decide to expend cognitive effort. Here we adopt a popular theory of opportunity costs and response vigor and to elucidate this question. This account, grounded in Reinforcement Learning, formalizes a trade-off between two costs: the harder work assumed necessary to emit faster actions and the opportunity cost inherent in acting more slowly (i.e., the delay that results to the next reward and subsequent rewards). Recent work reveals that the opportunity cost of time-operationalized as the average reward rate per unit time, theorized to be signaled by tonic dopamine levels, modulates the speed with which a person responds in a simple discrimination tasks. We extend this framework to cognitive effort in a diverse range of cognitive tasks, for which 1) the amount of cognitive effort demanded from the task varies from trial to trial and 2) the putative expenditure of cognitive effort holds measureable consequences in terms of accuracy and response time. In the domains of cognitive control, perceptual decision-making, and task-switching, we found that subjects tuned their level of effort exertion in accordance with the experienced average reward rate: when the opportunity cost of time was high, subjects made more errors and responded more quickly, which we interpret as a withdrawal of cognitive effort. That is, expenditure of cognitive effort appeared to be modulated by the opportunity cost of time. Further, and consistent with our account, the strength of this modulation was predicted by individual differences in efficacy of cognitive control. Taken together, our results elucidate the circumstances dictating how and when people expend cognitive effort. Copyright © 2018 Elsevier Ltd. All rights reserved.

Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature

PubMed Central

2013-01-01

Objective To investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care. Design Systematic review. Data sources EMBASE, MEDLINE, NHS EED, CINAHL, EconLit, Cochrane Library, and NHS HMIC. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cohort, case–control, before and after and cross-sectional study designs including an economic evaluation of management decisions made in any disease in secondary care within the context of an MDT meeting. Data extraction Two independent reviewers extracted data and assessed methodological quality using the Consensus on Health Economic Criteria (CHEC-list). MDTs were defined by evidence of two characteristics: decision making requiring a minimum of two disciplines; and regular meetings to discuss diagnosis, treatment and/or patient management, occurring at a physical location or by teleconferencing. Studies that reported on the costs of administering, preparing for, and attending MDT meetings and/or the subsequent direct medical costs of care, non-medical costs, or indirect costs, and any health outcomes that were relevant to the disease being investigated were included and classified as cancer or non-cancer MDTs. Results Fifteen studies (11 RCTs in non-cancer care, 2 cohort studies in cancer and non-cancer care, and 2 before and after studies in cancer and non cancer care) were identified, all with a high risk of bias. Twelve papers reported the frequency of meetings which varied from daily to three monthly and all reported the number of disciplines included (mean 5, range 2 to 9). The results from all studies showed mixed effects; a high degree of heterogeneity prevented a meta-analysis of findings; and none of the studies reported how the potential savings of MDT working may offset the costs of administering, preparing for, and attending MDT meetings. Conclusions Current evidence is insufficient to determine whether MDT working is cost-effective or not in secondary care. Further studies aimed at understanding the key aspects of MDT working that lead to cost-effective cancer and non-cancer care are required. PMID:23557141

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

PubMed Central

2013-01-01

Background Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective. PMID:23819578

Compliant walking appears metabolically advantageous at extreme step lengths.

PubMed

Kim, Jaehoon; Bertram, John E A

2018-05-19

Humans alter gait in response to unusual gait circumstances to accomplish the task of walking. For instance, subjects spontaneously increase leg compliance at a step length threshold as step length increases. Here we test the hypothesis that this transition occurs based on the level of energy expenditure, where compliant walking becomes less energetically demanding at long step lengths. To map and compare the metabolic cost of normal and compliant walking as step length increases. 10 healthy individuals walked on a treadmill using progressively increasing step lengths (100%, 120%, 140% and 160% of preferred step length), in both normal and compliant leg walking as energy expenditure was recorded via indirect calorimetry. Leg compliance was controlled by lowering the center-of-mass trajectory during stance, forcing the leg to flex and extend as the body moved over the foot contact. For normal step lengths, compliant leg walking was more costly than normal walking gait, but compliant leg walking energetic cost did not increase as rapidly for longer step lengths. This led to an intersection between normal and compliant walking cost curves at 114% relative step length (regression analysis; r 2  = 0.92 for normal walking; r 2  = 0.65 for compliant walking). Compliant leg walking is less energetically demanding at longer step lengths where a spontaneous shift to compliant walking has been observed, suggesting the human motor control system is sensitive to energetic requirements and will employ alternate movement patterns if advantageous strategies are available. The transition could be attributed to the interplay between (i) leg work controlling body travel during single stance and (ii) leg work to control energy loss in the step-to-step transition. Compliant leg walking requires more stance leg work at normal step lengths, but involves less energy loss at the step-to-step transition for very long steps. Copyright © 2018 Elsevier B.V. All rights reserved.

Gait as solution, but what is the problem? Exploring cost, economy and compromise in locomotion.

PubMed

Bertram, John E A

2013-12-01

Many studies have examined how legged mammals move, defining 'what' happens in locomotion. However, few ask 'why' those motions occur as they do. The energetic and functional constraints acting on an animal require that locomotion should be metabolically 'cost effective' and this in large part determines the strategies available to accomplish the task. Understanding the gaits utilised, within the spectrum of gaits possible, and determination of the value of specific relationships among speed, stride length, stride frequency and morphology, depends on identifying the fundamental costs involved and the effects of different movement strategies on those costs. It is argued here that a fundamental loss associated with moving on limbs (centre of mass momentum and energy loss) and two costs involved with controlling and replacing that loss (muscular work of the supporting limb during stance and muscular work of repositioning the limbs during swing) interact to determine the cost trade-offs involved and the optimisation strategies available for each species and speed. These optimisation strategies are what has been observed and characterised as gait. Copyright © 2013 Elsevier Ltd. All rights reserved.

Efficient Control Law Simulation for Multiple Mobile Robots

DOE Office of Scientific and Technical Information (OSTI.GOV)

Driessen, B.J.; Feddema, J.T.; Kotulski, J.D.

1998-10-06

In this paper we consider the problem of simulating simple control laws involving large numbers of mobile robots. Such simulation can be computationally prohibitive if the number of robots is large enough, say 1 million, due to the 0(N2 ) cost of each time step. This work therefore uses hierarchical tree-based methods for calculating the control law. These tree-based approaches have O(NlogN) cost per time step, thus allowing for efficient simulation involving a large number of robots. For concreteness, a decentralized control law which involves only the distance and bearing to the closest neighbor robot will be considered. The timemore » to calculate the control law for each robot at each time step is demonstrated to be O(logN).« less

Cost-Benefit Analysis of Internet Therapeutic Intervention on Patients With Diabetes

PubMed Central

Deng, Lan; White, Adam S.; Pawlowska, Monika; Pottinger, Betty; Aydin, Jessica; Chow, Nelson; Tildesley, Hugh D.

2015-01-01

Background: With the emergence of IBGMS for allowing for patients to communicate their self-monitored blood glucose (SMBG) readings with their health care providers, their impact on the management of diabetes is becoming well-supported with regards to clinical benefits. Their impact on healthcare costs, however, has yet to be investigated. This study aims to determine the cost-benefits of such interventions in comparison to routine care. Objectives: To analyze the cost-benefit of an Internet Blood Glucose Monitoring Service (IBGMS) in comparison to routine diabetes care. Patients and Methods: 200 patients were surveyed to assess the cost associated with doctor appointments in the past 12 months. Annual number of visits to medical services for diabetes and costs of transportation, parking, and time taken off work for visits were surveyed. Self-reported frequency of SMBG and most recent A1C were also surveyed. We compared 100 patients who used the IBGMS with 100 patients who only used routine care. Results: There is a trend of lowered total cost in the intervention group compared to the control group. The control group spent $210.89 per year on visits to physicians; the intervention group spent $131.26 (P = 0.128). Patients in control group visited their endocrinologist 1.76 times per year, those in intervention group visited their endocrinologist 1.36 times per year, significantly less frequently than the control group (P = 0.014). Number of visits to other medical services is similar between the groups. Average A1C in intervention group is 7.57%, in control group is 7.69% (P = 0.309). Conclusions: We have demonstrated that IBGMS, while not reaching statistical significance, may be associated with slightly reduced A1C and cost due to visiting physicians. PMID:25926853

Cost-benefit analysis of internet therapeutic intervention on patients with diabetes.

PubMed

Deng, Lan; White, Adam S; Pawlowska, Monika; Pottinger, Betty; Aydin, Jessica; Chow, Nelson; Tildesley, Hugh D

2015-04-01

With the emergence of IBGMS for allowing for patients to communicate their self-monitored blood glucose (SMBG) readings with their health care providers, their impact on the management of diabetes is becoming well-supported with regards to clinical benefits. Their impact on healthcare costs, however, has yet to be investigated. This study aims to determine the cost-benefits of such interventions in comparison to routine care. To analyze the cost-benefit of an Internet Blood Glucose Monitoring Service (IBGMS) in comparison to routine diabetes care. 200 patients were surveyed to assess the cost associated with doctor appointments in the past 12 months. Annual number of visits to medical services for diabetes and costs of transportation, parking, and time taken off work for visits were surveyed. Self-reported frequency of SMBG and most recent A1C were also surveyed. We compared 100 patients who used the IBGMS with 100 patients who only used routine care. There is a trend of lowered total cost in the intervention group compared to the control group. The control group spent $210.89 per year on visits to physicians; the intervention group spent $131.26 (P = 0.128). Patients in control group visited their endocrinologist 1.76 times per year, those in intervention group visited their endocrinologist 1.36 times per year, significantly less frequently than the control group (P = 0.014). Number of visits to other medical services is similar between the groups. Average A1C in intervention group is 7.57%, in control group is 7.69% (P = 0.309). We have demonstrated that IBGMS, while not reaching statistical significance, may be associated with slightly reduced A1C and cost due to visiting physicians.

Cost burden and treatment patterns associated with management of heavy menstrual bleeding.

PubMed

Jensen, Jeffrey T; Lefebvre, Patrick; Laliberté, François; Sarda, Sujata P; Law, Amy; Pocoski, Jennifer; Duh, Mei Sheng

2012-05-01

This study evaluated the healthcare resource use, work productivity loss, costs, and treatment patterns associated with newly diagnosed idiopathic heavy menstrual bleeding (HMB) using a large employer database. Medical and pharmacy claims (1998-2009) from 55 self-insured U.S. companies were analyzed. Women aged 18-52 years with ≥2 HMB claims (ICD-9 626.2, 627.0) and continuously enrolled for ≥6 months before the first claim were matched 1:1 with controls. Exclusion criteria were cancer, pregnancy, and infertility; HMB-related uterine conditions; endometrial ablation; hysterectomy; anticoagulant medications; and other known HMB causes. All-cause healthcare resource use and costs were compared between the HMB and control cohorts using statistical methods accounting for matched study design. Treatment patterns were examined for HMB subjects. HMB and control cohorts (n=29,842 in both) were matched and balanced in baseline characteristics and costs. During follow-up, HMB subjects had significantly higher all-cause resource use than did control subjects: hospitalization incidence rate ratio (IRR)=2.70 (95% confidence interval [CI] 2.62-2.79); emergency room visits IRR=1.35 (95% CI 1.31-1.38); outpatient visits IRR=1.29 (95% CI 1.29-1.30). Average annualized all-cause costs were also higher for HMB subjects than controls (mean difference $2,607, p<0.001). Costs associated with HMB claims represented 50% ($1,313) of the all-cause cost difference. Of HMB subjects, 63.2% underwent surgical treatment as initial therapy. In this large matched-cohort study, an idiopathic diagnosis of HMB was associated with high rates of surgical intervention and increased healthcare resource use and costs.

Advanced in-duct sorbent injection for SO{sub 2} control. Final technical report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stouffer, M.R.; Withium, J.A.; Rosenhoover, W.A.

1994-12-01

The objective of this research project was to develop a second generation duct sorbent injection technology as a cost-effective compliance option for the 1990 Clean Air Act Amendments. Research and development work was focused on the Advanced Coolside process, which showed the potential for exceeding the original performance targets of 90% SO{sub 2} removal and 60% sorbent utilization. Process development was conducted in a 1000 acfm pilot plant. The pilot plant testing showed that the Advanced Coolside process can achieve 90% SO{sub 2} removal at sorbent utilizations up to 75%. The testing also showed that the process has the potentialmore » to achieve very high removal efficiency (90 to >99%). By conducting conceptual process design and economic evaluations periodically during the project, development work was focused on process design improvements which substantially lowered process capital and operating costs, A final process economic study projects capital costs less than one half of those for limestone forced oxidation wet FGD. Projected total SO{sub 2} control cost is about 25% lower than wet FGD for a 260 MWe plant burning a 2.5% sulfur coal. A waste management study showed the acceptability of landfill disposal; it also identified a potential avenue for by-product utilization which should be further investigated. Based on the pilot plant performance and on the above economic projections, future work to scale up the Advanced Coolside process is recommended.« less

The prediction of engineering cost for green buildings based on information entropy

NASA Astrophysics Data System (ADS)

Liang, Guoqiang; Huang, Jinglian

2018-03-01

Green building is the developing trend in the world building industry. Additionally, construction costs are an essential consideration in building constructions. Therefore, it is necessary to investigate the problems of cost prediction in green building. On the basis of analyzing the cost of green building, this paper proposes the forecasting method of actual cost in green building based on information entropy and provides the forecasting working procedure. Using the probability density obtained from statistical data, such as labor costs, material costs, machinery costs, administration costs, profits, risk costs a unit project quotation and etc., situations can be predicted which lead to cost variations between budgeted cost and actual cost in constructions, through estimating the information entropy of budgeted cost and actual cost. The research results of this article have a practical significance in cost control of green building. Additionally, the method proposed in this article can be generalized and applied to a variety of other aspects in building management.

Comparison of cost-benefit analysis of nitrogen dioxide control in Tokyo, Japan with those in other countries and cities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Voorhees, A.S.; Araki, S.; Sakai, R.

1999-07-01

To evaluate the economic effectiveness of past NO{sub 2} controls in Tokyo, the authors compared the results of their cost-benefit analysis (CBA) of these controls with other investigations. The authors carried out a CBA of NO{sub 2} controls in Tokyo using Freeman's benefit methodology and EPA and Dixon et al. cost methodologies and they compared their assumptions and results to work done by other researchers for other countries and cities, which were collected from the literature. The authors assumed 2 to 3 days duration per incidence of respiratory illness. Kenkel suggested 4.1 days and Dixon et al. assumed 2 weeks. They estimated avoided incidence per person in adults as 2.6 (upper limit UL 2.7; lower limit LL 2.4) and in children as 0.33 (UL 0.35; LL 0.30). Ostro estimated 0.20 for respiratory symptoms in adults from NO{sub 2} exposure, 5.2 for respiratory symptoms and 0.078 for asthma attacks in adults from particulates. The authors estimated work loss days (WLDs) per person for workers as 4.7 (UL 5.0; LL 4.4) and for working mothers as 0.61 (UL 0.66; LL 0.56). Shin et al.'s per-person estimates included 4.5 WLDs in Bangkok, 3.7 in Beijing, 2.3 in Shanghai, and 1.1 in Kuala Lumpur. They estimated the cost effectiveness of NO{sub 2} control in Tokyo to bemore » $1,400/ton (UL $1,500; LL $1,300) for motor vehicles, $21,000/ton (UL $23,000; LL $$19,000) for all NO{sub x} sources, and $$91,000/ton (UL $98,000; LL $84,000) for stationary point sources. This compares to $240 to $$1,500/ton in West Virginia for all NO{sub x} sources, $$2,700/ton in northern Virginia from motor vehicles, $5,600/ton from motor vehicles in Virginia, and $17,000 to $26,000/ton from all NO{sub x} sources in the Chesapeake River Watershed. Herein, the benefits in Tokyo exceeded the costs by a ratio of approximately 6 to 1 (UL 7:1; LL 5:1).« less

Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study

PubMed Central

Fitzgerald, Sarah; Murphy, Aileen; Kirby, Ann; Geaney, Fiona; Perry, Ivan J

2018-01-01

Objective To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Design Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Setting Four multinational manufacturing workplaces in Cork, Ireland. Participants 517 randomly selected employees (18–65 years) from four workplaces. Interventions Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. Outcomes The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. Results The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost–benefit analysis, whereby the system-level intervention yields the highest net benefit (€56.56 per employee). Conclusions System-level dietary modification alone offers the most value per improving employee health-related quality of life and generating net benefit for employers by reducing absenteeism. While system-level dietary modification strategies are potentially sustainable obesity prevention interventions, future research should include long-term outcomes to determine if improvements in outcomes persist. Trial registration number ISRCTN35108237; Post-results. PMID:29502090

Cognitive cost as dynamic allocation of energetic resources

PubMed Central

Christie, S. Thomas; Schrater, Paul

2015-01-01

While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the “cost/benefit” and “limited resource” models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive look ahead, and model-free vs. model-based policy learning. PMID:26379482

Cognitive cost as dynamic allocation of energetic resources.

PubMed

Christie, S Thomas; Schrater, Paul

2015-01-01

While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the "cost/benefit" and "limited resource" models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive look ahead, and model-free vs. model-based policy learning.

Formation of an environmental restoration user group for radiological controls

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morris, R.L.

1993-12-31

An Environmental Restoration User Group for Radiological Controls will be proposed. Article 116 of the Radiological Control Manual encourages contractors to establish informal working associations that promote dialogue among similar facilities. Chem-Nuclear Geotech, Inc., is willing to initially organize and lead a users group to work on common problems, define standard methods, publish a Radiological Work Practices Handbook, and recommend regulatory changes to make environmental restoration programs more cost effective without compromising radiological control. A charter for the users group will be proposed. A questionnaire will be distributed to interested persons to assist in development of focus groups and agendamore » items for the first meeting. The first meeting is planned for May 25-26, 1993, in Grand Junction Colorado. All interested persons are welcome to attend.« less

Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

PubMed

Marsh, Fiona; Kremer, Christian; Duffy, Sean

2004-03-01

To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Randomised controlled trial. The gynaecology clinic of a large teaching hospital. Ninety-seven women with abnormal uterine bleeding requiring investigation. Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group ( pound 20.40 in the outpatient group vs pound 50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group-with an average cost of pound 3.46 in the outpatient group and pound 6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

Low-power grating detection system chip for high-speed low-cost length and angle precision measurement

NASA Astrophysics Data System (ADS)

Hou, Ligang; Luo, Rengui; Wu, Wuchen

2006-11-01

This paper forwards a low power grating detection chip (EYAS) on length and angle precision measurement. Traditional grating detection method, such as resister chain divide or phase locked divide circuit are difficult to design and tune. The need of an additional CPU for control and display makes these methods' implementation more complex and costly. Traditional methods also suffer low sampling speed for the complex divide circuit scheme and CPU software compensation. EYAS is an application specific integrated circuit (ASIC). It integrates micro controller unit (MCU), power management unit (PMU), LCD controller, Keyboard interface, grating detection unit and other peripherals. Working at 10MHz, EYAS can afford 5MHz internal sampling rate and can handle 1.25MHz orthogonal signal from grating sensor. With a simple control interface by keyboard, sensor parameter, data processing and system working mode can be configured. Two LCD controllers can adapt to dot array LCD or segment bit LCD, which comprised output interface. PMU alters system between working and standby mode by clock gating technique to save power. EYAS in test mode (system action are more frequently than real world use) consumes 0.9mw, while 0.2mw in real world use. EYAS achieved the whole grating detection system function, high-speed orthogonal signal handling in a single chip with very low power consumption.

75 FR 57769 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... treatment works (POTWs) and other water pollution control facilities in the United States, as well as an... records cost and technical data associated with POTWs and other water pollution control facilities... mail to: EPA Docket Center, Environmental Protection Agency, Water Docket, 1200 Pennsylvania Ave., NW...

Deficient manipulation of working memory in remitted depressed individuals: Behavioral and electrophysiological evidence.

PubMed

Liu, Mingfan; Zhou, Li; Wang, Xiumei; Jiang, Ying; Liu, Qiaosheng

2017-07-01

The study aimed to examine whether remitted depressed (RMD) individuals show a dysfunction of valence-dependent manipulation and its neurophysiological correlates. Event-related potentials were conducted on 25 individuals with remitted depression and 27 controls during a working memory manipulation task. The sorting costs and the P3b and slow wave (SW) amplitudes were analyzed. Compared to the control subjects, the RMD individuals revealed higher sorting costs, particularly when they were shown negative targets. The control individuals exhibited reduced P3b and SW amplitudes in response to the backward negative pictures, whereas the RMD participants exhibited increased central-parietal and lateral P3b and SW amplitudes in the backward condition. Both groups exhibited overall decreased P3b and SW amplitudes in response to the backward positive pictures. RMD individuals are associated with a deficient manipulation for negative material and an unimpaired manipulation for positive material. This study extends current knowledge that deficits in cognitive control persist after the remission of depressive symptoms. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

The effects of incremental costs of smoking and obesity on health care costs among adults: a 7-year longitudinal study.

PubMed

Moriarty, James P; Branda, Megan E; Olsen, Kerry D; Shah, Nilay D; Borah, Bijan J; Wagie, Amy E; Egginton, Jason S; Naessens, James M

2012-03-01

To provide the simultaneous 7-year estimates of incremental costs of smoking and obesity among employees and dependents in a large health care system. We used a retrospective cohort aged 18 years or older with continuous enrollment during the study period. Longitudinal multivariate cost analyses were performed using generalized estimating equations with demographic adjustments. The annual incremental mean costs of smoking by age group ranged from $1274 to $1401. The incremental costs of morbid obesity II by age group ranged from $5467 to $5530. These incremental costs drop substantially when comorbidities are included. Obesity and smoking have large long-term impacts on health care costs of working-age adults. Controlling comorbidities impacted incremental costs of obesity but may lead to underestimation of the true incremental costs because obesity is a risk factor for developing chronic conditions.

Protecting workers from pathogens. Employers must act now to comply with OSHA's new standard on bloodborne pathogens.

PubMed

White, C L

1992-04-01

A new standard set forth by the Occupational Safety and Health Administration (OSHA) requires healthcare employers to implement sweeping new controls in areas such as record keeping, engineering, hazard prevention, and work practice. Through the bloodborne pathogen standard, which went into effect on March 6, OSHA acknowledges that healthcare workers face significant health risks as a result of occupational exposure to blood and other infectious materials. Although most prudent healthcare providers already adhere to the Centers for Disease Control's universal precautions, the OSHA regulations include several additional mandatory measures that are more specific and stringent. The additional measures include the development of an exposure control plan, procedures for responding to an employee's exposure to bloodborne pathogens, the implementation of certain engineering and work practice controls to eliminate or minimize on-the-job exposure risks, and the provision of personal protective equipment and information and training programs. OSHA estimates that the greatest cost component of implementing procedures to bring a facility into compliance is attributable to the purchase of personal protective equipment. Although the costs of compliance are substantial, OSHA has estimated that these costs represent less than 1 percent of the healthcare industry's annual revenues. Violation of the bloodborne pathogen standard may result in penalties of up to $70,000, depending on the severity of the infraction. Criminal penalties are also possible for willful violations that result in worker death.

The importance of activity-based methods in radiology and the technology that now makes this possible.

PubMed

Monge, Paul

2006-01-01

Activity-based methods serve as a dynamic process that has allowed many other industries to reduce and control their costs, increase productivity, and streamline their processes while improving product quality and service. The method could serve the healthcare industry in an equally beneficial way. Activity-based methods encompass both activity based costing (ABC) and activity-based management (ABM). ABC is a cost management approach that links resource consumption to activities that an enterprise performs, and then assigns those activities and their associated costs to customers, products, or product lines. ABM uses the resource assignments derived in ABC so that operation managers can improve their departmental processes and workflows. There are three fundamental problems with traditional cost systems. First, traditional systems fail to reflect the underlying diversity of work taking place within an enterprise. Second, it uses allocations that are, for the most part, arbitrary Single step allocations fail to reflect the real work-the activities being performed and the associate resources actually consumed. Third, they only provide a cost number that, standing alone, does not provide any guidance on how to improve performance by lowering cost or enhancing throughput.

Charging, power management, and battery degradation mitigation in plug-in hybrid electric vehicles: A unified cost-optimal approach

NASA Astrophysics Data System (ADS)

Hu, Xiaosong; Martinez, Clara Marina; Yang, Yalian

2017-03-01

Holistic energy management of plug-in hybrid electric vehicles (PHEVs) in smart grid environment constitutes an enormous control challenge. This paper responds to this challenge by investigating the interactions among three important control tasks, i.e., charging, on-road power management, and battery degradation mitigation, in PHEVs. Three notable original contributions distinguish our work from existing endeavors. First, a new convex programming (CP)-based cost-optimal control framework is constructed to minimize the daily operational expense of a PHEV, which seamlessly integrates costs of the three tasks. Second, a straightforward but useful sensitivity assessment of the optimization outcome is executed with respect to price changes of battery and energy carriers. The potential impact of vehicle-to-grid (V2G) power flow on the PHEV economy is eventually analyzed through a multitude of comparative studies.

Partitionable-space enhanced coagulation (PEC) reactor and its working mechanism: a new prospective chemical technology for phosphorus pollution control.

PubMed

Zhang, Meng; Zheng, Ping; Abbas, Ghulam; Chen, Xiaoguang

2014-02-01

Phosphorus pollution control and phosphorus recycling, simultaneously, are focus of attention in the wastewater treatment. In this work, a novel reactor named partitionable-space enhanced coagulation (PEC) was invented for phosphorus control. The working performance and process mechanism of PEC reactor were investigated. The results showed that the PEC technology was highly efficient and cost-effective. The volumetric removal rate (VRR) reached up to 2.86 ± 0.04 kg P/(m(3) d) with a phosphorus removal rate of over 97%. The precipitant consumption was reduced to 2.60-2.76 kg Fe(II)/kg P with low operational cost of $ 0.632-0.673/kg P. The peak phosphorus content in precipitate was up to 30.44% by P2O5, which reveal the benefit of the recycling phosphorus resource. The excellent performance of PEC technology was mainly attributed to the partitionable-space and 'flocculation filter'. The partition limited the trans-regional back-mixing of reagents along the reactor, which promoted the precipitation reaction. The 'flocculation filter' retained the microflocs, enhancing the flocculation process. Copyright © 2013 Elsevier Ltd. All rights reserved.

2009 Mississippi Curriculum Framework: Postsecondary Ophthalmic Technology. (Program CIP-51.1801 - Opticianry/Dispensing Optician)

ERIC Educational Resources Information Center

Sciple, Eddie

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2008 Mississippi Curriculum Framework: Postsecondary Pharmacy Technology. (Program CIP: 51.0805 - Pharmacy Technician/Assistant)

ERIC Educational Resources Information Center

Juergens, John; Sanders, Marsha

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2006 Mississippi Curriculum Framework: Postsecondary Physical Therapist Assistant. (Program CIP: 51.0806 - Physical Therapist Assistant)

ERIC Educational Resources Information Center

Hester, Tom; Latham, Lisa; Crowson, Patti; Ennis, Kimberly

2006-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Occupational Therapy Assistant. (Program CIP: 51.0803 - Occupational Therapist Assistant)

ERIC Educational Resources Information Center

Hager, Sherry; Pulver, Tim; Chittom, Suzanne

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Surgical Technology. (Program CIP: 51.0909 - Surgical Technology/Technologist)

ERIC Educational Resources Information Center

Davis, Tonya; Elliott, Jessica; Gandy, Zielda; Binkley, Dottie; Wilburn, Cathy; Ladner, Melissa; Howell, Karen; Shirley, LeAnn; Hinton, Debbie; Allhoff, Tammy

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2006 Mississippi Curriculum Framework: Postsecondary Surgical Technology. (Program CIP: 51.0909 - Surgical Technology/Technologist)

ERIC Educational Resources Information Center

Tice, Tonya; Elliott, Jessica; Gandy, Zielda; Wilkerson, Tammy

2006-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Dental Assisting Technology. (Program CIP: 51.0601 - Dental Assisting/Assistant)

ERIC Educational Resources Information Center

Addison, Emily; Bokros, Christy; Gavant, H. Richard; Johnson, Robin

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Dental Hygiene Technology. (Program CIP: 51.0602 - Dental Hygienist)

ERIC Educational Resources Information Center

Alexander, Nick; Dunn, Catherine; Hill, Stanley; Lindsay, William

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2008 Mississippi Curriculum Framework: Postsecondary Massage Therapy. (Program CIP: 51.3501 - Massage Therapy/Therapeutic Massage)

ERIC Educational Resources Information Center

Patterson, Teresa; Russell, Cydnee

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2007 Mississippi Curriculum Framework: Postsecondary Optometric Assisting Technology. (Program CIP: 51.1802 - Optometric Technician/Assistant)

ERIC Educational Resources Information Center

Scott, Veronica

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Perchlorate Removal, Destruction, and Field Monitoring Demonstration

DTIC Science & Technology

2006-10-02

ion exchange unit. A pulsation dampener minimized pressure and flow fluctuations in the ion exchange system and a flow totalizer monitored total...instrumentation and controls, piping , electrical services, site work, service facilities, engineering, construction expenses, and other indirect costs were... Piping 113,750 157,500 Electrical services 48,750 67,500 Site work 65,000 90,000

2005 Mississippi Curriculum Framework: Postsecondary Gerontology Technology. (Program CIP: 19.0702 - Gerontology)

ERIC Educational Resources Information Center

Boulton, Mary

2005-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Medical Assisting Technology. (Program CIP-51.0801 - Medical /Clinical Assisting)

ERIC Educational Resources Information Center

Roberson, Kaye; King, Christine

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Occupational Safety and Health Technology. Program CIP: 15.0701

ERIC Educational Resources Information Center

Flowers, Walter M.

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Physical Therapist Assistant. (Program CIP: 51.0806 - Physical Therapist Assistant)

ERIC Educational Resources Information Center

Hester, Tom; Chapman, Pamela; Crowson, Patti; Ennis, Kimberly

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Paramedic. (Program CIP: 51.0904 - Emergency Medical Technology/Technician)

ERIC Educational Resources Information Center

Briscoe, Lisa; Bryant, Katrina; Deschamp, Clyde; Galtelli, Mark; Glasson, Kristi; Hall, David; Hood, Brenda; Mahaffey, Libby; McBryde, John; Read, John; Shirley, Gary

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Clothing and Textile Services. (Program CIP-19.0905)

ERIC Educational Resources Information Center

Redfield, Verlene

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Forestry Technology. (Program CIP: 03.0511 - Forest Technology/Technician)

ERIC Educational Resources Information Center

Jones, Luke; Keeton, Jeff

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2007 Mississippi Curriculum Framework: Postsecondary Forestry Technology. (Program CIP: 03.0511 - Forest Technology/Technician)

ERIC Educational Resources Information Center

Johnson, Carl; Loden, Emily; Keeton, Jeff; Thompson, Don; Mitchell, Brian; Couch, Andrew; Walker, Bob; Grado, Steve

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2007 Mississippi Curriculum Framework: Postsecondary Occupational Therapy Assistant. (Program CIP: 51.0803 - Occupational Therapist Assistant)

ERIC Educational Resources Information Center

Hager, Sherry; Pulver, Tim; Chittom, Suzanne

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2006 Mississippi Curriculum Framework: Postsecondary Paralegal Technology. (Program CIP: 22.0302 - Legal Assistant/Paralegal)

ERIC Educational Resources Information Center

Hinton, Amy; Phifer-Starks, Kim D.; Nelson, LaTricia

2006-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Paralegal Technology. (Program CIP: 22.0302 - Legal Assistant/Paralegal)

ERIC Educational Resources Information Center

Cox, Janet; Dinkins, Shivochie L.; Dozier, Darleen; Ford, Kathryn; Hinton, Amy; McDavid, Stephan; Phifer-Starks, Kim D.; Winston, Felicia

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Cardiovascular Technology. (Program CIP: 51.0901 - Cardiovascular Technology)

ERIC Educational Resources Information Center

Stanford-Means, Cynthia; Stevens, Richard

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Respiratory Care Technology. (Program CIP: 51.0908 - Respiratory Care Practitioner)

ERIC Educational Resources Information Center

Anderson, Lori; Brooks, Anthony; Miller, Shirley; Newell, Jim; Prince, Beverly; Smith, Jacqueline; Smith, Lynn; Ware, Chris

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2008 Mississippi Curriculum Framework: Postsecondary Radiologic Technology. (Program CIP: 51.0911 - Radiologic Technology/Science - Radiographer)

ERIC Educational Resources Information Center

Armstrong, David; Cochran, Timothy; Compton, Steve; Davis, Jennifer; Edgerton, Seena Shazowee; Kisner, Christie; Lewis, Judy; Sartin, Billie Faye; Shell, Deborah

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2006 Mississippi Curriculum Framework: Postsecondary Dental Assisting Technology. (Program CIP: 51.0601 - Dental Assisting/Assistant)

ERIC Educational Resources Information Center

Addison, Emily; Gavant, H. Richard

2006-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Job retention vocational rehabilitation for employed people with inflammatory arthritis (WORK-IA): a feasibility randomized controlled trial.

PubMed

Hammond, Alison; O'Brien, Rachel; Woodbridge, Sarah; Bradshaw, Lucy; Prior, Yeliz; Radford, Kate; Culley, June; Whitham, Diane; Ruth Pulikottil-Jacob

2017-07-21

Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome. A feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison. Fifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = -12.4 (SD 13.2); control = -2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status, indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure. This brief job retention VR is a credible and acceptable intervention for people with inflammatory arthritis with concerns about continuing to work due to arthritis. ISRCTN 76777720 . Registered 21.9.12.

Indirect costs and workplace productivity loss associated with non-Hodgkin lymphoma.

PubMed

Yu, Justin S; Hansen, Ryan N; Valderrama, Adriana; Carlson, Josh J

2016-11-01

The objective of this study was to examine indirect costs and workplace productivity loss (defined as an aggregate measure of absenteeism, short-term disability, and long-term disability days) associated with non-Hodgkin lymphoma (NHL) from a societal perspective in a commercially insured working-age United States population. The MarketScan(®) Commercial Claims and Encounters and Health and Productivity Management Databases (2007-2013) were used in this study, with controls matched 3:1 to NHL patients. In comparison to controls, NHL patients incurred significantly more workplace productivity loss (31.99 days; 95% CI: 25.24 days, 38.73 days; p < 0.001) and associated indirect costs ($6302.34; 95% CI: $4973.40, $7631.28; p < 0.001) in the 12-month post-diagnosis period when adjusting for covariates. NHL contributes significantly to losses in workplace productivity and higher associated indirect costs.

Low-cost autonomous orbit control about Mars: Initial simulation results

NASA Astrophysics Data System (ADS)

Dawson, S. D.; Early, L. W.; Potterveld, C. W.; Königsmann, H. J.

1999-11-01

Interest in studying the possibility of extraterrestrial life has led to the re-emergence of the Red Planet as a major target of planetary exploration. Currently proposed missions in the post-2000 period are routinely calling for rendezvous with ascent craft, long-term orbiting of, and sample-return from Mars. Such missions would benefit greatly from autonomous orbit control as a means to reduce operations costs and enable contact with Mars ground stations out of view of the Earth. This paper present results from initial simulations of autonomously controlled orbits around Mars, and points out possible uses of the technology and areas of routine Mars operations where such cost-conscious and robust autonomy could prove most effective. These simulations have validated the approach and control philosophies used in the development of this autonomous orbit controller. Future work will refine the controller, accounting for systematic and random errors in the navigation of the spacecraft from the sensor suite, and will produce prototype flight code for inclusion on future missions. A modified version of Microcosm's commercially available High Precision Orbit Propagator (HPOP) was used in the preparation of these results due to its high accuracy and speed of operation. Control laws were developed to allow an autonomously controlled spacecraft to continuously control to a pre-defined orbit about Mars with near-optimal propellant usage. The control laws were implemented as an adjunct to HPOP. The GSFC-produced 50 × 50 field model of the Martian gravitational potential was used in all simulations. The Martian atmospheric drag was modeled using an exponentially decaying atmosphere based on data from the Mars-GRAM NASA Ames model. It is hoped that the simple atmosphere model that was implemented can be significantly improved in the future so as to approach the fidelity of the Mars-GRAM model in its predictions of atmospheric density at orbital altitudes. Such additional work would take the form of solar flux (F10.7) and diurnal density dependencies. The autonomous controller is a-derivative of the proprietary and patented Microcosm Earth-orbiting control methodology which will be implemented on the upcoming Surrey Satellite Technology (SSTL) UoSAT-12 and the NASA EO-1 spacecraft missions. This work was funded by the NASA Jet Propulsion Laboratory under a Phase I SBIR (96.1 07.02 9444) and by internal Microcosm R&D funds as well as earlier supporting work done under a variety of USAF Research Laboratory-sponsored contracts [1, 2, 4, 12].

National evaluation of strategies to reduce safety violations for working from heights in construction companies: results from a randomized controlled trial.

PubMed

van der Molen, Henk F; den Herder, Aalt; Warning, Jan; Frings-Dresen, Monique H W

2016-01-09

The objective of this study is to evaluate the effectiveness of a face-to-face strategy and a direct mail strategy on safety violations while working from heights among construction companies compared to a control condition. Construction companies with workers at risk for fall injuries were eligible for this three-armed randomized controlled trial. In total, 27 cities were randomly assigned to intervention groups-where eligible companies were given either a face-to-face guidance strategy or a direct mailing strategy with access to internet facilities-or to a control group. The primary outcomes were the number and type of safety violations recorded by labor inspectors after three months. A process evaluation for both strategies was performed to determine reach, program implementation, satisfaction, knowledge and perceived safety behavior. A cost analysis was performed to establish the financial costs for each intervention strategy. Analyses were done by intention to treat. In total, 41% (n = 88) of the companies eligible for the face-to-face intervention participated and 73% (n = 69) for direct mail. Intervention materials were delivered to 69 % (face-to-face group) and 100 % (direct mail group); completion of intervention activities within companies was low. Satisfaction, increase in knowledge, and safety behavior did not differ between the intervention groups. Costs for personal advice were 28% higher than for direct mail. Ultimately, nine intervention companies were captured in the 288 worksite measurements performed by the labor inspectorate. No statistical differences in mean number of safety violations (1.8-2.4) or penalties (72%-100%) were found between the intervention and control groups based on all worksite inspections. No conclusions about the effect of face-to-face and direct mail strategies on safety violations could be drawn due to the limited number of intervention companies captured in the primary outcome measurements. The costs for a face-to-face strategy are higher compared with a direct mail strategy. No difference in awareness and attitude for safe working was found between employers and workers between both strategies. NTR 4298 on 29-Nov-2013.

Evidence-based economic analysis demonstrates that ecosystem service benefits of water hyacinth management greatly exceed research and control costs

PubMed Central

Harms, Nathan E.; Magen, Cedric; Liang, Dong; Nesslage, Genevieve M.; McMurray, Anna M.; Cofrancesco, Al F.

2018-01-01

Invasive species management can be a victim of its own success when decades of effective control cause memories of past harm to fade and raise questions of whether programs should continue. Economic analysis can be used to assess the efficiency of investing in invasive species control by comparing ecosystem service benefits to program costs, but only if appropriate data exist. We used a case study of water hyacinth (Eichhornia crassipes (Mart.) Solms), a nuisance floating aquatic plant, in Louisiana to demonstrate how comprehensive record-keeping supports economic analysis. Using long-term data sets, we developed empirical and spatio-temporal simulation models of intermediate complexity to project invasive species growth for control and no-control scenarios. For Louisiana, we estimated that peak plant cover would be 76% higher without the substantial growth rate suppression (84% reduction) that appeared due primarily to biological control agents. Our economic analysis revealed that combined biological and herbicide control programs, monitored over an unusually long time period (1975–2013), generated a benefit-cost ratio of about 34:1 derived from the relatively modest costs of $124 million ($2013) compared to the $4.2 billion ($2013) in benefits to anglers, waterfowl hunters, boating-dependent businesses, and water treatment facilities over the 38-year analysis period. This work adds to the literature by: (1) providing evidence of the effectiveness of water hyacinth biological control; (2) demonstrating use of parsimonious spatio-temporal models to estimate benefits of invasive species control; and (3) incorporating activity substitution into economic benefit transfer to avoid overstating benefits. Our study suggests that robust and cost-effective economic analysis is enabled by good record keeping and generalizable models that can demonstrate management effectiveness and promote social efficiency of invasive species control. PMID:29844976

Evidence-based economic analysis demonstrates that ecosystem service benefits of water hyacinth management greatly exceed research and control costs.

PubMed

Wainger, Lisa A; Harms, Nathan E; Magen, Cedric; Liang, Dong; Nesslage, Genevieve M; McMurray, Anna M; Cofrancesco, Al F

2018-01-01

Invasive species management can be a victim of its own success when decades of effective control cause memories of past harm to fade and raise questions of whether programs should continue. Economic analysis can be used to assess the efficiency of investing in invasive species control by comparing ecosystem service benefits to program costs, but only if appropriate data exist. We used a case study of water hyacinth ( Eichhornia crassipes (Mart.) Solms), a nuisance floating aquatic plant, in Louisiana to demonstrate how comprehensive record-keeping supports economic analysis. Using long-term data sets, we developed empirical and spatio-temporal simulation models of intermediate complexity to project invasive species growth for control and no-control scenarios. For Louisiana, we estimated that peak plant cover would be 76% higher without the substantial growth rate suppression (84% reduction) that appeared due primarily to biological control agents. Our economic analysis revealed that combined biological and herbicide control programs, monitored over an unusually long time period (1975-2013), generated a benefit-cost ratio of about 34:1 derived from the relatively modest costs of $124 million ($2013) compared to the $4.2 billion ($2013) in benefits to anglers, waterfowl hunters, boating-dependent businesses, and water treatment facilities over the 38-year analysis period. This work adds to the literature by: (1) providing evidence of the effectiveness of water hyacinth biological control; (2) demonstrating use of parsimonious spatio-temporal models to estimate benefits of invasive species control; and (3) incorporating activity substitution into economic benefit transfer to avoid overstating benefits. Our study suggests that robust and cost-effective economic analysis is enabled by good record keeping and generalizable models that can demonstrate management effectiveness and promote social efficiency of invasive species control.

Low-Cost Simulation to Teach Anesthetists' Non-Technical Skills in Rwanda.

PubMed

Skelton, Teresa; Nshimyumuremyi, Isaac; Mukwesi, Christian; Whynot, Sara; Zolpys, Lauren; Livingston, Patricia

2016-08-01

Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS)-task management, team working, situation awareness, and decision making-are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in sub-Saharan Africa. This pilot study investigates whether a low-cost simulation model, with good psychological fidelity, can be used effectively to teach ANTS during cesarean delivery in Rwanda. Study participants were anesthesia providers working in a tertiary referral hospital in Rwanda. Baseline observations were conducted for 20 anesthesia providers during cesarean delivery using the established ANTS framework. After the first observation set was complete, participants were randomly assigned to either simulation intervention or control groups. The simulation intervention group underwent ANTS training using low-cost high psychological fidelity simulation with debriefing. No training was offered to the control group. Postintervention observations were then conducted in the same manner as the baseline observations. The primary outcome was the overall ANTS score (maximum, 16). The median (range) ANTS score of the simulation group was 13.5 (11-16). The ANTS score of the control group was 8 (8-9), with a statistically significant difference (P = .002). Simulation participants showed statistically significant improvement in subcategories and in the overall ANTS score compared with ANTS score before simulation exposure. Rwandan anesthesia providers show improvement in ANTS practice during cesarean delivery after 1 teaching session using a low-cost high psychological fidelity simulation model with debriefing.

Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less.

PubMed

Torres-Rueda, Sergio; Wambura, Mwita; Weiss, Helen A; Plotkin, Marya; Kripke, Katharine; Chilongani, Joseph; Mahler, Hally; Kuringe, Evodius; Makokha, Maende; Hellar, Augustino; Schutte, Carl; Kazaura, Kokuhumbya J; Simbeye, Daimon; Mshana, Gerry; Larke, Natasha; Lija, Gissenge; Changalucha, John; Vassall, Anna; Hayes, Richard; Grund, Jonathan M; Terris-Prestholt, Fern

2018-03-19

Although voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition, demand for services is lower among men in most at-risk age groups (ages 20-34 years). A randomised controlled trial was conducted to assess the effectiveness of locally-tailored demand creation activities (including mass media, community mobilisation and targeted service delivery) in increasing uptake of campaign-delivered VMMC among men aged 20-34 years. We conducted an economic evaluation to understand the intervention's cost and cost-effectiveness. Tanzania (Njombe and Tabora regions). Cost data were collected on surgery, demand creation activities and monitoring and supervision related to VMMC implementation across clusters in both trial arms, as well as start-up activities for the intervention arm. The Decision Makers' Program Planning Tool was used to estimate the number of HIV infections averted and related cost savings given total VMMCs per cluster. Disability-adjusted life years were calculated and used to estimate incremental cost-effectiveness ratios. Client load was higher in the intervention arms than in the control arms: 4394 v. 2901, respectively, in Tabora and 1797 v. 1025 in Njombe. Despite additional costs of tailored demand creation, demand increased more than proportionally: mean costs per VMMC in the intervention arms were $62 in Tabora and $130 in Njombe, and in the control arms $70 and $191, respectively. More infections were averted in the intervention arm than in the control arm in Tabora (123 v. 67, respectively) and in Njombe (164 v. 102, respectively). The intervention dominated the control as it was both less costly and more effective. Cost-savings were observed in both regions stemming from the antiretroviral treatment costs averted as a result of the VMMCs performed. Spending more to address local preferences as a way to increase uptake of VMMC can be cost-saving.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tug fleet and ground operations schedules and controls. Volume 3: Program cost estimates

NASA Technical Reports Server (NTRS)

1975-01-01

Cost data for the tug DDT&E and operations phases are presented. Option 6 is the recommended option selected from seven options considered and was used as the basis for ground processing estimates. Option 6 provides for processing the tug in a factory clean environment in the low bay area of VAB with subsequent cleaning to visibly clean. The basis and results of the trade study to select Option 6 processing plan is included. Cost estimating methodology, a work breakdown structure, and a dictionary of WBS definitions is also provided.

Retrospective Cost Adaptive Control with Concurrent Closed-Loop Identification

NASA Astrophysics Data System (ADS)

Sobolic, Frantisek M.

Retrospective cost adaptive control (RCAC) is a discrete-time direct adaptive control algorithm for stabilization, command following, and disturbance rejection. RCAC is known to work on systems given minimal modeling information which is the leading numerator coefficient and any nonminimum-phase (NMP) zeros of the plant transfer function. This information is normally needed a priori and is key in the development of the filter, also known as the target model, within the retrospective performance variable. A novel approach to alleviate the need for prior modeling of both the leading coefficient of the plant transfer function as well as any NMP zeros is developed. The extension to the RCAC algorithm is the use of concurrent optimization of both the target model and the controller coefficients. Concurrent optimization of the target model and controller coefficients is a quadratic optimization problem in the target model and controller coefficients separately. However, this optimization problem is not convex as a joint function of both variables, and therefore nonconvex optimization methods are needed. Finally, insights within RCAC that include intercalated injection between the controller numerator and the denominator, unveil the workings of RCAC fitting a specific closed-loop transfer function to the target model. We exploit this interpretation by investigating several closed-loop identification architectures in order to extract this information for use in the target model.

Investigating Outfitting Density as a Cost Driver in Submarine Construction

DTIC Science & Technology

2015-09-01

Outfitting and furnishings, such as offices, medical, stores, berthing , joiner work and paint are allocated 12 to group 600. Group 700 is armament...handling, fire control, steering 600 Outfit and Furnishings Hull fittings, paint, insulation, berthing , offices, storerooms, medical 700 Armament...and is allocated for the service-life of the submarine. The AWE serves as the baseline weight for the Milestone B costing position for projected

Avoid costly mistakes of the past.

PubMed

Halley, Marc D

2013-03-01

Physician employment is here to stay. The challenge for healthcare finance professionals is to make physician relationships work without the financial losses experienced by hospitals that tried physician employment in the past. Capturing market share should be a key strategy in any physician employment effort. Physicians who are engaged and actively involved in the process make great business partners because they understand the productivity, efficiencies, and cost controls needed to succeed.

Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis.

PubMed

Hannemann, Pascal F W; Essers, Brigitte A B; Schots, Judith P M; Dullaert, Koen; Poeze, Martijn; Brink, Peter R G

2015-04-11

Physical forces have been widely used to stimulate bone growth in fracture repair. Addition of bone growth stimulation to the conservative treatment regime is more costly than standard health care. However, it might lead to cost-savings due to a reduction of the total amount of working days lost. This economic evaluation was performed to assess the cost-effectiveness of Pulsed Electromagnetic Fields (PEMF) compared to standard health care in the treatment of acute scaphoid fractures. An economic evaluation was carried out from a societal perspective, alongside a double-blind, randomized, placebo-controlled, multicenter trial involving five centres in The Netherlands. One hundred and two patients with a clinically and radiographically proven fracture of the scaphoid were included in the study and randomly allocated to either active bone growth stimulation or standard health care, using a placebo. All costs (medical costs and costs due to productivity loss) were measured during one year follow up. Functional outcome and general health related quality of life were assessed by the EuroQol-5D and PRWHE (patient rated wrist and hand evaluation) questionnaires. Utility scores were derived from the EuroQol-5D. The average total number of working days lost was lower in the active PEMF group (9.82 days) compared to the placebo group (12.91 days) (p = 0.651). Total medical costs of the intervention group (€1594) were significantly higher compared to the standard health care (€875). The total amount of mean QALY's (quality-adjusted life year) for the active PEMF group was 0.84 and 0.85 for the control group. The cost-effectiveness plane shows that the majority of all cost-effectiveness ratios fall into the quadrant where PEMF is not only less effective in terms of QALY's but also more costly. This study demonstrates that the desired effects in terms of cost-effectiveness are not met. When comparing the effects of PEMF to standard health care in terms of QALY's, PEMF cannot be considered a cost-effective treatment for acute fractures of the scaphoid bone. Netherlands Trial Register (NTR): NTR2064.

Economic and financial evaluation of neglected tropical diseases.

PubMed

Lee, Bruce Y; Bartsch, Sarah M; Gorham, Katrin M

2015-03-01

Economic and financing studies are particularly important for decision-making when resources are scarce or considerably limited. This is the case for neglected tropical diseases (NTDs). In fact, the definition of NTDs is an economic one. The shortage of resources for NTD control may be due in large part to the fact that the burden of NTDs and economic value of control measures have not been fully characterized. A number of economic study methodologies are available: cost of illness can quantify the extent, magnitude, and change of a problem; cost of intervention studies can outline the feasibility and guide the design of a policy or intervention; and cost-benefit, cost-effectiveness, and return-on-investment studies can determine the potential value of different interventions and policies. NTDs have unique characteristics that require special consideration in such analyses. Hence, approaches used for other diseases may need modifications to capture the full impact of NTDs. While the existing literature has made important findings, there is a need for substantially more work, as many NTDs and their associated interventions and policies require more evaluation. With increasing work in this area, NTDs may not be as 'neglected' in the future as they are now. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prospective memory and intraindividual variability in ongoing task response times in an adult lifespan sample: the role of cue focality.

PubMed

Ihle, Andreas; Ghisletta, Paolo; Kliegel, Matthias

2017-03-01

To contribute to the ongoing conceptual debate of what traditional mean-level ongoing task (OT) costs tell us about the attentional processes underlying prospective memory (PM), we investigated costs to intraindividual variability (IIV) in OT response times as a potentially sensitive indicator of attentional processes. Particularly, we tested whether IIV in OT responses may reflect controlled employment of attentional processes versus lapses of controlled attention, whether these processes differ across adulthood, and whether it is moderated by cue focality. We assessed 150 individuals (19-82 years) in a focal and a nonfocal PM condition. In addition, external measures of inhibition and working memory were assessed. In line with the predictions of the lapses-of-attention/inefficient-executive-control account, our data support the view that costs to IIV in OT trials of PM tasks reflect fluctuations in the efficiency of executive functioning, which was related to failures in prospective remembering, particularly in nonfocal PM tasks, potentially due to their increased executive demands. The additional value of considering costs to IIV over and beyond traditional mean-level OT costs in PM research is discussed.

Weaknesses in the USACE Defense Base Act Insurance Program Led to as Much as $58.5 Million in Refunds Not Returned to the U.S. Government and Other Problems

DTIC Science & Technology

2011-07-28

compensation insurance for their employees who work overseas. DBA insurance carriers provide disability and medical benefits to employees for work... insurance carriers provide disability and medical benefits to employees for work-related injuries and death benefits to eligible survivors for work-related...program to determine if contracting with a single DBA insurance provider would help control costs. Under a single provider model , contractors must use

Development of 6-DOF painting robot control system

NASA Astrophysics Data System (ADS)

Huang, Junbiao; Liu, Jianqun; Gao, Weiqiang

2017-01-01

With the development of society, the spraying technology of manufacturing industry in China has changed from the manual operation to the 6-DOF (Degree Of Freedom)robot automatic spraying. Spraying painting robot can not only complete the work which does harm to human being, but also improve the production efficiency and save labor costs. Control system is the most critical part of the 6-DOF robots, however, there is still a lack of relevant technology research in China. It is very necessary to study a kind of control system of 6-DOF spraying painting robots which is easy to operation, and has high efficiency and stable performance. With Googol controller platform, this paper develops programs based on Windows CE embedded systems to control the robot to finish the painting work. Software development is the core of the robot control system, including the direct teaching module, playback module, motion control module, setting module, man-machine interface, alarm module, log module, etc. All the development work of the entire software system has been completed, and it has been verified that the entire software works steady and efficient.

Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study.

PubMed

Fitzgerald, Sarah; Murphy, Aileen; Kirby, Ann; Geaney, Fiona; Perry, Ivan J

2018-03-03

To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Four multinational manufacturing workplaces in Cork, Ireland. 517 randomly selected employees (18-65 years) from four workplaces. Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost-benefit analysis, whereby the system-level intervention yields the highest net benefit (€56.56 per employee). System-level dietary modification alone offers the most value per improving employee health-related quality of life and generating net benefit for employers by reducing absenteeism. While system-level dietary modification strategies are potentially sustainable obesity prevention interventions, future research should include long-term outcomes to determine if improvements in outcomes persist. ISRCTN35108237; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial

PubMed Central

2010-01-01

Background Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain. The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. Methods/Design The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. Discussion For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System. Trial registration Trial registration number: NTR1047. PMID:20346183

Performance-based maintenance of gas turbines for reliable control of degraded power systems

NASA Astrophysics Data System (ADS)

Mo, Huadong; Sansavini, Giovanni; Xie, Min

2018-03-01

Maintenance actions are necessary for ensuring proper operations of control systems under component degradation. However, current condition-based maintenance (CBM) models based on component health indices are not suitable for degraded control systems. Indeed, failures of control systems are only determined by the controller outputs, and the feedback mechanism compensates the control performance loss caused by the component deterioration. Thus, control systems may still operate normally even if the component health indices exceed failure thresholds. This work investigates the CBM model of control systems and employs the reduced control performance as a direct degradation measure for deciding maintenance activities. The reduced control performance depends on the underlying component degradation modelled as a Wiener process and the feedback mechanism. To this aim, the controller features are quantified by developing a dynamic and stochastic control block diagram-based simulation model, consisting of the degraded components and the control mechanism. At each inspection, the system receives a maintenance action if the control performance deterioration exceeds its preventive-maintenance or failure thresholds. Inspired by realistic cases, the component degradation model considers random start time and unit-to-unit variability. The cost analysis of maintenance model is conducted via Monte Carlo simulation. Optimal maintenance strategies are investigated to minimize the expected maintenance costs, which is a direct consequence of the control performance. The proposed framework is able to design preventive maintenance actions on a gas power plant, to ensuring required load frequency control performance against a sudden load increase. The optimization results identify the trade-off between system downtime and maintenance costs as a function of preventive maintenance thresholds and inspection frequency. Finally, the control performance-based maintenance model can reduce maintenance costs as compared to CBM and pre-scheduled maintenance.

Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial

PubMed Central

2011-01-01

Background Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP. Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term). Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration ISRCTN: ISRCTN58719694 PMID:21859489

44 CFR 354.5 - Description of site-specific, plume pathway EPZ biennial exercise-related component services and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... Control Program Directors, and the Nuclear Energy Institute. (21) Implement and coordinate REP Program... from our REP Program Strategic Review implementation and oversight working group activities. (24) Costs...

44 CFR 354.5 - Description of site-specific, plume pathway EPZ biennial exercise-related component services and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... Control Program Directors, and the Nuclear Energy Institute. (21) Implement and coordinate REP Program... from our REP Program Strategic Review implementation and oversight working group activities. (24) Costs...

44 CFR 354.5 - Description of site-specific, plume pathway EPZ biennial exercise-related component services and...

Code of Federal Regulations, 2013 CFR

2013-10-01

... Control Program Directors, and the Nuclear Energy Institute. (21) Implement and coordinate REP Program... from our REP Program Strategic Review implementation and oversight working group activities. (24) Costs...

44 CFR 354.5 - Description of site-specific, plume pathway EPZ biennial exercise-related component services and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... Control Program Directors, and the Nuclear Energy Institute. (21) Implement and coordinate REP Program... from our REP Program Strategic Review implementation and oversight working group activities. (24) Costs...

Offset Printing Plate Quality Sensor on a Low-Cost Processor

PubMed Central

Poljak, Jelena; Botella, Guillermo; García, Carlos; Poljaček, Sanja Mahović; Prieto-Matías, Manuel; Tirado, Francisco

2013-01-01

The aim of this work is to develop a microprocessor-based sensor that measures the quality of the offset printing plate through the introduction of different image analysis applications. The main features of the presented system are the low cost, the low amount of power consumption, its modularity and easy integration with other industrial modules for printing plates, and its robustness against noise environments. For the sake of clarity, a viability analysis of previous software is presented through different strategies, based on dynamic histogram and Hough transform. This paper provides performance and scalability data compared with existing costly commercial devices. Furthermore, a general overview of quality control possibilities for printing plates is presented and could be useful to a system where such controls are regularly conducted. PMID:24284766

Using a commodity high-definition television for collaborative structural biology

PubMed Central

Yennamalli, Ragothaman; Arangarasan, Raj; Bryden, Aaron; Gleicher, Michael; Phillips, George N.

2014-01-01

Visualization of protein structures using stereoscopic systems is frequently needed by structural biologists working to understand a protein’s structure–function relationships. Often several scientists are working as a team and need simultaneous interaction with each other and the graphics representations. Most existing molecular visualization tools support single-user tasks, which are not suitable for a collaborative group. Expensive caves, domes or geowalls have been developed, but the availability and low cost of high-definition televisions (HDTVs) and game controllers in the commodity entertainment market provide an economically attractive option to achieve a collaborative environment. This paper describes a low-cost environment, using standard consumer game controllers and commercially available stereoscopic HDTV monitors with appropriate signal converters for structural biology collaborations employing existing binary distributions of commonly used software packages like Coot, PyMOL, Chimera, VMD, O, Olex2 and others. PMID:24904249

Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic asthma

PubMed Central

Brazier, Peter; Schauer, Uwe; Hamelmann, Eckard; Holmes, Steve; Pritchard, Clive; Warner, John O

2016-01-01

Introduction Chronic asthma is a significant burden for individual sufferers, adversely impacting their quality of working and social life, as well as being a major cost to the National Health Service (NHS). Temperature-controlled laminar airflow (TLA) therapy provides asthma patients at BTS/SIGN step 4/5 an add-on treatment option that is non-invasive and has been shown in clinical studies to improve quality of life for patients with poorly controlled allergic asthma. The objective of this study was to quantify the cost-effectiveness of TLA (Airsonett AB) technology as an add-on to standard asthma management drug therapy in the UK. Methods The main performance measure of interest is the incremental cost per quality-adjusted life year (QALY) for patients using TLA in addition to usual care versus usual care alone. The incremental cost of TLA use is based on an observational clinical study monitoring the incidence of exacerbations with treatment valued using NHS cost data. The clinical effectiveness, used to derive the incremental QALY data, is based on a randomised double-blind placebo-controlled clinical trial comprising participants with an equivalent asthma condition. Results For a clinical cohort of asthma patients as a whole, the incremental cost-effectiveness ratio (ICER) is £8998 per QALY gained, that is, within the £20 000/QALY cost-effectiveness benchmark used by the National Institute for Health and Care Excellence (NICE). Sensitivity analysis indicates that ICER values range from £18 883/QALY for the least severe patients through to TLA being dominant, that is, cost saving as well as improving quality of life, for individuals with the most severe and poorly controlled asthma. Conclusions Based on our results, Airsonett TLA is a cost-effective addition to treatment options for stage 4/5 patients. For high-risk individuals with more severe and less well controlled asthma, the use of TLA therapy to reduce incidence of hospitalisation would be a cost saving to the NHS. PMID:27026803

Economic Impacts from PM2.5 Pollution-Related Health Effects: A Case Study in Shanghai.

PubMed

Wu, Rui; Dai, Hancheng; Geng, Yong; Xie, Yang; Masui, Toshihiko; Liu, Zhiqing; Qian, Yiying

2017-05-02

PM 2.5 pollution-related diseases cause additional medical expenses and work time loss, leading to macroeconomic impact in high PM 2.5 concentration areas. Previous economic impact assessments of air pollution focused on benefits from environmental regulations while ignoring climate policies. In this study, we examine the health and economic impacts from PM 2.5 pollution under various air pollution control strategies and climate policies scenarios in the megacity of Shanghai. The estimation adopts an integrated model combining a Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model, exposure-response functions (ERFs), and a computable general equilibrium (CGE) model. The results show that without control measures, Shanghai's mortality caused by PM 2.5 pollution are estimated to be 192 400 cases in 2030 and the work time loss to be 72.1 h/cap annually. The corresponding GDP values and welfare losses would be approximately 2.26% and 3.14%, respectively. With an estimated control cost of 0.76% of local GDP, Shanghai would gain approximately 1.01% of local GDP through local air pollution control measures and climate policies. Furthermore, the application of multiregional integrated control strategies in neighboring provinces would be the most effective in reducing PM 2.5 concentration in Shanghai, leading to only 0.34% of GDP loss. At the sectoral level, labor-intensive sectors suffer more output loss from PM 2.5 pollution. Sectors with the highest control costs include power generation, iron and steel, and transport. The results indicate that the combination of multiregional integrated air pollution control strategies and climate policies would be cost-beneficial for Shanghai.

Electromechanical actuation for thrust vector control applications

NASA Technical Reports Server (NTRS)

Roth, Mary Ellen

1990-01-01

The advanced launch system (ALS), is a launch vehicle that is designed to be cost-effective, highly reliable, and operationally efficient with a goal of reducing the cost per pound to orbit. An electromechanical actuation (EMA) system is being developed as an attractive alternative to the hydraulic systems. The controller will integrate 20 kHz resonant link power management and distribution (PMAD) technology and pulse population modulation (PPM) techniques to implement field-oriented vector control (FOVC) of a new advanced induction motor. The driver and the FOVC will be microprocessor controlled. For increased system reliability, a built-in test (BITE) capability will be included. This involves introducing testability into the design of a system such that testing is calibrated and exercised during the design, manufacturing, maintenance, and prelaunch activities. An actuator will be integrated with the motor controller for performance testing of the EMA thrust vector control (TVC) system. The EMA system and work proposed for the future are discussed.

Modeling and Simulation of Bus Dispatching Policy for Timed Transfers on Signalized Networks

NASA Astrophysics Data System (ADS)

Cho, Hsun-Jung; Lin, Guey-Shii

2007-12-01

The major work of this study is to formulate the system cost functions and to integrate the bus dispatching policy with signal control. The integrated model mainly includes the flow dispersion model for links, signal control model for nodes, and dispatching control model for transfer terminals. All such models are inter-related for transfer operations in one-center transit network. The integrated model that combines dispatching policies with flexible signal control modes can be applied to assess the effectiveness of transfer operations. It is found that, if bus arrival information is reliable, an early dispatching decision made at the mean bus arrival times is preferable. The costs for coordinated operations with slack times are relatively low at the optimal common headway when applying adaptive route control. Based on such findings, a threshold function of bus headway for justifying an adaptive signal route control under various time values of auto drivers is developed.

2011 Mississippi Curriculum Framework: Postsecondary Conservation Law Enforcement Technology. (Program CIP: 03.0208 - Natural Resources Management and Policy, Other)

ERIC Educational Resources Information Center

Jones, Luke; Myrick, Dwight

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Campus Employment as a High Impact Practice: Relationship to Academic Success and Persistence of First-Generation College Students

ERIC Educational Resources Information Center

Savoca, Marianna

2016-01-01

The double burden of spiraling costs and limited financial aid has prompted more college students to work more hours than ever. Yet, working more hours can be detrimental to students' academic success and persistence, and first-generation college students are at even higher risk. While institutions cannot control off campus employment students…

2008 Mississippi Curriculum Framework: Postsecondary Irrigation Management Technology. (Program CIP:01.0699 - Applied Horticulture/Horticultural Business Services, Other)

ERIC Educational Resources Information Center

Oliver, Michael L.

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2008 Mississippi Curriculum Framework: Postsecondary Food Production and Management Technology. (Program CIP: 12.0508 - Institutional Food Workers)

ERIC Educational Resources Information Center

Carver, Matthew; Hoff, Jody; Little, Lisa; Samuel, Carolyn

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2006 Mississippi Curriculum Framework: Postsecondary Veterinary Technology. (Program CIP: 51.0808 - Veterinary/Animal Health Technology/Technician and Veterinary Assistant)

ERIC Educational Resources Information Center

Glenn, Bobby

2006-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Veterinary Technology. (Program CIP: 51.0808 - Veterinary/Animal Health Technology/Technician and Veterinary Assistant)

ERIC Educational Resources Information Center

Glenn, Bobby; Sills, Kirby

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2005 Mississippi Curriculum Framework: Postsecondary Banking and Finance Technology. (Program CIP: 52.0803 - Banking and Financial Support Services)

ERIC Educational Resources Information Center

Gullett, Janet; Thigpen, Herbert

2005-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Banking and Finance Technology. (Program CIP: 52.0803 - Banking and Financial Support Services)

ERIC Educational Resources Information Center

Gullett, Janet; Dinkins, Shivochie

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Early Childhood Education Technology. (Program CIP: 19.0709 - Child Care Provider/Assistant)

ERIC Educational Resources Information Center

Shumate, Win; Greene, Mary A.; Ford, Sandra; Jones, Pamela; Anders, Sheri

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

The Limits of Visual Working Memory in Children: Exploring Prioritization and Recency Effects with Sequential Presentation

ERIC Educational Resources Information Center

Berry, Ed D. J.; Waterman, Amanda H.; Baddeley, Alan D.; Hitch, Graham J.; Allen, Richard J.

2018-01-01

Recent research has demonstrated that, when instructed to prioritize a serial position in visual working memory (WM), adults are able to boost performance for this selected item, at a cost to nonprioritized items (e.g., Hu, Hitch, Baddeley, Zhang, & Allen, 2014). While executive control appears to play an important role in this ability, the…

2007 Mississippi Curriculum Framework: Postsecondary Agricultural Mechanics Technology. (Program CIP: 01.0201 - Agricultural Mechanics and Equipment/Machine Technology)

ERIC Educational Resources Information Center

Massey, Jeremy; Louwerens, Shane; Galey, Joe

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Agricultural Technician Technology. (Program CIP: 01.0201 - Agricultural Mechanics and Equipment/Machine Technology)

ERIC Educational Resources Information Center

Massey, Jeremy; Louwerens, Shane; Galey, Joe

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Meat Merchandising Technology. (Program CIP: 12.0506 - Meat Cutting/Meat Cutter)

ERIC Educational Resources Information Center

Jones, Roger; Currie, Lamar; Clayton, Sheila

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Emergency Medical Technician. (Program CIP: 51.0904 - Emergency Medical Technology/Technician)

ERIC Educational Resources Information Center

Briscoe, Lisa; Bryant, Katrina; Galtelli, Mark; Glasson, Kristi; Hall, David; Hood, Brenda; Mahaffey, Libby; McBryde, John; Read, John; Shirley, Gary; Wright, Al

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Funeral Service Technology. (Program CIP-12.0301 - Funeral Service and Mortuary Science)

ERIC Educational Resources Information Center

Anderson, Larry; Dickerson, Octavia; Harvey, Bill; Moore, Tony

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Nuclear Medicine Technology. (Program CIP: 51.0905 - Nuclear Medical Technology/Technologist)

ERIC Educational Resources Information Center

Boney, Linda; Lee, Joanne; Pyles, Alice; Whitfield, Stacy

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2008 Mississippi Curriculum Framework: Postsecondary Practical Nursing. (Program CIP: 51.3901 - Licensed Practical/Vocational Nurse Training)

ERIC Educational Resources Information Center

McNutt, Jana; Clowers, Pat; Collum, Lara; Canton, Dixie; Comfort, Sherri; Kron, Maxine; Mahaffey, Elizabeth; Hancock, Jane; Waldrup, Sandra; Walker, Sherri; Pearson, Lisa; Miller, Kelly; Cooper, Patti; Bedwell, Susan

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2007 Mississippi Curriculum Framework: Postsecondary Meat Merchandising Technology (Program CIP: 12.0506 - Meat Cutting/Meat Cutter)

ERIC Educational Resources Information Center

Jones, Roger; Currie, Lamar; Clayton, Sheila

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Diagnostic Medical Sonography Technology. (Program CIP: 51.0910 - Diagnostic Medical Sonography/Sonographer and Ultrasound)

ERIC Educational Resources Information Center

Finch, Wanda; Wilson, Lesa

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Health Information Technology. (Program CIP-51.0707-Medical Records Technology/Technician)

ERIC Educational Resources Information Center

Hoffman, Casey; Jones, Robin; McGuffee, Michelle; Scott, Nena

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2009 Mississippi Curriculum Framework: Postsecondary Court Reporting Technology. (Program CIP: 22.0303 - Court Reporting/Court Reporter)

ERIC Educational Resources Information Center

Adams, Geanell

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2007 Mississippi Curriculum Framework: Postsecondary Small Engine and Turf Equipment Repair Technology. (Program CIP: 01.0299 Agricultural Mechanization, Other )

ERIC Educational Resources Information Center

Spence, Allen; Campus, Raymond

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome.

PubMed

González López-Valcárcel, Beatriz; Librero, Julián; García-Sempere, Aníbal; Peña, Luz María; Bauer, Sofía; Puig-Junoy, Jaume; Oliva, Juan; Peiró, Salvador; Sanfélix-Gimeno, Gabriel

2017-07-01

Cost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia. Population-based retrospective cohort of 10 563 patients discharged alive after an ACS in 2009-2011. We examined a control group (low-income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance and middle-income to high-income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period. Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACE inhibitor or an angiotensin II receptor blocker (ACEI/ARB) and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence, respectively, p<0.01 for both). Adherence to statins decreased for the middle-income to high-income group as compared with the control group (7.8% increase of non-adherence, p<0.01). These effects seemed temporary. Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost sharing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Economic Evaluation of a Problem Solving Intervention to Prevent Recurrent Sickness Absence in Workers with Common Mental Disorders

PubMed Central

Arends, Iris; Bültmann, Ute; van Rhenen, Willem; Groen, Henk; van der Klink, Jac J. L.

2013-01-01

Objectives Workers with common mental disorders (CMDs) frequently experience recurrent sickness absence but scientifically evaluated interventions to prevent recurrences are lacking. The objectives of this study are to evaluate the cost-effectiveness and cost-benefit of a problem solving intervention aimed at preventing recurrent sickness absence in workers with CMDs compared to care as usual. Methods An economic evaluation was conducted alongside a cluster-randomised controlled trial with 12 months follow-up. Treatment providers were randomised to either a 2-day training in the SHARP-at work intervention, i.e. a problem solving intervention, or care as usual. Effect outcomes were the incidence of recurrent sickness absence and time to recurrent sickness absence. Self-reported health care utilisation was measured by questionnaires. A cost-effectiveness analysis (CEA) from the societal perspective and a cost-benefit analysis (CBA) from the employer’s perspective were conducted. Results The CEA showed that the SHARP-at work intervention was more effective but also more expensive than care as usual. The CBA revealed that employer’s occupational health care costs were significantly higher in the intervention group compared to care as usual. Overall, the SHARP-at work intervention showed no economic benefit compared to care as usual. Conclusions As implementation of the SHARP-at work intervention might require additional investments, health care policy makers need to decide if these investments are worthwhile considering the results that can be accomplished in reducing recurrent sickness absence. PMID:23951270

Impact of ITP on physician visits and workplace productivity.

PubMed

Tarantino, Michael D; Mathias, Susan D; Snyder, Claire F; Isitt, John J; Gernsheimer, Terry; Young, Joan

2010-02-01

To assess the impact of immune thrombocytopenic purpura (ITP) on primary care and specialist visits and workplace productivity. This was a cross-sectional, descriptive study comparing ITP patients to age- and gender-matched controls. Subjects completed a one-time web-based survey, which included questions on work loss, work productivity, and physician visits. ITP patients and controls were compared on these outcomes. For ITP patients, the relationship between work-related issues and physician visits with clinical characteristics (time since diagnosis, platelet count, number of treatments received, and an ITP-specific health-related quality of life measure, the ITP-PAQ) was explored. A total of 1002 ITP patients and 1031 controls completed the survey. On average, ITP patients were 46 years old, diagnosed 9 years ago, and had platelet counts of 148 x 10(9)/L; 37% had undergone splenectomy. More ITP patients had primary care (20% vs. 11%) and specialist (28% vs. 11%) visits in the past month versus controls (p < or = 0.001). Higher proportions of ITP patients have ever taken sick leave (56% vs. 30%), and missed chore hours in the past week (18% vs. 13%) (p < or = 0.003). ITP patients scored significantly worse than controls on all six work productivity items. Patients diagnosed within the past year were more likely to have specialist visits and to miss chore hours versus those diagnosed less recently. Worse ITP-PAQ scores and more ITP-related treatments were related to more physician visits and worse work-related and productivity outcomes. Platelet count is not associated with these outcomes. The study is limited by the potential for biased samples due to recruitment approaches, the inherent issues of a cross-sectional study design and recall bias in questionnaire responses. ITP was consistently associated with more physician visits and worse work and productivity outcomes. Future research should build on these findings by calculating a comprehensive cost-of-illness of ITP including both direct and indirect costs.

Low-cost modular array-field designs for flat-panel and concentrator photovoltaic systems

NASA Astrophysics Data System (ADS)

Post, H. N.; Carmichael, D. C.; Alexander, G.; Castle, J. A.

1982-09-01

Described are the design and development of low-cost, modular array fields for flat-panel and concentrator photovoltaic (PV) systems. The objective of the work was to reduce substantially the cost of the array-field Balance-of-System (BOS) subsystems and site-specific design costs as compared to previous PV installations. These subsystems include site preparation, foundations, support structures, electrical writing, grounding, lightning protection, electromagnetic interference considerations, and controls. To reduce these BOS and design costs, standardized modular (building-block) designs for flat-panel and concentrator array fields have been developed that are fully integrated and optimized for lowest life-cycle costs. Using drawings and specifications now available, these building-block designs can be used in multiples to install various size array fields. The developed designs are immediately applicable (1982) and reduce the array-field BOS costs to a fraction of previous costs.

Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study.

PubMed

Porath, Avi; Fund, Naama; Maor, Yasmin

2017-02-01

The aim of this study was to evaluate the direct costs of patients with diabetes ensured in a large health maintenance organization, Maccabi Health Services (MHS), in order to compare the medical costs of these patients to the medical costs of other patients insured by MHS and to assess the impact of poorly controlled diabetes on medical costs. A retrospective analysis of patients insured in MHS during 2012 was performed. Data were extracted automatically from the electronic database. A glycated hemoglobin (HbA1c) level of >9% (75 mmol/mol) was considered to define poorly controlled diabetes, and that of <7% (53 mmol/mol) and <8% (64 mmol/mol) to define controlled diabetes for patients aged <75 and ≥75 years, respectively. Multivariate analysis analyses were done to assess factors affecting cost. Data on a total of 99,017 patients with diabetes were obtained from the MHS database for 2012. Of these, 54% were male and 72% were aged 45-75 years. The median annual cost of treating diabetes was 4420 cost units (CU), with hospitalization accounting for 56% of the total costs. The median annual cost per patient in the age groups 35-44 and 75-84 years was 2836 CU and 7033 CU, respectively. Differences between costs for patients with diabetes and those for patients without diabetes was 85% for the age group 45-54 years but only 24% for the age group 75-84 years. Medical costs increased similarly with age for patients with controlled diabetes and those with poorly controlled diabetes costs, as did additional co-morbidities. Costs were significantly impacted by kidney disease. The costs for patients with an HbA1c level of 8.0-8.99% (64-74 mmol/mol) and 9.0-9.99% (75-85 mmol/mol) were 5722 and 5700 CU, respectively. In a multivariate analysis the factors affecting all patients' costs were HbA1C level, male gender, chronic diseases, complications of diabetes, disease duration, and stage of kidney function. The direct medical costs of patients with diabetes were significantly higher than those of patients without diabetes. The main drivers of these higher costs were hospitalizations and renal function. In poorly controlled patients the effect of HbA1c on costs was limited. These findings suggest that it is cost effective to identify patients with diabetes early in the course of the disease. The work was sponsored by internal funds of the authors. Article processing charges for this study was funded by Novo Nordisk.

The Economic Value of Long-Lasting Insecticidal Nets and Indoor Residual Spraying Implementation in Mozambique.

PubMed

Lee, Bruce Y; Bartsch, Sarah M; Stone, Nathan T B; Zhang, Shufang; Brown, Shawn T; Chatterjee, Chandrani; DePasse, Jay V; Zenkov, Eli; Briët, Olivier J T; Mendis, Chandana; Viisainen, Kirsi; Candrinho, Baltazar; Colborn, James

2017-06-01

AbstractMalaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology.

Effectiveness of a cognitive behavioural therapy-based rehabilitation programme (Progressive Goal Attainment Program) for patients who are work-disabled due to back pain: study protocol for a multicentre randomised controlled trial

PubMed Central

2013-01-01

Background Psychologically informed rehabilitation programmes such as the Progressive Goal Attainment Program (PGAP) have the potential to address pain-related disability by targeting known psychological factors that inhibit rehabilitation progress. However, no randomised controlled trials of this intervention exist and it has not been evaluated in the Irish health service context. Our objective was to evaluate the clinical efficacy and cost-effectiveness of the PGAP in a multicentre randomised controlled trial with patients who are work-disabled due to back pain. Methods and design Adult patients (ages 18 years and older) with nonmalignant back pain who are work-disabled because of chronic pain and not involved in litigation in relation to their pain were invited to take part. Patients were those who show at least one elevated psychosocial risk factor (above the 50th percentile) on pain disability, fear-based activity avoidance, fatigue, depression or pain catastrophizing. Following screening, patients are randomised equally to the intervention or control condition within each of the seven trial locations. Patients allocated to the control condition receive usual medical care only. Patients allocated to the PGAP intervention condition attend a maximum of 10 weekly individual sessions of structured active rehabilitation in addition to usual care. Sessions are delivered by a clinical psychologist and focus on graded activity, goal-setting, pacing activity and cognitive-behavioural therapy techniques to address possible barriers to rehabilitation. The primary analysis will be based on the amount of change on the Roland Morris Disability Questionnaire posttreatment. We will also measure changes in work status, pain intensity, catastrophizing, depression, fear avoidance and fatigue. Outcome measures are collected at baseline, posttreatment and 12-month follow-up. Health-related resource use is also collected pre- and posttreatment and at 12-month follow-up to evaluate cost-effectiveness. Discussion This study will be the first randomized controlled trial of the PGAP in chronic pain patients and will provide important information about the clinical and cost effectiveness of the programme as well as its feasibility in the context of the Irish health service. Trial registration Current Controlled Trials: ISRCTN61650533 PMID:24021094

Depression, quality of life, work productivity, resource use, and costs among women experiencing menopause and hot flashes: a cross-sectional study.

PubMed

Dibonaventura, Marco Dacosta; Wagner, Jan-Samuel; Alvir, Jose; Whiteley, Jennifer

2012-01-01

To examine the effect of depression on health-related quality of life, work productivity, resource use, and costs among women experiencing menopausal symptoms, including hot flashes. The study included data from the 2005 US National Health and Wellness Survey (N = 41,184), a cross-sectional, Internet-based survey representative of the adult US population. Among women who reported experiencing menopausal symptoms, including hot flashes, women who reported experiencing depression in the last year (n = 1,165) were compared with women who did not report experiencing depression in the last year (n = 2,467), controlling for demographic and health characteristics. Outcome measures included health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey [SF-8]), work productivity within the past 7 days, self-reported health care resource use within the past 6 months, and indirect and direct costs. Women experiencing depression were significantly more likely to be white, to be unemployed, to be uninsured, to currently smoke, to not exercise, and to be obese (all P < .05). After controlling for these differences, women experiencing depression reported significantly lower mental (39.66 vs 50.85, P < .05) and physical (44.05 vs 46.38, P < .05) SF-8 component summary scores. Similarly, the prevalences of time missed from work (5.31% vs 2.80%, P < .05), impairment while at work (25.00% vs 14.32%, P < .05), and impairment of daily activities (37.32% vs 23.16%, P < .05) due to health were greater among women experiencing depression. The numbers of physician visits (2.47 vs 1.77, P < .05), emergency room visits (0.27 vs 0.16, P < .05), and days hospitalized (0.36 vs 0.18, P < .05) in the past 6 months were also higher among women experiencing depression. Per woman per year indirect and direct costs were $3,066 and $1,075 higher, respectively, for women experiencing depression compared with those not experiencing depression. Approximately one-third of women experiencing menopausal symptoms, including hot flashes, also reported experiencing depression. These women reported significantly worse quality of life and significantly greater work productivity loss, health care resource use, and costs. Given the prevalence and burden, these findings suggest that proper assessment and management of depressive symptoms among women with menopause may have an important humanistic and economic benefit.

Intervention Costs From Communities Putting Prevention to Work.

PubMed

Honeycutt, Amanda A; Khavjou, Olga A; Bradley, Christina; Neuwahl, Simon; Hoerger, Thomas J; Bellard, David; Cash, Amanda J

2016-07-28

In 2010, the Centers for Disease Control and Prevention funded 50 communities to participate in the Communities Putting Prevention to Work (CPPW) program. CPPW supported community-based approaches to prevent or delay chronic disease and promote wellness by reducing tobacco use and obesity. We collected the direct costs of CPPW for the 44 communities funded through the American Recovery and Reinvestment Act (ARRA) and analyzed costs per person reached for all CPPW interventions and by intervention category. From 2011 through 2013, we collected quarterly data on costs from the 44 CPPW ARRA-funded communities. We estimated CPPW program costs as spending on labor; consultants; materials, travel, and services; overhead activities; and partners plus the value of in-kind donations. We estimated communities' costs per person reached for each intervention implemented and compared cost allocations across communities that focused on reducing tobacco use, or obesity, or both. Analyses were conducted in 2014; costs are reported in 2012 dollars. The largest share of CPPW total costs of $363 million supported interventions in communities that focused on obesity ($228 million). Average costs per person reached were less than $5 for 84% of tobacco-related interventions, 88% of nutrition interventions, and 89% of physical activity interventions. Costs per person reached were highest for social support and services interventions, almost $3 for tobacco‑use interventions and $1 for obesity prevention interventions. CPPW cost estimates are useful for comparing intervention cost per person reached with health outcomes and for addressing how community health intervention costs vary by type of intervention and by community size.

Intervention Costs From Communities Putting Prevention to Work

PubMed Central

Khavjou, Olga A.; Bradley, Christina; Neuwahl, Simon; Hoerger, Thomas J.; Bellard, David; Cash, Amanda J.

2016-01-01

Introduction In 2010, the Centers for Disease Control and Prevention funded 50 communities to participate in the Communities Putting Prevention to Work (CPPW) program. CPPW supported community-based approaches to prevent or delay chronic disease and promote wellness by reducing tobacco use and obesity. We collected the direct costs of CPPW for the 44 communities funded through the American Recovery and Reinvestment Act (ARRA) and analyzed costs per person reached for all CPPW interventions and by intervention category. Methods From 2011 through 2013, we collected quarterly data on costs from the 44 CPPW ARRA-funded communities. We estimated CPPW program costs as spending on labor; consultants; materials, travel, and services; overhead activities; and partners plus the value of in-kind donations. We estimated communities’ costs per person reached for each intervention implemented and compared cost allocations across communities that focused on reducing tobacco use, or obesity, or both. Analyses were conducted in 2014; costs are reported in 2012 dollars. Results The largest share of CPPW total costs of $363 million supported interventions in communities that focused on obesity ($228 million). Average costs per person reached were less than $5 for 84% of tobacco-related interventions, 88% of nutrition interventions, and 89% of physical activity interventions. Costs per person reached were highest for social support and services interventions, almost $3 for tobacco‑use interventions and $1 for obesity prevention interventions. Conclusions CPPW cost estimates are useful for comparing intervention cost per person reached with health outcomes and for addressing how community health intervention costs vary by type of intervention and by community size. PMID:27468157

Cost analysis of a coal-fired power plant using the NPV method

NASA Astrophysics Data System (ADS)

Kumar, Ravinder; Sharma, Avdhesh Kr.; Tewari, P. C.

2015-12-01

The present study investigates the impact of various factors affecting coal-fired power plant economics of 210 MW subcritical unit situated in north India for electricity generation. In this paper, the cost data of various units of thermal power plant in terms of power output capacity have been fitted using power law with the help of the data collected from a literature search. To have a realistic estimate of primary components or equipment, it is necessary to include the latest cost of these components. The cost analysis of the plant was carried out on the basis of total capital investment, operating cost and revenue. The total capital investment includes the total direct plant cost and total indirect plant cost. Total direct plant cost involves the cost of equipment (i.e. boiler, steam turbine, condenser, generator and auxiliary equipment including condensate extraction pump, feed water pump, etc.) and other costs associated with piping, electrical, civil works, direct installation cost, auxiliary services, instrumentation and controls, and site preparation. The total indirect plant cost includes the cost of engineering and set-up. The net present value method was adopted for the present study. The work presented in this paper is an endeavour to study the influence of some of the important parameters on the lifetime costs of a coal-fired power plant. For this purpose, parametric study with and without escalation rates for a period of 35 years plant life was evaluated. The results predicted that plant life, interest rate and the escalation rate were observed to be very sensitive on plant economics in comparison to other factors under study.

Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

PubMed Central

Rantz, Marilyn J.; Nahm, Helen E.; Zwygart-Stauffacher, Mary; Hicks, Lanis; Mehr, David; Flesner, Marcia; Petroski, Gregory F.; Madsen, Richard W.; Scott-Cawiezell, Jill

2012-01-01

Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. PMID:21816681

The role of mental health and addiction among high-cost patients: a population-based study.

PubMed

de Oliveira, Claire; Cheng, Joyce; Rehm, Jürgen; Kurdyak, Paul

2018-04-01

Previous work found that, among high-cost patients, those with a majority of mental health and addiction (MHA)-related costs (>50%) incur over 30% more costs than other high-cost patients. However, this work did not examine other high-cost patients in depth or whether they had any MHA-related costs. The objective of this analysis was to examine the role of MHA-related care among other high-cost patients. Using administrative healthcare data from Ontario, Canada, this study selected all patients in the 90th percentile of the cost distribution in 2012. It focused primarily on two groups based on the percentage of MHA-related costs relative to total costs: (1) high-cost patients with some MHA-related costs (0% > and <50%) and (2) high-cost patients with no MHA-related costs (0%). We examined socio-demographic and clinical characteristics, utilization and costs for both groups, and modeled patient-level costs using appropriate regression techniques. We also compared these groups with high-cost patients with a majority of MHA-related costs (>50%). High-cost patients with some MHA-related costs incurred over 40% more costs than those without ($27,883 vs $19,702). Patients with some MHA-related costs were older, lived in poorer neighborhoods, and had higher levels of comorbidity compared to those without. After controlling for relevant variables, having any type of MHA-related utilization increased costs by $2,698. Having a diagnosis of psychosis had a large impact on costs. This study did not examine children and adolescents. We were only able to account for 91% of all costs incurred by the public third-party payer; addiction-related costs from community-based agencies were not available. High-cost patients with MHA incur higher costs compared to those without. When considering interventions aimed at high-cost patients, policy-makers should consider their complex nature, specifically both their physical and MHA-related comorbidities.

Cost of tobacco-related diseases, including passive smoking, in Hong Kong.

PubMed

McGhee, S M; Ho, L M; Lapsley, H M; Chau, J; Cheung, W L; Ho, S Y; Pow, M; Lam, T H; Hedley, A J

2006-04-01

Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking. To estimate the health-related costs of tobacco from both active and passive smoking. Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of USD 1.3 million for a life lost. In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was USD 532 million for active smoking and USD 156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to USD 9.4 billion. The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere.

A Wireless Electroceutical Dressing Lowers Cost of Negative Pressure Wound Therapy

PubMed Central

Ghatak, Piya Das; Schlanger, Richard; Ganesh, Kasturi; Lambert, Lynn; Gordillo, Gayle M.; Martinsek, Patsy; Roy, Sashwati

2015-01-01

Objective: To test whether the use of a wireless electroceutical dressing (WED) (Procellera®) in conjunction with a 5-day negative pressure wound therapy (NPWT) may reduce the number of dressing changes required per week with this therapy. Approach: At the Ohio State University Comprehensive Wound Center, chronic wound patients (n=30) undergoing NPWT were randomized into two arms following consent as approved by the institutional review board. The control arm received standard of care NPWT, where the dressing change was performed thrice a week. The test arm received the same care except that the WED was added as an interface layer and dressing change was limited to twice a week. Results: A reduced cost of care was achieved using the WED in conjunction with NPWT. Despite fewer dressing changes in wounds dressed with the WED, closure outcomes were comparable with no overt signs of any wound complication, including infection. The cost of NPWT care during the week was significantly lower (from $2918 to $2346) in the WED-treated group compared with patients in the control arm. Innovation: This work introduces a novel technology platform involving a WED, which may be used in conjunction with NPWT. If used as such, NPWT is effective in decreasing the frequency of dressing change and lowering the cost of care. Conclusion: This work points toward the benefit of using the WED combined with NPWT. A larger clinical trial investigating the cost-effectiveness of WED in wound care is warranted. PMID:26005596

Economic consequences of improved temperature forecasts: An experiment with the Florida citrus growers (an update of control group results)

NASA Technical Reports Server (NTRS)

Braen, C.

1978-01-01

The economic experiment, the results obtained to date and the work which still remains to be done are summarized. Specifically, the experiment design is described in detail as are the developed data collection methodology and procedures, sampling plan, data reduction techniques, cost and loss models, establishment of frost severity measures, data obtained from citrus growers, National Weather Service and Federal Crop Insurance Corp. Resulting protection costs and crop losses for the control group sample, extrapolation of results of control group to the Florida citrus industry and the method for normalization of these results to a normal or average frost season so that results may be compared with anticipated similar results from test group measurements are discussed.

Recent National Transonic Facility Test Process Improvements (Invited)

NASA Technical Reports Server (NTRS)

Kilgore, W. A.; Balakrishna, S.; Bobbitt, C. W., Jr.; Adcock, J. B.

2001-01-01

This paper describes the results of two recent process improvements; drag feed-forward Mach number control and simultaneous force/moment and pressure testing, at the National Transonic Facility. These improvements have reduced the duration and cost of testing. The drag feed-forward Mach number control reduces the Mach number settling time by using measured model drag in the Mach number control algorithm. Simultaneous force/moment and pressure testing allows simultaneous collection of force/moment and pressure data without sacrificing data quality thereby reducing the overall testing time. Both improvements can be implemented at any wind tunnel. Additionally the NTF is working to develop and implement continuous pitch as a testing option as an additional method to reduce costs and maintain data quality.

Recent National Transonic Facility Test Process Improvements (Invited)

NASA Technical Reports Server (NTRS)

Kilgore, W. A.; Balakrishna, S.; Bobbitt, C. W., Jr.; Adcock, J. B.

2001-01-01

This paper describes the results of two recent process improvements; drag feed-forward Mach number control and simultaneous force/moment and pressure testing, at the National Transonic Facility. These improvements have reduced the duration and cost of testing. The drag feedforward Mach number control reduces the Mach number settling time by using measured model drag in the Mach number control algorithm. Simultaneous force/moment and pressure testing allows simultaneous collection of force/moment and pressure data without sacrificing data quality thereby reducing the overall testing time. Both improvements can be implemented at any wind tunnel. Additionally the NTF is working to develop and implement continuous pitch as a testing option as an additional method to reduce costs and maintain data quality.

Taking Control Of Compliance

PubMed Central

KOBER, SCOTT

2007-01-01

The cost of biologic therapies adds urgency to the need to develop realistic compliance strategies. By engaging and educating both the physician and patient, some MCOs are working hard to address at what has always been a complicated and formidable issue. PMID:23319920

Nonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis.

PubMed

Gnanenthiran, Sonali R; Adie, Sam; Harris, Ian A

2012-02-01

Decision-making regarding nonoperative versus operative treatment of patients with thoracolumbar burst fractures in the absence of neurologic deficits is controversial. Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences. Using meta-analysis, we therefore compared pain (VAS) and function (Roland Morris Disability Questionnaire) in patients with thoracolumbar burst fractures without neurologic deficit treated nonoperatively and operatively. Secondary outcomes included return to work, radiographic progression of kyphosis, radiographic progression of spinal canal stenosis, complications, cost, and length of hospitalization. We searched MEDLINE, EMBASE(®), and the Cochrane Central Register of Controlled Trials for 'thoracic fractures', 'lumbar fractures', 'non-operative', 'operative' and 'controlled clinical trials'. We established five criteria for inclusion. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The main analyses were performed on individual patient data from randomized controlled trials. Sensitivity analyses were performed on VAS pain, Roland Morris Disability Questionnaire score, kyphosis, and return to work, including data from nonrandomized controlled trials and using fixed effects meta-analysis. We identified four trials, including two randomized controlled trials consisting of 79 patients (41 with operative treatment and 38 with nonoperative treatment). The mean followups ranged from 24 to 118 months. We found no between-group differences in baseline pain, kyphosis, and Roland Morris Disability Questionnaire scores. At last followup, there were no between-group differences in pain, Roland Morris Disability Questionnaire scores, and return to work rates. We found an improvement in kyphosis ranging from means of 12.8º to 11º in the operative group, but surgery was associated with higher complication rates and costs. Operative management of thoracolumbar burst fractures without neurologic deficit may improve residual kyphosis, but does not appear to improve pain or function at an average of 4 years after injury and is associated with higher complication rates and costs. Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

Sci—Fri PM: Topics — 03: The Global Task Force on Radiotherapy for Cancer Control: Core Investments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Dyk, J.; Jaffray, D. A.; MacPherson, M. S.

The Union for International Cancer Control (UICC) is a membership-based, non-governmental organization with a mandate to “…to unite the cancer community to reduce the global cancer burden, to promote greater equity, and to integrate cancer control into the world health and development agenda.” COMP is an associate member of the UICC. It is well recognized by the UICC that there are major gaps between high, and low and middle income countries, in terms of access to cancer services including access to radiation therapy. In this context, the UICC has developed a Global Task Force on Radiotherapy for Cancer Control withmore » a charge to answer a single question: “What does it cost to close the gap between what exists today and reasonable access to radiotherapy globally?” The Task Force consists of leaders internationally recognized for their radiation treatment related expertise (radiation oncologists, medical physicists, radiation therapists) as well as those with global health and economics specialization. The Task Force has developed three working groups: (1) to look at the global burden of cancer; (2) to look at the infrastructure requirements (facilities, equipment, personnel); and (3) to consider outcomes in terms of numbers of lives saved and palliated patients. A report is due at the World Cancer Congress in December 2014. This presentation reviews the infrastructure considerations under analysis by the second work group. The infrastructure parameters being addressed include capital costs of buildings and equipment and operating costs, which include human resources, equipment servicing and quality control, and general overhead.« less

Bioinspired nanovalves with selective permeability and pH sensitivity

NASA Astrophysics Data System (ADS)

Zheng, Z.; Huang, X.; Schenderlein, M.; Moehwald, H.; Xu, G.-K.; Shchukin, D. G.

2015-01-01

Biological systems with controlled permeability and release functionality, which are among the successful examples of living beings to survive in evolution, have attracted intensive investigation and have been mimicked due to their broad spectrum of applications. We present in this work, for the first time, an example of nuclear pore complexes (NPCs)-inspired controlled release system that exhibits on-demand release of angstrom-sized molecules. We do so in a cost-effective way by stabilizing porous cobalt basic carbonates as nanovalves and realizing pH-sensitive release of entrapped subnano cargo. The proof-of-concept work also consists of the establishment of two mathematical models to explain the selective permeability of the nanovalves. Finally, gram-sized (or larger) quantities of the bio-inspired controlled release system can be synthesized through a scaling-up strategy, which opens up opportunities for controlled release of functional molecules in wider practical applications.Biological systems with controlled permeability and release functionality, which are among the successful examples of living beings to survive in evolution, have attracted intensive investigation and have been mimicked due to their broad spectrum of applications. We present in this work, for the first time, an example of nuclear pore complexes (NPCs)-inspired controlled release system that exhibits on-demand release of angstrom-sized molecules. We do so in a cost-effective way by stabilizing porous cobalt basic carbonates as nanovalves and realizing pH-sensitive release of entrapped subnano cargo. The proof-of-concept work also consists of the establishment of two mathematical models to explain the selective permeability of the nanovalves. Finally, gram-sized (or larger) quantities of the bio-inspired controlled release system can be synthesized through a scaling-up strategy, which opens up opportunities for controlled release of functional molecules in wider practical applications. Electronic supplementary information (ESI) available. See DOI: 10.1039/c4nr06378c

Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial.

PubMed

Brusco, Natasha Kareem; Watts, Jennifer J; Shields, Nora; Taylor, Nicholas F

2015-04-18

Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider. This study aimed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months, from a health system perspective inclusive of private costs. Cost effectiveness analyses alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence. A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI -4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01). There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. Sensitivity analyses varying the cost of informal carers and self-reported health service utilization, favored the intervention. From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for inpatients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence, for the inpatient stay and 12 months following discharge, without a cost shift into the community. Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213.

Humanistic and economic burden of fibromyalgia in Japan

PubMed Central

Lee, Lulu K; Ebata, Nozomi; Hlavacek, Patrick; DiBonaventura, Marco; Cappelleri, Joseph C; Sadosky, Alesia

2016-01-01

Purpose The aim of this study was to examine the health and economic burden associated with fibromyalgia among adults in Japan. Materials and methods Data from the 2011–2014 Japan National Health and Wellness Survey (n=115,271), a nationally representative survey of adults, were analyzed. The greedy matching algorithm was used to match the respondents who self-reported a diagnosis of fibromyalgia with those not having fibromyalgia (n=256). Generalized linear models, controlling for covariates (eg, age and sex), examined whether the respondents with fibromyalgia differed from matched controls based on health status (health utilities; Mental and Physical Component Summary scores from Medical Outcomes Study: 12-item Version 2 and 36-item Version 2 Short Form Survey), sleep quality (ie, sleep difficulty symptoms), work productivity (Work Productivity and Activity Impairment Questionnaire – General Health Version 2.0), health care resource use, and estimated annual indirect and direct costs (based on published annual wages and resource use events) in Japanese yen (¥). Results After adjustment for covariates, respondents with fibromyalgia relative to matched controls scored significantly lower on health utilities (adjusted means =0.547 vs 0.732), Mental Component Summary score (33.15 vs 45.88), and Physical Component Summary score (39.22 vs 50.81), all with P<0.001; these differences exceeded the clinically meaningful levels. In addition, those with fibromyalgia reported significantly poorer sleep quality than those without fibromyalgia. Respondents with fibromyalgia compared with those without fibromyalgia experienced significantly more loss in work productivity and health care resource use, resulting in those with fibromyalgia incurring indirect costs that were more than twice as high (adjusted means =¥2,826,395 vs ¥1,201,547) and direct costs that were nearly six times as high (¥1,941,118 vs ¥335,140), both with P<0.001. Conclusion Japanese adults with fibromyalgia experienced significantly poorer health-related quality of life and greater loss in work productivity and health care use than those without fibromyalgia, resulting in significantly higher costs. Improving the rates of diagnosis and treatment for this chronic pain condition may be helpful in addressing this considerable humanistic and economic burden. PMID:27853390

Speech-in-speech perception and executive function involvement

PubMed Central

Perrone-Bertolotti, Marcela; Tassin, Maxime

2017-01-01

This present study investigated the link between speech-in-speech perception capacities and four executive function components: response suppression, inhibitory control, switching and working memory. We constructed a cross-modal semantic priming paradigm using a written target word and a spoken prime word, implemented in one of two concurrent auditory sentences (cocktail party situation). The prime and target were semantically related or unrelated. Participants had to perform a lexical decision task on visual target words and simultaneously listen to only one of two pronounced sentences. The attention of the participant was manipulated: The prime was in the pronounced sentence listened to by the participant or in the ignored one. In addition, we evaluate the executive function abilities of participants (switching cost, inhibitory-control cost and response-suppression cost) and their working memory span. Correlation analyses were performed between the executive and priming measurements. Our results showed a significant interaction effect between attention and semantic priming. We observed a significant priming effect in the attended but not in the ignored condition. Only priming effects obtained in the ignored condition were significantly correlated with some of the executive measurements. However, no correlation between priming effects and working memory capacity was found. Overall, these results confirm, first, the role of attention for semantic priming effect and, second, the implication of executive functions in speech-in-noise understanding capacities. PMID:28708830

A participatory supportive return to work program for workers without an employment contract, sick-listed due to a common mental disorder: an economic evaluation alongside a randomized controlled trial.

PubMed

Lammerts, Lieke; van Dongen, Johanna M; Schaafsma, Frederieke G; van Mechelen, Willem; Anema, Johannes R

2017-02-02

Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care. In addition, its return on investment was evaluated. An economic evaluation was conducted alongside a 12-month randomized controlled trial. A total of 186 participants was randomly allocated to the new program (n = 94) or to usual care (n = 92). Effect measures were the duration until sustainable RTW in competitive employment and quality-adjusted life years (QALYs) gained. Costs included intervention costs, medical costs and absenteeism costs. Registered data of the Dutch Social Security Agency were used to assess the duration until sustainable RTW, intervention costs and absenteeism costs. QALYs and medical costs were assessed using three- or six-monthly questionnaires. Missing data were imputed using multiple imputations. Cost-effectiveness analysis and cost-utility analysis were conducted from the societal perspective. A return on investment analysis was conducted from the social insurer's perspective. Various sensitivity analyses were performed to assess the robustness of the results. The new program had no significant effect on the duration until sustainable RTW and QALYs gained. Intervention costs and medical costs were significantly higher in the intervention group. From the societal perspective, the maximum probability of cost-effectiveness for duration until sustainable RTW was 0.64 at a willingness to pay of about €10 000/day, and 0.27 for QALYs gained, regardless of the willingness to pay. From the social insurer's perspective, the probability of financial return was 0.18. From the societal perspective, the new program was neither cost-effective in improving sustainable RTW nor in gaining QALYs. From the social insurer's perspective, the program did not result in a positive financial return. Therefore, the present study provided no evidence to support its implementation. The trial was listed at the Dutch Trial Register (NTR) under NTR3563 on August 7, 2012.

Sensitivity of Optimal Solutions to Control Problems for Second Order Evolution Subdifferential Inclusions.

PubMed

Bartosz, Krzysztof; Denkowski, Zdzisław; Kalita, Piotr

In this paper the sensitivity of optimal solutions to control problems described by second order evolution subdifferential inclusions under perturbations of state relations and of cost functionals is investigated. First we establish a new existence result for a class of such inclusions. Then, based on the theory of sequential [Formula: see text]-convergence we recall the abstract scheme concerning convergence of minimal values and minimizers. The abstract scheme works provided we can establish two properties: the Kuratowski convergence of solution sets for the state relations and some complementary [Formula: see text]-convergence of the cost functionals. Then these two properties are implemented in the considered case.

Advanced Targeting Cost Function Design for Evolutionary Optimization of Control of Logistic Equation

NASA Astrophysics Data System (ADS)

Senkerik, Roman; Zelinka, Ivan; Davendra, Donald; Oplatkova, Zuzana

2010-06-01

This research deals with the optimization of the control of chaos by means of evolutionary algorithms. This work is aimed on an explanation of how to use evolutionary algorithms (EAs) and how to properly define the advanced targeting cost function (CF) securing very fast and precise stabilization of desired state for any initial conditions. As a model of deterministic chaotic system, the one dimensional Logistic equation was used. The evolutionary algorithm Self-Organizing Migrating Algorithm (SOMA) was used in four versions. For each version, repeated simulations were conducted to outline the effectiveness and robustness of used method and targeting CF.

A design study for a simple-to-fly, constant attitude light aircraft

NASA Technical Reports Server (NTRS)

Smetana, F. O.; Humphreys, D. E.; Montoya, R. J.; Rickard, W. W.; Wilkinson, I. E.

1973-01-01

The activities during a four-year study by doctoral students to evolve in detail a design for a simple-to-fly, constant attitude light airplane are described. The study indicated that such aircraft could materially reduce the hazards to light airplane occupants which arise from the high pilot work load and poor visibility that occur during landing. Preliminary cost studies indicate that in volume production this system would increase the cost of the aircraft in roughly the same fashion that automatic transmission, power steering, power brakes, and cruise control increase the cost of a compact car.

Control approach development for variable recruitment artificial muscles

NASA Astrophysics Data System (ADS)

Jenkins, Tyler E.; Chapman, Edward M.; Bryant, Matthew

2016-04-01

This study characterizes hybrid control approaches for the variable recruitment of fluidic artificial muscles with double acting (antagonistic) actuation. Fluidic artificial muscle actuators have been explored by researchers due to their natural compliance, high force-to-weight ratio, and low cost of fabrication. Previous studies have attempted to improve system efficiency of the actuators through variable recruitment, i.e. using discrete changes in the number of active actuators. While current variable recruitment research utilizes manual valve switching, this paper details the current development of an online variable recruitment control scheme. By continuously controlling applied pressure and discretely controlling the number of active actuators, operation in the lowest possible recruitment state is ensured and working fluid consumption is minimized. Results provide insight into switching control scheme effects on working fluids, fabrication material choices, actuator modeling, and controller development decisions.

Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: a randomized controlled trial.

PubMed

Brouwers, Evelien P M; de Bruijne, Martine C; Terluin, Berend; Tiemens, Bea G; Verhaak, Peter F M

2007-04-01

Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders. In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later. Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group. Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.

NREL's Work for the U.S. Navy Illuminates Energy and Cost Savings | News

Science.gov Websites

load controls and whole-building energy efficiency retrofits as good investments for the Navy. " Program Director Steve Gorin said. Advanced power strips, a plug load control technology that cuts power and an office building with capacity for roughly 100 staff. While plug load savings depend on what can

Ecological Relevance Determines Task Priority in Older Adults' Multitasking.

PubMed

Doumas, Michail; Krampe, Ralf Th

2015-05-01

Multitasking is a challenging aspect of human behavior, especially if the concurrently performed tasks are different in nature. Several studies demonstrated pronounced performance decrements (dual-task costs) in older adults for combinations of cognitive and motor tasks. However, patterns of costs among component tasks differed across studies and reasons for participants' resource allocation strategies remained elusive. We investigated young and older adults' multitasking of a working memory task and two sensorimotor tasks, one with low (finger force control) and one with high ecological relevance (postural control). The tasks were performed in single-, dual-, and triple-task contexts. Working memory accuracy was reduced in dual-task contexts with either sensorimotor task and deteriorated further under triple-task conditions. Postural and force performance deteriorated with age and task difficulty in dual-task contexts. However, in the triple-task context with its maximum resource demands, older adults prioritized postural control over both force control and memory. Our results identify ecological relevance as the key factor in older adults' multitasking. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

2007 Mississippi Curriculum Framework: Postsecondary Diagnostic Medical Sonography Technology. (Program CIP: 51.0910 - Diagnostic Medical Sonography/Sonographer and Ultrasound Technician)

ERIC Educational Resources Information Center

Larimore, Crystal; Megginson, Nita; Weekley, Tracy B.

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2005 Mississippi Curriculum Framework: Postsecondary Health Care Assistant. (Program CIP: 51.1614 - Nurse/Nursing Assistant/Aide and Client Care Assistant)

ERIC Educational Resources Information Center

Sims, Addie; Burch, Brenda; River, Jayne; Hull, Jennifer; Williams, Judy; Cross, Ella; Lowe, Pam

2005-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Health-Care Assistant. (Program CIP-51.3902 - Nurse/Nursing Assistant/Aide and Client Care Assistant)

ERIC Educational Resources Information Center

Jackson, Jennifer; Sims, Addie

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Design of electric control system for automatic vegetable bundling machine

NASA Astrophysics Data System (ADS)

Bao, Yan

2017-06-01

A design can meet the requirements of automatic bale food structure and has the advantages of simple circuit, and the volume is easy to enhance the electric control system of machine carrying bunch of dishes and low cost. The bundle of vegetable machine should meet the sensor to detect and control, in order to meet the control requirements; binding force can be adjusted by the button to achieve; strapping speed also can be adjusted, by the keys to set; sensors and mechanical line connection, convenient operation; can be directly connected with the plug, the 220V power supply can be connected to a power source; if, can work, by the transmission signal sensor, MCU to control the motor, drive and control procedures for small motor. The working principle of LED control circuit and temperature control circuit is described. The design of electric control system of automatic dish machine.

Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial.

PubMed

Sandberg, Magnus; Jakobsson, Ulf; Midlöv, Patrik; Kristensson, Jimmie

2015-12-01

To evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility. One hundred and fifty-three frail older people living at home were randomly assigned to either an intervention (n = 80) or a control group (n = 73). The 1-year intervention was carried out by nurses and physiotherapists working as case managers, who undertook home visits at least once a month. Differences in costs and quality-adjusted life years (QALYs) based on the health-related quality-of-life instruments EQ-5D and EQ-VAS, and also the incremental cost-effectiveness ratio were investigated. All analyses used the intention-to-treat principle. There were no significant differences between the intervention group and control group for total cost, EQ-5D-based QALY or EQ-VAS-based QALY for the 1-year study. Incremental cost-effectiveness ratio was not conducted because no significant differences were found for either EQ-5D- or EQ-VAS-based QALY, or costs. However, the intervention group had significantly lower levels of informal care and help with instrumental activities of daily living both as costs (3,927 vs. 6,550, p = 0.037) and provided hours (200 vs. 333 hours per year, p = 0.037). The intervention was cost neutral and does not seem to have affected health-related quality of life for the 1-year study, which may be because the follow-up period was too short. The intervention seems to have reduced hours and cost of informal care and help required with instrumental activities of daily living. This suggests that the intervention provides relief to informal caregivers.

Household Costs of Leprosy Reactions (ENL) in Rural India

PubMed Central

Chandler, David J.; Hansen, Kristian S.; Mahato, Bhabananda; Darlong, Joydeepa; John, Annamma; Lockwood, Diana N. J.

2015-01-01

Background Erythema nodosum leprosum (ENL) is a common immune-mediated complication of lepromatous (LL) and borderline lepromatous (BL) leprosy. Most patients experience chronic or multiple acute ENL over many years during an economically active period of their lives. Understanding the economic burden of ENL is essential to provide effective patient support, yet this area has not been investigated. Methods Ninety-one patients with LL or BL leprosy attending a leprosy hospital in Purulia district of West Bengal, India, were interviewed using a structured questionnaire. Cases (n = 53) were identified as those who had one or more episodes of ENL within the last 3 years. Controls (n = 38) had LL or BL leprosy but no history of ENL. Data were collected on household income, direct and indirect costs, and coping strategies. Findings The total household cost was Rs 1543 per month or 27.9% (IQR 13.2-52.6) of monthly household income for cases, and Rs 237 per month or 4.9% (IQR 1.7-13.4) of monthly household income for controls. Indirect costs accounted for 65% of total household costs for cases. Direct costs accounted for the remaining 35% of household costs, and resulted almost entirely from treatment-seeking in the private sector. Total household costs exceeded 40% of household income for 37.7% of cases (n = 20) and 2.6% of controls (n = 1) [1 USD = 59 INR]. Interpretation Households affected by ENL face significant economic burden and are at risk of being pushed further into poverty. Health policy should acknowledge the importance of private sector provision and the significant contribution to total household costs of lost productivity (indirect cost). Further work is needed to explore this area and identify solutions. PMID:25590638

Public Mistrust of the U.S. Health Care System's Profit Motives: Mixed-Methods Results from a Randomized Controlled Trial.

PubMed

Richmond, Jennifer; Powell, Wizdom; Maurer, Maureen; Mangrum, Rikki; Gold, Marthe R; Pathak-Sen, Ela; Yang, Manshu; Carman, Kristin L

2017-12-01

Decision makers are increasingly tasked with reducing health care costs, but the public may be mistrustful of these efforts. Public deliberation helps gather input on these types of issues by convening a group of diverse individuals to learn about and discuss values-based dilemmas. To explore public perceptions of health care costs and how they intersect with medical mistrust. This mixed-methods study analyzed data from a randomized controlled trial including four public deliberation groups (n = 96) and a control group (n = 348) comprising English-speaking adults aged 18 years and older. Data were collected in 2012 in four U.S. regions. We used data from four survey items to compare attitude shifts about costs among participants in deliberation groups to participants in the control group. We qualitatively analyzed deliberation transcripts to identify themes related to attitude shifts and to provide context for quantitative results about attitude shifts. Deliberation participants were significantly more likely than control group participants to agree that doctors and patients should consider cost when making treatment decisions (β = 0.59; p < 0.01) and that people should consider the effect on group premiums when making treatment decisions (β = 0.48; p < 0.01). Qualitatively, participants mistrusted the health care system's profit motives (e.g., that systems prioritize making money over patient needs); however, after grappling with patient/doctor autonomy and learning about and examining their own views related to costs during the process of deliberation, they largely concluded that payers have the right to set some boundaries to curb costs. Individuals who are informed about costs may be receptive to boundaries that reduce societal health care costs, despite their mistrust of the health care system's profit motives, especially if decision makers communicate their rationale in a transparent manner. Future work should aim to develop transparent policies and practices that earn public trust.

Human-in-the-loop Bayesian optimization of wearable device parameters

PubMed Central

Malcolm, Philippe; Speeckaert, Jozefien; Siviy, Christoper J.; Walsh, Conor J.; Kuindersma, Scott

2017-01-01

The increasing capabilities of exoskeletons and powered prosthetics for walking assistance have paved the way for more sophisticated and individualized control strategies. In response to this opportunity, recent work on human-in-the-loop optimization has considered the problem of automatically tuning control parameters based on realtime physiological measurements. However, the common use of metabolic cost as a performance metric creates significant experimental challenges due to its long measurement times and low signal-to-noise ratio. We evaluate the use of Bayesian optimization—a family of sample-efficient, noise-tolerant, and global optimization methods—for quickly identifying near-optimal control parameters. To manage experimental complexity and provide comparisons against related work, we consider the task of minimizing metabolic cost by optimizing walking step frequencies in unaided human subjects. Compared to an existing approach based on gradient descent, Bayesian optimization identified a near-optimal step frequency with a faster time to convergence (12 minutes, p < 0.01), smaller inter-subject variability in convergence time (± 2 minutes, p < 0.01), and lower overall energy expenditure (p < 0.01). PMID:28926613

An Inexpensive Robotics Laboratory.

ERIC Educational Resources Information Center

Inigo, R. M.; Angulo, J. M.

1985-01-01

Describes the design and implementation of a simple robot manipulator. The manipulator has three degrees of freedom and is controlled by a general purpose microcomputer. The basis for the manipulator (which costs under $100) is a simple working model of a crane. (Author/JN)

75 FR 52942 - Two Proposed CERCLA Section 122(g) Administrative Agreements for De Minimis Settlements for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... settlement is between EPA and MG Automation and Controls Corporation (``MG'') and Occidental Chemical... accounts for, among other things, uncertainties associated with the costs of that future work at the Site...

A Low-Cost EEG System-Based Hybrid Brain-Computer Interface for Humanoid Robot Navigation and Recognition

PubMed Central

Choi, Bongjae; Jo, Sungho

2013-01-01

This paper describes a hybrid brain-computer interface (BCI) technique that combines the P300 potential, the steady state visually evoked potential (SSVEP), and event related de-synchronization (ERD) to solve a complicated multi-task problem consisting of humanoid robot navigation and control along with object recognition using a low-cost BCI system. Our approach enables subjects to control the navigation and exploration of a humanoid robot and recognize a desired object among candidates. This study aims to demonstrate the possibility of a hybrid BCI based on a low-cost system for a realistic and complex task. It also shows that the use of a simple image processing technique, combined with BCI, can further aid in making these complex tasks simpler. An experimental scenario is proposed in which a subject remotely controls a humanoid robot in a properly sized maze. The subject sees what the surrogate robot sees through visual feedback and can navigate the surrogate robot. While navigating, the robot encounters objects located in the maze. It then recognizes if the encountered object is of interest to the subject. The subject communicates with the robot through SSVEP and ERD-based BCIs to navigate and explore with the robot, and P300-based BCI to allow the surrogate robot recognize their favorites. Using several evaluation metrics, the performances of five subjects navigating the robot were quite comparable to manual keyboard control. During object recognition mode, favorite objects were successfully selected from two to four choices. Subjects conducted humanoid navigation and recognition tasks as if they embodied the robot. Analysis of the data supports the potential usefulness of the proposed hybrid BCI system for extended applications. This work presents an important implication for the future work that a hybridization of simple BCI protocols provide extended controllability to carry out complicated tasks even with a low-cost system. PMID:24023953

A low-cost EEG system-based hybrid brain-computer interface for humanoid robot navigation and recognition.

PubMed

Choi, Bongjae; Jo, Sungho

2013-01-01

This paper describes a hybrid brain-computer interface (BCI) technique that combines the P300 potential, the steady state visually evoked potential (SSVEP), and event related de-synchronization (ERD) to solve a complicated multi-task problem consisting of humanoid robot navigation and control along with object recognition using a low-cost BCI system. Our approach enables subjects to control the navigation and exploration of a humanoid robot and recognize a desired object among candidates. This study aims to demonstrate the possibility of a hybrid BCI based on a low-cost system for a realistic and complex task. It also shows that the use of a simple image processing technique, combined with BCI, can further aid in making these complex tasks simpler. An experimental scenario is proposed in which a subject remotely controls a humanoid robot in a properly sized maze. The subject sees what the surrogate robot sees through visual feedback and can navigate the surrogate robot. While navigating, the robot encounters objects located in the maze. It then recognizes if the encountered object is of interest to the subject. The subject communicates with the robot through SSVEP and ERD-based BCIs to navigate and explore with the robot, and P300-based BCI to allow the surrogate robot recognize their favorites. Using several evaluation metrics, the performances of five subjects navigating the robot were quite comparable to manual keyboard control. During object recognition mode, favorite objects were successfully selected from two to four choices. Subjects conducted humanoid navigation and recognition tasks as if they embodied the robot. Analysis of the data supports the potential usefulness of the proposed hybrid BCI system for extended applications. This work presents an important implication for the future work that a hybridization of simple BCI protocols provide extended controllability to carry out complicated tasks even with a low-cost system.

Future Concepts for Realtime Data Interfaces for Control Centers

NASA Technical Reports Server (NTRS)

Kearney, Mike W., III

2004-01-01

Existing methods of exchanging realtime data between the major control centers in the International Space Station program have resulted in a patchwork of local formats being imposed on each Mission Control Center. This puts the burden on a data customer to comply with the proprietary data formats of each data supplier. This has increased the cost and complexity for each participant, limited access to mission data and hampered the development of efficient and flexible operations concepts. Ideally, a universal format should be promoted in the industry to prevent the unnecessary burden of each center processing a different data format standard for every external interface with another center. With the broad acceptance of XML and other conventions used in other industries, it is now time for the Aerospace industry to fully engage and establish such a standard. This paper will briefly consider the components that would be required by such a standard (XML schema, data dictionaries, etc.) in order to accomplish the goal of a universal low-cost interface, and acquire broad industry acceptance. We will then examine current approaches being developed by standards bodies and other groups. The current state of CCSDS panel work will be reviewed, with a survey of the degree of industry acceptance. Other widely accepted commercial approaches will be considered, sometimes complimentary to the standards work, but sometimes not. The question is whether de facto industry standards are in concert with, or in conflict with the direction of the standards bodies. And given that state of affairs, the author will consider whether a new program establishing its Mission Control Center should implement a data interface based on those standards. The author proposes that broad industry support to unify the various efforts will enable collaboration between control centers and space programs to a wider degree than is currently available. This will reduce the cost for programs to provide realtime access to their data, hence reducing the cost of access to space, and benefiting the industry as a whole.

The comparative effectiveness of clinic, work-site, phone, and Web-based tobacco treatment programs.

PubMed

An, Lawrence C; Betzner, Anne; Schillo, Barbara; Luxenberg, Michael G; Christenson, Matthew; Wendling, Ann; Saul, Jessie E; Kavanaugh, Annette

2010-10-01

Tobacco treatment programs may be offered in clinical settings, at work-sites, via telephone helplines, or over the Internet. Little comparative data exist regarding the real-world effectiveness of these programs. This paper compares the reach, effectiveness, and costs of these different modes of cessation assistance. This is an observational study of cohorts of participants in Minnesota's QUITPLAN programs in 2004. Cessation assistance was provided in person at 9 treatment centers, using group counseling at 68 work-sites, via a telephone helpline, or via the Internet. The main outcomes of the study are enrollment by current smokers, self-reported 30-day abstinence, and cost per quit. Reach was calculated statewide for the helpline and Web site, regionally for the treatment centers, and for the employee population for work-site programs. Enrollment was greatest for the Web site (n = 4,698), followed by the helpline (n = 2,351), treatment centers (n = 616), and work-sites (n = 479). The Web site attracted younger smokers. Smokers at treatment centers had higher levels of nicotine dependence. The helpline reached more socially disadvantaged smokers. Responder 30-day abstinence rates were higher for the helpline (29.3%), treatment centers (25.8%), and work-sites (19.6%) compared with the online program (12.5%). These differences persisted after controlling for baseline differences in participant characteristics and use of pharmacological therapy. The cost per quit was lowest for the Web site program ($291 per quit, 95% CI = $229-$372). Treatment center, work-site, helpline, and Web site programs differ in their reach, effectiveness, and estimated cost per quit. Each program plays a part in assisting populations of tobacco users in quitting.

State-level medical and absenteeism cost of asthma in the United States.

PubMed

Nurmagambetov, Tursynbek; Khavjou, Olga; Murphy, Louise; Orenstein, Diane

2017-05-01

For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.

Exploring the potential impact of rotavirus vaccination on work absenteeism among female administrative personnel of the City of Antwerp through a retrospective database analysis.

PubMed

Standaert, Baudouin; Van de Mieroop, Els; Nelen, Vera

2015-06-30

Rotavirus vaccination has been reimbursed in Belgium since November 2006 with a high uptake (>85%). Economic analyses of the vaccine have been reported, including estimates of indirect cost gain related to the reduction in work absenteeism. The objective of this study was to evaluate the latter parameter using real-life data. A simple model estimated the reduction in absent workdays per working mother with a firstborn baby after the introduction of the rotavirus vaccine. Next, data on work absences were retrospectively analysed (from 2003 to 2012) using a database of administrative employees (n=11,600 working women per year) in the City of Antwerp. Observed reductions in absenteeism after the introduction of the vaccine were compared with the results from the model. These reductions would most likely be observed during the epidemic periods of rotavirus (from January to the end of May) for short-duration absences of ≤ 5 days. We compared data from outside epidemic periods (from June to December), expecting no changes over time prevaccine and postvaccine introduction, as well as with a control group of women aged 30-35 years with no first child. Model estimates were 0.73 working days gained per working mother. In the database of the City of Antwerp, we identified a gain of 0.88 working days during the epidemic period, and an accumulated gain of 2.24 days over a 3-year follow-up period. In the control group, no decrease in absenteeism was measured. Giving vaccine access to working mothers resulted in an estimated accumulated net cost gain of €187 per mother. Reduction in absenteeism among working mothers was observed during periods of the epidemic after the introduction of the rotavirus vaccine in Belgium. This reduction is in line with estimates of indirect cost gains used in economic evaluations of the rotavirus vaccine. HO-12-12768. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Exploring the potential impact of rotavirus vaccination on work absenteeism among female administrative personnel of the City of Antwerp through a retrospective database analysis

PubMed Central

Standaert, Baudouin; Van de Mieroop, Els; Nelen, Vera

2015-01-01

Objectives Rotavirus vaccination has been reimbursed in Belgium since November 2006 with a high uptake (>85%). Economic analyses of the vaccine have been reported, including estimates of indirect cost gain related to the reduction in work absenteeism. The objective of this study was to evaluate the latter parameter using real-life data. Design and setting A simple model estimated the reduction in absent workdays per working mother with a firstborn baby after the introduction of the rotavirus vaccine. Next, data on work absences were retrospectively analysed (from 2003 to 2012) using a database of administrative employees (n=11 600 working women per year) in the City of Antwerp. Observed reductions in absenteeism after the introduction of the vaccine were compared with the results from the model. These reductions would most likely be observed during the epidemic periods of rotavirus (from January to the end of May) for short-duration absences of ≤5 days. We compared data from outside epidemic periods (from June to December), expecting no changes over time prevaccine and postvaccine introduction, as well as with a control group of women aged 30–35 years with no first child. Results Model estimates were 0.73 working days gained per working mother. In the database of the City of Antwerp, we identified a gain of 0.88 working days during the epidemic period, and an accumulated gain of 2.24 days over a 3-year follow-up period. In the control group, no decrease in absenteeism was measured. Giving vaccine access to working mothers resulted in an estimated accumulated net cost gain of €187 per mother. Conclusions Reduction in absenteeism among working mothers was observed during periods of the epidemic after the introduction of the rotavirus vaccine in Belgium. This reduction is in line with estimates of indirect cost gains used in economic evaluations of the rotavirus vaccine. Trial registration number HO-12-12768. PMID:26129633

NASA Affordable Vehicle Avionics (AVA). Common Modular Avionics System for Nanolaunchers Offering Affordable Access to Space; [Space Technology: Game Changing Development

NASA Technical Reports Server (NTRS)

Aquilina, Rudy

2017-01-01

Small satellites are becoming ever more capable of performing valuable missions for both government and commercial customers. However, currently these satellites can be launched affordably only as secondary payloads. This makes it difficult for the small satellite mission to launch when needed, to the desired orbit, and with acceptable risk. What is needed is a class of low-cost launchers, so that launch costs to low-Earth orbit (LEO) are commensurate with payload costs. Several private and government-sponsored launch vehicle developers are working toward just that-the ability to affordably insert small payloads into LEO. But until now, cost of the complex avionics remained disproportionately high. AVA (Affordable Vehicle Avionics) solves this problem. Significant contributors to the cost of launching nanosatellites to orbit are the avionics and software systems that steer and control the launch vehicles, sequence stage separation, deploy payloads, and telemeter data. The high costs of these guidance, navigation and control (GNC) avionics systems are due in part to the current practice of developing unique, single-use hardware and software for each launch. High-performance, high-reliability inertial sensors components with heritage from legacy launchers also contribute to costs-but can low-cost commercial inertial sensors work just as well? NASA Ames Research Center has developed and tested a prototype low-cost avionics package for space launch vehicles that provides complete GNC functionality in a package smaller than a tissue box (100 millimeters by 120 millimeters by 69 millimeters; 4 inches by 4.7 inches by 2.7 inches), with a mass of less than 0.84 kilogram (2 pounds. AVA takes advantage of commercially available, low-cost, mass-produced, miniaturized sensors, filtering their more noisy inertial data with real-time GPS (Global Positioning Satellite) data. The goal of the AVA project is to produce and light-verify a common suite of avionics and software that deliver affordable, capable GNC and telemetry avionics with application to multiple nanolaunch vehicles at 1 percent of the cost of current state-of-the-art avionics.

From strategy development to routine implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control

PubMed Central

Manzi, Fatuma; Hutton, Guy; Schellenberg, Joanna; Tanner, Marcel; Alonso, Pedro; Mshinda, Hassan; Schellenberg, David

2008-01-01

Background Achieving the Millennium Development Goals for health requires a massive scaling-up of interventions in Sub Saharan Africa. Intermittent Preventive Treatment in infants (IPTi) is a promising new tool for malaria control. Although efficacy information is available for many interventions, there is a dearth of data on the resources required for scaling up of health interventions. Method We worked in partnership with the Ministry of Health and Social Welfare (MoHSW) to develop an IPTi strategy that could be implemented and managed by routine health services. We tracked health system and other costs of (1) developing the strategy and (2) maintaining routine implementation of the strategy in five districts in southern Tanzania. Financial costs were extracted and summarized from a costing template and semi-structured interviews were conducted with key informants to record time and resources spent on IPTi activities. Results The estimated financial cost to start-up and run IPTi in the whole of Tanzania in 2005 was US$1,486,284. Start-up costs of US$36,363 were incurred at the national level, mainly on the development of Behaviour Change Communication (BCC) materials, stakeholders' meetings and other consultations. The annual running cost at national level for intervention management and monitoring and drug purchase was estimated at US$459,096. Start-up costs at the district level were US$7,885 per district, mainly expenditure on training. Annual running costs were US$170 per district, mainly for printing of BCC materials. There was no incremental financial expenditure needed to deliver the intervention in health facilities as supplies were delivered alongside routine vaccinations and available health workers performed the activities without working overtime. The economic cost was estimated at 23 US cents per IPTi dose delivered. Conclusion The costs presented here show the order of magnitude of expenditures needed to initiate and to implement IPTi at national scale in settings with high Expanded Programme on Immunization (EPI) coverage. The IPTi intervention appears to be affordable even within the budget constraints of Ministries of Health of most sub-Saharan African countries. PMID:18671874

The cost effectiveness of NHS physiotherapy support for occupational health (OH) services.

PubMed

Phillips, Ceri J; Phillips Nee Buck, Rhiannon; Main, Chris J; Watson, Paul J; Davies, Shân; Farr, Angela; Harper, Christie; Noble, Gareth; Aylward, Mansel; Packman, Julie; Downton, Matt; Hale, Janine

2012-02-23

Musculoskeletal pain is detrimental to quality of life (QOL) and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG) established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP) comprising: 1.) telephone advice and triage, 2.) face-to-face physiotherapy assessment and treatment if required, and 3.) workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY) was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3%) and 199 (40.9%) were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the health gains contributed to a cost/QALY of £1386-£7760, which would represent value for money according to current UK thresholds. Sensitivity analyses demonstrated that the service would remain cost effective until the service costs were increased to 160% per user. This pragmatic evaluation of the OHPPP indicated that it was likely to be feasible in terms of service usage and could potentially be cost effective in terms of QALYs. Further, the study confirmed that improving physical health status for musculoskeletal pain patients is important in reducing problems with work capacity and related costs. This study suggests that this type of service could be potentially be useful in reducing the burden of pain and should be further investigated, ideally via randomised controlled trials assessing effectiveness and cost-effectiveness.

Optimal regulatory strategies for metabolic pathways in Escherichia coli depending on protein costs

PubMed Central

Wessely, Frank; Bartl, Martin; Guthke, Reinhard; Li, Pu; Schuster, Stefan; Kaleta, Christoph

2011-01-01

While previous studies have shed light on the link between the structure of metabolism and its transcriptional regulation, the extent to which transcriptional regulation controls metabolism has not yet been fully explored. In this work, we address this problem by integrating a large number of experimental data sets with a model of the metabolism of Escherichia coli. Using a combination of computational tools including the concept of elementary flux patterns, methods from network inference and dynamic optimization, we find that transcriptional regulation of pathways reflects the protein investment into these pathways. While pathways that are associated to a high protein cost are controlled by fine-tuned transcriptional programs, pathways that only require a small protein cost are transcriptionally controlled in a few key reactions. As a reason for the occurrence of these different regulatory strategies, we identify an evolutionary trade-off between the conflicting requirements to reduce protein investment and the requirement to be able to respond rapidly to changes in environmental conditions. PMID:21772263

Advisory Algorithm for Scheduling Open Sectors, Operating Positions, and Workstations

NASA Technical Reports Server (NTRS)

Bloem, Michael; Drew, Michael; Lai, Chok Fung; Bilimoria, Karl D.

2012-01-01

Air traffic controller supervisors configure available sector, operating position, and work-station resources to safely and efficiently control air traffic in a region of airspace. In this paper, an algorithm for assisting supervisors with this task is described and demonstrated on two sample problem instances. The algorithm produces configuration schedule advisories that minimize a cost. The cost is a weighted sum of two competing costs: one penalizing mismatches between configurations and predicted air traffic demand and another penalizing the effort associated with changing configurations. The problem considered by the algorithm is a shortest path problem that is solved with a dynamic programming value iteration algorithm. The cost function contains numerous parameters. Default values for most of these are suggested based on descriptions of air traffic control procedures and subject-matter expert feedback. The parameter determining the relative importance of the two competing costs is tuned by comparing historical configurations with corresponding algorithm advisories. Two sample problem instances for which appropriate configuration advisories are obvious were designed to illustrate characteristics of the algorithm. Results demonstrate how the algorithm suggests advisories that appropriately utilize changes in airspace configurations and changes in the number of operating positions allocated to each open sector. The results also demonstrate how the advisories suggest appropriate times for configuration changes.

Magnetic bearings: A key technology for advanced rocket engines?

NASA Technical Reports Server (NTRS)

Girault, J. PH.

1992-01-01

For several years, active magnetic bearings (AMB) have demonstrated their capabilities in many fields, from industrial compressors to control wheel suspension for spacecraft. Despite this broad area, no significant advance has been observed in rocket propulsion turbomachinery, where size, efficiency, and cost are crucial design criteria. To this respect, Societe Europeenne de Propulsion (SEP) had funded for several years significant efforts to delineate the advantages and drawbacks of AMB applied to rocket propulsion systems. Objectives of this work, relative technological basis, and improvements are described and illustrated by advanced turbopump layouts. Profiting from the advantages of compact design in cryogenic environments, the designs show considerable improvements in engine life, performances, and reliability. However, these conclusions should still be tempered by high recurrent costs, mainly due to the space-rated electronics. Development work focused on this point and evolution of electronics show the possibility to decrease production costs by an order of magnitude.

Conservation and laundry: using outside vendors to clean reusable linens.

PubMed

McKnight, D

1992-08-01

Using outside laundry facilities is a viable and efficient means for hospitals to clean and sanitize soiled linens. Such services also allow hospitals to achieve cost-effective linen systems. All kinds of linen products, including gowns, sheets, blankets, pillowcases, mops, diapers, and surgical textiles, are easily processed through such purveyors. Even newer fabrics with improved barrier protection qualities can be serviced. The three elements that make up the laundry cost equation are purchasing, processing, and usage. Improvements and reductions in any one of these areas positively affect the other two. With this in mind, a hospital and an outside laundry service should work closely together to improve linen management, to control usage, and to remove waste, thus reducing hospitals' per-patient-day costs. Close interaction and teamwork will make the relationship work with dynamic results. Together, both parties will grow and meet the ever-evolving needs of the health care industry.

Two-layer wireless distributed sensor/control network based on RF

NASA Astrophysics Data System (ADS)

Feng, Li; Lin, Yuchi; Zhou, Jingjing; Dong, Guimei; Xia, Guisuo

2006-11-01

A project of embedded Wireless Distributed Sensor/Control Network (WDSCN) based on RF is presented after analyzing the disadvantages of traditional measure and control system. Because of high-cost and complexity, such wireless techniques as Bluetooth and WiFi can't meet the needs of WDSCN. The two-layer WDSCN is designed based on RF technique, which operates in the ISM free frequency channel with low power and high transmission speed. Also the network is low cost, portable and moveable, integrated with the technologies of computer network, sensor, microprocessor and wireless communications. The two-layer network topology is selected in the system; a simple but efficient self-organization net protocol is designed to fit the periodic data collection, event-driven and store-and-forward. Furthermore, adaptive frequency hopping technique is adopted for anti-jamming apparently. The problems about power reduction and synchronization of data in wireless system are solved efficiently. Based on the discussion above, a measure and control network is set up to control such typical instruments and sensors as temperature sensor and signal converter, collect data, and monitor environmental parameters around. This system works well in different rooms. Experiment results show that the system provides an efficient solution to WDSCN through wireless links, with high efficiency, low power, high stability, flexibility and wide working range.

A decentralized approach to reducing the social costs of cascading failures

NASA Astrophysics Data System (ADS)

Hines, Paul

Large cascading failures in electrical power networks come with enormous social costs. These can be direct financial costs, such as the loss of refrigerated foods in grocery stores, or more indirect social costs, such as the traffic congestion that results from the failure of traffic signals. While engineers and policy makers have made numerous technical and organizational changes to reduce the frequency and impact of large cascading failures, the existing data, as described in Chapter 2 of this work, indicate that the overall frequency and impact of large electrical blackouts in the United States are not decreasing. Motivated by the cascading failure problem, this thesis describes a new method for Distributed Model Predictive Control and a power systems application. The central goal of the method, when applied to power systems, is to reduce the social costs of cascading failures by making small, targeted reductions in load and generation and changes to generator voltage set points. Unlike some existing schemes that operate from centrally located control centers, the method is operated by software agents located at substations distributed throughout the power network. The resulting multi-agent control system is a new approach to decentralized control, combining Distributed Model Predictive Control and Reciprocal Altruism. Experimental results indicate that this scheme can in fact decrease the average size, and thus social costs, of cascading failures. Over 100 randomly generated disturbances to a model of the IEEE 300 bus test network, the method resulted in nearly an order of magnitude decrease in average event size (measured in cost) relative to cascading failure simulations without remedial control actions. Additionally, the communication requirements for the method are measured, and found to be within the bandwidth capabilities of current communications technology (on the order of 100kB/second). Experiments on several resistor networks with varying structures, including a random graph, a scale-free network and a power grid indicate that the effectiveness of decentralized control schemes, like the method proposed here, is a function of the structure of the network that is to be controlled.

Evidence for composite cost functions in arm movement planning: an inverse optimal control approach.

PubMed

Berret, Bastien; Chiovetto, Enrico; Nori, Francesco; Pozzo, Thierry

2011-10-01

An important issue in motor control is understanding the basic principles underlying the accomplishment of natural movements. According to optimal control theory, the problem can be stated in these terms: what cost function do we optimize to coordinate the many more degrees of freedom than necessary to fulfill a specific motor goal? This question has not received a final answer yet, since what is optimized partly depends on the requirements of the task. Many cost functions were proposed in the past, and most of them were found to be in agreement with experimental data. Therefore, the actual principles on which the brain relies to achieve a certain motor behavior are still unclear. Existing results might suggest that movements are not the results of the minimization of single but rather of composite cost functions. In order to better clarify this last point, we consider an innovative experimental paradigm characterized by arm reaching with target redundancy. Within this framework, we make use of an inverse optimal control technique to automatically infer the (combination of) optimality criteria that best fit the experimental data. Results show that the subjects exhibited a consistent behavior during each experimental condition, even though the target point was not prescribed in advance. Inverse and direct optimal control together reveal that the average arm trajectories were best replicated when optimizing the combination of two cost functions, nominally a mix between the absolute work of torques and the integrated squared joint acceleration. Our results thus support the cost combination hypothesis and demonstrate that the recorded movements were closely linked to the combination of two complementary functions related to mechanical energy expenditure and joint-level smoothness.

Cost-effectiveness of environmental management for vector control in resource development projects.

PubMed

Bos, R

1991-01-01

Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the general health services will make it even more difficult to gain a clear insight in the matter.

Main control computer security model of closed network systems protection against cyber attacks

NASA Astrophysics Data System (ADS)

Seymen, Bilal

2014-06-01

The model that brings the data input/output under control in closed network systems, that maintains the system securely, and that controls the flow of information through the Main Control Computer which also brings the network traffic under control against cyber-attacks. The network, which can be controlled single-handedly thanks to the system designed to enable the network users to make data entry into the system or to extract data from the system securely, intends to minimize the security gaps. Moreover, data input/output record can be kept by means of the user account assigned for each user, and it is also possible to carry out retroactive tracking, if requested. Because the measures that need to be taken for each computer on the network regarding cyber security, do require high cost; it has been intended to provide a cost-effective working environment with this model, only if the Main Control Computer has the updated hardware.

Cost-effectiveness of detecting and treating diabetic retinopathy.

PubMed

Javitt, J C; Aiello, L P

1996-01-01

To determine, from the health insurer's perspective, the cost of preventing vision loss in patients with diabetes mellitus through ophthalmologic screening and treatment and to calculate the cost-effectiveness of these interventions as compared with that of other medical interventions. Computer modeling, incorporating data from population-based epidemiologic studies and multicenter clinical trials. Monte Carlo simulation was used, combined with sensitivity analysis and present value analysis of cost savings. Screening and treatment of eye disease in patients with diabetes mellitus costs $3190 per quality-adjusted life-year (QALY) saved. This average cost is a weighted average (based on prevalence disease) of the cost-effectiveness of detecting and treating diabetic eye disease in those with insulin-dependent diabetes mellitus ($1996 per QALY), those with non-insulin-dependent diabetes mellitus (NIDDM) who use insulin for glycemic control ($2933 per QALY), and those with NIDDM who do not use insulin for glycemic control ($3530 per QALY). Our analysis indicates that prevention programs aimed at improving eye care for diabetic persons not only result in substantial federal budgetary savings but are highly cost-effective health investments for society. Ophthalmologic screening for diabetic persons is more cost-effective than many routinely provided health interventions. Because diabetic eye disease is the leading cause of new cases of blindness among working-age Americans, these results support the widespread use of screening and treatment for diabetic eye disease.

The Mental Vitality @ Work study: design of a randomized controlled trial on the effect of a workers' health surveillance mental module for nurses and allied health professionals

PubMed Central

2011-01-01

Background Employees in health care service are at high risk for developing mental health complaints. The effects of mental health complaints on work can have serious consequences for the quality of care provided by these workers. To help health service workers remain healthy and productive, preventive actions are necessary. A Workers' Health Surveillance (WHS) mental module may be an effective strategy to monitor and promote good (mental) health and work performance. The objective of this paper is to describe the design of a three arm cluster randomized controlled trial on the effectiveness of a WHS mental module for nurses and allied health professionals. Two strategies for this WHS mental module will be compared along with data from a control group. Additionally, the cost effectiveness of the approaches will be evaluated from a societal perspective. Methods The study is designed as a cluster randomized controlled trial consisting of three arms (two intervention groups, 1 control group) with randomization at ward level. The study population consists of 86 departments in one Dutch academic medical center with a total of 1731 nurses and allied health professionals. At baseline, after three months and after six months of follow-up, outcomes will be assessed by online questionnaires. In both intervention arms, participants will complete a screening to detect problems in mental health and work functioning and receive feedback on their screening results. In cases of impairments in mental health or work functioning in the first intervention arm, a consultation with an occupational physician will be offered. The second intervention arm offers a choice of self-help e-mental health interventions, which will be tailored based on each individual's mental health state and work functioning. The primary outcomes will be help-seeking behavior and work functioning. Secondary outcomes will be mental health and wellbeing. Furthermore, cost-effectiveness in both intervention arms will be assessed, and a process evaluation will be performed. Discussion When it is proven effective compared to a control group, a WHS mental module for nurses and allied health professionals could be implemented and used on a regular basis by occupational health services in hospitals to improve employees' mental health and work functioning. Trial Registration NTR2786 PMID:21569282

Advanced Outage and Control Center: Strategies for Nuclear Plant Outage Work Status Capabilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gregory Weatherby

The research effort is a part of the Light Water Reactor Sustainability (LWRS) Program. LWRS is a research and development program sponsored by the Department of Energy, performed in close collaboration with industry to provide the technical foundations for licensing and managing the long-term, safe and economical operation of current nuclear power plants. The LWRS Program serves to help the US nuclear industry adopt new technologies and engineering solutions that facilitate the continued safe operation of the plants and extension of the current operating licenses. The Outage Control Center (OCC) Pilot Project was directed at carrying out the applied researchmore » for development and pilot of technology designed to enhance safe outage and maintenance operations, improve human performance and reliability, increase overall operational efficiency, and improve plant status control. Plant outage management is a high priority concern for the nuclear industry from cost and safety perspectives. Unfortunately, many of the underlying technologies supporting outage control are the same as those used in the 1980’s. They depend heavily upon large teams of staff, multiple work and coordination locations, and manual administrative actions that require large amounts of paper. Previous work in human reliability analysis suggests that many repetitive tasks, including paper work tasks, may have a failure rate of 1.0E-3 or higher (Gertman, 1996). With between 10,000 and 45,000 subtasks being performed during an outage (Gomes, 1996), the opportunity for human error of some consequence is a realistic concern. Although a number of factors exist that can make these errors recoverable, reducing and effectively coordinating the sheer number of tasks to be performed, particularly those that are error prone, has the potential to enhance outage efficiency and safety. Additionally, outage management requires precise coordination of work groups that do not always share similar objectives. Outage managers are concerned with schedule and cost, union workers are concerned with performing work that is commensurate with their trade, and support functions (safety, quality assurance, and radiological controls, etc.) are concerned with performing the work within the plants controls and procedures. Approaches to outage management should be designed to increase the active participation of work groups and managers in making decisions that closed the gap between competing objectives and the potential for error and process inefficiency.« less

The Mental Vitality @ Work study: design of a randomized controlled trial on the effect of a workers' health surveillance mental module for nurses and allied health professionals.

PubMed

Gärtner, Fania R; Ketelaar, Sarah M; Smeets, Odile; Bolier, Linda; Fischer, Eva; van Dijk, Frank J H; Nieuwenhuijsen, Karen; Sluiter, Judith K

2011-05-10

Employees in health care service are at high risk for developing mental health complaints. The effects of mental health complaints on work can have serious consequences for the quality of care provided by these workers. To help health service workers remain healthy and productive, preventive actions are necessary. A Workers' Health Surveillance (WHS) mental module may be an effective strategy to monitor and promote good (mental) health and work performance. The objective of this paper is to describe the design of a three arm cluster randomized controlled trial on the effectiveness of a WHS mental module for nurses and allied health professionals. Two strategies for this WHS mental module will be compared along with data from a control group. Additionally, the cost effectiveness of the approaches will be evaluated from a societal perspective. The study is designed as a cluster randomized controlled trial consisting of three arms (two intervention groups, 1 control group) with randomization at ward level. The study population consists of 86 departments in one Dutch academic medical center with a total of 1731 nurses and allied health professionals. At baseline, after three months and after six months of follow-up, outcomes will be assessed by online questionnaires. In both intervention arms, participants will complete a screening to detect problems in mental health and work functioning and receive feedback on their screening results. In cases of impairments in mental health or work functioning in the first intervention arm, a consultation with an occupational physician will be offered. The second intervention arm offers a choice of self-help e-mental health interventions, which will be tailored based on each individual's mental health state and work functioning. The primary outcomes will be help-seeking behavior and work functioning. Secondary outcomes will be mental health and wellbeing. Furthermore, cost-effectiveness in both intervention arms will be assessed, and a process evaluation will be performed. When it is proven effective compared to a control group, a WHS mental module for nurses and allied health professionals could be implemented and used on a regular basis by occupational health services in hospitals to improve employees' mental health and work functioning. NTR2786.

Site planning and integration fiscal year 1999 multi-year work plan (MYWP) update for WBS 1.8.2.1

DOE Office of Scientific and Technical Information (OSTI.GOV)

SCHULTZ, E.A.

The primary mission of the Site Planning and Integration (SP and I) project is to assist Fluor Daniel Project Direction to ensure that all work performed under the Project Hanford Management Contract (PHMC) is adequately planned, executed, controlled, and that performance is measured and reported in an integrated fashion. Furthermore, SP and I is responsible for the development, implementation, and management of systems and processes that integrate technical, schedule, and cost baselines for PHMC work.

Flexible workspace design and ergonomics training: impacts on the psychosocial work environment, musculoskeletal health, and work effectiveness among knowledge workers.

PubMed

Robertson, Michelle M; Huang, Yueng-Hsiang; O'Neill, Michael J; Schleifer, Lawrence M

2008-07-01

A macroergonomics intervention consisting of flexible workspace design and ergonomics training was conducted to examine the effects on psychosocial work environment, musculoskeletal health, and work effectiveness in a computer-based office setting. Knowledge workers were assigned to one of four conditions: flexible workspace (n=121), ergonomics training (n=92), flexible workspace+ergonomics training (n=31), and a no-intervention control (n=45). Outcome measures were collected 2 months prior to the intervention and 3 and 6 months post-intervention. Overall, the study results indicated positive, significant effects on the outcome variables for the two intervention groups compared to the control group, including work-related musculoskeletal discomfort, job control, environmental satisfaction, sense of community, ergonomic climate, communication and collaboration, and business process efficiency (time and costs). However, attrition of workers in the ergonomics training condition precluded an evaluation of the effects of this intervention. This study suggests that a macroergonomics intervention is effective among knowledge workers in office settings.

Opioid therapy for nonspecific low back pain and the outcome of chronic work loss.

PubMed

Volinn, Ernest; Fargo, Jamison D; Fine, Perry G

2009-04-01

Outcomes of opioid therapy for noncancer pain remain to be more fully explored. Loss of work is among these outcomes. Especially when work loss becomes "chronic" (persists >or=90 days), it has profound psycho-social repercussions that compound suffering of those already in pain. Furthermore, costs escalate as work loss persists. We thus explored associations between opioid therapy for back pain and chronic work loss. Data consisted of workers compensation claims for nonspecific low back pain. We used multivariate analyses to control for diverse covariates. Workers with no opioid prescriptions constituted the reference group. Findings included the following: compared with the (no opioid) reference group, odds of chronic work loss were six times greater for claimants with schedule II ("strong") opioids; compared with the reference group, odds of chronic work loss were 11-14 times greater for claimants with opioid prescriptions of any type during a period of >or=90 days; and three years after injury, costs of claimants with schedule II opioids averaged $19,453 higher than costs of claimants in the reference group. Our analysis was not designed to ascertain antecedent causes, or why chronic work loss occurred in the first place. Rather, we focused on an ensuing consequence of opioid therapy, i.e., the outcome of chronic work loss, which occurred far removed in time (>or=90 days) after the worker's recorded date of back injury. The strong associations observed suggest that for most workers opioid therapy did not arrest the cycle of work loss and pain.

A stochastic optimal feedforward and feedback control methodology for superagility

NASA Technical Reports Server (NTRS)

Halyo, Nesim; Direskeneli, Haldun; Taylor, Deborah B.

1992-01-01

A new control design methodology is developed: Stochastic Optimal Feedforward and Feedback Technology (SOFFT). Traditional design techniques optimize a single cost function (which expresses the design objectives) to obtain both the feedforward and feedback control laws. This approach places conflicting demands on the control law such as fast tracking versus noise atttenuation/disturbance rejection. In the SOFFT approach, two cost functions are defined. The feedforward control law is designed to optimize one cost function, the feedback optimizes the other. By separating the design objectives and decoupling the feedforward and feedback design processes, both objectives can be achieved fully. A new measure of command tracking performance, Z-plots, is also developed. By analyzing these plots at off-nominal conditions, the sensitivity or robustness of the system in tracking commands can be predicted. Z-plots provide an important tool for designing robust control systems. The Variable-Gain SOFFT methodology was used to design a flight control system for the F/A-18 aircraft. It is shown that SOFFT can be used to expand the operating regime and provide greater performance (flying/handling qualities) throughout the extended flight regime. This work was performed under the NASA SBIR program. ICS plans to market the software developed as a new module in its commercial CACSD software package: ACET.

Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial.

PubMed

Lambeek, Ludeke C; Bosmans, Judith E; Van Royen, Barend J; Van Tulder, Maurits W; Van Mechelen, Willem; Anema, Johannes R

2010-11-30

To evaluate the cost effectiveness, cost utility, and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain. Economic evaluation alongside a randomised controlled trial with 12 months' follow-up. Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals) in the Netherlands, 2005-9. 134 adults aged 18-65 sick listed because of chronic low back pain: 66 were randomised to integrated care and 68 to usual care. Integrated care consisted of a workplace intervention based on participatory ergonomics, with involvement of a supervisor, and a graded activity programme based on cognitive behavioural principles. Usual care was provided by general practitioners and occupational physicians according to Dutch guidelines. The primary outcome was duration until sustainable return to work. The secondary outcome was quality adjusted life years (QALYs), measured using EuroQol. Total costs in the integrated care group (£13 165, SD £13 600) were significantly lower than in the usual care group (£18 475, SD £13 616). Cost effectiveness planes and acceptability curves showed that integrated care was cost effective compared with usual care for return to work and QALYs gained. The cost-benefit analyses showed that every £1 invested in integrated care would return an estimated £26. The net societal benefit of integrated care compared with usual care was £5744. Implementation of an integrated care programme for patients sick listed with chronic low back pain has a large potential to significantly reduce societal costs, increase effectiveness of care, improve quality of life, and improve function on a broad scale. Integrated care therefore has large gains for patients and society as well as for employers.

Automatic and strategic effects in the guidance of attention by working memory representations

PubMed Central

Carlisle, Nancy B.; Woodman, Geoffrey F.

2010-01-01

Theories of visual attention suggest that working memory representations automatically guide attention toward memory-matching objects. Some empirical tests of this prediction have produced results consistent with working memory automatically guiding attention. However, others have shown that individuals can strategically control whether working memory representations guide visual attention. Previous studies have not independently measured automatic and strategic contributions to the interactions between working memory and attention. In this study, we used a classic manipulation of the probability of valid, neutral, and invalid cues to tease apart the nature of such interactions. This framework utilizes measures of reaction time (RT) to quantify the costs and benefits of attending to memory-matching items and infer the relative magnitudes of automatic and strategic effects. We found both costs and benefits even when the memory-matching item was no more likely to be the target than other items, indicating an automatic component of attentional guidance. However, the costs and benefits essentially doubled as the probability of a trial with a valid cue increased from 20% to 80%, demonstrating a potent strategic effect. We also show that the instructions given to participants led to a significant change in guidance distinct from the actual probability of events during the experiment. Together, these findings demonstrate that the influence of working memory representations on attention is driven by both automatic and strategic interactions. PMID:20643386

Automatic and strategic effects in the guidance of attention by working memory representations.

PubMed

Carlisle, Nancy B; Woodman, Geoffrey F

2011-06-01

Theories of visual attention suggest that working memory representations automatically guide attention toward memory-matching objects. Some empirical tests of this prediction have produced results consistent with working memory automatically guiding attention. However, others have shown that individuals can strategically control whether working memory representations guide visual attention. Previous studies have not independently measured automatic and strategic contributions to the interactions between working memory and attention. In this study, we used a classic manipulation of the probability of valid, neutral, and invalid cues to tease apart the nature of such interactions. This framework utilizes measures of reaction time (RT) to quantify the costs and benefits of attending to memory-matching items and infer the relative magnitudes of automatic and strategic effects. We found both costs and benefits even when the memory-matching item was no more likely to be the target than other items, indicating an automatic component of attentional guidance. However, the costs and benefits essentially doubled as the probability of a trial with a valid cue increased from 20% to 80%, demonstrating a potent strategic effect. We also show that the instructions given to participants led to a significant change in guidance distinct from the actual probability of events during the experiment. Together, these findings demonstrate that the influence of working memory representations on attention is driven by both automatic and strategic interactions. Copyright © 2010 Elsevier B.V. All rights reserved.

Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560].

PubMed

Steenstra, Ivan A; Anema, Johannes R; Bongers, Paulien M; de Vet, Henrica C W; van Mechelen, Willem

2003-11-21

To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2-8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management. An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiophobia and pain coping. The cost-effectiveness analysis includes the direct and indirect costs due to low back pain. The outcome measures are assessed before randomization (after 2-6 weeks on sick leave) and 12 weeks, 26 weeks and 52 weeks after first day of sick leave. The combination of these interventions has been subject of earlier research in Canada. The results of the current RCT will: 1. crossvalidate the Canadian findings in an different sociocultural environment; 2. add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain. Results might lead to alterations of existing (inter)national guidelines.

The Economic Value of Long-Lasting Insecticidal Nets and Indoor Residual Spraying Implementation in Mozambique

PubMed Central

Lee, Bruce Y.; Bartsch, Sarah M.; Stone, Nathan T. B.; Zhang, Shufang; Brown, Shawn T.; Chatterjee, Chandrani; DePasse, Jay V.; Zenkov, Eli; Briët, Olivier J. T.; Mendis, Chandana; Viisainen, Kirsi; Candrinho, Baltazar; Colborn, James

2017-01-01

Malaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology. PMID:28719286

Improving return-to-work after childbirth: design of the Mom@Work study, a randomised controlled trial and cohort study.

PubMed

Stomp-van den Berg, Suzanne G M; van Poppel, Mireille N M; Hendriksen, Ingrid J M; Bruinvels, David J; Uegaki, Kimi; de Bruijne, Martine C; van Mechelen, Willem

2007-03-29

Many women suffer from health problems after giving birth, which can lead to sick leave. About 30% of Dutch workers are on sick leave after maternity leave. Structural contact of supervisors with employees on maternity leave, supported by early medical advice of occupational physicians, may increase the chances of return-to-work after maternity leave. In addition, to understand the process of sick leave and return-to-work after childbirth it is important to gain insight into which factors hinder return-to-work after childbirth, as well, as which prognostic factors lead to the development of postpartum health complaints. In this paper, the design of the Mom@Work study is described. The Mom@Work study is simultaneously a randomised controlled trial and a cohort study. Pregnant women working for at least 12 hours a week at one of the 15 participating companies are eligible to participate. The supervisors of these pregnant employees are randomised at 35 weeks pregnancy into the intervention group or control group. During maternity leave, supervisors in the intervention group contact their employee six weeks after delivery using a structured interview. When employees do not expect to return to their jobs at the end of their scheduled maternity leave due to health problems, the supervisor offers early support of the occupational physician. Supervisors in the control group have no structural contact with their employees during maternity leave. Measurements take place at 30 weeks pregnancy and at 6, 12, 24 and 52 weeks postpartum. In addition, cost data are collected. For the RCT, primary outcome measures are sick leave and return-to-work, and secondary outcome measures are costs, health, satisfaction with intervention and global feelings of recovery. Outcome measures for the cohort are pregnancy-related pelvic girdle pain, fatigue and depression. Finally, a number of prognostic factors for return-to-work and for the development of complaints will be measured. The Mom@Work study will provide important information about return-to-work of employees after giving birth. Results will give insight in prognosis of postpartum sick leave and complaints. Also, the role of supervisors and occupational physicians in successful return-to-work after childbirth will be clarified.

Concluding Thoughts

ERIC Educational Resources Information Center

Palmer, James C.

2014-01-01

Community college leaders face several fundamental challenges as they work on sustaining the fiscal viability of their institutions. These include the need to anticipate the unintended consequences of performance-based funding, diversify revenue streams in ways that reduce fiscal dependence on tuition and state appropriations, control costs, and…

Case Management: Service or Symptom?

ERIC Educational Resources Information Center

Netting, F. Ellen

1992-01-01

Provides overview of case management, its history, and contemporary models. Examines challenges that case management poses for social work profession: covering up issue that health and human services delivery system is nonsystem; maintaining client-centered perspective in cost-obsessed environment; dealing with quality control; coping with…

Buying Into Maintenance.

ERIC Educational Resources Information Center

May, Abigail

1998-01-01

Describes how educational institutions are recognizing the short-sightedness of deferred maintenance. Discusses the challenges facing schools as they confront maintenance costs and what they must do to address the problem. Offers advice on proactive stances toward maintenance such as computerized work control processes, maintenance zones, and…

21 CFR 1404.445 - What action may I take if a primary tier participant knowingly does business with an excluded or...

Code of Federal Regulations, 2010 CFR

2010-04-01

... may also disallow costs, annul or terminate the transaction, issue a stop work order, or take any... (NONPROCUREMENT) Responsibilities of Office of National Drug Control Policy Officials Regarding Transactions...

Handbook for industrial noise control

NASA Technical Reports Server (NTRS)

1981-01-01

The basic principles of sound, measuring techniques, and instrumentation associated with general purpose noise control are discussed. Means for identifying and characterizing a noise problem so that subsequent work may provide the most efficient and cost effective solution are outlined. A methodology for choosing appropriate noise control materials and the proper implementation of control procedures is detailed. The most significant NASA sponsored contributions to the state of the art development of optimum noise control technologies are described including cases in which aeroacoustics and related research have shed some light on ways of reducing noise generation at its source.

Handbook for industrial noise control

NASA Astrophysics Data System (ADS)

The basic principles of sound, measuring techniques, and instrumentation associated with general purpose noise control are discussed. Means for identifying and characterizing a noise problem so that subsequent work may provide the most efficient and cost effective solution are outlined. A methodology for choosing appropriate noise control materials and the proper implementation of control procedures is detailed. The most significant NASA sponsored contributions to the state of the art development of optimum noise control technologies are described including cases in which aeroacoustics and related research have shed some light on ways of reducing noise generation at its source.

How to prevent trachoma and blindness.

PubMed

1995-01-01

The etiology associated with the loss of vision due to trachoma has been studied in great detail; so much so, that this cause of human suffering and potential blindness is now considered preventable. This brief communication describes the issues of trachoma prevention, available treatment, cost of prevention, and implementation challenges to establishing a program and making it work. International organizations such as WHO and UNICEF, in collaboration with nongovernmental organizations (NGOs) and local and national governments, have designed a simple yet effective trachoma control program. At the center of the program is community involvement. Better sanitation and access to clean water are two important community issues. Health education from childhood to adulthood is also critical. Individual knowledge about this disease has direct self-care implications (e.g., increased face washing). Treatment consists of antibiotics or simple surgery. Both have been developed to be low-cost and effective. National health officials must determine where health care funds are to be spent. This trachoma control program should be considered cost-effective. Materials and training are available for program implementation. Cost need no longer be the limiting factor in the establishment of a trachoma prevention and control program.

Openstage: A Low-Cost Motorized Microscope Stage with Sub-Micron Positioning Accuracy

PubMed Central

Campbell, Robert A. A.; Eifert, Robert W.; Turner, Glenn C.

2014-01-01

Recent progress in intracellular calcium sensors and other fluorophores has promoted the widespread adoption of functional optical imaging in the life sciences. Home-built multiphoton microscopes are easy to build, highly customizable, and cost effective. For many imaging applications a 3-axis motorized stage is critical, but commercially available motorization hardware (motorized translators, controller boxes, etc) are often very expensive. Furthermore, the firmware on commercial motor controllers cannot easily be altered and is not usually designed with a microscope stage in mind. Here we describe an open-source motorization solution that is simple to construct, yet far cheaper and more customizable than commercial offerings. The cost of the controller and motorization hardware are under $1000. Hardware costs are kept low by replacing linear actuators with high quality stepper motors. Electronics are assembled from commonly available hobby components, which are easy to work with. Here we describe assembly of the system and quantify the positioning accuracy of all three axes. We obtain positioning repeatability of the order of in X/Y and in Z. A hand-held control-pad allows the user to direct stage motion precisely over a wide range of speeds ( to ), rapidly store and return to different locations, and execute “jumps” of a fixed size. In addition, the system can be controlled from a PC serial port. Our “OpenStage” controller is sufficiently flexible that it could be used to drive other devices, such as micro-manipulators, with minimal modifications. PMID:24586468

Into Turbulent Air: Hummingbird Aerodynamic Control in Unsteady Circumstances

DTIC Science & Technology

2016-06-24

costs of flight. We have also completed studies of hummingbird hovering flight within a vertical wind tunnel to enable study of the vortex ring state...vertical wind tunnel to enable study of the vortex ring state, a well-known problem in helicopter descent. This work evaluated both ascending and...wakes. DISTRIBUTION A: Distribution approved for public release. Our work with hummingbirds hovering in a vertical wind tunnel has enabled

Defense AT and L, Volume 42, Number 4, July-August 2013

DTIC Science & Technology

2013-07-01

to Controlling Costs Steven Hurt and Alan Heckler DoD design of support concepts for all weapon systems must be structurally...Manager, is published bimonthly by the DAU Press and is free to all U.S. and foreign national subscribers. Periodical postage is paid at the U.S...works in defense acqui- sition, technology, and logistics for all the hard work, dedication, professionalism, and, increasingly, the patience and

A Manual of Mosquito Control Projects and Committee Assignments for 4-H and Scouts Biology Class Projects, Organized Community Service Programs, and Individuals Interested in Environmental Management.

ERIC Educational Resources Information Center

Hart, Richard A.

The mosquito control projects presented in this manual were prepared from an educational viewpoint and are intended for use by students in 4-H and Scouts and as a supplement to high school and college biology course work. The major emphasis of the projects is on integrated pest management, an approach utilizing cost-effective control methods which…

Strategies to reduce safety violations for working from heights in construction companies: study protocol for a randomized controlled trial.

PubMed

van der Molen, Henk F; Frings-Dresen, Monique H W

2014-05-31

Safety measures should be applied to reduce work-related fatal and non-fatal fall injuries. However, according to the labor inspectorate, more than 80% of Dutch construction sites violate safety regulations for working from heights. To increase compliance with safety regulations, employers and workers have to select, implement and monitor safety measures. To facilitate this behavioral change, stimulating knowledge awareness and personalized feedback are frequently advocated behavior change techniques. For this study, two behavior change strategies have been developed in addition to the announcement of safety inspections by the labor inspectorate. These strategies consist of 1) face-to-face contacts with safety consultants and 2) direct mail with access to internet facilities. The objective of this study is to evaluate the effectiveness of these two strategies on the safety violations for working from heights, the process and the cost measures. This study is a block randomized intervention trial in 27 cities to establish the effects of the face-to-face guidance strategy (N = 9), a direct mailing strategy (N = 9) and a control condition of no guidance (N = 9) on safety violations to record by labor inspectors after three months. A process evaluation for both strategies will be performed to determine program implementation (reach, dose delivered and dose received), satisfaction, knowledge and perceived safety behavior. A cost analysis will be performed to establish the financial costs for both strategies. The present study is in accordance with the CONSORT statement. This study increases insight into performing practice-based randomized controlled trials. The outcome will help to evaluate the effect of two guidance strategies on safety violations. If these strategies are effective, implementation of these strategies through the national institute of safety and health or labor inspectorate can take place to guide construction companies in complying with safety regulations. NTR 4298 on 29-nov-2013.

Development of Low-cost plotter for educational purposes using Arduino

NASA Astrophysics Data System (ADS)

Karthik, Siriparapu; Thirumal Reddy, Palwai; Marimuthu, K. Prakash

2017-08-01

With the development of CAD/CAM/CAE concept to product realization time has reduced drastically. Most of the activities such as design, drafting, and visualizations are carried out using high-end computers and commercial software. This has reduced the overall lead-time to market. It is important in the current scenario to equip the students with knowledge of advanced technological developments in order to use them effectively. However, the cost associated with the systems are very high which is not affordable to students. The present work is an attempt to build a low-cost plotter integrating some of the software that are available and components got from scrapped electronic devices. Here the authors are introducing G-code plotter with 3-axis which can implement the given g-code in 2D plane (X-Y). Lifting pen and adjusting to the base component is in the Z-axis. All conventional plotting devices existing until date are costly and need basic knowledge before operating. Our aim is to make students understand the working of plotter and the usage of G-code, achieving this at a much affordable cost. Arduino Uno controls the stepper motors, which can accurately plot the given dimensions.

Teaming Up for Asthma Control: EPR-3 Compliant School Program in Missouri Is Effective and Cost-Efficient.

PubMed

Francisco, Benjamin; Rood, Tammy; Nevel, Rebekah; Foreman, Paul; Homan, Sherri

2017-05-25

Teaming Up for Asthma Control (TUAC) is a work force development intervention to improve asthma control among children by increasing the competency of school nurses and delivering guideline-based education. We hypothesized that the knowledge and skills of participating school nurses would improve and that this change would positively affect students' asthma health and reduce health care utilization cost. Asthma education for school nurses was provided online in a pretest/posttest format or in instructor-led groups. Students with persistent asthma were identified by using a checklist. Expert evaluators obtained student participants' preassessments/postassessments before and after the 3 asthma checkups by the school nurse, and the assessments were compared. Health care costs were assessed using Medicaid administrative claims data. A total of 54 school nurses and 178 students in Missouri participated in the TUAC evaluation from 2011 through 2014. Among school nurses who completed the online education (n = 42, 77.8%), knowledge scores significantly increased from pretest (49.1%) to posttest (90.7%, P < .001). Of school nurses who completed assessments on 3 children (n = 34), 91.2% met the ±6% equivalence for 1 or more assessments on forced expiratory volume in 1 second (FEV 1 ) compared with the expert evaluator. At enrollment, 69.7% of students had "not well-controlled" or "very poorly controlled" asthma. Postintervention, FEV 1 significantly improved (82.9% to 92.1% predicted), and self-reported impairment and tobacco smoke exposure significantly declined (P < .001). For TUAC students enrolled in Medicaid, there was an average 12-month health care cost difference (-$1,431) compared with controls. School nurses effectively assessed asthma status, students' outcomes improved, and health care utilization costs declined. This evaluation contributed to program improvements to further improve health outcomes among students with asthma.

Economics of ingot slicing with an internal diameter saw for low-cost solar cells

NASA Technical Reports Server (NTRS)

Daud, T.; Liu, J. K.; Fiegl, G.

1981-01-01

Slicing of silicon ingots using diamond impregnated internal diameter blade saws has been a standard technology of the semiconductor industry. This paper describes work on improvements to this technology for 10 cm diameter ingot slicing. Ingot rotation, dynamic blade edge control with feedback, mechanized blade dressing and development of thinner blades are the approaches tried. A comparison of the results for wafering with and without ingot rotation is also made. A sensitivity analysis of the major cost elements in wafering is performed for 10 cm diameter ingot and extended to the 15 cm diameter ingot case. Various parameter values such as machine cost, feed rate and consumable materials cost are identified both for single and multiple ingot slicing.

Cost-effectiveness of the screening and treatment of diabetic retinopathy. What are the costs of underutilization?

PubMed

Fendrick, A M; Javitt, J C; Chiang, Y P

1992-01-01

Diabetic retinal disease remains a leading cause of visual disability among those of working age. Controlled trials have demonstrated that timely diagnosis and photocoagulation treatment can reduce significantly the likelihood of visual impairment in affected diabetic patients. Using a prospective simulation model, we show that an annual screening and treatment program saves thousands of years of vision and reduces medical expenditures over the lifetime of a cohort of Swedish Type I diabetic patients.

Mapping the benefit-cost ratios of interventions against bovine trypanosomosis in Eastern Africa.

PubMed

Shaw, A P M; Wint, G R W; Cecchi, G; Torr, S J; Mattioli, R C; Robinson, T P

2015-12-01

This study builds upon earlier work mapping the potential benefits from bovine trypanosomosis control and analysing the costs of different approaches. Updated costs were derived for five intervention techniques: trypanocides, targets, insecticide-treated cattle, aerial spraying and the release of sterile males. Two strategies were considered: continuous control and elimination. For mapping the costs, cattle densities, environmental constraints, and the presence of savannah or riverine tsetse species were taken into account. These were combined with maps of potential benefits to produce maps of benefit-cost ratios. The results illustrate a diverse picture, and they clearly indicate that no single technique or strategy is universally profitable. For control using trypanocide prophylaxis, returns are modest, even without accounting for the risk of drug resistance but, in areas of low cattle densities, this is the only approach that yields a positive return. Where cattle densities are sufficient to support it, the use of insecticide-treated cattle stands out as the most consistently profitable technique, widely achieving benefit-cost ratios above 5. In parts of the high-potential areas such as the mixed farming, high-oxen-use zones of western Ethiopia, the fertile crescent north of Lake Victoria and the dairy production areas in western and central Kenya, all tsetse control strategies achieve benefit-cost ratios from 2 to over 15, and for elimination strategies, ratios from 5 to over 20. By contrast, in some areas, notably where cattle densities are below 20per km(2), the costs of interventions against tsetse match or even outweigh the benefits, especially for control scenarios using aerial spraying or the deployment of targets where both savannah and riverine flies are present. If the burden of human African trypanosomosis were factored in, the benefit-cost ratios of some of the low-return areas would be considerably increased. Comparatively, elimination strategies give rise to higher benefit-cost ratios than do those for continuous control. However, the costs calculated for elimination assume problem-free, large scale operations, and they rest on the outputs of entomological models that are difficult to validate in the field. Experience indicates that the conditions underlying successful and sustained elimination campaigns are seldom met. By choosing the most appropriate thresholds for benefit-cost ratios, decision-makers and planners can use the maps to define strategies, assist in prioritising areas for intervention, and help choose among intervention techniques and approaches. The methodology would have wider applicability in analysing other disease constraints with a strong spatial component. Copyright © 2015 A.P.M Shaw. Published by Elsevier B.V. All rights reserved.

Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory: A Randomized Clinical Trial.

PubMed

Roberts, Gehan; Quach, Jon; Spencer-Smith, Megan; Anderson, Peter J; Gathercole, Susan; Gold, Lisa; Sia, Kah-Ling; Mensah, Fiona; Rickards, Field; Ainley, John; Wake, Melissa

2016-05-02

Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking. To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching. Population-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses. Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes' duration at school. Directly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs. Of 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, -3.0 [95% CI, -5.4 to -0.7]; P = .01). Intervention costs were A$1035 per child. Working memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm. anzctr.org.au Identifier: ACTRN12610000486022.

Distraction control processes in free recall: benefits and costs to performance.

PubMed

Marsh, John E; Sörqvist, Patrik; Hodgetts, Helen M; Beaman, C Philip; Jones, Dylan M

2015-01-01

How is semantic memory influenced by individual differences under conditions of distraction? This question was addressed by observing how participants recalled visual target words--drawn from a single category--while ignoring spoken distractor words that were members of either the same or a different (single) category. Working memory capacity (WMC) was related to disruption only with synchronous, not asynchronous, presentation, and distraction was greater when the words were presented synchronously. Subsequent experiments found greater negative priming of distractors among individuals with higher WMC, but this may be dependent on targets and distractors being comparable category exemplars. With less dominant category members as distractors, target recall was impaired--relative to control--only among individuals with low WMC. The results highlight the role of cognitive control resources in target-distractor selection and the individual-specific cost implications of such cognitive control. PsycINFO Database Record (c) 2015 APA, all rights reserved.

Maximum Power Point tracking charge controllers for telecom applications -- Analysis and economics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wills, R.H.

Simple charge controllers connect photovoltaic modules directly to the battery bank resulting in a significant power loss if the battery bank voltage differs greatly from the PV Maximum Power Point (MPP) voltage. Recent modeling work at AES has shown that dc-dc converter type MPP tracking charge controllers can deliver more than 30% more energy from PV modules to the battery when the PV modules are cool and the battery state of charge is low--this is typically both the worst case condition (i.e., winter) and also the design condition that determines the PV array size. Economic modeling, based on typical telecommore » system installed costs shows benefits of more than $3/Wp for MPPT over conventional charge controllers in this application--a value that greatly exceeds the additional cost of the dc-dc converter.« less

An Ongoing Revolution: Resource Sharing and OCLC.

ERIC Educational Resources Information Center

Nevins, Kate

1998-01-01

Discusses early developments in the Online Computer Library Center (OCLC) interlibrary loan, including use of OCLC for verification and request transmittal, improved service to patrons, internal cost control, affect on work flow and borrowing patterns. Describes advances in OCLC, including internationalization, electronic information access,…

Inventory of federal data systems in the United states for injury surveillance, research and prevention activities

DOT National Transportation Integrated Search

1996-05-01

The mission of the National Center for Injury Prevention and Control (NCIPC) : is to reduce morbidity, disability, death, and costs associated with injuries : outside the workplace in the United States. NCIPC works closely with other : federal agenci...

Design of a compensation for an ARMA model of a discrete time system. M.S. Thesis

NASA Technical Reports Server (NTRS)

Mainemer, C. I.

1978-01-01

The design of an optimal dynamic compensator for a multivariable discrete time system is studied. Also the design of compensators to achieve minimum variance control strategies for single input single output systems is analyzed. In the first problem the initial conditions of the plant are random variables with known first and second order moments, and the cost is the expected value of the standard cost, quadratic in the states and controls. The compensator is based on the minimum order Luenberger observer and it is found optimally by minimizing a performance index. Necessary and sufficient conditions for optimality of the compensator are derived. The second problem is solved in three different ways; two of them working directly in the frequency domain and one working in the time domain. The first and second order moments of the initial conditions are irrelevant to the solution. Necessary and sufficient conditions are derived for the compensator to minimize the variance of the output.

The Virtual Mission Operations Center

NASA Technical Reports Server (NTRS)

Moore, Mike; Fox, Jeffrey

1994-01-01

Spacecraft management is becoming more human intensive as spacecraft become more complex and as operations costs are growing accordingly. Several automation approaches have been proposed to lower these costs. However, most of these approaches are not flexible enough in the operations processes and levels of automation that they support. This paper presents a concept called the Virtual Mission Operations Center (VMOC) that provides highly flexible support for dynamic spacecraft management processes and automation. In a VMOC, operations personnel can be shared among missions, the operations team can change personnel and their locations, and automation can be added and removed as appropriate. The VMOC employs a form of on-demand supervisory control called management by exception to free operators from having to actively monitor their system. The VMOC extends management by exception, however, so that distributed, dynamic teams can work together. The VMOC uses work-group computing concepts and groupware tools to provide a team infrastructure, and it employs user agents to allow operators to define and control system automation.

Achieving compliance with the European Working Time Directive in a large teaching hospital: a strategic approach.

PubMed

Jones, Gareth J; Vanderpump, Mark P J; Easton, Mark; Baker, Daryll M; Ball, Carol; Leenane, Michael; O'Brien, Heather; Turner, Nigel; Else, Martin; Reid, Wendy M N; Johnson, Margaret

2004-01-01

This paper describes the strategy which achieved European Working Time Directive (EWTD) compliance at the Royal Free Hampstead NHS Trust in medicine and surgery. Compliance with EWTD regulations was assessed by diary card exercise, clinical care assessed through critical incident reports, electronic handover documents and nursing reports, training opportunities assessed by unit training directors, cost controls assessed by finance department analysis, and workload assessed by staff attendance on wards, in casualty and in theatres. There was a change in focus of care to a consultant-led, specialist registrar- (SpR-)driven service extending into evenings and on weekends, coupled with a move to a multi-skilled team for night cover, and to a move from traditional on-call shifts to a full shift system across both medicine and surgery. Compliance with the EWTD was achieved whilst maintaining good standards of clinical care, ensuring training opportunities for doctors in training, controlling payroll costs, removing the need for locums, and reducing workload for both junior doctors and consultants.

An approach to the design of operations systems

NASA Technical Reports Server (NTRS)

Chafin, Roy L.; Curran, Patrick S.

1993-01-01

The MultiMission Control Team (MMCT) consists of mission controllers which provides Real-Time operations support for the Mars Observer project. The Real-Time Operations task is to insure the integrity of the ground data system, to insure that the configuration is correct to support the mission, and to monitor the spacecraft for the Spacecraft Team. Operations systems are typically developed by adapting operations systems from previous projects. Problems tend to be solved empirically when they are either anticipated or observed in testing. This development method has worked in the past when time was available for extensive Ops testing. In the present NASA budget environment, a more cost conscious design approach has become necessary. Cost is a concern because operations is an ongoing, continuous activity. Reducing costs entails reducing staff. Reducing staffing levels potentially increases the risk of mission failure. Therefore, keeping track of the risk level is necessary.

Aerodynamic design and optimization in one shot

NASA Technical Reports Server (NTRS)

Ta'asan, Shlomo; Kuruvila, G.; Salas, M. D.

1992-01-01

This paper describes an efficient numerical approach for the design and optimization of aerodynamic bodies. As in classical optimal control methods, the present approach introduces a cost function and a costate variable (Lagrange multiplier) in order to achieve a minimum. High efficiency is achieved by using a multigrid technique to solve for all the unknowns simultaneously, but restricting work on a design variable only to grids on which their changes produce nonsmooth perturbations. Thus, the effort required to evaluate design variables that have nonlocal effects on the solution is confined to the coarse grids. However, if a variable has a nonsmooth local effect on the solution in some neighborhood, it is relaxed in that neighborhood on finer grids. The cost of solving the optimal control problem is shown to be approximately two to three times the cost of the equivalent analysis problem. Examples are presented to illustrate the application of the method to aerodynamic design and constraint optimization.

Complete low-cost implementation of a teleoperated control system for a humanoid robot.

PubMed

Cela, Andrés; Yebes, J Javier; Arroyo, Roberto; Bergasa, Luis M; Barea, Rafael; López, Elena

2013-01-24

Humanoid robotics is a field of a great research interest nowadays. This work implements a low-cost teleoperated system to control a humanoid robot, as a first step for further development and study of human motion and walking. A human suit is built, consisting of 8 sensors, 6 resistive linear potentiometers on the lower extremities and 2 digital accelerometers for the arms. The goal is to replicate the suit movements in a small humanoid robot. The data from the sensors is wirelessly transmitted via two ZigBee RF configurable modules installed on each device: the robot and the suit. Replicating the suit movements requires a robot stability control module to prevent falling down while executing different actions involving knees flexion. This is carried out via a feedback control system with an accelerometer placed on the robot's back. The measurement from this sensor is filtered using Kalman. In addition, a two input fuzzy algorithm controlling five servo motors regulates the robot balance. The humanoid robot is controlled by a medium capacity processor and a low computational cost is achieved for executing the different algorithms. Both hardware and software of the system are based on open platforms. The successful experiments carried out validate the implementation of the proposed teleoperated system.

Complete Low-Cost Implementation of a Teleoperated Control System for a Humanoid Robot

PubMed Central

Cela, Andrés; Yebes, J. Javier; Arroyo, Roberto; Bergasa, Luis M.; Barea, Rafael; López, Elena

2013-01-01

Humanoid robotics is a field of a great research interest nowadays. This work implements a low-cost teleoperated system to control a humanoid robot, as a first step for further development and study of human motion and walking. A human suit is built, consisting of 8 sensors, 6 resistive linear potentiometers on the lower extremities and 2 digital accelerometers for the arms. The goal is to replicate the suit movements in a small humanoid robot. The data from the sensors is wirelessly transmitted via two ZigBee RF configurable modules installed on each device: the robot and the suit. Replicating the suit movements requires a robot stability control module to prevent falling down while executing different actions involving knees flexion. This is carried out via a feedback control system with an accelerometer placed on the robot's back. The measurement from this sensor is filtered using Kalman. In addition, a two input fuzzy algorithm controlling five servo motors regulates the robot balance. The humanoid robot is controlled by a medium capacity processor and a low computational cost is achieved for executing the different algorithms. Both hardware and software of the system are based on open platforms. The successful experiments carried out validate the implementation of the proposed teleoperated system. PMID:23348029

A theoretical model of the evolution of maternal effects under parent-offspring conflict.

PubMed

Uller, Tobias; Pen, Ido

2011-07-01

The evolution of maternal effects on offspring phenotype should depend on the extent of parent-offspring conflict and costs and constraints associated with maternal and offspring strategies. Here, we develop a model of maternal effects on offspring dispersal phenotype under parent-offspring conflict to evaluate such dependence. In the absence of evolutionary constraints and costs, offspring evolve dispersal rates from different patch types that reflect their own, rather than the maternal, optima. This result also holds true when offspring are unable to assess their own environment because the maternal phenotype provides an additional source of information. Consequently, maternal effects on offspring diapause, dispersal, and other traits that do not necessarily represent costly resource investment are more likely to maximize offspring than maternal fitness. However, when trait expression was costly, the evolutionarily stable dispersal rates tended to deviate from those under both maternal and offspring control. We use our results to (re)interpret some recent work on maternal effects and their adaptive value and provide suggestions for future work. © 2011 The Author(s). Evolution© 2011 The Society for the Study of Evolution.

Web-based guided self-help for employees with depressive symptoms (Happy@Work): design of a randomized controlled trial

PubMed Central

2013-01-01

Background Depressive disorders are highly prevalent in the working population and are associated with excessive costs for both society and companies. Effective treatment for employees with depressive symptoms in occupational health care is limited. The purpose of this study is to investigate the effectiveness and cost-effectiveness of an indicated preventive web-based guided self-help course for employees with depressive symptoms. Methods The study is a two-arm randomized controlled trial comparing a web-based guided self-help course with care-as-usual. The self-help course consists of 6 weekly lessons. Weekly support will be provided by a coach via the website. Subjects in the care-as-usual group do not receive any treatment in addition to regular care. 200 white collar workers from several national and international companies in the Netherlands will be recruited via different methods such as banners on the company’s intranet, pamphlets and posters. Subjects will be included when they: have elevated depressive symptoms (score ≥16 on the Center for Epidemiologic Studies Depression scale), are 18 years of age or older, have access to the Internet and can be contacted via e-mail. Exclusion criteria are: partial or full work absenteeism, a legal labor dispute with the employer and receiving treatment from the company’s occupational health care at study entrance. The primary outcome is depressive symptoms. Secondary outcomes include work absenteeism, work performance, burnout, anxiety, quality of life, health care use and production losses. Outcome data will be collected at 8 weeks, 6 months, and 12 months after baseline. Analyses will be based on the intention-to-treat principle. The cost-effectiveness analyses will be performed from a societal and a company’s perspective. A process evaluation will be conducted alongside the study. Discussion This study evaluates the effectiveness and cost-effectiveness of a web-based guided self-help course for employees with depressive symptoms. This study could stimulate the use of e-mental health interventions in the worksite setting. Trial registration Nederlands Trial Register (NTR): TC2993 PMID:23418886

Cutting costs: the impact of price lists on the cost development at the emergency department.

PubMed

Schilling, Ulf Martin

2010-12-01

It was shown that physicians working at the Swedish emergency department (ED) are unaware of the costs for investigations performed. This study evaluated the possible impact of price lists on the overall laboratory and radiology costs at the ED of a Swedish university hospital. Price lists including the most common laboratory analyses and radiological investigations at the ED were created. The lists were distributed to all internal medicine physicians by e-mail and exposed above their working stations continually. No lists were provided for the orthopaedic control group. The average costs for laboratory and radiological investigations during the months of June and July 2007 and 2008 were calculated. Neither clinical nor admission procedures were changed. The physicians were blinded towards the study. Statistical analysis was performed using the Student's t-test. A total of 1442 orthopaedic and 1585 medical patients were attended to in 2007. In 2008, 1467 orthopaedic and 1637 medical patients required emergency service. The average costs per patient were 980.27 SKR (98€)/999.41 SKR (100€, +1.95%) for orthopaedic and 1081.36 SKR (108€)/877.3 SKR (88€, -18.8%) for medical patients. Laboratory costs decreased by 9% in orthopaedic and 21.4% in medical patients. Radiology costs changed +5.4% in orthopaedic and -20.59% in medical patients. The distribution and promotion of price lists as a tool at the ED to heighten cost awareness resulted in a major decrease in the investigation costs. A significant decrease in radiological costs could be observed. It can be concluded that price lists are an effective tool to cut costs in public healthcare.

Distribution Locational Real-Time Pricing Based Smart Building Control and Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hao, Jun; Dai, Xiaoxiao; Zhang, Yingchen

This paper proposes an real-virtual parallel computing scheme for smart building operations aiming at augmenting overall social welfare. The University of Denver's campus power grid and Ritchie fitness center is used for demonstrating the proposed approach. An artificial virtual system is built in parallel to the real physical system to evaluate the overall social cost of the building operation based on the social science based working productivity model, numerical experiment based building energy consumption model and the power system based real-time pricing mechanism. Through interactive feedback exchanged between the real and virtual system, enlarged social welfare, including monetary cost reductionmore » and energy saving, as well as working productivity improvements, can be achieved.« less

Experimental research on coalbed gas drainage effect and economy of long directional borehole in roof

NASA Astrophysics Data System (ADS)

Yang, Huiming; Hu, Liangping

2017-05-01

In order to study the coalbed gas drainage effect and economy of long directional roof borehole, 2 boreholes were laid out in Xinji No. 2 mine to analyze its gas drainage and investment costs comparing with high position roof borehole and high position roof roadway. The result indicates that the long directional roof borehole save investment by 44.8% and shorten the construction period by 30%, comparing with high position roof roadway for controlling gas in the working face. Investment slightly less and shorten the construction period by 47.5%, comparing with the roof high position borehole. Therefore, the method of the long directional roof borehole to drain coalbed gas in working face is the most cost-effective.

Control of heat and humidity in German mines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schlotte, W.

1999-07-01

In order to increase the economic efficiency of West European hard coal, great efforts are being made at present in the coal-producing countries to lower production costs. This aim is to be achieved in Germany, among other things, by a drastic increase in the saleable output per working face up to an average of 10,000 t/d in these cases where very long longwall faces (400 m {+-} 50 m) are possible. With the substantially greater heat input into the air stream which this involves, there is the danger that climatic limits will be exceeded even at longwall faces with lowermore » than average rock temperatures. Working in high temperatures and/or humidities can lead to risky lack of concentration of the miners to heat collapse and extremely dangerous heat stroke. In order to minimize the costs for mine climate control well-proven planning software and climitization technology is necessary for underground workings. With the DMT climate simulation programs, both the dry and the extremely significant humid heat transfer can be calculated and the optimum air cooling system for a mine can be designed with due regard to technical and economic aspects.« less

Work environment satisfaction and employee health: panel evidence from Denmark, France and Spain, 1994-2001.

PubMed

Datta Gupta, Nabanita; Kristensen, Nicolai

2008-02-01

This paper investigates whether a satisfactory work environment can promote employee health even after controlling for socioeconomic status and life style factors. A dynamic panel model of health is estimated from worker samples from Denmark, France and Spain, employing both self-assessed general health and the presence of a functional limitation. In all three countries and for both types of health measures, a good perceived work environment is found to be a highly significant determinant of worker health even after controlling for unobserved heterogeneity and minimizing reverse causality. The marginal effect is, however, larger in France and Denmark than in Spain. Several potential explanations for this finding are discussed. Further, a satisfactory working environment is found to be at least as important for employee health as socioeconomic status. Thus, investing in giving workers a satisfying work environment could be a low-cost way of improving employee health.

A compatible control algorithm for greenhouse environment control based on MOCC strategy.

PubMed

Hu, Haigen; Xu, Lihong; Zhu, Bingkun; Wei, Ruihua

2011-01-01

Conventional methods used for solving greenhouse environment multi-objective conflict control problems lay excessive emphasis on control performance and have inadequate consideration for both energy consumption and special requirements for plant growth. The resulting solution will cause higher energy cost. However, during the long period of work and practice, we find that it may be more reasonable to adopt interval or region control objectives instead of point control objectives. In this paper, we propose a modified compatible control algorithm, and employ Multi-Objective Compatible Control (MOCC) strategy and an extant greenhouse model to achieve greenhouse climate control based on feedback control architecture. A series of simulation experiments through various comparative studies are presented to validate the feasibility of the proposed algorithm. The results are encouraging and suggest the energy-saving application to real-world engineering problems in greenhouse production. It may be valuable and helpful to formulate environmental control strategies, and to achieve high control precision and low energy cost for real-world engineering application in greenhouse production. Moreover, the proposed approach has also potential to be useful for other practical control optimization problems with the features like the greenhouse environment control system.

A Compatible Control Algorithm for Greenhouse Environment Control Based on MOCC Strategy

PubMed Central

Hu, Haigen; Xu, Lihong; Zhu, Bingkun; Wei, Ruihua

2011-01-01

Conventional methods used for solving greenhouse environment multi-objective conflict control problems lay excessive emphasis on control performance and have inadequate consideration for both energy consumption and special requirements for plant growth. The resulting solution will cause higher energy cost. However, during the long period of work and practice, we find that it may be more reasonable to adopt interval or region control objectives instead of point control objectives. In this paper, we propose a modified compatible control algorithm, and employ Multi-Objective Compatible Control (MOCC) strategy and an extant greenhouse model to achieve greenhouse climate control based on feedback control architecture. A series of simulation experiments through various comparative studies are presented to validate the feasibility of the proposed algorithm. The results are encouraging and suggest the energy-saving application to real-world engineering problems in greenhouse production. It may be valuable and helpful to formulate environmental control strategies, and to achieve high control precision and low energy cost for real-world engineering application in greenhouse production. Moreover, the proposed approach has also potential to be useful for other practical control optimization problems with the features like the greenhouse environment control system. PMID:22163799

Costs and benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease: a randomized controlled trial.

PubMed

Farias, Catharinne C; Resqueti, Vanessa; Dias, Fernando A L; Borghi-Silva, Audrey; Arena, Ross; Fregonezi, Guilherme A F

2014-01-01

The current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). This was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (GPR)]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). Only 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the GPR (FEV1: 50.9 ± 14% predicted and FEV1: 56 ± 0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05). The final mean cost per patient for the GPR was R$ 148.75 (~US$ 75.00) and no patient significantly exceeded this value. However, 2 patients in the CG did exceed this value, incurring a cost of R$ 689.15 (~US$ 345.00). Aerobic walking demonstrated significant clinical benefits in a cost-efficient manner in patients with COPD.

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial.

PubMed

Hunter, Ruth F; Brennan, Sarah F; Tang, Jianjun; Smith, Oliver J; Murray, Jennifer; Tully, Mark A; Patterson, Chris; Longo, Alberto; Hutchinson, George; Prior, Lindsay; French, David P; Adams, Jean; McIntosh, Emma; Kee, Frank

2016-07-22

Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions. This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme. The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a 'points' based loyalty platform, whereby local businesses 'sponsor' the incentive (retail vouchers) in return for increased footfall to their business. ISRCTN17975376 (Registered 19/09/2014).

ADCS controllers comparison for small satellitess in Low Earth Orbit

NASA Astrophysics Data System (ADS)

Calvo, Daniel; Laverón-Simavilla, Ana; Lapuerta, Victoria

2016-07-01

Fuzzy logic controllers are flexible and simple, suitable for small satellites Attitude Determination and Control Subsystems (ADCS). In a previous work, a tailored Fuzzy controller was designed for a nanosatellite. Its performance and efficiency were compared with a traditional Proportional Integrative Derivative (PID) controller within the same specific mission. The orbit height varied along the mission from injection at around 380 km down to 200 km height, and the mission required pointing accuracy over the whole time. Due to both, the requirements imposed by such a low orbit, and the limitations in the power available for the attitude control, an efficient ADCS is required. Both methodologies, fuzzy and PID, were fine-tuned using an automated procedure to grant maximum efficiency with fixed performances. The simulations showed that the Fuzzy controller is much more efficient (up to 65% less power required) in single manoeuvres, achieving similar, or even better, precision than the PID. The accuracy and efficiency improvement of the Fuzzy controller increase with orbit height because the environmental disturbances decrease, approaching the ideal scenario. However, the controllers are meant to be used in a vast range of situations and configurations which exceed those used in the calibration process carried out in the previous work. To assess the suitability and performance of both controllers in a wider framework, parametric and statistical methods have been applied using the Monte Carlo technique. Several parameters have been modified randomly at the beginning of each simulation: the moments of inertia of the whole satellite and of the momentum wheel, the residual magnetic dipole and the initial conditions of the test. These parameters have been chosen because they are the main source of uncertainty during the design phase. The variables used for the analysis are the error (critical for science) and the operation cost (which impacts the mission lifetime and outcome). The analysis of the simulations has shown that, in overall, the PID error is over twice the Fuzzy error and the PID cost is over 40% bigger than the Fuzzy cost. This suggests that a Fuzzy controller may be a better solution in a wider range of configurations than other classical solutions like the PID.

Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial.

PubMed

Sturkenboom, Ingrid H W M; Hendriks, Jan C M; Graff, Maud J L; Adang, Eddy M M; Munneke, Marten; Nijhuis-van der Sanden, Maria W G; Bloem, Bastiaan R

2015-07-01

A large randomized clinical trial (the Occupational Therapy in Parkinson's Disease [OTiP] study) recently demonstrated that home-based occupational therapy improves perceived performance in daily activities of people with Parkinson's disease (PD). The aim of the current study was to evaluate the cost-effectiveness of this intervention. We performed an economic evaluation over a 6-month period for both arms of the OTiP study. Participants were 191 community-dwelling PD patients and 180 primary caregivers. The intervention group (n = 124 patients) received 10 weeks of home-based occupational therapy; the control group (n = 67 patients) received usual care (no occupational therapy). Costs were assessed from a societal perspective including healthcare use, absence from work, informal care, and intervention costs. Health utilities were evaluated using EuroQol-5d. We estimated cost differences and cost utility using linear mixed models and presented the net monetary benefit at different values for willingness to pay per quality-adjusted life-year gained. In our primary analysis, we excluded informal care hours because of substantial missing data for this item. The estimated mean total costs for the intervention group compared with controls were €125 lower for patients, €29 lower for caregivers, and €122 higher for patient-caregiver pairs (differences not significant). At a value of €40,000 per quality-adjusted life-year gained (reported threshold for PD), the net monetary benefit of the intervention per patient was €305 (P = 0.74), per caregiver €866 (P = 0.01) and per patient-caregiver pair €845 (P = 0.24). In conclusion, occupational therapy did not significantly impact on total costs compared with usual care. Positive cost-effectiveness of the intervention was only significant for caregivers. © 2015 International Parkinson and Movement Disorder Society.

48 CFR 970.1504-1-4 - Types of contracts and fee arrangements.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-based management contract, those contract types which incentivize performance and cost control are... performance result or outcome. (e) Because the nature and complexity of the work performed under a management... AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Contracting by Negotiation 970...

Does Your Technology Support Measure Up?

ERIC Educational Resources Information Center

Abramson, Paul

1998-01-01

Provides tips on ways to keep computer systems in colleges and universities from failing while also controlling costs. Trinity College (Hartford) is used to illustrate how proper staffing, system maintenance, hardware purchasing decisions, technician compensation, and the use of students for maintenance work can effectively support a school's…

Review of Department of Defense Education Activity (DODEA) Schools. Volume II: Quantitative Analysis of Educational Quality

DTIC Science & Technology

2000-10-01

most enlightening sources found on how to approach the problem were as follows: 1. Eric A. Hanushek and Others, Making Schools Work, Improving... Hanushek traces the history of educational inputs and outputs in the United States. Since the 1950s, test scores have not increased, while...important inputs see Eric A. Hanushek and Others, Making Schools Work: Improving Performance and Controlling Costs, The Brookings Institution, 1994 and

System analysis study of space platform and station accommodations for life sciences research facilities. Volume 2: Study results. Appendix E: Work breakdown structure and dictionary

NASA Technical Reports Server (NTRS)

Wiley, Lowell F.

1985-01-01

A work breakdown structure for the Space Station Life Sciences Research Facility (LSRF) is presented up to level 5. The purpose is to provide the framework for task planning and control and to serve as a basis for budgeting, task assignment, cost collection and report, and contractual performance measurement and tracking of the Full Scale Development Phase tasks.

More efficient optimization of long-term water supply portfolios

NASA Astrophysics Data System (ADS)

Kirsch, Brian R.; Characklis, Gregory W.; Dillard, Karen E. M.; Kelley, C. T.

2009-03-01

The use of temporary transfers, such as options and leases, has grown as utilities attempt to meet increases in demand while reducing dependence on the expansion of costly infrastructure capacity (e.g., reservoirs). Earlier work has been done to construct optimal portfolios comprising firm capacity and transfers, using decision rules that determine the timing and volume of transfers. However, such work has only focused on the short-term (e.g., 1-year scenarios), which limits the utility of these planning efforts. Developing multiyear portfolios can lead to the exploration of a wider range of alternatives but also increases the computational burden. This work utilizes a coupled hydrologic-economic model to simulate the long-term performance of a city's water supply portfolio. This stochastic model is linked with an optimization search algorithm that is designed to handle the high-frequency, low-amplitude noise inherent in many simulations, particularly those involving expected values. This noise is detrimental to the accuracy and precision of the optimized solution and has traditionally been controlled by investing greater computational effort in the simulation. However, the increased computational effort can be substantial. This work describes the integration of a variance reduction technique (control variate method) within the simulation/optimization as a means of more efficiently identifying minimum cost portfolios. Random variation in model output (i.e., noise) is moderated using knowledge of random variations in stochastic input variables (e.g., reservoir inflows, demand), thereby reducing the computing time by 50% or more. Using these efficiency gains, water supply portfolios are evaluated over a 10-year period in order to assess their ability to reduce costs and adapt to demand growth, while still meeting reliability goals. As a part of the evaluation, several multiyear option contract structures are explored and compared.

Development of advanced Czochralski growth process to produce low cost 150 kg silicon ingots from a single crucible for technology readiness

NASA Technical Reports Server (NTRS)

1980-01-01

The design and development of an advanced Czochralski crystal grower are described. Several exhaust gas analysis system equipment specifications studied are discussed. Process control requirements were defined and design work began on the melt temperature, melt level, and continuous diameter control. Sensor development included assembly and testing of a bench prototype of a diameter scanner system.

Pest Control and Pollination Cost-Benefit Analysis of Hedgerow Restoration in a Simplified Agricultural Landscape.

PubMed

Morandin, L A; Long, R F; Kremen, C

2016-05-11

Field edge habitat in homogeneous agricultural landscapes can serve multiple purposes including enhanced biodiversity, water quality protection, and habitat for beneficial insects, such as native bees and natural enemies. Despite this ecosystem service value, adoption of field border plantings, such as hedgerows, on large-scale mono-cropped farms is minimal. With profits primarily driving agricultural production, a major challenge affecting hedgerow plantings is linked to establishment costs and the lack of clear economic benefits on the restoration investment. Our study documented that hedgerows are economically viable to growers by enhancing beneficial insects and natural pest control and pollination on farms. With pest control alone, our model shows that it would take 16 yr to break even from insecticide savings on the US$4,000 cost of a typical 300-m hedgerow field edge planting. By adding in pollination benefits by native bees, where honey bees (Apis mellifera L.) may be limiting, the return time is reduced to 7 yr. USDA cost share programs allow for a quicker return on a hedgerow investment. Our study shows that over time, small-scale restoration can be profitable, helping to overcome the barrier of cost associated with field edge habitat restoration on farms. Published by Oxford University Press on behalf of Entomological Society of America 2016. This work is written by US Government employees and is in the public domain in the United States.

Impact of policy on greenhouse gas emissions and economics of biodiesel production.

PubMed

Olivetti, Elsa; Gülşen, Ece; Malça, João; Castanheira, Erica; Freire, Fausto; Dias, Luis; Kirchain, Randolph

2014-07-01

As an alternative transportation fuel to petrodiesel, biodiesel has been promoted within national energy portfolio targets across the world. Early estimations of low lifecycle greenhouse gas (GHG) emissions of biodiesel were a driver behind extensive government support in the form of financial incentives for the industry. However, studies consistently report a high degree of uncertainty in these emissions estimates, raising questions concerning the carbon benefits of biodiesel. Furthermore, the implications of feedstock blending on GHG emissions uncertainty have not been explicitly addressed despite broad practice by the industry to meet fuel quality standards and to control costs. This work investigated the impact of feedstock blending on the characteristics of biodiesel by using a chance-constrained (CC) blend optimization method. The objective of the optimization is minimization of feedstock costs subject to fuel standards and emissions constraints. Results indicate that blending can be used to manage GHG emissions uncertainty characteristics of biodiesel, and to achieve cost reductions through feedstock diversification. Simulations suggest that emissions control policies that restrict the use of certain feedstocks based on their GHG estimates overlook blending practices and benefits, increasing the cost of biodiesel. In contrast, emissions control policies which recognize the multifeedstock nature of biodiesel provide producers with feedstock selection flexibility, enabling them to manage their blend portfolios cost effectively, potentially without compromising fuel quality or emissions reductions.

Stabilization for sampled-data neural-network-based control systems.

PubMed

Zhu, Xun-Lin; Wang, Youyi

2011-02-01

This paper studies the problem of stabilization for sampled-data neural-network-based control systems with an optimal guaranteed cost. Unlike previous works, the resulting closed-loop system with variable uncertain sampling cannot simply be regarded as an ordinary continuous-time system with a fast-varying delay in the state. By defining a novel piecewise Lyapunov functional and using a convex combination technique, the characteristic of sampled-data systems is captured. A new delay-dependent stabilization criterion is established in terms of linear matrix inequalities such that the maximal sampling interval and the minimal guaranteed cost control performance can be obtained. It is shown that the newly proposed approach can lead to less conservative and less complex results than the existing ones. Application examples are given to illustrate the effectiveness and the benefits of the proposed method.

Economic Cost of Dengue in Puerto Rico

PubMed Central

Halasa, Yara A.; Shepard, Donald S.; Zeng, Wu

2012-01-01

Dengue, endemic in Puerto Rico, reached a record high in 2010. To inform policy makers, we derived annual economic cost. We assessed direct and indirect costs of hospitalized and ambulatory dengue illness in 2010 dollars through surveillance data and interviews with 100 laboratory-confirmed dengue patients treated in 2008–2010. We corrected for underreporting by using setting-specific expansion factors. Work absenteeism because of a dengue episode exceeded the absenteeism for an episode of influenza or acute otitis media. From 2002 to 2010, the aggregate annual cost of dengue illness averaged $38.7 million, of which 70% was for adults (age 15+ years). Hospitalized patients accounted for 63% of the cost of dengue illness, and fatal cases represented an additional 17%. Households funded 48% of dengue illness cost, the government funded 24%, insurance funded 22%, and employers funded 7%. Including dengue surveillance and vector control activities, the overall annual cost of dengue was $46.45 million ($12.47 per capita). PMID:22556069

Multi-criteria analysis for PM10 planning

NASA Astrophysics Data System (ADS)

Pisoni, Enrico; Carnevale, Claudio; Volta, Marialuisa

To implement sound air quality policies, Regulatory Agencies require tools to evaluate outcomes and costs associated to different emission reduction strategies. These tools are even more useful when considering atmospheric PM10 concentrations due to the complex nonlinear processes that affect production and accumulation of the secondary fraction of this pollutant. The approaches presented in the literature (Integrated Assessment Modeling) are mainly cost-benefit and cost-effective analysis. In this work, the formulation of a multi-objective problem to control particulate matter is proposed. The methodology defines: (a) the control objectives (the air quality indicator and the emission reduction cost functions); (b) the decision variables (precursor emission reductions); (c) the problem constraints (maximum feasible technology reductions). The cause-effect relations between air quality indicators and decision variables are identified tuning nonlinear source-receptor models. The multi-objective problem solution provides to the decision maker a set of not-dominated scenarios representing the efficient trade-off between the air quality benefit and the internal costs (emission reduction technology costs). The methodology has been implemented for Northern Italy, often affected by high long-term exposure to PM10. The source-receptor models used in the multi-objective analysis are identified processing long-term simulations of GAMES multiphase modeling system, performed in the framework of CAFE-Citydelta project.

Optimizing Optics For Remotely Controlled Underwater Vehicles

NASA Astrophysics Data System (ADS)

Billet, A. B.

1984-09-01

The past decade has shown a dramatic increase in the use of unmanned tethered vehicles in worldwide marine fields. These vehicles are used for inspection, debris removal and object retrieval. With advanced robotic technology, remotely operated vehicles (ROVs) are now able to perform a variety of jobs previously accomplished only by divers. The ROVs can be used at greater depths and for riskier jobs, and safety to the diver is increased, freeing him for safer, more cost-effective tasks requiring human capabilities. Secondly, the ROV operation becomes more cost effective to use as work depth increases. At 1000 feet a diver's 10 minutes of work can cost over $100,000 including support personnel, while an ROV operational cost might be 1/20 of the diver cost per day, based on the condition that the cost for ROV operation does not change with depth, as it does for divers. In the ROV operation the television lens must be as good as the human eye, with better light gathering capability than the human eye. The RCV-150 system is an example of these advanced technology vehicles. With the requirements of manueuverability and unusual inspection, a responsive, high performance, compact vehicle was developed. The RCV-150 viewing subsystem consists of a television camera, lights, and topside monitors. The vehicle uses a low light level Newvicon television camera. The camera is equipped with a power-down iris that closes for burn protection when the power is off. The camera can pan f 50 degrees and tilt f 85 degrees on command from the surface. Four independently controlled 250 watt quartz halogen flood lamps illuminate the viewing area as required; in addition, two 250 watt spotlights are fitted. A controlled nine inch CRT monitor provides real time camera pictures for the operator. The RCV-150 vehicle component system consists of the vehicle structure, the vehicle electronics, and hydraulic system which powers the thruster assemblies and the manipulator. For this vehicle, a light weight, high response hydraulic system was developed in a very small package.

["Back pain coach". A project for patients with back pain].

PubMed

Lindena, G; Marnitz, U; Hartmann, P; Müller, G

2012-12-01

Back pain is a challenge for case management but is a health insurance fund (HIF) that identifies high risk patients and includes them in a back pain assessment and a multimodal program cost-effective? Case managers of a HIF contacted selected patients and requested information on pain and current perspectives. Patients in the intervention group were offered a multimodal assessment and, if applicable, a multimodal treatment program. Control group patients received verbal or written (back book) information. Cost data were evaluated with respect to the interview data 1 year prior and 1 year afterwards. Of the 800 insured persons contacted 621 were nationwide, 88 were regional controls and 91 were intervention patients. Inability to work was still rising in all groups but less in the intervention group versus both control groups. Drugs, hospital as well as cure/adjuvant costs were less for intervention patients than in both control groups. The investment for the program was thus more than refinanced. Case management was well accepted but the intervention was in need of training for case managers and the specific diagnostic and treatment option regionally. The HIF was responsible for the study investment and project partners shared the training of the HIF regional case managers.

Microencapsulation of Self Healing Agents for Corrosion Control Coatings

NASA Technical Reports Server (NTRS)

Jolley, S. T.; Li, W.; Buhrow, J. W.; Calle, L. M.

2011-01-01

Corrosion, the environmentally induced degradation of materials, is a very costly problem that has a major impact on the global economy. Results from a 2-year breakthrough study released in 2002 by the U.S. Federal Highway Administration (FHWA) showed that the total annual estimated direct cost associated with metallic corrosion in nearly every U.S. industry sector was a staggering $276 billion, approximately 3.1% of the nation's Gross Domestic Product (GOP). Corrosion protective coatings are widely used to protect metallic structures from the detrimental effects of corrosion but their effectiveness can be seriously compromised by mechanical damage, such as a scratch, that exposes the metallic substrate. The incorporation of a self healing mechanism into a corrosion control coating would have the potential to significantly increase its effectiveness and useful lifetime. This paper describes work performed to incorporate a number of microcapsule-based self healing systems into corrosion control coatings. The work includes the preparation and evaluation of self-healing systems based on curable epoxy, acrylate, and siloxane resins, as well as, microencapsulated systems based on passive, solvent born, healing agent delivery. The synthesis and optimization of microcapsule-based self healing systems for thin coating (less than 100 micron) will be presented.

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.

PubMed

Khan, Fary; Ng, Louisa; Turner-Stokes, Lynne

2009-01-21

Multiple sclerosis is a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established. To evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in pwMS; to evaluate the cost effectiveness of these programs. Electronic searches included: Cochrane Central Register of Controlled Trials "CENTRAL" 2008 issue 3, MEDLINE (PubMed) (1966- 2008), EMBASE (1988- 2008), CINAHL (1982- 2008), PEDro (1990- 2008), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register. Randomized and controlled clinical trials, including before - after controlled trials, that compare VR rehabilitation with alternative intervention such as standard or a lesser form of intervention or waitlist controls. Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs. Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a)'competitive employment', in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering 'work ability' by improving participants' confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness. There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

48 CFR 43.203 - Change order accounting procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

...., engineering costs and costs of obsolete or reperformed work). (2) Costs of added distinct work caused by the...) Contractors' accounting systems are seldom designed to segregate the costs of performing changed work... possible need to revise their accounting procedures to comply with the cost segregation requirements of the...

48 CFR 43.203 - Change order accounting procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

...., engineering costs and costs of obsolete or reperformed work). (2) Costs of added distinct work caused by the...) Contractors' accounting systems are seldom designed to segregate the costs of performing changed work... possible need to revise their accounting procedures to comply with the cost segregation requirements of the...

48 CFR 43.203 - Change order accounting procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

...., engineering costs and costs of obsolete or reperformed work). (2) Costs of added distinct work caused by the...) Contractors' accounting systems are seldom designed to segregate the costs of performing changed work... possible need to revise their accounting procedures to comply with the cost segregation requirements of the...

48 CFR 43.203 - Change order accounting procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

...., engineering costs and costs of obsolete or reperformed work). (2) Costs of added distinct work caused by the...) Contractors' accounting systems are seldom designed to segregate the costs of performing changed work... possible need to revise their accounting procedures to comply with the cost segregation requirements of the...

An intervention that reduces stress in people who combine work with informal care: randomized controlled trial results.

PubMed

Boezeman, Edwin J; Nieuwenhuijsen, Karen; Sluiter, Judith K

2018-06-01

The aim of the research was to examine whether a role-focused self-help course intervention would decrease caregiver stress and distress, and functioning problems, among people who suffer stress because they combine paid work with informal care. A pre-registered (NTR 5528) randomized controlled design was applied (intervention vs. wait list control). Participants (n = 128) were people who had paid work and were suffering stress due to their involvement in informal care activities. Participants allocated to the intervention group (n = 65) received the role-focused self-help course. Control group members (n = 63) received this intervention after all measurements. Prior to the random allocation (pre-test), and 1 month (post-test 1) and 2 months (post-test 2) after allocation, all participants completed a questionnaire that measured their caregiver stress (primary outcome), distress, work functioning, negative care-to-work interference and negative care-to-social and personal life interference. Mixed model ANOVAs were used to test the effectiveness of the intervention. Two months after allocation, the intervention group participants had lower levels of caregiver stress and distress compared with the control group participants. The intervention did not directly resolve impaired work functioning or interference of care with work and social/personal life. The intervention decreases caregiver stress and distress in people who suffer stress because they combine paid work with informal caring. The intervention (Dutch version) can be downloaded at no cost from www.amc.nl/mantelzorgstress.

Economic consequences of improved temperature forecasts: An experiment with the Florida citrus growers (control group results). Executive summary. [weather forecasting

NASA Technical Reports Server (NTRS)

1977-01-01

A demonstration experiment is being planned to show that frost and freeze prediction improvements are possible utilizing timely Synchronous Meteorological Satellite temperature measurements and that this information can affect Florida citrus grower operations and decisions so as to significantly reduce the cost for frost and freeze protection and crop losses. The design and implementation of the first phase of an economic experiment which will monitor citrus growers decisions, actions, costs and losses, and meteorological forecasts and actual weather events was carried out. The economic experiment was designed to measure the change in annual protection costs and crop losses which are the direct result of improved temperature forecasts. To estimate the benefits that may result from improved temperature forecasting capability, control and test groups were established with effective separation being accomplished temporally. The control group, utilizing current forecasting capability, was observed during the 1976-77 frost season and the results are reported. A brief overview is given of the economic experiment, the results obtained to date, and the work which still remains to be done.

Integrated Arrival and Departure Schedule Optimization Under Uncertainty

NASA Technical Reports Server (NTRS)

Xue, Min; Zelinski, Shannon

2014-01-01

In terminal airspace, integrating arrivals and departures with shared waypoints provides the potential of improving operational efficiency by allowing direct routes when possible. Incorporating stochastic evaluation as a post-analysis process of deterministic optimization, and imposing a safety buffer in deterministic optimization, are two ways to learn and alleviate the impact of uncertainty and to avoid unexpected outcomes. This work presents a third and direct way to take uncertainty into consideration during the optimization. The impact of uncertainty was incorporated into cost evaluations when searching for the optimal solutions. The controller intervention count was computed using a heuristic model and served as another stochastic cost besides total delay. Costs under uncertainty were evaluated using Monte Carlo simulations. The Pareto fronts that contain a set of solutions were identified and the trade-off between delays and controller intervention count was shown. Solutions that shared similar delays but had different intervention counts were investigated. The results showed that optimization under uncertainty could identify compromise solutions on Pareto fonts, which is better than deterministic optimization with extra safety buffers. It helps decision-makers reduce controller intervention while achieving low delays.

Cost-effectiveness of an intensive group training protocol compared to physiotherapy guideline care for sub-acute and chronic low back pain: design of a randomised controlled trial with an economic evaluation. [ISRCTN45641649

PubMed Central

van der Roer, Nicole; van Tulder, Maurits W; Barendse, Johanna M; van Mechelen, Willem; Franken, Willemien K; Ooms, Arjan C; de Vet, Henrica CW

2004-01-01

Background Low back pain is a common disorder in western industrialised countries and the type of treatments for low back pain vary considerably. Methods In a randomised controlled trial the cost-effectiveness and cost-utility of an intensive group training protocol versus physiotherapy guideline care for sub-acute and chronic low back pain patients is evaluated. Patients with back pain for longer than 6 weeks who are referred to physiotherapy care by their general practitioner or medical specialist are included in the study. The intensive group training protocol combines exercise therapy with principles of behavioural therapy ("graded activity") and back school. This training protocol is compared to physiotherapy care according to the recently published Low Back Pain Guidelines of the Royal Dutch College for Physiotherapy. Primary outcome measures are general improvement, pain intensity, functional status, work absenteeism and quality of life. The direct and indirect costs will be assessed using cost diaries. Patients will complete questionnaires at baseline and 6, 13, 26 and 52 weeks after randomisation. Discussion No trials are yet available that have evaluated the effect of an intensive group training protocol including behavioural principles and back school in a primary physiotherapy care setting and no data on cost-effectiveness and cost-utility are available. PMID:15560843

Introducing a new semi-active engine mount using force controlled variable stiffness

NASA Astrophysics Data System (ADS)

Azadi, Mojtaba; Behzadipour, Saeed; Faulkner, Gary

2013-05-01

This work introduces a new concept in designing semi-active engine mounts. Engine mounts are under continuous development to provide better and more cost-effective engine vibration control. Passive engine mounts do not provide satisfactory solution. Available semi-active and active mounts provide better solutions but they are more complex and expensive. The variable stiffness engine mount (VSEM) is a semi-active engine mount with a simple ON-OFF control strategy. However, unlike available semi-active engine mounts that work based on damping change, the VSEM works based on the static stiffness change by using a new fast response force controlled variable spring. The VSEM is an improved version of the vibration mount introduced by the authors in their previous work. The results showed significant performance improvements over a passive rubber mount. The VSEM also provides better vibration control than a hydromount at idle speed. Low hysteresis and the ability to be modelled by a linear model in low-frequency are the advantages of the VSEM over the vibration isolator introduced earlier and available hydromounts. These specifications facilitate the use of VSEM in the automotive industry, however, further evaluation and developments are needed for this purpose.

78 FR 1266 - Notice of Intent To Seek Approval To Extend a Current Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-08

... (salaries, indirect costs, equipment, etc.), and character of work (basic research, applied research, or.... SUPPLEMENTARY INFORMATION: Title of Collection: Higher Education Research and Development Survey. OMB Control... Project: The Higher Education Research and Development Survey (formerly known as the Survey of Research...

Attitude: A Component of Competent Performance.

ERIC Educational Resources Information Center

Meussling, Vonne

The findings of a survey of attitude studies to determine the effect of students' attitudes on communication competence as they enter the work force and develop their careers are reported in this paper. The paper explains how attitude improvement is an effective management tool in controlling costly absenteeism, output, job productivity, work…

Six degree of freedom active vibration damping for space application

NASA Technical Reports Server (NTRS)

Haynes, Leonard S.

1993-01-01

Work performed during the period 1 Jan. - 31 Mar. 1993 on six degree of freedom active vibration damping for space application is presented. A performance and cost report is included. Topics covered include: actuator testing; mechanical amplifier design; and neural network control system development and experimental evaluation.

48 CFR 736.602-3 - Evaluation board functions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... industry with respect to such factors as control of costs, quality of work, and ability to meet schedules, to the extent such information is available; (4) Ability to assign an adequate number of qualified... architect-engineer is able to perform with its own forces when required; (6) Ability of the architect...

48 CFR 736.602-3 - Evaluation board functions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... industry with respect to such factors as control of costs, quality of work, and ability to meet schedules, to the extent such information is available; (4) Ability to assign an adequate number of qualified... architect-engineer is able to perform with its own forces when required; (6) Ability of the architect...

48 CFR 736.602-3 - Evaluation board functions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... industry with respect to such factors as control of costs, quality of work, and ability to meet schedules, to the extent such information is available; (4) Ability to assign an adequate number of qualified... architect-engineer is able to perform with its own forces when required; (6) Ability of the architect...

Laboratory, semi-pilot and room scale study of nitrite and molybdate mediated control of H(2)S emission from swine manure.

PubMed

Moreno, Lyman; Predicala, Bernardo; Nemati, Mehdi

2010-04-01

The effects of manure age on emission of H(2)S and required level of nitrite or molybdate to control these emissions were investigated in the present work. Molybdate mediated control of H(2)S emission was also studied in semi-pilot scale open systems, and in specifically designed chambers which simulated swine production rooms. With fresh 1-, 3- and 6-month old manures average H(2)S concentration in the headspace gas of the closed systems were 4856+/-460, 3431+/-208, 1037+/-98 ppm and non-detectable, respectively. Moreover, the level of nitrite or molybdate required to control the emission of H(2)S decreased as manure age increased. In the semi-pilot scale open system and chambers, average H(2)S concentration at the surface of agitated fresh manure were 831+/-26 and 88.4+/-5.7 ppm, respectively. Furthermore, 0.1-0.25 mM molybdate was sufficient to control the emission of H(2)S. A cost study for an average size swine operation showed that the cost of treatment with molybdate was less than 1% of the overall production cost for each market hog. Copyright 2009 Elsevier Ltd. All rights reserved.

Fabrication & characterization of thin film Perovskite solar cells under ambient conditions

NASA Astrophysics Data System (ADS)

Shah, Vivek T.

High efficiency solar cells based on inorganic materials such as silicon have been commercialized and used to harness energy from the sun and convert it into electrical energy. However, they are energy-intensive and rigid. Thin film solar cells based on inorganic-organic hybrid lead halide perovskite compounds have the potential to be a disruptive technology in the field of renewable energy sector of the economy. Perovskite solar cell (PSC) technology is a viable candidate for low-cost large scale production as it is solution processable at low temperature on a flexible substrate. However, for commercialization, PSCs need to compete with the cost and efficiency of crystalline silicon solar cells. High efficiency PSCs have been fabricated under highly controlled conditions in what is known as a glove-box, which adds to the cost of fabrication of PSCs. This additional cost can be significantly reduced by eliminating the use of glove-box for fabrication. Therefore, in this work, thin film PSCs were fabricated at ambient conditions on glass substrates. A power conversion efficiency of 5.6% was achieved with optimum fabrication control and minimal exposure to moisture.

Accelerating Industrial Adoption of Metal Additive Manufacturing Technology

NASA Astrophysics Data System (ADS)

Vartanian, Kenneth; McDonald, Tom

2016-03-01

While metal additive manufacturing (AM) technology has clear benefits, there are still factors preventing its adoption by industry. These factors include the high cost of metal AM systems, the difficulty for machinists to learn and operate metal AM machines, the long approval process for part qualification/certification, and the need for better process controls; however, the high AM system cost is the main barrier deterring adoption. In this paper, we will discuss an America Makes-funded program to reduce AM system cost by combining metal AM technology with conventional computerized numerical controlled (CNC) machine tools. Information will be provided on how an Optomec-led team retrofitted a legacy CNC vertical mill with laser engineered net shaping (LENS®—LENS is a registered trademark of Sandia National Labs) AM technology, dramatically lowering deployment cost. The upgraded system, dubbed LENS Hybrid Vertical Mill, enables metal additive and subtractive operations to be performed on the same machine tool and even on the same part. Information on the LENS Hybrid system architecture, learnings from initial system deployment and continuing development work will also be provided to help guide further development activities within the materials community.

The Effects of Quality of Care on Costs: A Conceptual Framework

PubMed Central

Nuckols, Teryl K; Escarce, José J; Asch, Steven M

2013-01-01

Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. PMID:23758513

Practice Level Costs of Office-Based Hypertension Performance Improvement: The Heart Healthy Lenoir Study.

PubMed

Primary care practice leaders who consider engaging in quality improvement (QI) need to understand the practice level costs incurred when asking staff to take on new tasks. The Heart Healthy Lenoir study is a prospective cohort trial in which QI methods were used to enhance hypertension (HTN) care and reduce racial disparities in blood pressure control in small rural primary care practices in North Carolina. As part of this effort, we performed an activity-based costing analysis to describe the costs incurred to develop, implement, and maintain key tasks.We interviewed 20 practice stakeholders and phone-based health coaches during 2012-2014. We calculated the time invested by individuals to perform each task within each study phase and applied national hourly wages to generate cost estimates. Our descriptive analyses focus on four of the most widely used practices. Activities included time to abstract HTN control data, participate in project meetings, identify patients with uncontrolled HTN, create standardized work, and provide additional health coaching for patients with uncontrolled HTN. Despite practice and staffing differences, the developmental phase costs were similar, ranging from $879 to $1,417. Implementation costs varied more widely as practices took different approaches to identifying patients with uncontrolled HTN. Practice-specific phone health coaching costs ranged from $19,508 to more than $38,000. This study adds to the growing literature regarding practice level costs of engaging in systems change. Understanding these costs and balancing them against practice incentives may be helpful as stakeholders make decisions regarding HTN QI.

The economic burden of cancer care in Canada: a population-based cost study

PubMed Central

de Oliveira, Claire; Weir, Sharada; Rangrej, Jagadish; Krahn, Murray D.; Mittmann, Nicole; Hoch, Jeffrey S.; Chan, Kelvin K.W.; Peacock, Stuart

2018-01-01

Background: Resource and cost issues are a growing concern in health care. Thus, it is important to have an accurate estimate of the economic burden of care. Previous work has estimated the economic burden of cancer care for Canada; however, there is some concern this estimate is too low. The objective of this analysis was to provide a comprehensive revised estimate of this burden. Methods: We used a case-control prevalence-based approach to estimate direct annual cancer costs from 2005 to 2012. We used patient-level administrative health care data from Ontario to correctly attribute health care costs to cancer. We employed the net cost method (cost difference between patients with cancer and control subjects without cancer) to account for costs directly and indirectly related to cancer and its sequelae. Using average patient-level cost estimates from Ontario, we applied proportions from national health expenditures data to obtain the economic burden of cancer care for Canada. All costs were adjusted to 2015 Canadian dollars. Results: Costs of cancer care rose steadily over our analysis period, from $2.9 billion in 2005 to $7.5 billion in 2012, mostly owing to the increase in costs of hospital-based care. Most expenditures for health care services increased over time, with chemotherapy and radiation therapy expenditures accounting for the largest increases over the study period. Our cost estimates were larger than those in the Economic Burden of Illness in Canada 2005-2008 report for every year except 2005 and 2006. Interpretation: The economic burden of cancer care in Canada is substantial. Further research is needed to understand how the economic burden of cancer compares to that of other diseases. PMID:29301745

Health care costs for the evaluation, surgery, and follow-up care of living kidney donors.

PubMed

Habbous, Steven; Sarma, Sisira; Barnieh, Lianne; McArthur, Eric; Klarenbach, Scott; Manns, Braden; Begen, Mehmet A; Lentine, Krista L; Garg, Amit X

2018-04-19

The health care costs to evaluate, perform surgery, and follow a living kidney donor for the year after donation are poorly described. We obtained information on the health care costs of 1099 living kidney donors between April 1, 2004 and March 31, 2014 from Ontario, Canada using comprehensive health care administrative databases. We estimated the cost of 3 periods of the living donation process: the predonation evaluation period (start of evaluation until the day before donation), perioperative period (day of donation until 30-days postdonation), and 1 year of follow-up period (after perioperative period until 1-year postdonation). We analyzed data for donors and healthy matched nondonor controls using regression-based methods to estimate the incremental cost of living donation. Costs are presented from the perspective of the Canadian health care payer (2017 $CAD). The incremental health care costs (compared with controls) for the evaluation, perioperative, and follow-up periods were $3,596 (95% confidence interval (CI) $3,350-$3,842), $11,694 ($11,415-$11,973), and $1,011 ($793-$1,230), respectively, totalling $16,290 ($15,814-$16,767). The evaluation cost was higher if the intended recipient started dialysis part-way through the donor evaluation [$886 ($19, $1,752)]. The perioperative cost varied across transplant centers (p<0.0001). While substantial costs of living donor care are related to the nephrectomy procedure, comprehensive assessment of costs must also include the evaluation and follow-up periods. These estimates are informative for planning future work to support and expand living donation and transplantation, and directing efforts to improve the cost efficiency of living donor care.

A Low-Cost Inkjet-Printed Aptamer-Based Electrochemical Biosensor for the Selective Detection of Lysozyme.

PubMed

Khan, Niazul Islam; Maddaus, Alec G; Song, Edward

2018-01-15

Recently, inkjet-printing has gained increased popularity in applications such as flexible electronics and disposable sensors, as well as in wearable sensors because of its multifarious advantages. This work presents a novel, low-cost immobilization technique using inkjet-printing for the development of an aptamer-based biosensor for the detection of lysozyme, an important biomarker in various disease diagnosis. The strong affinity between the carbon nanotube (CNT) and the single-stranded DNA is exploited to immobilize the aptamers onto the working electrode by printing the ink containing the dispersion of CNT-aptamer complex. The inkjet-printing method enables aptamer density control, as well as high resolution patternability. Our developed sensor shows a detection limit of 90 ng/mL with high target selectivity against other proteins. The sensor also demonstrates a shelf-life for a reasonable period. This technology has potential for applications in developing low-cost point-of-care diagnostic testing kits for home healthcare.

Exposure to crystalline silica at Alberta work sites: review of controls.

PubMed

Radnoff, Diane; Todor, Maria S; Beach, Jeremy

2015-01-01

From 2009 to 2013, Alberta Jobs, Skills, Training, and Labour (JSTL) conducted a project to evaluate exposure to crystalline silica and assess controls to protect workers. Information on exposure results has been previously reported; this article discusses the data collected on workplace controls. Information on work site controls was collected during exposure assessments consisting of qualitative information on controls in place and used by workers at the time of the assessments. Where there was sufficient data, the information was further analyzed to evaluate the impact of a particular control. While many types of controls were observed, they were not always effective or in use. The control available most often was respiratory protective equipment (RPE). Generally, when respirators were used, they were correctly selected for the level of measured exposure. However, not all workers who were potentially overexposed wore respirators at the time of the assessments. When the use of respirators was taken into account, about one-third of workers were still potentially exposed over the Alberta occupational exposure limit. The industries with the highest levels of exposure tended to be those with the most unprotected workers. Issues were identified with the use of improper work practices such as dry cleaning methods, lack of documented work procedures, poor housekeeping, and lack of training which may have contributed to worker exposure levels. There is a wide range in the efficacy of controls, particularly engineering controls. Most of the literature focuses on engineering controls; however administrative controls also play a role in reducing worker exposure. Data collected in this work indicated that simple changes to work procedures and behavior (such as improved housekeeping) may be effective, low-cost ways to reduce workplace exposure. More study is required to evaluate the impact and efficacy of administrative controls such as housekeeping and training. Employers must select and evaluate controls in the context of overall workplace health and safety programs and ensure that they are supported by supervision, good work practices. and training.

Work-related abuse: a replication, new items, and persistent questions.

PubMed

Brush, Lisa D

2002-12-01

This study compared independently developed tools to measure work-related control, abuse, and sabotage. Interviewers administered the Work/School Abuse Scale (W/SAS; Riger, Ahrens, & Blickenstaff, 2000) to 40 welfare recipients, and a Work-Related Control, Abuse, and Sabotage Checklist (WORCASC) to a total of 162 welfare recipients, including the same 40 who answered the W/SAS. I report and compare results on W/SAS and WORCASC with 40 non-sheltered (i.e., not residing in a shelter) respondents and discuss instrument strengths and weaknesses. Measurement analyses provided preliminary empirical answers to questions about the relationship between battering and work. Findings confirmed the reliability of the two instruments, the extent to which they measure something distinct from physical abuse, and their association with relevant outcomes such as being written up, reprimanded, or losing pay at work. Measurement questions are salient in the context of debates over welfare reforms and efforts to reconcile the ways researchers, advocates, service providers, and policy makers understand and address the costs of taking a beating.

Improvements in Cz silicon PV module manufacturing

NASA Astrophysics Data System (ADS)

King, Richard R.; Mitchell, Kim W.; Jester, Theresa L.

1997-02-01

Work focused on reducing the cost per watt of Cz Si photovoltaic modules under Phase I of Siemens Solar Industries' DOE/NREL PVMaT 4A subcontract is described. Module cost components are analyzed and solutions to high-cost items are discussed in terms of specific module designs. The approaches of using larger cells and modules to reduce per-part processing cost, and of minimizing yield loss are particularly leveraging. Yield components for various parts of the fabrication process and various types of defects are shown, and measurements of the force required to break wafers throughout the cell fabrication sequence are given. The most significant type of yield loss is mechanical breakage. The implementation of statistical process control on key manufacturing processes at Siemens Solar Industries is described. Module configurations prototyped during Phase I of this project and scheduled to begin production in Phase II have a projected cost per watt reduction of 19%.

Adult age differences in task switching.

PubMed

Kray, J; Lindenberger, U

2000-03-01

Age differences in 2 components of task-set switching speed were investigated in 118 adults aged 20 to 80 years using task-set homogeneous (e.g., AAAA ...) and task-set heterogeneous (e.g., AABBAABB ... ) blocks. General switch costs were defined as latency differences between heterogeneous and homogeneous blocks. whereas specific switch costs were defined as differences between switch and nonswitch trials within heterogeneous blocks. Both types of costs generalized over verbal, figural, and numeric stimulus materials; were more highly correlated to fluid than to crystallized abilities; and were not eliminated after 6 sessions of practice, indicating that they reflect basic and domain-general aspects of cognitive control. Most important, age-associated increments in costs were significantly greater for general than for specific switch costs, suggesting that the ability to efficiently maintain and coordinate 2 alternating task sets in working memory instead of 1 is more negatively affected by advancing age than the ability to execute the task switch itself.

The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm.

PubMed

Kessler, R C; Lane, M; Stang, P E; Van Brunt, D L

2009-01-01

Little is known about the effects of adult attention deficit hyperactivity disorder (ADHD) on work performance or accidents-injuries.MethodA survey was administered in 2005 and 2006 to employees of a large manufacturing firm to assess the prevalence and correlates of adult ADHD. Respondents (4,140 in 2005, 4,423 in 2006, including 2,656 in both surveys) represented 35-38% of the workforce. ADHD was assessed with the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS), a validated screening scale for DSM-IV adult ADHD. Sickness absence, work performance and workplace accidents-injuries were assessed with the WHO Health and Work Performance Questionnaire (HPQ). The estimated current prevalence (standard error) of DSM-IV ADHD was 1.9% (0.4). ADHD was associated with a 4-5% reduction in work performance (chi12=9.1, p=0.001), a 2.1 relative-odds of sickness absence (chi12=6.2, p=0.013), and a 2.0 relative-odds of workplace accidents-injuries (chi12=5.1, p=0.024). The human capital value (standard error) of the lost work performance associated with ADHD totaled USD 4,336 (676) per worker with ADHD in the year before interview. No data were available to monetize other workplace costs of accidents-injuries (e.g. destruction of equipment). Only a small minority of workers with ADHD were in treatment. Adult ADHD is a significantly impairing condition among workers. Given the low rate of treatment and high human capital costs, in conjunction with evidence from controlled trials that treatment can reduce ADHD-related impairments, ADHD would seem to be a good candidate for workplace trials that evaluate treatment cost-effectiveness from the employer's perspective.

The cost-effectiveness of temozolomide in the adjuvant treatment of newly diagnosed glioblastoma in the United States

PubMed Central

Messali, Andrew; Hay, Joel W.; Villacorta, Reginald

2013-01-01

Background The objective of this work was to determine the cost-effectiveness of temozolomide compared with that of radiotherapy alone in the adjuvant treatment of newly diagnosed glioblastoma. Temozolomide is the only chemotherapeutic agent to have demonstrated a significant survival benefit in a randomized clinical trial. Our analysis builds on earlier work by incorporating caregiver time costs and generic temozolomide availability. It is also the first analysis applicable to the US context. Methods A systematic literature review was conducted to collect relevant data. Transition probabilities were calculated from randomized controlled trial data comparing temozolomide plus radiotherapy with radiotherapy alone. Direct costs were calculated from charges reported by the Mayo Clinic. Utilities were obtained from a previous cost-utility analysis. Using these data, a Markov model with a 1-month cycle length and 5-year time horizon was constructed. Results The addition of brand Temodar and generic temozolomide to the standard radiotherapy regimen was associated with base-case incremental cost-effectiveness ratios of $102 364 and $8875, respectively, per quality-adjusted life-year. The model was most sensitive to the progression-free survival associated with the use of only radiotherapy. Conclusions Both the brand and generic base-case estimates are cost-effective under a willingness-to-pay threshold of $150 000 per quality-adjusted life-year. All 1-way sensitivity analyses produced incremental cost-effectiveness ratios below this threshold. We conclude that both the brand Temodar and generic temozolomide are cost-effective treatments for newly diagnosed glioblastoma within the US context. However, assuming that the generic product produces equivalent quality of life and survival benefits, it would be significantly more cost-effective than the brand option. PMID:23935155

Revisiting control establishments for emerging energy hubs

NASA Astrophysics Data System (ADS)

Nasirian, Vahidreza

Emerging small-scale energy systems, i.e., microgrids and smartgrids, rely on centralized controllers for voltage regulation, load sharing, and economic dispatch. However, the central controller is a single-point-of-failure in such a design as either the controller or attached communication links failure can render the entire system inoperable. This work seeks for alternative distributed control structures to improve system reliability and help to the scalability of the system. A cooperative distributed controller is proposed that uses a noise-resilient voltage estimator and handles global voltage regulation and load sharing across a DC microgrid. Distributed adaptive droop control is also investigated as an alternative solution. A droop-free distributed control is offered to handle voltage/frequency regulation and load sharing in AC systems. This solution does not require frequency measurement and, thus, features a fast frequency regulation. Distributed economic dispatch is also studied, where a distributed protocol is designed that controls generation units to merge their incremental costs into a consensus and, thus, push the entire system to generate with the minimum cost. Experimental verifications and Hardware-in-the-Loop (HIL) simulations are used to study efficacy of the proposed control protocols.

The emotional costs of caring incurred by men and women in the British labour market.

PubMed

Barron, David Nicholas; West, Elizabeth

2007-11-01

This study investigates whether men and women in caring occupations experience more negative job-related feelings at the end of the day compared to the rest of the working population. The data are from Wave Nine of the British Household Panel Survey (1999) where respondents were asked whether, at the end of the working day, they tended to keep worrying or have trouble unwinding, and the extent to which work left them feeling exhausted or "used up." Their responses to these questions were used to develop ordinal dependent variables. Control variables in the models include: number of children, age, hours worked per week, managerial responsibilities and job satisfaction, all of which have been shown in previous research to be significantly related to "job burnout." The results are that those in caring occupations are more likely to feel worried, tense, drained and exhausted at the end of the working day. Women in particular appear to pay a high emotional cost for working in caring occupations. Men do not emerge unscathed, but report significantly lower levels of worry and exhaustion at the end of the day than do women.

Growth of InAs NWs with controlled morphology by CVD

NASA Astrophysics Data System (ADS)

Huang, Y. S.; Li, M.; Wang, J.; Xing, Y.; Xu, H. Q.

2017-06-01

We report on the growth of single crystal InAs NWs on Si/SiOx substrates by chemical vapor deposition (CVD). By adjusting growth parameters, the diameters, morphology, length and the proportion of superlattice ZB InAs NWs (NWs) can be controlled on a Si/SiOx substrate. Our work provides a low-cost route to grow and phase-engineer single crystal InAs NWs for a wide range of potential applications.

Hydronic Heating Retrofits for Low-Rise Multifamily Buildings - Phase 1: Boiler Control Replacement and Monitoring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dentz, J.; Henderson, H.

2012-04-01

The ARIES Collaborative, a Department of Energy Building America research team, partnered with NeighborWorks America affiliate Homeowners' Rehab Inc. (HRI) of Cambridge, MA to implement and study improvements to the heating system in one of the non-profit's housing developments. The heating control systems in the 42-unit Columbia CAST housing development were upgraded in an effort projected to reduce heating costs by 15 to 25 percent.

Rotorcraft Low Altitude IFR Benefit/Cost Analysis: Operations Analysis

DTIC Science & Technology

1991-12-01

Anoll Len D. Dzamba Linda J. LaBelle Randahl N. Lindgren Robert B. Newman Deborah J. Peisen Systems Control Technology , Inc. 1611 N. Kent Street, Suite...Lindgren, Robert B. Newman, Deborah J. Peisen 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) Systems Control Technology , Inc. 1611...headquarters of United Technology /Sikorsky to get them through this area. 5.7.3.3 Communications Coverage Corporate/executive operators were well satisfied

Modification of the ECAS reference steam power generating plant to comply with the EPA 1979 new source performance standards

NASA Technical Reports Server (NTRS)

Fogelson, S. A.; Chait, I. L.; Bradley, W. J.; Benson, W.

1980-01-01

Detailed capital cost estimates for the ECAS and modified reference plants in mid-1978 dollars for both 250 and 175 F (394 and 353 K) stack gas reheat temperatures based on the cost estimates developed for the ECAS study are presented. The scope of the work included technical assessment of sulfur dioxide scrubber system design, on site calcination versus purchased lime, reheat of stack gas, effect of sulfur dioxide scrubber on particulate emission, and control of nitrogen oxides.

Work plan for the Isotopes Facilities Deactivation Project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-08-01

The purpose of the Isotopes Facilities Deactivation Project (IFDP) is to place former isotopes production facilities at the Oak Ridge National Laboratory in a safe, stable, and environmentally sound condition; suitable for an extended period of minimum surveillance and maintenance (S and M) and as quickly and economical as possible. Implementation and completion of the deactivation project will further reduce the risks to the environment and to public safety and health. Furthermore, completion of the project will result in significant S and M cost savings in future years. The IFDP work plan defines the project schedule, the cost estimate, andmore » the technical approach for the project. A companion document, the EFDP management plan, has been prepared to document the project objectives, define organizational relationships and responsibilities, and outline the management control systems to be employed in the management of the project. The project has adopted the strategy of deactivating the simple facilities first, to reduce the scope of the project and to gain experience before addressing more difficult facilities. A decision support system is being developed to identify the activities that best promote the project mission and result in the largest cost savings. This work plan will be reviewed and revised annually. Deactivation of EFDP Facilities was initiated in FY 1994 and will be completed in FY 2000. The schedule for deactivation of facilities is shown. The total cost of the project is estimated to be $51M. The costs are summarized. Upon completion of deactivation, annual S and M costs of these facilities will be reduced from the current level of $5M per year to less than $1M per year.« less

The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers

PubMed Central

Bernaards, Claire M; Ariëns, Geertje AM; Hildebrandt, Vincent H

2006-01-01

Background Neck and upper limb symptoms are frequently reported by computer workers. Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms. A combined approach targeting work style and lifestyle physical activity seems promising, but little is known on the effectiveness of such combined interventions. Methods/design The RSI@Work study is a randomised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers. Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and/or the last two weeks are randomised into three groups: (1) work style group, (2) work style and physical activity group, or (3) control group. The work style intervention consists of six group meetings in a six month period that take place at the workplace, during work time, and under the supervision of a specially trained counsellor. The goal of this intervention is to stimulate workplace adjustment and to improve body posture, the number and quality of breaks and coping behaviour with regard to high work demands. In the combined (work style and physical activity) intervention the additional goal is to increase moderate to heavy physical activity. The control group receives usual care. Primary outcome measures are degree of recovery, pain intensity, disability, number of days with neck and upper limb symptoms, and number of months without neck and upper limb symptoms. Outcome measures will be assessed at baseline and six and 12 months after randomisation. Cost-effectiveness of the group meetings will be assessed using an employer's perspective. Discussion This study will be one of the first to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention in reducing neck and upper limb symptoms of computer workers. The results of the study are expected in 2007. PMID:17062141

How Do the Approaches to Accountability Compare for Charities Working in International Development?

PubMed Central

Kirsch, David

2014-01-01

Approaches to accountability vary between charities working to reduce under-five mortality in underdeveloped countries, and healthcare workers and facilities in Canada. Comparison reveals key differences, similarities and trade-offs. For example, while health professionals are governed by legislation and healthcare facilities have a de facto obligation to be accredited, charities and other international organizations are not subject to mandatory international laws or guidelines or to de facto international standards. Charities have policy goals similar to those found in the Canadian substudies, including access, quality, cost control, cost-effectiveness and customer satisfaction. However, the relative absence of external policy tools means that these goals may not be realized. Accountability can be beneficial, but too much or the wrong kind of accountability can divert resources and diminish returns. PMID:25305397

[Computed assisted voice recognition. A dream or reality in the pathologist's routine work?].

PubMed

Delling, G; Delling, D

1999-03-01

During the last 30 years the analysis of human speech with powerful computers has taken great strides; therefore, cost-effective, comfortable solutions are now available for use in professional routine work. The advantages of using voice recognition are the creation of new documentation or archives, reduced personnel costs and, last but not least, independence in cases of unforeseen notification of illness or owing to annual leave. For voice recognition systems to be used easily, a considerable amount of time must be invested for the first 3 months. Younger colleagues in particular will be more motivated to dictate more precisely and more detailed because of the introduction of voice recognition. The effects on other sectors of medical training, quality control, histology report preparation, and transmission can only be speculated.

Modeling the role of information and limited optimal treatment on disease prevalence.

PubMed

Kumar, Anuj; Srivastava, Prashant K; Takeuchi, Yasuhiro

2017-02-07

Disease outbreaks induce behavioural changes in healthy individuals to avoid contracting infection. We first propose a compartmental model which accounts for the effect of individual's behavioural response due to information of the disease prevalence. It is assumed that the information is growing as a function of infective population density that saturates at higher density of infective population and depends on active educational and social programmes. Model analysis has been performed and the global stability of equilibrium points is established. Further, choosing the treatment (a pharmaceutical intervention) and the effect of information (a non-pharmaceutical intervention) as controls, an optimal control problem is formulated to minimize the cost and disease fatality. In the cost functional, the nonlinear effect of controls is accounted. Analytical characterization of optimal control paths is done with the help of Pontryagin's Maximum Principle. Numerical findings suggest that if only control via information is used, it is effective and economical for early phase of disease spread whereas treatment works well for long term control except for initial phase. Furthermore, we observe that the effect of information induced behavioural response plays a crucial role in the absence of pharmaceutical control. Moreover, comprehensive use of both the control interventions is more effective than any single applied control policy and it reduces the number of infective individuals and minimizes the economic cost generated from disease burden and applied controls. Thus, the combined effect of both the control policies is found more economical during the entire epidemic period whereas the implementation of a single policy is not found economically viable. Copyright © 2016 Elsevier Ltd. All rights reserved.

Processing implicit control: evidence from reading times

PubMed Central

McCourt, Michael; Green, Jeffrey J.; Lau, Ellen; Williams, Alexander

2015-01-01

Sentences such as “The ship was sunk to collect the insurance” exhibit an unusual form of anaphora, implicit control, where neither anaphor nor antecedent is audible. The non-finite reason clause has an understood subject, PRO, that is anaphoric; here it may be understood as naming the agent of the event of the host clause. Yet since the host is a short passive, this agent is realized by no audible dependent. The putative antecedent to PRO is therefore implicit, which it normally cannot be. What sorts of representations subserve the comprehension of this dependency? Here we present four self-paced reading time studies directed at this question. Previous work showed no processing cost for implicit vs. explicit control, and took this to support the view that PRO is linked syntactically to a silent argument in the passive. We challenge this conclusion by reporting that we also find no processing cost for remote implicit control, as in: “The ship was sunk. The reason was to collect the insurance.” Here the dependency crosses two independent sentences, and so cannot, we argue, be mediated by syntax. Our Experiments 1–4 examined the processing of both implicit (short passive) and explicit (active or long passive) control in both local and remote configurations. Experiments 3 and 4 added either “3 days ago” or “just in order” to the local conditions, to control for the distance between the passive and infinitival verbs, and for the predictability of the reason clause, respectively. We replicate the finding that implicit control does not impose an additional processing cost. But critically we show that remote control does not impose a processing cost either. Reading times at the reason clause were never slower when control was remote. In fact they were always faster. Thus, efficient processing of local implicit control cannot show that implicit control is mediated by syntax; nor, in turn, that there is a silent but grammatically active argument in passives. PMID:26579016

Control of Fine Particulate (PM2.5) Emissions from Restaurant Operations.

PubMed

Whynot, Jill; Quinn, Gary; Perryman, Pamela; Votlucka, Peter

1999-09-01

This paper describes efforts to reduce particulate matter (PM) emissions from restaurant operations, including application of an existing control method to a new equipment type. Commercial charbroiling in the South Coast Air Basin results in emissions of approximately 10 tons/day of fine particulate matter ( PM 2.5) and 1.3 tons/day of volatile organic compounds (VOCs). Over a seven-year period, the South Coast Air Quality Management District worked with industry to develop test methods for measuring emissions from various cooking operations, evaluate control technologies, and develop a rule to reduce these emissions. Of the two basic types of charbroilers-chain-driven and underfired-underfired produce four times the emissions when equivalent amounts of product are cooked. Cost-effective control technology is currently available only for chain-driven charbroilers. The application of flameless catalytic oxidizers to chain-driven charbroilers was found to effectively reduce emissions by at least 83% and is cost-effective. The catalysts have been used worldwide at restaurants for several years. Research efforts are underway to identify control options for underfired charbroilers. Implementation of Rule 1138, Control of Emissions from Restaurant Operations, adopted November 14, 1997, will result in reductions of 0.5 tons/day of PM 2.5 and 0.2 tons/day of VOCs. Future rules will result in reductions from underfired charbroilers and possibly other restaurant equipment when cost-effective solutions are available.

Control of fine particulate (PM2.5) emissions from restaurant operations.

PubMed

Whynot, J; Quinn, G; Perryman, P; Votlucka, P

1999-09-01

This paper describes efforts to reduce particulate matter (PM) emissions from restaurant operations, including application of an existing control method to a new equipment type. Commercial charbroiling in the South Coast Air Basin results in emissions of approximately 10 tons/day of fine particulate matter (PM2.5) and 1.3 tons/day of volatile organic compounds (VOCs). Over a seven-year period, the South Coast Air Quality Management District worked with industry to develop test methods for measuring emissions from various cooking operations, evaluate control technologies, and develop a rule to reduce these emissions. Of the two basic types of charbroilers--chain-driven and underfired--underfired produce four times the emissions when equivalent amounts of product are cooked. Cost-effective control technology is currently available only for chain-driven charbroilers. The application of flameless catalytic oxidizers to chain-driven charbroilers was found to effectively reduce emissions by at least 83% and is cost-effective. The catalysts have been used worldwide at restaurants for several years. Research efforts are underway to identify control options for underfired charbroilers. Implementation of Rule 1138, Control of Emissions from Restaurant Operations, adopted November 14, 1997, will result in reductions of 0.5 tons/day of PM2.5 and 0.2 tons/day of VOCs. Future rules will result in reductions from underfired charbroilers and possibly other restaurant equipment when cost-effective solutions are available.

Effect of part-time practice on patient outcomes.

PubMed

Parkerton, Patricia H; Wagner, Edward H; Smith, Dean G; Straley, Hugh L

2003-09-01

Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. To determine whether patient outcomes vary with physicians' clinic hours. Cross-sectional retrospective design assessing primary care practices in 1998. All 25 outpatient-clinics of a single medical group in western Washington. One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time). Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender). While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P =.001), diabetic management (3% higher, P =.033), and for patient satisfaction (3% higher, P =.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P =.212) or ambulatory costs (P =.323). Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery--the FOCCUS study.

PubMed

Cuthbertson, Brian H; Campbell, Marion K; Stott, Stephen A; Elders, Andrew; Hernández, Rodolfo; Boyers, Dwayne; Norrie, John; Kinsella, John; Brittenden, Julie; Cook, Jonathan; Rae, Daniela; Cotton, Seonaidh C; Alcorn, David; Addison, Jennifer; Grant, Adrian

2011-01-01

Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Prospective Clinical Trials, ISRCTN32188676.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery - the FOCCUS study

PubMed Central

2011-01-01

Introduction Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. Methods This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. Results A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Conclusions Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Trial registration Prospective Clinical Trials, ISRCTN32188676 PMID:22177541

Costs and benefits of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: a randomized controlled trial

PubMed Central

Farias, Catharinne C.; Resqueti, Vanessa; Dias, Fernando A. L.; Borghi-Silva, Audrey; Arena, Ross; Fregonezi, Guilherme A. F.

2014-01-01

Objective The current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). Method This was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (GPR)]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). Results Only 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the GPR (FEV1: 50.9±14% predicted and FEV1: 56±0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05). The final mean cost per patient for the GPR was R$ 148.75 (~US$ 75.00) and no patient significantly exceeded this value. However, 2 patients in the CG did exceed this value, incurring a cost of R$ 689.15 (~US$ 345.00). Conclusion Aerobic walking demonstrated significant clinical benefits in a cost-efficient manner in patients with COPD. PMID:24838809

Two Undergraduate Projects for Data Acquisition and Control

NASA Astrophysics Data System (ADS)

Hiersche, Kelly; Pena, Tara; Grogan, Tanner; Wright, Matthew

We are designing two separate instruments for use in our undergraduate laboratory. In the first project, a Raspberry Pi is used to simultaneously monitor a large number of current and voltage readings and store them in a database. In our second project, we are constructing our own microcontrollers to work as a general-purpose interface based off work carried out in Review of Scientific Instruments 84, 103101 (2013). It was designed for low cost and simple construction, making it ideal for undergraduate level work. This circuit has room for two interchangeable daughter boards, giving it the capability to work as a general lab interface, lock-in detector, or waveform generator.

Assessing value-for-money in maternal and newborn health

PubMed Central

Madaj, Barbara; Kumar, Shubha

2017-01-01

Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both ‘economy’ and ‘efficiency’ can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case–control studies or randomised controlled trials can be used to assess ‘effectiveness’. To assess ‘cost-effectiveness’, cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such ‘economy’ and ‘efficiency’ are relatively easy to assess. However, ‘effectiveness’ and ‘cost-effectiveness’ which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help. PMID:29081998

Assessing value-for-money in maternal and newborn health.

PubMed

Banke-Thomas, Aduragbemi; Madaj, Barbara; Kumar, Shubha; Ameh, Charles; van den Broek, Nynke

2017-01-01

Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both 'economy' and 'efficiency' can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case-control studies or randomised controlled trials can be used to assess 'effectiveness'. To assess 'cost-effectiveness', cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such 'economy' and 'efficiency' are relatively easy to assess. However, 'effectiveness' and 'cost-effectiveness' which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help.

Cost of dengue cases in eight countries in the Americas and Asia: a prospective study.

PubMed

Suaya, Jose A; Shepard, Donald S; Siqueira, João B; Martelli, Celina T; Lum, Lucy C S; Tan, Lian Huat; Kongsin, Sukhontha; Jiamton, Sukhum; Garrido, Fàtima; Montoya, Romeo; Armien, Blas; Huy, Rekol; Castillo, Leticia; Caram, Mariana; Sah, Binod K; Sughayyar, Rana; Tyo, Karen R; Halstead, Scott B

2009-05-01

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Performance costs when emotion tunes inappropriate cognitive abilities: implications for mental resources and behavior.

PubMed

Storbeck, Justin

2012-08-01

Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency. In 2 experiments, either an approach-motivated positive state or a withdrawal-motivated negative state was induced, and then participants completed a verbal or a spatial working memory task creating conditions of emotion-cognition alignment (e.g., approach/verbal) or misalignment (e.g., approach/spatial). A control condition was also included. To examine behavioral costs due to depleted self-control resources, participants completed either a Stroop task (Stroop, 1935; Experiment 1) or a Black/White implicit association test (IAT; Greenwald, McGhee, & Schwartz, 1998; Experiment 2). Participants in the misalignment conditions performed worse on the Stroop task, and they were worse at controlling their implicit attitude biases on the IAT. Thus, when emotion tunes inappropriate cognitive tendencies for one's current environment, self-control resources become depleted, impairing behavioral control. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

A Plan for Advanced Guidance and Control Technology for 2nd Generation Reusable Launch Vehicles

NASA Technical Reports Server (NTRS)

Hanson, John M.; Fogle, Frank (Technical Monitor)

2002-01-01

Advanced guidance and control (AG&C) technologies are critical for meeting safety/reliability and cost requirements for the next generation of reusable launch vehicle (RLV). This becomes clear upon examining the number of expendable launch vehicle failures in the recent past where AG&C technologies would have saved a RLV with the same failure mode, the additional vehicle problems where this technology applies, and the costs associated with mission design with or without all these failure issues. The state-of-the-art in guidance and control technology, as well as in computing technology, is at the point where we can took to the possibility of being able to safely return a RLV in any situation where it can physically be recovered. This paper outlines reasons for AG&C, current technology efforts, and the additional work needed for making this goal a reality.

Orbit transfer rocket engine integrated control and health monitoring system technology readiness assessment

NASA Technical Reports Server (NTRS)

Bickford, R. L.; Collamore, F. N.; Gage, M. L.; Morgan, D. B.; Thomas, E. R.

1992-01-01

The objectives of this task were to: (1) estimate the technology readiness of an integrated control and health monitoring (ICHM) system for the Aerojet 7500 lbF Orbit Transfer Vehicle engine preliminary design assuming space based operations; and (2) estimate the remaining cost to advance this technology to a NASA defined 'readiness level 6' by 1996 wherein the technology has been demonstrated with a system validation model in a simulated environment. The work was accomplished through the conduct of four subtasks. In subtask 1 the minimally required functions for the control and monitoring system was specified. The elements required to perform these functions were specified in Subtask 2. In Subtask 3, the technology readiness level of each element was assessed. Finally, in Subtask 4, the development cost and schedule requirements were estimated for bringing each element to 'readiness level 6'.

Quantifying the Impact of Unavailability in Cyber-Physical Environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aissa, Anis Ben; Abercrombie, Robert K; Sheldon, Federick T.

2014-01-01

The Supervisory Control and Data Acquisition (SCADA) system discussed in this work manages a distributed control network for the Tunisian Electric & Gas Utility. The network is dispersed over a large geographic area that monitors and controls the flow of electricity/gas from both remote and centralized locations. The availability of the SCADA system in this context is critical to ensuring the uninterrupted delivery of energy, including safety, security, continuity of operations and revenue. Such SCADA systems are the backbone of national critical cyber-physical infrastructures. Herein, we propose adapting the Mean Failure Cost (MFC) metric for quantifying the cost of unavailability.more » This new metric combines the classic availability formulation with MFC. The resulting metric, so-called Econometric Availability (EA), offers a computational basis to evaluate a system in terms of the gain/loss ($/hour of operation) that affects each stakeholder due to unavailability.« less

The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial.

PubMed

Speklé, Erwin M; Heinrich, Judith; Hoozemans, Marco J M; Blatter, Birgitte M; van der Beek, Allard J; van Dieën, Jaap H; van Tulder, Maurits W

2010-11-11

The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave. The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping. The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found. In this study, the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies' perspective and, therefore, this study does not provide a financial reason for implementing this intervention. However, with a relatively small investment, the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement. NTR1117.