A non-stationary cost-benefit based bivariate extreme flood estimation approach

NASA Astrophysics Data System (ADS)

Qi, Wei; Liu, Junguo

2018-02-01

Cost-benefit analysis and flood frequency analysis have been integrated into a comprehensive framework to estimate cost effective design values. However, previous cost-benefit based extreme flood estimation is based on stationary assumptions and analyze dependent flood variables separately. A Non-Stationary Cost-Benefit based bivariate design flood estimation (NSCOBE) approach is developed in this study to investigate influence of non-stationarities in both the dependence of flood variables and the marginal distributions on extreme flood estimation. The dependence is modeled utilizing copula functions. Previous design flood selection criteria are not suitable for NSCOBE since they ignore time changing dependence of flood variables. Therefore, a risk calculation approach is proposed based on non-stationarities in both marginal probability distributions and copula functions. A case study with 54-year observed data is utilized to illustrate the application of NSCOBE. Results show NSCOBE can effectively integrate non-stationarities in both copula functions and marginal distributions into cost-benefit based design flood estimation. It is also found that there is a trade-off between maximum probability of exceedance calculated from copula functions and marginal distributions. This study for the first time provides a new approach towards a better understanding of influence of non-stationarities in both copula functions and marginal distributions on extreme flood estimation, and could be beneficial to cost-benefit based non-stationary bivariate design flood estimation across the world.

A novel method of estimating cost of therapy by using patient population characteristics: analysis of fluoroquinolones in various populations with different distributions of renal function.

PubMed

Enzweiler, Kevin A; Bosso, John A; White, Roger L

2003-07-01

Formulary decisions regarding a given drug class are often made in the absence of patient outcome and/or sophisticated pharmacoeconomic data. Analyses that consider factors beyond simple acquisition costs may be useful in such situations. For example, the cost implications of using manufacturers' recommendations for dosing in patients with renal dysfunction may be important, depending on the distribution of various levels of renal function within a patient population. Using four 1000-patient populations representing different renal function distributions and a fifth population of our medical center's distribution, we determined the costs of therapy for intravenous and oral levofloxacin, gatifloxacin, and moxifloxacin for a 10-day course of therapy for community-acquired pneumonia. Costs considered were average wholesale prices (AWPs), 50% of AWP, or same daily price, plus intravenous dose preparation and administration costs when applicable. Costs for each renal function distribution were examined for significant differences with an analysis-of-variance test. Also, costs of failing to adjust dosing regimens for decreased renal function were determined. Differences in fluoroquinolone costs (AWP, 50% AWP, or when matched as the same daily price) among the populations were found. When considering same daily prices, differences among populations ranged from about 35,000 dollars with intravenous gatifloxacin to more than 51,000 dollars for intravenous levofloxacin (all fluoroquinolones, p>0.05). Within a population, differences in costs among the intravenous fluoroquinolones ranged from 47,000-99,000 dollars. Rank orders of the drugs and population costs of therapy were affected by the pricing structure used and varied by the specific population and drug. Differences among the fluoroquinolones or populations were much smaller (<2100 dollars) when considering oral regimens. Costs potentially incurred by failing to adjust dosing for renal function were substantial. Formulary decisions can be facilitated by considering factors such as patient characteristics and related dosing in addition to simple acquisition costs. In our example, consideration of the distribution of renal function within a given patient population and related dosing for these fluoroquinolones revealed potentially important differences within the class.

Axiomatic foundations for cost-effectiveness analysis.

PubMed

Canning, David

2013-12-01

We show that individual utilities can be measured in units of healthy life years. Social preferences over these life metric utilities are assumed to satisfy the Pareto principle, anonymity, and invariance to a change in origin. These axioms generate a utilitarian social welfare function implying the use of cost-effectiveness analysis in ordering health projects, based on maximizing the healthy years equivalents gained from a fixed health budget. For projects outside the health sector, our cost-effectiveness axioms imply a form of cost-benefit analysis where both costs and benefits are measured in equivalent healthy life years. Copyright © 2013 John Wiley & Sons, Ltd.

Validation of the OpCost logging cost model using contractor surveys

Treesearch

Conor K. Bell; Robert F. Keefe; Jeremy S. Fried

2017-01-01

OpCost is a harvest and fuel treatment operations cost model developed to function as both a standalone tool and an integrated component of the Bioregional Inventory Originated Simulation Under Management (BioSum) analytical framework for landscape-level analysis of forest management alternatives. OpCost is an updated implementation of the Fuel Reduction Cost Simulator...

Model reduction by weighted Component Cost Analysis

NASA Technical Reports Server (NTRS)

Kim, Jae H.; Skelton, Robert E.

1990-01-01

Component Cost Analysis considers any given system driven by a white noise process as an interconnection of different components, and assigns a metric called 'component cost' to each component. These component costs measure the contribution of each component to a predefined quadratic cost function. A reduced-order model of the given system may be obtained by deleting those components that have the smallest component costs. The theory of Component Cost Analysis is extended to include finite-bandwidth colored noises. The results also apply when actuators have dynamics of their own. Closed-form analytical expressions of component costs are also derived for a mechanical system described by its modal data. This is very useful to compute the modal costs of very high order systems. A numerical example for MINIMAST system is presented.

Cost-effectiveness analysis of total ankle arthroplasty.

PubMed

SooHoo, Nelson F; Kominski, Gerald

2004-11-01

There is renewed interest in total ankle arthroplasty as an alternative to ankle fusion in the treatment of end-stage ankle arthritis. Despite a lack of long-term data on the clinical outcomes associated with these implants, the use of ankle arthroplasty is expanding. The purpose of this cost-effectiveness analysis was to evaluate whether the currently available literature justifies the emerging use of total ankle arthroplasty. This study also identifies thresholds for the durability and function of ankle prostheses that, if met, would support more widespread dissemination of this new technology. A decision model was created for the treatment of ankle arthritis. The literature was reviewed to identify possible outcomes and their probabilities following ankle fusion and ankle arthroplasty. Each outcome was weighted for quality of life with use of a utility factor, and effectiveness was expressed in units of quality-adjusted life years. Gross costs were estimated from Medicare charge and reimbursement data for the relevant codes. The effect of the uncertainty of estimates of costs and effectiveness was assessed with sensitivity analysis. The reference case of our model assumed a ten-year duration of survival of the prosthesis, resulting in an incremental cost-effectiveness ratio for ankle arthroplasty of $18,419 per quality-adjusted life year gained. This reflects a gain of 0.52 quality-adjusted life years at a cost of $9578 when ankle arthroplasty is chosen over fusion. This ratio compares favorably with the cost-effectiveness of other medical and surgical interventions. Sensitivity analysis determined that the cost per quality-adjusted life year gained with ankle arthroplasty rises above $50,000 if the prosthesis is assumed to fail before seven years. Treatment options with ratios above $50,000 per quality-adjusted life year are commonly considered to have limited cost-effectiveness. This threshold is also crossed when the theoretical functional advantages of ankle arthroplasty are eliminated in sensitivity analysis. The currently available literature has not yet shown that total ankle arthroplasty predictably results in levels of durability and function that make it cost-effective at this time. However, the reference case of this analysis does demonstrate that total ankle arthroplasty has the potential to be a cost-effective alternative to ankle fusion. This reference case assumes that the theoretical functional advantages of ankle arthroplasty over ankle fusion will be borne out in future clinical studies. Performance of total ankle replacement will be better justified if these thresholds are met in published long-term clinical trials.

ANL/RBC: A computer code for the analysis of Rankine bottoming cycles, including system cost evaluation and off-design performance

NASA Technical Reports Server (NTRS)

Mclennan, G. A.

1986-01-01

This report describes, and is a User's Manual for, a computer code (ANL/RBC) which calculates cycle performance for Rankine bottoming cycles extracting heat from a specified source gas stream. The code calculates cycle power and efficiency and the sizes for the heat exchangers, using tabular input of the properties of the cycle working fluid. An option is provided to calculate the costs of system components from user defined input cost functions. These cost functions may be defined in equation form or by numerical tabular data. A variety of functional forms have been included for these functions and they may be combined to create very general cost functions. An optional calculation mode can be used to determine the off-design performance of a system when operated away from the design-point, using the heat exchanger areas calculated for the design-point.

Analysis of Commuter Rail Costs and Cost Allocation Methods

DOT National Transportation Integrated Search

1983-07-01

The report addresses the issues of commuter rail service costs and the compensation methods used to allocate railroad expenses to the commuter service function. The report consists of six sections. Section 1 describes the study purpose, scope, method...

COST FUNCTION STUDIES FOR POWER REACTORS

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

Heestand, J.; Wos, L.T.

1961-11-01

A function to evaluate the cost of electricity produced by a nuclear power reactor was developed. The basic equation, revenue = capital charges + profit + operating expenses, was expanded in terms of various cost parameters to enable analysis of multiregion nuclear reactors with uranium and/or plutonium for fuel. A corresponding IBM 704 computer program, which will compute either the price of electricity or the value of plutonium, is presented in detail. (auth)

Economic evaluation of a bio-psycho-social intervention for comorbid disorders in a traumatized population in post-war Kosovo.

PubMed

Chang, Wei-Lun; Andersen, Carit Jacques; Berisha, Besa Shatri; Estrup, Olena; Wang, Shr-Jie

2018-05-08

Post-hoc economic evaluation of a bio-psycho-social intervention in post-war Kosovo from a societal perspective. Cost-effectiveness analysis, cost-utility analysis, and partial cost-benefit analysis using data from a randomized controlled trial. Thirty-four torture/war victims with comorbid conditions enrolled in 2012-2013. Participants were randomly assigned to an "intervention" and a "waiting-list" group. Changes in mental, emotional and physical health and functional impairment were assessed before and after treatment, along with increase in labour income as a proxy for productivity gain. The cost of an extra unit of effectiveness and an additional quality-adjusted life year were calculated. The total cost per participant was €1,322 including, or €1,019 excluding, research costs. Wide variations in costs of changes in mental, emotional and physical effectiveness were demonstrated. Multidisciplinary intervention resulted in functional improvement at a cost of €10,508 per quality-adjusted life year gained. With a mean monthly income increase to €133 (18%) after intervention, the intervention cost per participant would be equal to the total increase in monthly income after 4-5 years, assuming the increased level is maintained. Socio-economic benefit associated with quality-adjusted life year gain is shown, although the cost of an additional quality-adjusted life year is above the World Health Organization cost-effectiveness threshold.

Risk aversion and uncertainty in cost-effectiveness analysis: the expected-utility, moment-generating function approach.

PubMed

Elbasha, Elamin H

2005-05-01

The availability of patient-level data from clinical trials has spurred a lot of interest in developing methods for quantifying and presenting uncertainty in cost-effectiveness analysis (CEA). Although the majority has focused on developing methods for using sample data to estimate a confidence interval for an incremental cost-effectiveness ratio (ICER), a small strand of the literature has emphasized the importance of incorporating risk preferences and the trade-off between the mean and the variance of returns to investment in health and medicine (mean-variance analysis). This paper shows how the exponential utility-moment-generating function approach is a natural extension to this branch of the literature for modelling choices from healthcare interventions with uncertain costs and effects. The paper assumes an exponential utility function, which implies constant absolute risk aversion, and is based on the fact that the expected value of this function results in a convenient expression that depends only on the moment-generating function of the random variables. The mean-variance approach is shown to be a special case of this more general framework. The paper characterizes the solution to the resource allocation problem using standard optimization techniques and derives the summary measure researchers need to estimate for each programme, when the assumption of risk neutrality does not hold, and compares it to the standard incremental cost-effectiveness ratio. The importance of choosing the correct distribution of costs and effects and the issues related to estimation of the parameters of the distribution are also discussed. An empirical example to illustrate the methods and concepts is provided. Copyright 2004 John Wiley & Sons, Ltd

Economic analysis of the space shuttle system, volume 1

NASA Technical Reports Server (NTRS)

1972-01-01

An economic analysis of the space shuttle system is presented. The analysis is based on economic benefits, recurring costs, non-recurring costs, and ecomomic tradeoff functions. The most economic space shuttle configuration is determined on the basis of: (1) objectives of reusable space transportation system, (2) various space transportation systems considered and (3) alternative space shuttle systems.

Cost analysis of incidental durotomy in spine surgery.

PubMed

Nandyala, Sreeharsha V; Elboghdady, Islam M; Marquez-Lara, Alejandro; Noureldin, Mohamed N B; Sankaranarayanan, Sriram; Singh, Kern

2014-08-01

Retrospective database analysis. To characterize the consequences of an incidental durotomy with regard to perioperative complications and total hospital costs. There is a paucity of data regarding how an incidental durotomy and its associated complications may relate to total hospital costs. The Nationwide Inpatient Sample database was queried from 2008 to 2011. Patients who underwent cervical or lumbar decompression and/or fusion procedures were identified, stratified by approach, and separated into cohorts based on a documented intraoperative incidental durotomy. Patient demographics, comorbidities (Charlson Comorbidity Index), length of hospital stay, perioperative outcomes, and costs were assessed. Analysis of covariance and multivariate linear regression were used to assess the adjusted mean costs of hospitalization as a function of durotomy. The incidental durotomy rate in cervical and lumbar spine surgery is 0.4% and 2.9%, respectively. Patients with an incidental durotomy incurred a longer hospitalization and a greater incidence of perioperative complications including hematoma and neurological injury (P < 0.001). Regression analysis demonstrated that a cervical durotomy and its postoperative sequelae contributed an additional adjusted $7638 (95% confidence interval, 6489-8787; P < 0.001) to the total hospital costs. Similarly, lumbar durotomy contributed an additional adjusted $2412 (95% confidence interval, 1920-2902; P < 0.001) to the total hospital costs. The approach-specific procedural groups demonstrated similar discrepancies in the mean total hospital costs as a function of durotomy. This analysis of the Nationwide Inpatient Sample database demonstrates that incidental durotomies increase hospital resource utilization and costs. In addition, it seems that a cervical durotomy and its associated complications carry a greater financial burden than a lumbar durotomy. Further studies are warranted to investigate the long-term financial implications of incidental durotomies in spine surgery and to reduce the costs associated with this complication. 3.

Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services.

PubMed

Younis, Mustafa Z; Jabr, Samer; Smith, Pamela C; Al-Hajeri, Maha; Hartmann, Michael

2011-01-01

Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs). We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit. Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy. Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

An Ownership/Lease Cost Comparison Analysis of Heavy Equipment Motor Vehicles in Air Force Materiel Command

DTIC Science & Technology

1994-09-01

costs are the costs associated with a particular piece of equipment that do not change despite change in variable operating cost ( Horngren and Foster...The Operating and maintenance costs account for direct and indirect costs associated with their respective functions and vary with the utilization of...each vehicle. The operating direct cost includes all on-base and off- base fuel cost . Indirect operations costs account for bench 28 stock items

Analysis of Different Cost Functions in the Geosect Airspace Partitioning Tool

NASA Technical Reports Server (NTRS)

Wong, Gregory L.

2010-01-01

A new cost function representing air traffic controller workload is implemented in the Geosect airspace partitioning tool. Geosect currently uses a combination of aircraft count and dwell time to select optimal airspace partitions that balance controller workload. This is referred to as the aircraft count/dwell time hybrid cost function. The new cost function is based on Simplified Dynamic Density, a measure of different aspects of air traffic controller workload. Three sectorizations are compared. These are the current sectorization, Geosect's sectorization based on the aircraft count/dwell time hybrid cost function, and Geosect s sectorization based on the Simplified Dynamic Density cost function. Each sectorization is evaluated for maximum and average workload along with workload balance using the Simplified Dynamic Density as the workload measure. In addition, the Airspace Concept Evaluation System, a nationwide air traffic simulator, is used to determine the capacity and delay incurred by each sectorization. The sectorization resulting from the Simplified Dynamic Density cost function had a lower maximum workload measure than the other sectorizations, and the sectorization based on the combination of aircraft count and dwell time did a better job of balancing workload and balancing capacity. However, the current sectorization had the lowest average workload, highest sector capacity, and the least system delay.

Orbital transfer vehicle concept definition and system analysis study, 1985. Volume 5: Work breakdown structure and dictionary

NASA Technical Reports Server (NTRS)

Nelson, James H.; Callan, Daniel R.

1985-01-01

To establish consistency and visibility within the Orbital Transfer Vehicle (OTV) program, a preliminary work breakdown structure (WBS) and dictionary were developed. The dictionary contains definitions of terms to be used in conjunction with the WBS so that a clear understanding of the content of the hardware, function, and cost elements may be established. The OTV WBS matrix is a two-dimensional structure which shows the interrelationship of these dimensions: the hardware elements dimension and the phase and function dimension. The dimension of time cannot be shown graphically, but must be considered. Each cost entry varies with time so that it is necessary to know these cost values by year for budget planning and approval as well as for establishing cost streams for discounting purposes in the economic analysis. While a multiple dimensional approach may at first appear complex, it actually provides benefits which outweigh any concern. This structural interrelationship provides the capability to view and analyze the OTV costs from a number of different financial and management aspects. Cost may be summed by hardware groupings, phases, or functions. The WBS may be used in a number of dimensional or single listing format applications.

A cost-function approach to rival penalized competitive learning (RPCL).

PubMed

Ma, Jinwen; Wang, Taijun

2006-08-01

Rival penalized competitive learning (RPCL) has been shown to be a useful tool for clustering on a set of sample data in which the number of clusters is unknown. However, the RPCL algorithm was proposed heuristically and is still in lack of a mathematical theory to describe its convergence behavior. In order to solve the convergence problem, we investigate it via a cost-function approach. By theoretical analysis, we prove that a general form of RPCL, called distance-sensitive RPCL (DSRPCL), is associated with the minimization of a cost function on the weight vectors of a competitive learning network. As a DSRPCL process decreases the cost to a local minimum, a number of weight vectors eventually fall into a hypersphere surrounding the sample data, while the other weight vectors diverge to infinity. Moreover, it is shown by the theoretical analysis and simulation experiments that if the cost reduces into the global minimum, a correct number of weight vectors is automatically selected and located around the centers of the actual clusters, respectively. Finally, we apply the DSRPCL algorithms to unsupervised color image segmentation and classification of the wine data.

Effect of Increased Intensity of Physiotherapy on Patient Outcomes After Stroke: An Economic Literature Review and Cost-Effectiveness Analysis

PubMed Central

Chan, B

2015-01-01

Background Functional improvements have been seen in stroke patients who have received an increased intensity of physiotherapy. This requires additional costs in the form of increased physiotherapist time. Objectives The objective of this economic analysis is to determine the cost-effectiveness of increasing the intensity of physiotherapy (duration and/or frequency) during inpatient rehabilitation after stroke, from the perspective of the Ontario Ministry of Health and Long-term Care. Data Sources The inputs for our economic evaluation were extracted from articles published in peer-reviewed journals and from reports from government sources or the Canadian Stroke Network. Where published data were not available, we sought expert opinion and used inputs based on the experts' estimates. Review Methods The primary outcome we considered was cost per quality-adjusted life-year (QALY). We also evaluated functional strength training because of its similarities to physiotherapy. We used a 2-state Markov model to evaluate the cost-effectiveness of functional strength training and increased physiotherapy intensity for stroke inpatient rehabilitation. The model had a lifetime timeframe with a 5% annual discount rate. We then used sensitivity analyses to evaluate uncertainty in the model inputs. Results We found that functional strength training and higher-intensity physiotherapy resulted in lower costs and improved outcomes over a lifetime. However, our sensitivity analyses revealed high levels of uncertainty in the model inputs, and therefore in the results. Limitations There is a high level of uncertainty in this analysis due to the uncertainty in model inputs, with some of the major inputs based on expert panel consensus or expert opinion. In addition, the utility outcomes were based on a clinical study conducted in the United Kingdom (i.e., 1 study only, and not in an Ontario or Canadian setting). Conclusions Functional strength training and higher-intensity physiotherapy may result in lower costs and improved health outcomes. However, these results should be interpreted with caution. PMID:26366241

The efficiency of life insurance and family Takaful in Malaysia: Relative efficiency using the stochastic cost frontier analysis

NASA Astrophysics Data System (ADS)

Baharin, Roziana; Isa, Zaidi

2013-04-01

This paper focuses on the Stochastic cost Frontier Analysis (SFA) approach, in an attempt to measure the relationship between efficiency and organizational structure for Takaful and insurance operators in Malaysia's dual financial system. This study applied a flexible cost functional form i.e., Fourier Flexible Functional Form, for a sample consisting of 19 firms, chosen between 2002 and 2010, by employing the Battese and Coelli invariant efficiency model. The findings show that on average, there is a significant difference in cost efficiency between the Takaful industry and the insurance industry. It was found that Takaful has lower cost efficiency than conventional insurance, which shows that the organization form has an influence on efficiency. Overall, it was observed that the level of efficiency scores for both life insurance and family Takaful do not vary across time.

Learning a cost function for microscope image segmentation.

PubMed

Nilufar, Sharmin; Perkins, Theodore J

2014-01-01

Quantitative analysis of microscopy images is increasingly important in clinical researchers' efforts to unravel the cellular and molecular determinants of disease, and for pathological analysis of tissue samples. Yet, manual segmentation and measurement of cells or other features in images remains the norm in many fields. We report on a new system that aims for robust and accurate semi-automated analysis of microscope images. A user interactively outlines one or more examples of a target object in a training image. We then learn a cost function for detecting more objects of the same type, either in the same or different images. The cost function is incorporated into an active contour model, which can efficiently determine optimal boundaries by dynamic programming. We validate our approach and compare it to some standard alternatives on three different types of microscopic images: light microscopy of blood cells, light microscopy of muscle tissue sections, and electron microscopy cross-sections of axons and their myelin sheaths.

Economics of human performance and systems total ownership cost.

PubMed

Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z

2012-01-01

Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.

Toward a new payment system for inpatient rehabilitation. Part II: Reimbursing providers.

PubMed

Saitto, Carlo; Marino, Claudia; Fusco, Danilo; Arcà, Massimo; Perucci, Carlo A

2005-09-01

The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment. We sought to define an average length of effective stay and recovery trends by impairment category, to design a prospective payment system that takes into account costs and expected recovery trends, and to compare the calculated reimbursement with the predicted costs estimated in a previous study (Saitto C, Marino C, Fusco D, et al. A new prospective payment system for inpatient rehabilitation. Part I: predicting resource consumption. Med Care. 2005;43:844-855). We considered all rehabilitation admissions from 5 Italian inpatient facilities during a 12-month period for which total cost of care had already been estimated and daily cost predicted through regression model. We ascertained recovery trends by impairment category through repeated MDS-PAC schedules and factorial analysis of functional status. We defined effective stay and daily resource consumption by impairment category and used these parameters to calculate reimbursement for the admission. We compared our reimbursement with predicted cost through regression analysis and evaluated the goodness of fit through residual analysis. We calculated reimbursement for 2079 admissions. The r(2) values for the reimbursement to cost correlation ranged from 0.54 in the whole population to 0.56 for "multiple trauma" to 0.85 for "other medical disorders." The best fit was found in the central quintiles of the cost and severity distributions. For each impairment category, we determined the number of days of effective hospital stay and the trends of functional gain. We demonstrated, at least within the Italian health care system, the feasibility of a reimbursement system that matches costs with functional recovery. By linking reimbursement to effective stay adjusted for trends of functional gain, we suggest it is possible to avoid both needless cuts and extensions of hospital admissions.

Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial.

PubMed Central

Lorgelly, Paula K.; Dias, Joseph J.; Bradley, Mary J.; Burke, Frank D.

2005-01-01

OBJECTIVE: There is insufficient evidence regarding the clinical and cost-effectiveness of surgical interventions for carpal tunnel syndrome. This study evaluates the cost, effectiveness and cost-effectiveness of minimally invasive surgery compared with conventional open surgery. PATIENTS AND METHODS: 194 sufferers (208 hands) of carpal tunnel syndrome were randomly assigned to each treatment option. A self-administered questionnaire assessed the severity of patients' symptoms and functional status pre- and postoperatively. Treatment costs were estimated from resource use and hospital financial data. RESULTS: Minimally invasive carpal tunnel decompression is marginally more effective than open surgery in terms of functional status, but not significantly so. Little improvement in symptom severity was recorded for either intervention. Minimally invasive surgery was found to be significantly more costly than open surgery. The incremental cost effectiveness ratio for functional status was estimated to be 197 UK pounds, such that a one percentage point improvement in functioning costs 197 UK pounds when using the minimally invasive technique. CONCLUSIONS: Minimally invasive carpal tunnel decompression appears to be more effective but more costly. Initial analysis suggests that the additional expense for such a small improvement in function and no improvement in symptoms would not be regarded as value-for-money, such that minimally invasive carpal tunnel release is unlikely to be considered a cost-effective alternative to the traditional open surgery procedure. PMID:15720906

Cost per successfully treated patient for vortioxetine versus duloxetine in adults with major depressive disorder: an analysis of the complete symptoms of depression and functional outcome.

PubMed

Christensen, Michael Cronquist; Munro, Vicki

2018-04-01

To determine the cost-effectiveness of vortioxetine vs duloxetine in adults with moderate-to-severe major depressive disorder (MDD) in Norway using a definition of a successfully treated patient (STP) that incorporates improvement in both mood symptoms and functional capacity. Using the population of patients who completed the 8-week CONNECT study, the cost-effectiveness of vortioxetine (n = 168) (10-20 mg/day) vs duloxetine (n = 176) (60 mg/day) was investigated for the treatment of adults in Norway with moderate-to-severe MDD and self-reported cognitive dysfunction over an 8-week treatment period. Cost-effectiveness was assessed in terms of cost per STP, defined as improvement in mood symptoms (≥50% decrease from baseline in Montgomery-Åsberg Depression Rating Scale total score) and change in UCSD [University of California San Diego] performance-based skills assessment [UPSA] score of ≥7. The base case analysis utilized pharmacy retail price (apotek utsalgspris (AUP)) for branded vortioxetine (Brintellix) and branded duloxetine (Cymbalta). After 8 weeks of antidepressant therapy, there were more STPs with vortioxetine than with duloxetine (27.4% vs 22.5%, respectively). The mean number needed to treat for each STP was 3.6 for vortioxetine and 4.4 for duloxetine, resulting in a lower mean cost per STP for vortioxetine (NOK [Norwegian Kroner] 3264) than for duloxetine (NOK 3310) and an incremental cost per STP of NOK 3051. The use of a more challenging change in the UPSA score from baseline (≥9) resulted in a mean cost per STP of NOK 3822 for vortioxetine compared with NOK 3983 for duloxetine and an incremental cost per STP of NOK 3181. Vortioxetine may be a cost-effective alternative to duloxetine, owing to its superior ability to improve functional capacity. The dual-response STP concept introduced here represents a more comprehensive analysis of the cost-effectiveness of antidepressants.

Controlling for quality in the hospital cost function.

PubMed

Carey, Kathleen; Stefos, Theodore

2011-06-01

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be $22,413. The results contribute to a growing business case for inpatient safety in hospital services.

Smoke Alarm Giveaway and Installation Programs

PubMed Central

Liu, Ying; Mack, Karin A.; Diekman, Shane T.

2015-01-01

Background The burden of residential fire injury and death is substantial. Targeted smoke alarm giveaway and installation programs are popular interventions used to reduce residential fire mortality and morbidity. Purpose To evaluate the cost effectiveness and cost benefit of implementing a giveaway or installation program in a small hypothetic community with a high risk of fire death and injury through a decision-analysis model. Methods Model inputs included program costs; program effectiveness (life-years and quality-adjusted life-years saved); and monetized program benefits (medical cost, productivity, property loss and quality-of-life losses averted) and were identified through structured reviews of existing literature (done in 2011) and supplemented by expert opinion. Future costs and effectiveness were discounted at a rate of 3% per year. All costs were expressed in 2011 U.S. dollars. Results Cost-effectiveness analysis (CEA) resulted in anaverage cost-effectiveness ratio (ACER) of $51,404 per quality-adjusted life-years (QALYs) saved and $45,630 per QALY for the giveaway and installation programs, respectively. Cost–benefit analysis (CBA) showed that both programs were associated with a positive net benefit with a benefit–cost ratio of 2.1 and 2.3, respectively. Smoke alarm functional rate, baseline prevalence of functional alarms, and baseline home fire death rate were among the most influential factors for the CEA and CBA results. Conclusions Both giveaway and installation programs have an average cost-effectiveness ratio similar to or lower than the median cost-effectiveness ratio reported for other interventionsto reduce fatal injuries in homes. Although more effort is required, installation programs result in lower cost per outcome achieved compared with giveaways. PMID:22992356

Systems design analysis applied to launch vehicle configuration

NASA Technical Reports Server (NTRS)

Ryan, R.; Verderaime, V.

1993-01-01

As emphasis shifts from optimum-performance aerospace systems to least lift-cycle costs, systems designs must seek, adapt, and innovate cost improvement techniques in design through operations. The systems design process of concept, definition, and design was assessed for the types and flow of total quality management techniques that may be applicable in a launch vehicle systems design analysis. Techniques discussed are task ordering, quality leverage, concurrent engineering, Pareto's principle, robustness, quality function deployment, criteria, and others. These cost oriented techniques are as applicable to aerospace systems design analysis as to any large commercial system.

A methodology for commonality analysis, with applications to selected space station systems

NASA Technical Reports Server (NTRS)

Thomas, Lawrence Dale

1989-01-01

The application of commonality in a system represents an attempt to reduce costs by reducing the number of unique components. A formal method for conducting commonality analysis has not been established. In this dissertation, commonality analysis is characterized as a partitioning problem. The cost impacts of commonality are quantified in an objective function, and the solution is that partition which minimizes this objective function. Clustering techniques are used to approximate a solution, and sufficient conditions are developed which can be used to verify the optimality of the solution. This method for commonality analysis is general in scope. It may be applied to the various types of commonality analysis required in the conceptual, preliminary, and detail design phases of the system development cycle.

A cost minimization analysis of early correction of anterior crossbite-a randomized controlled trial.

PubMed

Wiedel, Anna-Paulina; Norlund, Anders; Petrén, Sofia; Bondemark, Lars

2016-04-01

Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents' loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. Treatment with FA or RA. There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. Costs depend on local factors and should not be directly extrapolated to other locations. The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. This trial was not registered. The protocol was not published before trial commencement. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A cost minimization analysis of early correction of anterior crossbite—a randomized controlled trial

PubMed Central

Norlund, Anders; Petrén, Sofia; Bondemark, Lars

2016-01-01

Summary Objective: Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. Design, Setting, and Participants: Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents’ loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. Interventions: Treatment with FA or RA. Results: There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. Limitations: Costs depend on local factors and should not be directly extrapolated to other locations. Conclusion: The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. Trial registration: This trial was not registered. Protocol: The protocol was not published before trial commencement. PMID:25940585

Airport costs and production technology : a translog cost function analysis with implications for economic development.

DOT National Transportation Integrated Search

2011-07-01

Based upon 50 large and medium hub airports over a 13 year period, this research estimates one and two : output translog models of airport short run operating costs. Output is passengers transported on non-stop : segments and pounds of cargo shipped....

Kelsey A. W. Horowitz | NREL

Science.gov Websites

Technologies, processes, business approaches, and policies to drive clean energy technology cost reductions and Muhammad Alam. 2017. An analysis of the Cost and Performance of Photovoltaic Systems as a Function Wiley & Sons, Ltd. doi:10.1002/pip.2755 Horowitz, Kelsey A.W. and Michael Woodhouse. "Cost and

Airport costs and production technology : a translog cost function analysis with implications for economic development.

DOT National Transportation Integrated Search

2011-12-01

Based upon 50 large and medium hub airports over a 13 year period, this research estimates one and two : output translog models of airport short run operating costs. Output is passengers transported on non-stop : segments and pounds of cargo shipped....

Are Public Master's Institutions Cost Efficient? A Stochastic Frontier and Spatial Analysis

ERIC Educational Resources Information Center

Titus, Marvin A.; Vamosiu, Adriana; McClure, Kevin R.

2017-01-01

The current study examines costs, measured by educational and general (E&G) spending, and cost efficiency at 252 public master's institutions in the United States over a nine-year (2004-2012) period. We use a multi-product quadratic cost function and results from a random-effects model with a first-order autoregressive (AR1) disturbance term…

A case study in electricity regulation: Theory, evidence, and policy

NASA Astrophysics Data System (ADS)

Luk, Stephen Kai Ming

This research provides a thorough empirical analysis of the problem of excess capacity found in the electricity supply industry in Hong Kong. I utilize a cost-function based temporary equilibrium framework to investigate empirically whether the current regulatory scheme encourages the two utilities to overinvest in capital, and how much consumers would have saved if the underutilized capacity is eliminated. The research is divided into two main parts. The first section attempts to find any evidence of over-investment in capital. As a point of departure from traditional analysis, I treat physical capital as quasi-fixed, which implies a restricted cost function to represent the firm's short-run cost structure. Under such specification, the firm minimizes the cost of employing variable factor inputs subject to predetermined levels of quasi-fixed factors. Using a transcendental logarithmic restricted cost function, I estimate the cost-side equivalent of marginal product of capital, or commonly referred to as "shadow values" of capital. The estimation results suggest that the two electric utilities consistently over-invest in generation capacity. The second part of this research focuses on the economies of capital utilization, and the estimation of distortion cost in capital investment. Again, I utilize a translog specification of the cost function to estimate the actual cost of the excess capacity, and to find out how much consumers could have saved if the underutilized generation capacity were brought closer to the international standard. Estimation results indicate that an increase in the utilization rate can significantly reduce the costs of both utilities. And if the current excess capacity were reduced to the international standard, the combined savings in costs for both firms will reach 4.4 billion. This amount of savings, if redistributed to all consumers evenly, will translate into a 650 rebate per capita. Finally, two policy recommendations: a more stringent policy towards capacity expansion and the creation of a reimbursement program, are discussed.

Smoke alarm giveaway and installation programs: an economic evaluation.

PubMed

Liu, Ying; Mack, Karin A; Diekman, Shane T

2012-10-01

The burden of residential fire injury and death is substantial. Targeted smoke alarm giveaway and installation programs are popular interventions used to reduce residential fire mortality and morbidity. To evaluate the cost effectiveness and cost benefit of implementing a giveaway or installation program in a small hypothetic community with a high risk of fire death and injury through a decision-analysis model. Model inputs included program costs; program effectiveness (life-years and quality-adjusted life-years saved); and monetized program benefits (medical cost, productivity, property loss and quality-of-life losses averted) and were identified through structured reviews of existing literature (done in 2011) and supplemented by expert opinion. Future costs and effectiveness were discounted at a rate of 3% per year. All costs were expressed in 2011 U.S. dollars. Cost-effectiveness analysis (CEA) resulted in an average cost-effectiveness ratio (ACER) of $51,404 per quality-adjusted life-years (QALYs) saved and $45,630 per QALY for the giveaway and installation programs, respectively. Cost-benefit analysis (CBA) showed that both programs were associated with a positive net benefit with a benefit-cost ratio of 2.1 and 2.3, respectively. Smoke alarm functional rate, baseline prevalence of functional alarms, and baseline home fire death rate were among the most influential factors for the CEA and CBA results. Both giveaway and installation programs have an average cost-effectiveness ratio similar to or lower than the median cost-effectiveness ratio reported for other interventions to reduce fatal injuries in homes. Although more effort is required, installation programs result in lower cost per outcome achieved compared with giveaways. Published by Elsevier Inc.

Demonstration Advanced Avionics System (DAAS), Phase 1

NASA Technical Reports Server (NTRS)

Bailey, A. J.; Bailey, D. G.; Gaabo, R. J.; Lahn, T. G.; Larson, J. C.; Peterson, E. M.; Schuck, J. W.; Rodgers, D. L.; Wroblewski, K. A.

1981-01-01

Demonstration advanced anionics system (DAAS) function description, hardware description, operational evaluation, and failure mode and effects analysis (FMEA) are provided. Projected advanced avionics system (PAAS) description, reliability analysis, cost analysis, maintainability analysis, and modularity analysis are discussed.

Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial

PubMed Central

McBain, Ryan K; Salhi, Carmel; Hann, Katrina; Salomon, Joshua A; Kim, Jane J; Betancourt, Theresa S

2016-01-01

Background: One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. Methods: The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15–24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An ‘ingredients approach’ estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. Results: Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers’ interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = −1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. Conclusions: The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials. Trial Registration: clinicaltrials.gov Identifier: RPCGA-YRI-21003 PMID:26345320

Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial.

PubMed

McBain, Ryan K; Salhi, Carmel; Hann, Katrina; Salomon, Joshua A; Kim, Jane J; Betancourt, Theresa S

2016-05-01

One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials. clinicaltrials.gov Identifier: RPCGA-YRI-21003. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Space transfer vehicle concepts and requirements study. Volume 3, book 1: Program cost estimates

NASA Technical Reports Server (NTRS)

Peffley, Al F.

1991-01-01

The Space Transfer Vehicle (STV) Concepts and Requirements Study cost estimate and program planning analysis is presented. The cost estimating technique used to support STV system, subsystem, and component cost analysis is a mixture of parametric cost estimating and selective cost analogy approaches. The parametric cost analysis is aimed at developing cost-effective aerobrake, crew module, tank module, and lander designs with the parametric cost estimates data. This is accomplished using cost as a design parameter in an iterative process with conceptual design input information. The parametric estimating approach segregates costs by major program life cycle phase (development, production, integration, and launch support). These phases are further broken out into major hardware subsystems, software functions, and tasks according to the STV preliminary program work breakdown structure (WBS). The WBS is defined to a low enough level of detail by the study team to highlight STV system cost drivers. This level of cost visibility provided the basis for cost sensitivity analysis against various design approaches aimed at achieving a cost-effective design. The cost approach, methodology, and rationale are described. A chronological record of the interim review material relating to cost analysis is included along with a brief summary of the study contract tasks accomplished during that period of review and the key conclusions or observations identified that relate to STV program cost estimates. The STV life cycle costs are estimated on the proprietary parametric cost model (PCM) with inputs organized by a project WBS. Preliminary life cycle schedules are also included.

Costs explained by function rather than diagnosis--results from the SNAC Nordanstig elderly cohort in Sweden.

PubMed

Lindholm, C; Gustavsson, A; Jönsson, L; Wimo, A

2013-05-01

Because the prevalence of many brain disorders rises with age, and brain disorders are costly, the economic burden of brain disorders will increase markedly during the next decades. The purpose of this study is to analyze how the costs to society vary with different levels of functioning and with the presence of a brain disorder. Resource utilization and costs from a societal viewpoint were analyzed versus cognition, activities of daily living (ADL), instrumental activities of daily living (IADL), brain disorder diagnosis and age in a population-based cohort of people aged 65 years and older in Nordanstig in Northern Sweden. Descriptive statistics, non-parametric bootstrapping and a generalized linear model (GLM) were used for the statistical analyses. Most people were zero users of care. Societal costs of dementia were by far the highest, ranging from SEK 262,000 (mild) to SEK 519,000 per year (severe dementia). In univariate analysis, all measures of functioning were significantly related to costs. When controlling for ADL and IADL in the multivariate GLM, cognition did not have a statistically significant effect on total cost. The presence of a brain disorder did not impact total cost when controlling for function. The greatest shift in costs was seen when comparing no dependency in ADL and dependency in one basic ADL function. It is the level of functioning, rather than the presence of a brain disorder diagnosis, which predicts costs. ADLs are better explanatory variables of costs than Mini mental state examination. Most people in a population-based cohort are zero users of care. Copyright © 2012 John Wiley & Sons, Ltd.

Gain optimization with non-linear controls

NASA Technical Reports Server (NTRS)

Slater, G. L.; Kandadai, R. D.

1984-01-01

An algorithm has been developed for the analysis and design of controls for non-linear systems. The technical approach is to use statistical linearization to model the non-linear dynamics of a system by a quasi-Gaussian model. A covariance analysis is performed to determine the behavior of the dynamical system and a quadratic cost function. Expressions for the cost function and its derivatives are determined so that numerical optimization techniques can be applied to determine optimal feedback laws. The primary application for this paper is centered about the design of controls for nominally linear systems but where the controls are saturated or limited by fixed constraints. The analysis is general, however, and numerical computation requires only that the specific non-linearity be considered in the analysis.

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

PubMed

Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

2016-01-20

Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Launch vehicle systems design analysis

NASA Technical Reports Server (NTRS)

Ryan, Robert; Verderaime, V.

1993-01-01

Current launch vehicle design emphasis is on low life-cycle cost. This paper applies total quality management (TQM) principles to a conventional systems design analysis process to provide low-cost, high-reliability designs. Suggested TQM techniques include Steward's systems information flow matrix method, quality leverage principle, quality through robustness and function deployment, Pareto's principle, Pugh's selection and enhancement criteria, and other design process procedures. TQM quality performance at least-cost can be realized through competent concurrent engineering teams and brilliance of their technical leadership.

Cost-effectiveness Analysis in R Using a Multi-state Modeling Survival Analysis Framework: A Tutorial.

PubMed

Williams, Claire; Lewsey, James D; Briggs, Andrew H; Mackay, Daniel F

2017-05-01

This tutorial provides a step-by-step guide to performing cost-effectiveness analysis using a multi-state modeling approach. Alongside the tutorial, we provide easy-to-use functions in the statistics package R. We argue that this multi-state modeling approach using a package such as R has advantages over approaches where models are built in a spreadsheet package. In particular, using a syntax-based approach means there is a written record of what was done and the calculations are transparent. Reproducing the analysis is straightforward as the syntax just needs to be run again. The approach can be thought of as an alternative way to build a Markov decision-analytic model, which also has the option to use a state-arrival extended approach. In the state-arrival extended multi-state model, a covariate that represents patients' history is included, allowing the Markov property to be tested. We illustrate the building of multi-state survival models, making predictions from the models and assessing fits. We then proceed to perform a cost-effectiveness analysis, including deterministic and probabilistic sensitivity analyses. Finally, we show how to create 2 common methods of visualizing the results-namely, cost-effectiveness planes and cost-effectiveness acceptability curves. The analysis is implemented entirely within R. It is based on adaptions to functions in the existing R package mstate to accommodate parametric multi-state modeling that facilitates extrapolation of survival curves.

Simulation analysis of a microcomputer-based, low-cost Omega navigation system

NASA Technical Reports Server (NTRS)

Lilley, R. W.; Salter, R. J., Jr.

1976-01-01

The current status of research on a proposed micro-computer-based, low-cost Omega Navigation System (ONS) is described. The design approach emphasizes minimum hardware, maximum software, and the use of a low-cost, commercially-available microcomputer. Currently under investigation is the implementation of a low-cost navigation processor and its interface with an omega sensor to complete the hardware-based ONS. Sensor processor functions are simulated to determine how many of the sensor processor functions can be handled by innovative software. An input data base of live Omega ground and flight test data was created. The Omega sensor and microcomputer interface modules used to collect the data are functionally described. Automatic synchronization to the Omega transmission pattern is described as an example of the algorithms developed using this data base.

Cost drivers and resource allocation in military health care systems.

PubMed

Fulton, Larry; Lasdon, Leon S; McDaniel, Reuben R

2007-03-01

This study illustrates the feasibility of incorporating technical efficiency considerations in the funding of military hospitals and identifies the primary drivers for hospital costs. Secondary data collected for 24 U.S.-based Army hospitals and medical centers for the years 2001 to 2003 are the basis for this analysis. Technical efficiency was measured by using data envelopment analysis; subsequently, efficiency estimates were included in logarithmic-linear cost models that specified cost as a function of volume, complexity, efficiency, time, and facility type. These logarithmic-linear models were compared against stochastic frontier analysis models. A parsimonious, three-variable, logarithmic-linear model composed of volume, complexity, and efficiency variables exhibited a strong linear relationship with observed costs (R(2) = 0.98). This model also proved reliable in forecasting (R(2) = 0.96). Based on our analysis, as much as $120 million might be reallocated to improve the United States-based Army hospital performance evaluated in this study.

Cost analysis and facility reimbursement in the long-term health care industry.

PubMed Central

Ullmann, S G

1984-01-01

This article examines costs and develops a system of prospective reimbursement for the industry committed to long-term health care. Together with estimates of average cost functions--for purposes of determining those factors affecting the costs of long-term health care, the author examines in depth the cost effects of patient mix and facility quality. Policy implications are indicated. The article estimates cost savings and predicted improvements in facility performance resulting from adoption of a prospective reimbursement system. PMID:6427138

Analytical and numerical analysis of inverse optimization problems: conditions of uniqueness and computational methods

PubMed Central

Zatsiorsky, Vladimir M.

2011-01-01

One of the key problems of motor control is the redundancy problem, in particular how the central nervous system (CNS) chooses an action out of infinitely many possible. A promising way to address this question is to assume that the choice is made based on optimization of a certain cost function. A number of cost functions have been proposed in the literature to explain performance in different motor tasks: from force sharing in grasping to path planning in walking. However, the problem of uniqueness of the cost function(s) was not addressed until recently. In this article, we analyze two methods of finding additive cost functions in inverse optimization problems with linear constraints, so-called linear-additive inverse optimization problems. These methods are based on the Uniqueness Theorem for inverse optimization problems that we proved recently (Terekhov et al., J Math Biol 61(3):423–453, 2010). Using synthetic data, we show that both methods allow for determining the cost function. We analyze the influence of noise on the both methods. Finally, we show how a violation of the conditions of the Uniqueness Theorem may lead to incorrect solutions of the inverse optimization problem. PMID:21311907

Analysis on the cost structure of product recall for reverse supply chain

NASA Astrophysics Data System (ADS)

Yanhua, Feng; Xuhui, Xia; Zheng, Yang

2017-12-01

The research on the reverse supply chain of product recall mainly focused on the recall network structure, logistics mode and so on. In this paper, when product recall and supply channel are fixed, the specific structure and function expression of cost are analyzed according to the peak season and off-season of recall activities, and whether the assembly manufacturer, supplier and recyclers are cooperated situation, respectively, to build the total cost structure of the function model. Finally, the model is validated correctly through the automotive industry and the electromechanical industry.

An Analysis of Cost Analysis Methods Used during Contract Evaluation and Source Selection in Government Contracting.

DTIC Science & Technology

1986-12-01

optimal value can be stated as, Marginal Productivity of Marginal Productivity of Good A Good B " Price of Good A Price of Good B This...contractor proposed production costs could be used. _11 i4 W Vi..:. II. CONTRACT PROPOSAL EVALUATION A. PRICE ANALYSIS Price analysis, in its broadest sense...enters the market with a supply function represented by line S2, then the new price will be reestablished at price OP2 and quantity OQ2. Price

A cost-effective methodology for the design of massively-parallel VLSI functional units

NASA Technical Reports Server (NTRS)

Venkateswaran, N.; Sriram, G.; Desouza, J.

1993-01-01

In this paper we propose a generalized methodology for the design of cost-effective massively-parallel VLSI Functional Units. This methodology is based on a technique of generating and reducing a massive bit-array on the mask-programmable PAcube VLSI array. This methodology unifies (maintains identical data flow and control) the execution of complex arithmetic functions on PAcube arrays. It is highly regular, expandable and uniform with respect to problem-size and wordlength, thereby reducing the communication complexity. The memory-functional unit interface is regular and expandable. Using this technique functional units of dedicated processors can be mask-programmed on the naked PAcube arrays, reducing the turn-around time. The production cost of such dedicated processors can be drastically reduced since the naked PAcube arrays can be mass-produced. Analysis of the the performance of functional units designed by our method yields promising results.

Optimizing cost-efficiency in mean exposure assessment - cost functions reconsidered

PubMed Central

2011-01-01

Background Reliable exposure data is a vital concern in medical epidemiology and intervention studies. The present study addresses the needs of the medical researcher to spend monetary resources devoted to exposure assessment with an optimal cost-efficiency, i.e. obtain the best possible statistical performance at a specified budget. A few previous studies have suggested mathematical optimization procedures based on very simple cost models; this study extends the methodology to cover even non-linear cost scenarios. Methods Statistical performance, i.e. efficiency, was assessed in terms of the precision of an exposure mean value, as determined in a hierarchical, nested measurement model with three stages. Total costs were assessed using a corresponding three-stage cost model, allowing costs at each stage to vary non-linearly with the number of measurements according to a power function. Using these models, procedures for identifying the optimally cost-efficient allocation of measurements under a constrained budget were developed, and applied on 225 scenarios combining different sizes of unit costs, cost function exponents, and exposure variance components. Results Explicit mathematical rules for identifying optimal allocation could be developed when cost functions were linear, while non-linear cost functions implied that parts of or the entire optimization procedure had to be carried out using numerical methods. For many of the 225 scenarios, the optimal strategy consisted in measuring on only one occasion from each of as many subjects as allowed by the budget. Significant deviations from this principle occurred if costs for recruiting subjects were large compared to costs for setting up measurement occasions, and, at the same time, the between-subjects to within-subject variance ratio was small. In these cases, non-linearities had a profound influence on the optimal allocation and on the eventual size of the exposure data set. Conclusions The analysis procedures developed in the present study can be used for informed design of exposure assessment strategies, provided that data are available on exposure variability and the costs of collecting and processing data. The present shortage of empirical evidence on costs and appropriate cost functions however impedes general conclusions on optimal exposure measurement strategies in different epidemiologic scenarios. PMID:21600023

Optimizing cost-efficiency in mean exposure assessment--cost functions reconsidered.

PubMed

Mathiassen, Svend Erik; Bolin, Kristian

2011-05-21

Reliable exposure data is a vital concern in medical epidemiology and intervention studies. The present study addresses the needs of the medical researcher to spend monetary resources devoted to exposure assessment with an optimal cost-efficiency, i.e. obtain the best possible statistical performance at a specified budget. A few previous studies have suggested mathematical optimization procedures based on very simple cost models; this study extends the methodology to cover even non-linear cost scenarios. Statistical performance, i.e. efficiency, was assessed in terms of the precision of an exposure mean value, as determined in a hierarchical, nested measurement model with three stages. Total costs were assessed using a corresponding three-stage cost model, allowing costs at each stage to vary non-linearly with the number of measurements according to a power function. Using these models, procedures for identifying the optimally cost-efficient allocation of measurements under a constrained budget were developed, and applied on 225 scenarios combining different sizes of unit costs, cost function exponents, and exposure variance components. Explicit mathematical rules for identifying optimal allocation could be developed when cost functions were linear, while non-linear cost functions implied that parts of or the entire optimization procedure had to be carried out using numerical methods.For many of the 225 scenarios, the optimal strategy consisted in measuring on only one occasion from each of as many subjects as allowed by the budget. Significant deviations from this principle occurred if costs for recruiting subjects were large compared to costs for setting up measurement occasions, and, at the same time, the between-subjects to within-subject variance ratio was small. In these cases, non-linearities had a profound influence on the optimal allocation and on the eventual size of the exposure data set. The analysis procedures developed in the present study can be used for informed design of exposure assessment strategies, provided that data are available on exposure variability and the costs of collecting and processing data. The present shortage of empirical evidence on costs and appropriate cost functions however impedes general conclusions on optimal exposure measurement strategies in different epidemiologic scenarios.

Use of cost-effectiveness analysis to determine inventory size for a national cord blood bank.

PubMed

Howard, David H; Meltzer, David; Kollman, Craig; Maiers, Martin; Logan, Brent; Gragert, Loren; Setterholm, Michelle; Horowitz, Mary M

2008-01-01

Transplantation with stem cells from stored umbilical cord blood units is an alternative to living unrelated bone marrow transplantation. The larger the inventory of stored cord units, the greater the likelihood that transplant candidates will match to a unit, but storing units is costly. The authors present the results of a study, commissioned by the Institute of Medicine, as part of a report on the establishment of a national cord blood bank, examining the optimal inventory level. They emphasize the unique challenges of undertaking cost-effectiveness analysis in this field and the contribution of the analysis to policy. The authors estimate the likelihood that transplant candidates will match to a living unrelated marrow donor or a cord blood unit as a function of cord blood inventory and then calculate the life-years gained for each transplant type by match level using historical data. They develop a model of the cord blood inventory level to estimate total costs as a function of the number of stored units. The cost per life-year gained associated with increasing inventory from 50,000 to 100,000 units is $44,000 to $86,000 and from 100,000 to 150,000 units is $64,000 to $153,000, depending on the assumption about the degree to which survival rates for cord transplants vary by match quality. Expanding the cord blood inventory above current levels is cost-effective by conventional standards. The analysis helped shape the Institute of Medicine's report, but it is difficult to determine the extent to which the analysis influenced subsequent congressional legislation.

Design, processing and testing of LSI arrays: Hybrid microelectronics task

NASA Technical Reports Server (NTRS)

Himmel, R. P.; Stuhlbarg, S. M.; Ravetti, R. G.; Zulueta, P. J.

1979-01-01

Mathematical cost factors were generated for both hybrid microcircuit and printed wiring board packaging methods. A mathematical cost model was created for analysis of microcircuit fabrication costs. The costing factors were refined and reduced to formulae for computerization. Efficient methods were investigated for low cost packaging of LSI devices as a function of density and reliability. Technical problem areas such as wafer bumping, inner/outer leading bonding, testing on tape, and tape processing, were investigated.

Programme Costing - A Logical Step Toward Improved Management.

ERIC Educational Resources Information Center

McDougall, Ronald N.

The analysis of costs of university activities from a functional or program point of view, rather than an organizational unit basis, is not only an imperative for the planning and management of universities, but also a logical method of examing the costs of university operations. A task force of the Committee of Finance Officers-Universities of…

SEASAT economic assessment. Volume 10: The SATIL 2 program (a program for the evaluation of the costs of an operational SEASAT system as a function of operational requirements and reliability. [computer programs for economic analysis and systems analysis of SEASAT satellite systems

NASA Technical Reports Server (NTRS)

1975-01-01

The SATIL 2 computer program was developed to assist with the programmatic evaluation of alternative approaches to establishing and maintaining a specified mix of operational sensors on spacecraft in an operational SEASAT system. The program computes the probability distributions of events (i.e., number of launch attempts, number of spacecraft purchased, etc.), annual recurring cost, and present value of recurring cost. This is accomplished for the specific task of placing a desired mix of sensors in orbit in an optimal fashion in order to satisfy a specified sensor demand function. Flow charts are shown, and printouts of the programs are given.

Effects of Arthroscopy for Femoroacetabular Impingement Syndrome on Quality of Life and Economic Outcomes.

PubMed

Mather, Richard C; Nho, Shane J; Federer, Andrew; Demiralp, Berna; Nguyen, Jennifer; Saavoss, Asha; Salata, Michael J; Philippon, Marc J; Bedi, Asheesh; Larson, Christopher M; Byrd, J W Thomas; Koenig, Lane

2018-04-01

The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. Economic and decision analysis; Level of evidence, 2. The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.

Theoretical and experimental researches on the operating costs of a wastewater treatment plant

NASA Astrophysics Data System (ADS)

Panaitescu, M.; Panaitescu, F.-V.; Anton, I.-A.

2015-11-01

Purpose of the work: The total cost of a sewage plants is often determined by the present value method. All of the annual operating costs for each process are converted to the value of today's correspondence and added to the costs of investment for each process, which leads to getting the current net value. The operating costs of the sewage plants are subdivided, in general, in the premises of the investment and operating costs. The latter can be stable (normal operation and maintenance, the establishment of power) or variables (chemical and power sludge treatment and disposal, of effluent charges). For the purpose of evaluating the preliminary costs so that an installation can choose between different alternatives in an incipient phase of a project, can be used cost functions. In this paper will be calculated the operational cost to make several scenarios in order to optimize its. Total operational cost (fixed and variable) is dependent global parameters of wastewater treatment plant. Research and methodology: The wastewater treatment plant costs are subdivided in investment and operating costs. We can use different cost functions to estimate fixed and variable operating costs. In this study we have used the statistical formulas for cost functions. The method which was applied to study the impact of the influent characteristics on the costs is economic analysis. Optimization of plant design consist in firstly, to assess the ability of the smallest design to treat the maximum loading rates to a given effluent quality and, secondly, to compare the cost of the two alternatives for average and maximum loading rates. Results: In this paper we obtained the statistical values for the investment cost functions, operational fixed costs and operational variable costs for wastewater treatment plant and its graphical representations. All costs were compared to the net values. Finally we observe that it is more economical to build a larger plant, especially if maximum loading rates are reached. The actual target of operational management is to directly implement the presented cost functions in a software tool, in which the design of a plant and the simulation of its behaviour are evaluated simultaneously.

Orbit Clustering Based on Transfer Cost

NASA Technical Reports Server (NTRS)

Gustafson, Eric D.; Arrieta-Camacho, Juan J.; Petropoulos, Anastassios E.

2013-01-01

We propose using cluster analysis to perform quick screening for combinatorial global optimization problems. The key missing component currently preventing cluster analysis from use in this context is the lack of a useable metric function that defines the cost to transfer between two orbits. We study several proposed metrics and clustering algorithms, including k-means and the expectation maximization algorithm. We also show that proven heuristic methods such as the Q-law can be modified to work with cluster analysis.

Circuit class or seven-day therapy for increasing intensity of rehabilitation after stroke: protocol of the CIRCIT trial.

PubMed

Hillier, Susan; English, Coralie; Crotty, Maria; Segal, Leonie; Bernhardt, Julie; Esterman, Adrian

2011-12-01

There is strong evidence for a dose-response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40-80 points or motor 38-62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

Technology requirements for communication satellites in the 1980's

NASA Technical Reports Server (NTRS)

Burtt, J. E.; Moe, C. R.; Elms, R. V.; Delateur, L. A.; Sedlacek, W. C.; Younger, G. G.

1973-01-01

The key technology requirements are defined for meeting the forecasted demands for communication satellite services in the 1985 to 1995 time frame. Evaluation is made of needs for services and technical and functional requirements for providing services. The future growth capabilities of the terrestrial telephone network, cable television, and satellite networks are forecasted. The impact of spacecraft technology and booster performance and costs upon communication satellite costs are analyzed. Systems analysis techniques are used to determine functional requirements and the sensitivities of technology improvements for reducing the costs of meeting requirements. Recommended development plans and funding levels are presented, as well as the possible cost saving for communications satellites in the post 1985 era.

[Cost-consequence analysis of respiratory preventive intervention among institutionalized older people: randomized controlled trial].

PubMed

Cebrià I Iranzo, Maria Dels Àngels; Tortosa-Chuliá, M Ángeles; Igual-Camacho, Celedonia; Sancho, Patricia; Galiana, Laura; Tomás, José Manuel

2014-01-01

The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment. A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n=54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective. The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to Euro 21,678. This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

National law enforcement telecommunications network

NASA Technical Reports Server (NTRS)

Reilly, N. B.; Garrison, G. W.; Sohn, R. L.; Gallop, D. L.; Goldstein, B. L.

1975-01-01

Alternative approaches are analyzed to a National Law Enforcement Telecommunications Network (NALECOM) designed to service all state-to-state and state-to-national criminal justice communications traffic needs in the United States. Network topology options were analyzed, and equipment and personnel requirements for each option were defined in accordance with NALECOM functional specifications and design guidelines. Evaluation criteria were developed and applied to each of the options leading to specific conclusions. Detailed treatments of methods for determining traffic requirements, communication line costs, switcher configurations and costs, microwave costs, satellite system configurations and costs, facilities, operations and engineering costs, network delay analysis and network availability analysis are presented. It is concluded that a single regional switcher configuration is the optimum choice based on cost and technical factors. A two-region configuration is competitive. Multiple-region configurations are less competitive due to increasing costs without attending benefits.

Combining self-organizing mapping and supervised affinity propagation clustering approach to investigate functional brain networks involved in motor imagery and execution with fMRI measurements.

PubMed

Zhang, Jiang; Liu, Qi; Chen, Huafu; Yuan, Zhen; Huang, Jin; Deng, Lihua; Lu, Fengmei; Zhang, Junpeng; Wang, Yuqing; Wang, Mingwen; Chen, Liangyin

2015-01-01

Clustering analysis methods have been widely applied to identifying the functional brain networks of a multitask paradigm. However, the previously used clustering analysis techniques are computationally expensive and thus impractical for clinical applications. In this study a novel method, called SOM-SAPC that combines self-organizing mapping (SOM) and supervised affinity propagation clustering (SAPC), is proposed and implemented to identify the motor execution (ME) and motor imagery (MI) networks. In SOM-SAPC, SOM was first performed to process fMRI data and SAPC is further utilized for clustering the patterns of functional networks. As a result, SOM-SAPC is able to significantly reduce the computational cost for brain network analysis. Simulation and clinical tests involving ME and MI were conducted based on SOM-SAPC, and the analysis results indicated that functional brain networks were clearly identified with different response patterns and reduced computational cost. In particular, three activation clusters were clearly revealed, which include parts of the visual, ME and MI functional networks. These findings validated that SOM-SAPC is an effective and robust method to analyze the fMRI data with multitasks.

Oligopolies with contingent workforce and unemployment insurance systems

NASA Astrophysics Data System (ADS)

Matsumoto, Akio; Merlone, Ugo; Szidarovszky, Ferenc

2015-10-01

In the recent literature the introduction of modified cost functions has added reality into the classical oligopoly analysis. Furthermore, the market evolution requires much more flexibility to firms, and in several countries contingent workforce plays an important role in the production choices by the firms. Therefore, an analysis of dynamic adjustment costs is in order to understand oligopoly dynamics. In this paper, dynamic single-product oligopolies without product differentiation are first examined with the additional consideration of production adjustment costs. Linear inverse demand and cost functions are considered and it is assumed that the firms adjust their outputs partially toward best response. The set of the steady states is characterized by a system of linear inequalities and there are usually infinitely many steady states. The asymptotic behavior of the output trajectories is examined by using computer simulation. The numerical results indicate that the resulting dynamics is richer than in the case of the classical Cournot model. This model and results are then compared to oligopolies with unemployment insurance systems when the additional cost is considered if firms do not use their maximum capacities.

Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease.

PubMed

Rosenheck, Robert A; Leslie, Douglas L; Sindelar, Jody L; Miller, Edward A; Tariot, Peter N; Dagerman, Karen S; Davis, Sonia M; Lebowitz, Barry D; Rabins, Peter; Hsiao, John K; Lieberman, Jeffery A; Schneider, Lon S

2007-11-01

Second-generation antipsychotics (SGAs) are prescribed for psychosis, aggression, and agitation in Alzheimer disease (AD). To conduct a cost-benefit analysis of SGAs and placebo (taken to represent a "watchful waiting" treatment strategy) for psychosis and aggression in outpatients with AD. Randomized placebo-controlled trial of alternative SGA initiation strategies. Forty-two outpatient clinics. Outpatients with AD and psychosis, aggression, or agitation (N = 421). Intervention Participants were randomly assigned to treatment with olanzapine, quetiapine fumarate, risperidone, or placebo with the option of double-blind rerandomization to another antipsychotic or citalopram hydrobromide or open treatment over 9 months. Monthly interviews documented health service use and costs. The economic perspective addressed total health care and medication costs. Costs of study drugs were estimated from wholesale prices with adjustment for discounts and rebates. Quality-adjusted life-years (QALYs) were assessed with the Health Utilities Index Mark 3 and were supplemented with measures of functioning, activities of daily living, and quality of life. Primary analyses were conducted using all available data. Secondary analyses excluded observations after the first medication change (ie, phase 1 only). Cost-benefit analysis was conducted using the net health benefits approach in a sensitivity analysis in which QALYs were valued at $50,000 per year and $100,000 per year. Average total health costs, including medications, were significantly lower for placebo than for SGAs, by $50 to $100 per month. There were no differences between treatments in QALYs or other measures of function. Phase 1-only analyses were broadly similar. Net-benefit analysis showed greater net health benefits for placebo as compared with other treatments, with probabilities ranging from 50% to 90%. There were no differences in measures of effectiveness between initiation of active treatments or placebo (which represented watchful waiting) but the placebo group had significantly lower health care costs. clinicaltrials.gov Identifier: NCT00015548.

Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating.

PubMed

Francis, Tittu; Washington, Travis; Srivastava, Karan; Moutzouros, Vasilios; Makhni, Eric C; Hakeos, William

2017-11-01

Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal. To choose the most cost-effective treatment strategy, surgeons must understand how implant costs and return to the operating room influence the most cost-effective strategy. This cost-effective analysis study explored the optimal treatment strategies by using decision analysis tools. An expected-value decision tree was constructed to estimate costs based on the 2 implant choices. Values for critical variables, such as implant removal rate, were obtained from the literature. A Monte Carlo simulation consisting of 100,000 trials was used to incorporate variability in medical costs and implant removal rates. Sensitivity analysis and strategy tables were used to show how different variables influence the most cost-effective strategy. TBW was the most cost-effective strategy, with a cost savings of approximately $1300. TBW was also the dominant strategy by being the most cost-effective solution in 63% of the Monte Carlo trials. Sensitivity analysis identified implant costs for plate fixation and surgical costs for implant removal as the most sensitive parameters influencing the cost-effective strategy. Strategy tables showed the most cost-effective solution as 2 parameters vary simultaneously. TBW is the most cost-effective strategy in treating Mayo IIA olecranon fractures despite a higher rate of return to the operating room. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Organizational Perspectives on Rapid Response Team Structure, Function, and Cost: A Qualitative Study.

PubMed

Smith, Patricia L; McSweeney, Jean

Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs. The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs. Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics. The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost. It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits.

New approach to the retrieval of AOD and its uncertainty from MISR observations over dark water

NASA Astrophysics Data System (ADS)

Witek, Marcin L.; Garay, Michael J.; Diner, David J.; Bull, Michael A.; Seidel, Felix C.

2018-01-01

A new method for retrieving aerosol optical depth (AOD) and its uncertainty from Multi-angle Imaging SpectroRadiometer (MISR) observations over dark water is outlined. MISR's aerosol retrieval algorithm calculates cost functions between observed and pre-simulated radiances for a range of AODs (from 0.0 to 3.0) and a prescribed set of aerosol mixtures. The previous version 22 (V22) operational algorithm considered only the AOD that minimized the cost function for each aerosol mixture and then used a combination of these values to compute the final, best estimate AOD and associated uncertainty. The new approach considers the entire range of cost functions associated with each aerosol mixture. The uncertainty of the reported AOD depends on a combination of (a) the absolute values of the cost functions for each aerosol mixture, (b) the widths of the cost function distributions as a function of AOD, and (c) the spread of the cost function distributions among the ensemble of mixtures. A key benefit of the new approach is that, unlike the V22 algorithm, it does not rely on empirical thresholds imposed on the cost function to determine the success or failure of a particular mixture. Furthermore, a new aerosol retrieval confidence index (ARCI) is established that can be used to screen high-AOD retrieval blunders caused by cloud contamination or other factors. Requiring ARCI ≥ 0.15 as a condition for retrieval success is supported through statistical analysis and outperforms the thresholds used in the V22 algorithm. The described changes to the MISR dark water algorithm will become operational in the new MISR aerosol product (V23), planned for release in 2017.

New Approach to the Retrieval of AOD and its Uncertainty from MISR Observations Over Dark Water

NASA Astrophysics Data System (ADS)

Witek, M. L.; Garay, M. J.; Diner, D. J.; Bull, M. A.; Seidel, F.

2017-12-01

A new method for retrieving aerosol optical depth (AOD) and its uncertainty from Multi-angle Imaging SpectroRadiometer (MISR) observations over dark water is outlined. MISR's aerosol retrieval algorithm calculates cost functions between observed and pre-simulated radiances for a range of AODs (from 0.0 to 3.0) and a prescribed set of aerosol mixtures. The previous Version 22 (V22) operational algorithm considered only the AOD that minimized the cost function for each aerosol mixture, then used a combination of these values to compute the final, "best estimate" AOD and associated uncertainty. The new approach considers the entire range of cost functions associated with each aerosol mixture. The uncertainty of the reported AOD depends on a combination of a) the absolute values of the cost functions for each aerosol mixture, b) the widths of the cost function distributions as a function of AOD, and c) the spread of the cost function distributions among the ensemble of mixtures. A key benefit of the new approach is that, unlike the V22 algorithm, it does not rely on arbitrary thresholds imposed on the cost function to determine the success or failure of a particular mixture. Furthermore, a new Aerosol Retrieval Confidence Index (ARCI) is established that can be used to screen high-AOD retrieval blunders caused by cloud contamination or other factors. Requiring ARCI≥0.15 as a condition for retrieval success is supported through statistical analysis and outperforms the thresholds used in the V22 algorithm. The described changes to the MISR dark water algorithm will become operational in the new MISR aerosol product (V23), planned for release in 2017.

Functional Status, Quality of Life, and Costs Associated With Fibromyalgia Subgroups: A Latent Profile Analysis.

PubMed

Luciano, Juan V; Forero, Carlos G; Cerdà-Lafont, Marta; Peñarrubia-María, María Teresa; Fernández-Vergel, Rita; Cuesta-Vargas, Antonio I; Ruíz, José M; Rozadilla-Sacanell, Antoni; Sirvent-Alierta, Elena; Santo-Panero, Pilar; García-Campayo, Javier; Serrano-Blanco, Antoni; Pérez-Aranda, Adrián; Rubio-Valera, María

2016-10-01

Although fibromyalgia syndrome (FM) is considered a heterogeneous condition, there is no generally accepted subgroup typology. We used hierarchical cluster analysis and latent profile analysis to replicate Giesecke's classification in Spanish FM patients. The second aim was to examine whether the subgroups differed in sociodemographic characteristics, functional status, quality of life, and in direct and indirect costs. A total of 160 FM patients completed the following measures for cluster derivation: the Center for Epidemiological Studies-Depression Scale, the Trait Anxiety Inventory, the Pain Catastrophizing Scale, and the Control over Pain subscale. Pain threshold was measured with a sphygmomanometer. In addition, the Fibromyalgia Impact Questionnaire-Revised, the EuroQoL-5D-3L, and the Client Service Receipt Inventory were administered for cluster validation. Two distinct clusters were identified using hierarchical cluster analysis ("hypersensitive" group, 69.8% and "functional" group, 30.2%). In contrast, the latent profile analysis goodness-of-fit indices supported the existence of 3 FM patient profiles: (1) a "functional" profile (28.1%) defined as moderate tenderness, distress, and pain catastrophizing; (2) a "dysfunctional" profile (45.6%) defined by elevated tenderness, distress, and pain catastrophizing; and (3) a "highly dysfunctional and distressed" profile (26.3%) characterized by elevated tenderness and extremely high distress and catastrophizing. We did not find significant differences in sociodemographic characteristics between the 2 clusters or among the 3 profiles. The functional profile was associated with less impairment, greater quality of life, and lower health care costs. We identified 3 distinct profiles which accounted for the heterogeneity of FM patients. Our findings might help to design tailored interventions for FM patients.

Failure Mode Identification Through Clustering Analysis

NASA Technical Reports Server (NTRS)

Arunajadai, Srikesh G.; Stone, Robert B.; Tumer, Irem Y.; Clancy, Daniel (Technical Monitor)

2002-01-01

Research has shown that nearly 80% of the costs and problems are created in product development and that cost and quality are essentially designed into products in the conceptual stage. Currently, failure identification procedures (such as FMEA (Failure Modes and Effects Analysis), FMECA (Failure Modes, Effects and Criticality Analysis) and FTA (Fault Tree Analysis)) and design of experiments are being used for quality control and for the detection of potential failure modes during the detail design stage or post-product launch. Though all of these methods have their own advantages, they do not give information as to what are the predominant failures that a designer should focus on while designing a product. This work uses a functional approach to identify failure modes, which hypothesizes that similarities exist between different failure modes based on the functionality of the product/component. In this paper, a statistical clustering procedure is proposed to retrieve information on the set of predominant failures that a function experiences. The various stages of the methodology are illustrated using a hypothetical design example.

A non-stationary cost-benefit analysis approach for extreme flood estimation to explore the nexus of 'Risk, Cost and Non-stationarity'

NASA Astrophysics Data System (ADS)

Qi, Wei

2017-11-01

Cost-benefit analysis is commonly used for engineering planning and design problems in practice. However, previous cost-benefit based design flood estimation is based on stationary assumption. This study develops a non-stationary cost-benefit based design flood estimation approach. This approach integrates a non-stationary probability distribution function into cost-benefit analysis, and influence of non-stationarity on expected total cost (including flood damage and construction costs) and design flood estimation can be quantified. To facilitate design flood selections, a 'Risk-Cost' analysis approach is developed, which reveals the nexus of extreme flood risk, expected total cost and design life periods. Two basins, with 54-year and 104-year flood data respectively, are utilized to illustrate the application. It is found that the developed approach can effectively reveal changes of expected total cost and extreme floods in different design life periods. In addition, trade-offs are found between extreme flood risk and expected total cost, which reflect increases in cost to mitigate risk. Comparing with stationary approaches which generate only one expected total cost curve and therefore only one design flood estimation, the proposed new approach generate design flood estimation intervals and the 'Risk-Cost' approach selects a design flood value from the intervals based on the trade-offs between extreme flood risk and expected total cost. This study provides a new approach towards a better understanding of the influence of non-stationarity on expected total cost and design floods, and could be beneficial to cost-benefit based non-stationary design flood estimation across the world.

["Activity based costing" in radiology].

PubMed

Klose, K J; Böttcher, J

2002-05-01

The introduction of diagnosis related groups for reimbursement of hospital services in Germany (g-drg) demands for a reconsideration of utilization of radiological products and costs related to them. Traditional cost accounting as approach to internal, department related budgets are compared with the accounting method of activity based costing (ABC). The steps, which are necessary to implement ABC in radiology are developed. The introduction of a process-oriented cost analysis is feasible for radiology departments. ABC plays a central role in the set-up of decentralized controlling functions within this institutions. The implementation seems to be a strategic challenge for department managers to get more appropriate data for adequate enterprise decisions. The necessary steps of process analysis can be used for other purposes (Certification, digital migration) as well.

Integrated Undergraduate Management Education: An Informal Benefit/Cost Analysis

ERIC Educational Resources Information Center

Casey, William L., Jr.

2005-01-01

This paper seeks to contribute to the literature of management education by evaluating assessment data on Babson College's integrated undergraduate management core program (IMC). Transitions from functionally isolated curricula to more integrated alternatives involve both benefits and costs, accruing to faculty, students and sponsoring…

Statistical Optimality in Multipartite Ranking and Ordinal Regression.

PubMed

Uematsu, Kazuki; Lee, Yoonkyung

2015-05-01

Statistical optimality in multipartite ranking is investigated as an extension of bipartite ranking. We consider the optimality of ranking algorithms through minimization of the theoretical risk which combines pairwise ranking errors of ordinal categories with differential ranking costs. The extension shows that for a certain class of convex loss functions including exponential loss, the optimal ranking function can be represented as a ratio of weighted conditional probability of upper categories to lower categories, where the weights are given by the misranking costs. This result also bridges traditional ranking methods such as proportional odds model in statistics with various ranking algorithms in machine learning. Further, the analysis of multipartite ranking with different costs provides a new perspective on non-smooth list-wise ranking measures such as the discounted cumulative gain and preference learning. We illustrate our findings with simulation study and real data analysis.

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

PubMed

Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

The Necessity of Functional Analysis for Space Exploration Programs

NASA Technical Reports Server (NTRS)

Morris, A. Terry; Breidenthal, Julian C.

2011-01-01

As NASA moves toward expanded commercial spaceflight within its human exploration capability, there is increased emphasis on how to allocate responsibilities between government and commercial organizations to achieve coordinated program objectives. The practice of program-level functional analysis offers an opportunity for improved understanding of collaborative functions among heterogeneous partners. Functional analysis is contrasted with the physical analysis more commonly done at the program level, and is shown to provide theoretical performance, risk, and safety advantages beneficial to a government-commercial partnership. Performance advantages include faster convergence to acceptable system solutions; discovery of superior solutions with higher commonality, greater simplicity and greater parallelism by substituting functional for physical redundancy to achieve robustness and safety goals; and greater organizational cohesion around program objectives. Risk advantages include avoidance of rework by revelation of some kinds of architectural and contractual mismatches before systems are specified, designed, constructed, or integrated; avoidance of cost and schedule growth by more complete and precise specifications of cost and schedule estimates; and higher likelihood of successful integration on the first try. Safety advantages include effective delineation of must-work and must-not-work functions for integrated hazard analysis, the ability to formally demonstrate completeness of safety analyses, and provably correct logic for certification of flight readiness. The key mechanism for realizing these benefits is the development of an inter-functional architecture at the program level, which reveals relationships between top-level system requirements that would otherwise be invisible using only a physical architecture. This paper describes the advantages and pitfalls of functional analysis as a means of coordinating the actions of large heterogeneous organizations for space exploration programs.

Cost and performance model for redox flow batteries

NASA Astrophysics Data System (ADS)

Viswanathan, Vilayanur; Crawford, Alasdair; Stephenson, David; Kim, Soowhan; Wang, Wei; Li, Bin; Coffey, Greg; Thomsen, Ed; Graff, Gordon; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent

2014-02-01

A cost model is developed for all vanadium and iron-vanadium redox flow batteries. Electrochemical performance modeling is done to estimate stack performance at various power densities as a function of state of charge and operating conditions. This is supplemented with a shunt current model and a pumping loss model to estimate actual system efficiency. The operating parameters such as power density, flow rates and design parameters such as electrode aspect ratio and flow frame channel dimensions are adjusted to maximize efficiency and minimize capital costs. Detailed cost estimates are obtained from various vendors to calculate cost estimates for present, near-term and optimistic scenarios. The most cost-effective chemistries with optimum operating conditions for power or energy intensive applications are determined, providing a roadmap for battery management systems development for redox flow batteries. The main drivers for cost reduction for various chemistries are identified as a function of the energy to power ratio of the storage system. Levelized cost analysis further guide suitability of various chemistries for different applications.

Cost-effectiveness of open versus laparoscopic versus robotic-assisted laparoscopic cystectomy and urinary diversion.

PubMed

Zehnder, Pascal; Gill, Inderbir S

2011-09-01

To provide insight into the recently published cost comparisons in the context of open, laparoscopic, and robotic-assisted laparoscopic radical cystectomy and to demonstrate the complexity of such economic analyses. Most economic evaluations are from a hospital perspective and summarize short-term perioperative therapeutic costs. However, the contributing factors (e.g. study design, included variables, robotic amortization plan, supply contract, surgical volume, surgeons' experience, etc.) vary substantially between the institutions. In addition, a real cost-effective analysis considering cost per quality-adjusted life-year gained is not feasible because of the lack of long-term oncologic and functional outcome data with the robotic procedure. On the basis of a modeled cost analysis using results from published series, robotic-assisted cystectomy was - with few exceptions - found to be more expensive when compared with the open approach. Immediate costs are affected most by operative time, followed by length of hospital stay, robotic supply, case volume, robotic cost, and transfusion rate. Any complication substantially impacts overall costs. Economic cost evaluations are complex analyses influenced by numerous factors that hardly allow an interinstitutional comparison. Robotic-assisted cystectomy is constantly refined with many institutions being somewhere on their learning curve. Transparent reports of oncologic and functional outcome data from centers of expertise applying standardized methods will help to properly analyze the real long-term benefits of robotic surgery and successor technologies and prevent us from becoming slaves of successful marketing strategies.

The 747 primary flight control systems reliability and maintenance study

NASA Technical Reports Server (NTRS)

1979-01-01

The major operational characteristics of the 747 Primary Flight Control Systems (PFCS) are described. Results of reliability analysis for separate control functions are presented. The analysis makes use of a NASA computer program which calculates reliability of redundant systems. Costs for maintaining the 747 PFCS in airline service are assessed. The reliabilities and cost will provide a baseline for use in trade studies of future flight control system design.

Cost versus utility of aclidinium bromide 400 µg plus formoterol fumarate dihydrate 12 µg compared to aclidinium bromide 400 µg alone in the management of moderate-to-severe COPD

PubMed Central

Ramos, Mafalda; Haughney, John; Henry, Nathaniel; Lindner, Leandro; Lamotte, Mark

2016-01-01

Purpose Aclidinium–formoterol 400/12 µg is a long-acting muscarinic antagonist (LAMA) and a long-acting β2-agonist in a fixed-dose combination used in the management of patients with COPD. This study aimed to assess the cost-effectiveness of aclidinium–formoterol 400/12 µg against the long-acting muscarinic antagonist aclidinium bromide 400 µg. Materials and methods A five-health-state Markov transition model with monthly cycles was developed using MS Excel to simulate patients with moderate-to-severe COPD and their initial lung-function improvement following treatment with aclidinium–formoterol 400/12 µg or aclidinium 400 µg. Health states were based on severity levels defined by Global Initiative for Chronic Obstructive Lung Disease 2010 criteria. The analysis was a head-to-head comparison without step-up therapy, from the NHS Scotland perspective, over a 5-year time horizon. Clinical data on initial lung-function improvement were provided by a pooled analysis of the ACLIFORM and AUGMENT trials. Management, event costs, and utilities were health state-specific. Costs and effects were discounted at an annual rate of 3.5%. The outcome of the analysis was expressed as cost (UK£) per quality-adjusted life-year (QALY) gained. The analysis included one way and probabilistic sensitivity analyses to investigate the impact of parameter uncertainty on model outputs. Results Aclidinium–formoterol 400/12 µg provided marginally higher costs (£41) and more QALYs (0.014), resulting in an incremental cost-effectiveness ratio of £2,976/QALY. Sensitivity analyses indicated that results were robust to key parameter variations, and the main drivers were: mean baseline forced expiratory volume in 1 second (FEV1), risk of exacerbation, FEV1 improvement from aclidinium–formoterol 400/12 µg, and lung-function decline. The probability of aclidinium–formoterol 400/12 µg being cost-effective (using a willingness-to-pay threshold of £20,000/QALY) versus aclidinium 400 µg was 79%. Conclusion In Scotland, aclidinium–formoterol 400/12 µg can be considered a cost-effective treatment option compared to aclidinium 400 µg alone in patients with moderate-to-severe COPD. PMID:27672337

Maximising profits for an EPQ model with unreliable machine and rework of random defective items

NASA Astrophysics Data System (ADS)

Pal, Brojeswar; Sankar Sana, Shib; Chaudhuri, Kripasindhu

2013-03-01

This article deals with an economic production quantity (EPQ) model in an imperfect production system. The production system may undergo in 'out-of-control' state from 'in-control' state, after a certain time that follows a probability density function. The density function varies with reliability of the machinery system that may be controlled by new technologies, investing more costs. The defective items produced in 'out-of-control' state are reworked at a cost just after the regular production time. Occurrence of the 'out-of-control' state during or after regular production-run time is analysed and also graphically illustrated separately. Finally, an expected profit function regarding the inventory cost, unit production cost and selling price is maximised analytically. Sensitivity analysis of the model with respect to key parameters of the system is carried out. Two numerical examples are considered to test the model and one of them is illustrated graphically.

U.S. Balance-of-Station Cost Drivers and Sensitivities (Presentation)

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

Maples, B.

2012-10-01

With balance-of-system (BOS) costs contributing up to 70% of the installed capital cost, it is fundamental to understanding the BOS costs for offshore wind projects as well as potential cost trends for larger offshore turbines. NREL developed a BOS model using project cost estimates developed by GL Garrad Hassan. Aspects of BOS covered include engineering and permitting, ports and staging, transportation and installation, vessels, foundations, and electrical. The data introduce new scaling relationships for each BOS component to estimate cost as a function of turbine parameters and size, project parameters and size, and soil type. Based on the new BOSmore » model, an analysis to understand the non‐turbine costs has been conducted. This analysis establishes a more robust baseline cost estimate, identifies the largest cost components of offshore wind project BOS, and explores the sensitivity of the levelized cost of energy to permutations in each BOS cost element. This presentation shows results from the model that illustrates the potential impact of turbine size and project size on the cost of energy from U.S. offshore wind plants.« less

Analysis of space tug operating techniques (study 2.4). Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1972-01-01

The costs of tug refurbishment were studied, using existing cost estimating relationships, to establish the cost of maintaining the reusable third stage of the space transportation system. Refurbishment operations sheets which describe the actual tasks that are necessary to keep the equipment functioning properly were used along with refurbishment operations sheets which contain all of the pertinent descriptive information for each of the major vehicle areas. Tug refurbishment costs per mission are tabulated.

Identification of an educational production function for diverse technologies

NASA Technical Reports Server (NTRS)

Mcclung, R. L.

1977-01-01

Production function analysis used to estimate the cost effectiveness of three alternative technologies in higher education: traditional instruction, instructional television, and computer-assisted instruction is presented. Criteria and selection of a functional form are outlined and a general discussion of variable selection and measurement is presented.

A Note on Costing the Teaching Activity in Higher Education

ERIC Educational Resources Information Center

Birch, D. W.; And Others

1977-01-01

One method of calculating unit costs for the teaching function is explained. A formula is developed for allocating expenditures on the basis of a timetable analysis and tested on data from Lanchester Polytechnic and Loughborough University for the academic year 1972-73. (Author/LBH)

Expected value analysis for integrated supplier selection and inventory control of multi-product inventory system with fuzzy cost

NASA Astrophysics Data System (ADS)

Sutrisno, Widowati, Tjahjana, R. Heru

2017-12-01

The future cost in many industrial problem is obviously uncertain. Then a mathematical analysis for a problem with uncertain cost is needed. In this article, we deals with the fuzzy expected value analysis to solve an integrated supplier selection and supplier selection problem with uncertain cost where the costs uncertainty is approached by a fuzzy variable. We formulate the mathematical model of the problems fuzzy expected value based quadratic optimization with total cost objective function and solve it by using expected value based fuzzy programming. From the numerical examples result performed by the authors, the supplier selection problem was solved i.e. the optimal supplier was selected for each time period where the optimal product volume of all product that should be purchased from each supplier for each time period was determined and the product stock level was controlled as decided by the authors i.e. it was followed the given reference level.

Cost estimation model for advanced planetary programs, fourth edition

NASA Technical Reports Server (NTRS)

Spadoni, D. J.

1983-01-01

The development of the planetary program cost model is discussed. The Model was updated to incorporate cost data from the most recent US planetary flight projects and extensively revised to more accurately capture the information in the historical cost data base. This data base is comprised of the historical cost data for 13 unmanned lunar and planetary flight programs. The revision was made with a two fold objective: to increase the flexibility of the model in its ability to deal with the broad scope of scenarios under consideration for future missions, and to maintain and possibly improve upon the confidence in the model's capabilities with an expected accuracy of 20%. The Model development included a labor/cost proxy analysis, selection of the functional forms of the estimating relationships, and test statistics. An analysis of the Model is discussed and two sample applications of the cost model are presented.

Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes.

PubMed

Jones, Roy W; Lebrec, Jeremie; Kahle-Wrobleski, Kristin; Dell'Agnello, Grazia; Bruno, Giuseppe; Vellas, Bruno; Argimon, Josep M; Dodel, Richard; Haro, Josep Maria; Wimo, Anders; Reed, Catherine

2017-01-01

We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.

Usability evaluation of low-cost virtual reality hand and arm rehabilitation games.

PubMed

Seo, Na Jin; Arun Kumar, Jayashree; Hur, Pilwon; Crocher, Vincent; Motawar, Binal; Lakshminarayanan, Kishor

2016-01-01

The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quality analysis. The games (kitchen, archery, and puzzle) were developed in the laboratory to encourage coordinated finger and arm movements. Lower-cost motion tracking devices, the P5 Glove and Microsoft Kinect, were used to record the movements. People with stroke were found to desire motivating and easy-to-use games with clinical insights and encouragement from therapists. The House of Quality analysis revealed that the games should be improved by obtaining evidence for clinical effectiveness, including clinical feedback regarding improving functional abilities, adapting the games to the user's changing functional ability, and improving usability of the motion-tracking devices. This study reports the expectations of people with stroke for rehabilitation games and usability analysis that can help guide development of future games.

Implementation of MCA Method for Identification of Factors for Conceptual Cost Estimation of Residential Buildings

NASA Astrophysics Data System (ADS)

Juszczyk, Michał; Leśniak, Agnieszka; Zima, Krzysztof

2013-06-01

Conceptual cost estimation is important for construction projects. Either underestimation or overestimation of building raising cost may lead to failure of a project. In the paper authors present application of a multicriteria comparative analysis (MCA) in order to select factors influencing residential building raising cost. The aim of the analysis is to indicate key factors useful in conceptual cost estimation in the early design stage. Key factors are being investigated on basis of the elementary information about the function, form and structure of the building, and primary assumptions of technological and organizational solutions applied in construction process. The mentioned factors are considered as variables of the model which aim is to make possible conceptual cost estimation fast and with satisfying accuracy. The whole analysis included three steps: preliminary research, choice of a set of potential variables and reduction of this set to select the final set of variables. Multicriteria comparative analysis is applied in problem solution. Performed analysis allowed to select group of factors, defined well enough at the conceptual stage of the design process, to be used as a describing variables of the model.

Economic Impact of Dementia by Disease Severity: Exploring the Relationship between Stage of Dementia and Cost of Care in Taiwan.

PubMed

Ku, Li-Jung Elizabeth; Pai, Ming-Chyi; Shih, Pei-Yu

2016-01-01

Given the shortage of cost-of-illness studies in dementia outside of the Western population, the current study estimated the annual cost of dementia in Taiwan and assessed whether different categories of care costs vary by severity using multiple disease-severity measures. This study included 231 dementia patient-caregiver dyads in a dementia clinic at a national university hospital in southern Taiwan. Three disease measures including cognitive, functional, and behavioral disturbances were obtained from patients based on medical history. A societal perspective was used to estimate the total costs of dementia according to three cost sub-categories. The association between dementia severity and cost of care was examined through bivariate and multivariate analyses. Total costs of care for moderate dementia patient were 1.4 times the costs for mild dementia and doubled from mild to severe dementia among our community-dwelling dementia sample. Multivariate analysis indicated that functional declines had a greater impact on all cost outcomes as compared to behavioral disturbance, which showed no impact on any costs. Informal care costs accounted for the greatest share in total cost of care for both mild (42%) and severe (43%) dementia patients. Since the total costs of dementia increased with severity, providing care to delay disease progression, with a focus on maintaining patient physical function, may reduce the overall cost of dementia. The greater contribution of informal care to total costs as opposed to social care also suggests a need for more publicly-funded long-term care services to assist family caregivers of dementia patients in Taiwan.

A Comparative Analysis of the Safety, Efficacy, and Cost of Islet Versus Pancreas Transplantation in Nonuremic Patients With Type 1 Diabetes

PubMed Central

Moassesfar, S.; Masharani, U.; Frassetto, L. A.; Szot, G. L.; Tavakol, M.; Stock, P. G.; Posselt, A. M.

2017-01-01

Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long-term insulin independence in selected patients with T1D. PMID:26595767

Quasi-static ensemble variational data assimilation: a theoretical and numerical study with the iterative ensemble Kalman smoother

NASA Astrophysics Data System (ADS)

Fillion, Anthony; Bocquet, Marc; Gratton, Serge

2018-04-01

The analysis in nonlinear variational data assimilation is the solution of a non-quadratic minimization. Thus, the analysis efficiency relies on its ability to locate a global minimum of the cost function. If this minimization uses a Gauss-Newton (GN) method, it is critical for the starting point to be in the attraction basin of a global minimum. Otherwise the method may converge to a local extremum, which degrades the analysis. With chaotic models, the number of local extrema often increases with the temporal extent of the data assimilation window, making the former condition harder to satisfy. This is unfortunate because the assimilation performance also increases with this temporal extent. However, a quasi-static (QS) minimization may overcome these local extrema. It accomplishes this by gradually injecting the observations in the cost function. This method was introduced by Pires et al. (1996) in a 4D-Var context. We generalize this approach to four-dimensional strong-constraint nonlinear ensemble variational (EnVar) methods, which are based on both a nonlinear variational analysis and the propagation of dynamical error statistics via an ensemble. This forces one to consider the cost function minimizations in the broader context of cycled data assimilation algorithms. We adapt this QS approach to the iterative ensemble Kalman smoother (IEnKS), an exemplar of nonlinear deterministic four-dimensional EnVar methods. Using low-order models, we quantify the positive impact of the QS approach on the IEnKS, especially for long data assimilation windows. We also examine the computational cost of QS implementations and suggest cheaper algorithms.

Is Surgery for Displaced, Midshaft Clavicle Fractures in Adults Cost-Effective? Results Based on a Multicenter Randomized Controlled Trial

PubMed Central

2010-01-01

Objectives To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults. Design Formal cost-effectiveness analysis based on a prospective, randomized controlled trial. Setting Eight hospitals in Canada (seven university affiliated and one community hospital) Patients/Participants 132 adults with acute, completely displaced, midshaft clavicle fractures Intervention Clavicle ORIF versus nonoperative treatment Main Outcome Measurements Utilities derived from SF-6D Results The base-case cost per quality adjusted life year (QALY) gained for ORIF was $65,000. Cost-effectiveness improved to $28,150/QALY gained when the functional benefit from ORIF was assumed to be permanent, with cost per QALY gained falling below $50,000 when the functional advantage persisted for 9.3 years or more. In other sensitivity analyses, the cost per QALY gained for ORIF fell below $50,000 when ORIF cost less than $10,465 (base case cost $13,668) or the long-term utility difference between nonoperative treatment and ORIF was greater than 0.034 (base-case difference 0.014). Short-term disutility associated with fracture healing also affected cost-effectiveness, with the cost per QALY gained for ORIF falling below $50,000 when the utility of a fracture treated nonoperatively prior to union was less than 0.617 (base-case utility 0.706) or when nonoperative treatment increased the time to union by 20 weeks (base-case difference 12 weeks). Conclusions The cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared to nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had favorable value compared with many accepted health interventions. PMID:20577073

Product Development and Cost Analysis of Fabricating the Prototype of Roller Clamp in Intravenous (I.V) Tubing Medical Devices using Fused Deposition Modeling (FDM) Technology

NASA Astrophysics Data System (ADS)

Way, Yusoff

2018-01-01

The main aim of this research is to develop a new prototype and to conduct cost analysis of the existing roller clamp which is one of parts attached to Intravenous (I.V) Tubing used in Intravenous therapy medical device. Before proceed with the process to manufacture the final product using Fused Deposition Modeling (FDM) Technology, the data collected from survey were analyzed using Product Design Specifications approach. Selected concept has been proven to have better quality, functions and criteria compared to the existing roller clamp and the cost analysis of fabricating the roller clamp prototype was calculated.

Optimum sensitivity derivatives of objective functions in nonlinear programming

NASA Technical Reports Server (NTRS)

Barthelemy, J.-F. M.; Sobieszczanski-Sobieski, J.

1983-01-01

The feasibility of eliminating second derivatives from the input of optimum sensitivity analyses of optimization problems is demonstrated. This elimination restricts the sensitivity analysis to the first-order sensitivity derivatives of the objective function. It is also shown that when a complete first-order sensitivity analysis is performed, second-order sensitivity derivatives of the objective function are available at little additional cost. An expression is derived whose application to linear programming is presented.

An Analysis of Costs in Institutions of Higher Education in England

ERIC Educational Resources Information Center

Johnes, Geraint; Johnes, Jill; Thanassoulis, Emmanuel

2008-01-01

Cost functions are estimated, using random effects and stochastic frontier methods, for English higher education institutions. The article advances on existing literature by employing finer disaggregation by subject, institution type and location, and by introducing consideration of quality effects. Estimates are provided of average incremental…

A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements.

PubMed

Brown, Heather; D'Amico, Francesco; Knapp, Martin; Orrell, Martin; Rehill, Amritpal; Vale, Luke; Robinson, Louise

2018-03-12

Identify if cost-effectiveness of Maintenance Cognitive Simulation Therapy (MCST) differs by type of living arrangement and cognitive ability of the person with dementia. Next, a value of information analysis is performed to inform decisions about future research. Incremental cost-effectiveness analysis applying seemingly unrelated regressions using data from a multicentre RCT of MCST versus treatment as usual in a population which had already received 7 weeks of CST for dementia (ISRCTN: 26286067). The findings from the cost-effectiveness analysis are used to inform a value of information analysis. The results are dependent upon how quality adjusted life years (QALYs) are measured. MCST might be cost-effective compared to standard treatment for those who live alone and those with higher levels of cognitive functioning. If a further RCT was to be conducted for this sub-group of the population, value of information analysis suggests a total sample of 48 complete cases for both sub-groups would be required for a two-arm trial. The expected net gain of conducting this future research is £920 million. Preliminary results suggest that MCST may be most cost-efficient for people with dementia who live alone and/or who have higher cognition. Future research in this area is needed.

Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients.

PubMed

Lundqvist, Christofer; Beiske, Antonie Giæver; Reiertsen, Ola; Kristiansen, Ivar Sønbø

2014-12-01

Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication to IDL were assessed at baseline, and subsequently at 3, 6, 9 and 12 months follow-up. We used the Unified PD Rating Scale (UPDRS) for function and 15D for Quality of Life (QoL). Costs were assessed using quarterly structured patient questionnaires and hospital registries. Costs per quality adjusted life year (QALY) were estimated for conventional treatment prior to switch and for 1-year treatment with IDL. Probabilistic sensitivity analysis was based on bootstrapping. IDL significantly improved functional scores and was safe to use. One-year conventional oral treatment entailed 0.63 QALY while IDL entailed 0.68 (p > 0.05). The estimated total 1-year treatment cost was NOK419,160 on conventional treatment and NOK890,920 on IDL, representing a cost of NOK9.2 million (€1.18 mill) per additional QALY. The incremental cost per unit UPDRS improvement was NOK25,000 (€3,250). Medication was the dominant cost during IDL (45% of total costs), it represented only 6.4% of the total for conventional treatment. IDL improves function but is not cost effective using recommended thresholds for cost/QALY in Norway.

[Determination of cost-effective strategies in colorectal cancer screening].

PubMed

Dervaux, B; Eeckhoudt, L; Lebrun, T; Sailly, J C

1992-01-01

The object of the article is to implement particular methodologies in order to determine which strategies are cost-effective in the mass screening of colorectal cancer after a positive Hemoccult test. The first approach to be presented consists in proposing a method which enables all the admissible diagnostic strategies to be determined. The second approach enables a minimal cost function to be estimated using an adaptation of "Data Envelopment Analysis". This method proves to be particularly successful in cost-efficiency analysis, when the performance indicators are numerous and hard to aggregate. The results show that there are two cost-effective strategies after a positive Hemoccult test: coloscopy and sigmoidoscopy; they put into question the relevance of double contrast barium enema in the diagnosis of colo-rectal lesions.

Multibody model reduction by component mode synthesis and component cost analysis

NASA Technical Reports Server (NTRS)

Spanos, J. T.; Mingori, D. L.

1990-01-01

The classical assumed-modes method is widely used in modeling the dynamics of flexible multibody systems. According to the method, the elastic deformation of each component in the system is expanded in a series of spatial and temporal functions known as modes and modal coordinates, respectively. This paper focuses on the selection of component modes used in the assumed-modes expansion. A two-stage component modal reduction method is proposed combining Component Mode Synthesis (CMS) with Component Cost Analysis (CCA). First, each component model is truncated such that the contribution of the high frequency subsystem to the static response is preserved. Second, a new CMS procedure is employed to assemble the system model and CCA is used to further truncate component modes in accordance with their contribution to a quadratic cost function of the system output. The proposed method is demonstrated with a simple example of a flexible two-body system.

OMB A-76: Full Costing and Its Impact at Installation Level within the U.S. Army.

DTIC Science & Technology

1980-09-01

United States Army B.S., United States Military Academy, 1972 Submitted in partial fulfillment of the requirements for the degree of -- MASTER OF SCIENCE...65 F. PRIVATE INDUSTRY AND GOVERNMENT CONTRACTS ----- 67 G. FULL COSTING AND THE OMB CCH OVERHEAD POOLS --- 69 H. OMB A-76 ELEMENTS OF COST...analysis prepared in accordance with OMB A-76 and the supplementing Cost Comparison Handbook (OMB CCH ) prior to in-house performance of a CITA function

Operations analysis (study 2.1): Shuttle upper stage software requirements

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1974-01-01

An investigation of software costs related to space shuttle upper stage operations with emphasis on the additional costs attributable to space servicing was conducted. The questions and problem areas include the following: (1) the key parameters involved with software costs; (2) historical data for extrapolation of future costs; (3) elements of the basic software development effort that are applicable to servicing functions; (4) effect of multiple servicing on complexity of the operation; and (5) are recurring software costs significant. The results address these questions and provide a foundation for estimating software costs based on the costs of similar programs and a series of empirical factors.

A Didactic Analysis of Functional Queues

ERIC Educational Resources Information Center

Rinderknecht, Christian

2011-01-01

When first introduced to the analysis of algorithms, students are taught how to assess the best and worst cases, whereas the mean and amortized costs are considered advanced topics, usually saved for graduates. When presenting the latter, aggregate analysis is explained first because it is the most intuitive kind of amortized analysis, often…

An economics systems analysis of land mobile radio telephone services

NASA Technical Reports Server (NTRS)

Leroy, B. E.; Stevenson, S. M.

1980-01-01

The economic interaction of the terrestrial and satellite systems is considered. Parametric equations are formulated to allow examination of necessary user thresholds and growth rates as a function of system costs. Conversely, first order allowable systems costs are found as a function of user thresholds and growth rates. Transitions between satellite and terrestrial service systems are examined. User growth rate density (user/year/sq km) is shown to be a key parameter in the analysis of systems compatibility. The concept of system design matching the price/demand curves is introduced and examples are given. The role of satellite systems is critically examined and the economic conditions necessary for the introduction of satellite service are identified.

An Analysis of Vocal Stereotypy and Therapist Fading

ERIC Educational Resources Information Center

Athens, Elizabeth S.; Vollmer, Timothy R.; Sloman, Kimberly N.; Pipkin, Claire St. Peter

2008-01-01

A functional analysis for a boy with Down syndrome and autism suggested that vocal stereotypy was maintained by automatic reinforcement. The analysis also showed that instructions and noncontingent attention suppressed vocal stereotypy. A treatment package consisting of noncontingent attention, contingent demands, and response cost effectively…

Full-scale system impact analysis: Digital document storage project

NASA Technical Reports Server (NTRS)

1989-01-01

The Digital Document Storage Full Scale System can provide cost effective electronic document storage, retrieval, hard copy reproduction, and remote access for users of NASA Technical Reports. The desired functionality of the DDS system is highly dependent on the assumed requirements for remote access used in this Impact Analysis. It is highly recommended that NASA proceed with a phased, communications requirement analysis to ensure that adequate communications service can be supplied at a reasonable cost in order to validate recent working assumptions upon which the success of the DDS Full Scale System is dependent.

Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes

PubMed Central

Jones, Roy W.; Lebrec, Jeremie; Kahle-Wrobleski, Kristin; Dell'Agnello, Grazia; Bruno, Giuseppe; Vellas, Bruno; Argimon, Josep M.; Dodel, Richard; Haro, Josep Maria; Wimo, Anders; Reed, Catherine

2017-01-01

Background/Aims We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Results Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia. PMID:28611822

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

PubMed

Taniguchi, Yu; Kitamura, Akihiko; Nofuji, Yu; Ishizaki, Tatsuro; Seino, Satoshi; Yokoyama, Yuri; Shinozaki, Tomohiro; Murayama, Hiroshi; Mitsutake, Seigo; Amano, Hidenori; Nishi, Mariko; Matsuyama, Yutaka; Fujiwara, Yoshinori; Shinkai, Shoji

2018-03-26

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

Economic Impact of Dementia by Disease Severity: Exploring the Relationship between Stage of Dementia and Cost of Care in Taiwan

PubMed Central

Ku, Li-Jung Elizabeth; Pai, Ming-Chyi; Shih, Pei-Yu

2016-01-01

Objective Given the shortage of cost-of-illness studies in dementia outside of the Western population, the current study estimated the annual cost of dementia in Taiwan and assessed whether different categories of care costs vary by severity using multiple disease-severity measures. Methods This study included 231 dementia patient–caregiver dyads in a dementia clinic at a national university hospital in southern Taiwan. Three disease measures including cognitive, functional, and behavioral disturbances were obtained from patients based on medical history. A societal perspective was used to estimate the total costs of dementia according to three cost sub-categories. The association between dementia severity and cost of care was examined through bivariate and multivariate analyses. Results Total costs of care for moderate dementia patient were 1.4 times the costs for mild dementia and doubled from mild to severe dementia among our community-dwelling dementia sample. Multivariate analysis indicated that functional declines had a greater impact on all cost outcomes as compared to behavioral disturbance, which showed no impact on any costs. Informal care costs accounted for the greatest share in total cost of care for both mild (42%) and severe (43%) dementia patients. Conclusions Since the total costs of dementia increased with severity, providing care to delay disease progression, with a focus on maintaining patient physical function, may reduce the overall cost of dementia. The greater contribution of informal care to total costs as opposed to social care also suggests a need for more publicly-funded long-term care services to assist family caregivers of dementia patients in Taiwan. PMID:26859891

A Review of Models of Cost and Training Effectiveness Analysis (CTEA). Volume 1. Training Effectiveness Analysis

DTIC Science & Technology

1987-10-01

19 treated in interaction with each other and the hardware and software design. The authors point out some of the inadequacies in HP technologies and...life cycle costs recognition performance on secondary tasks effort/efficiency number of wins ( gaming tasks) number of instructors needed amount of...student interacts with this material in real time via a terminal and display system. The computer performs many functions, such as diagnose student

Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial.

PubMed

Oestergaard, Lisa G; Christensen, Finn B; Nielsen, Claus V; Bünger, Cody E; Fruensgaard, Soeren; Sogaard, Rikke

2013-11-01

Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up. To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery. In a previously reported randomized controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, it seems relevant to address the societal perspective including return to work, quality of life, and costs. A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in euros. Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI). The fast-track strategy tended to be costlier by €6869 (95% CI, -4640 to 18,378) while at the same time leading to significantly poorer outcomes of functional disability by -9 points (95% CI, -18 to -3) and a tendency for a reduced gain in quality-adjusted life years by -0.04 (95% CI, -0.13 to 0.01). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness. Initiating rehabilitation at 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice. .

Long-term healthcare costs and functional outcomes associated with lack of remission in schizophrenia: a post-hoc analysis of a prospective observational study

PubMed Central

2012-01-01

Background Little is known about the long-term outcomes for patients with schizophrenia who fail to achieve symptomatic remission. This post-hoc analysis of a 3-year study compared the costs of mental health services and functional outcomes between individuals with schizophrenia who met or did not meet cross-sectional symptom remission at study enrollment. Methods This post-hoc analysis used data from a large, 3-year prospective, non-interventional observational study of individuals treated for schizophrenia in the United States conducted between July 1997 and September 2003. At study enrollment, individuals were classified as non-remitted or remitted using the Schizophrenia Working Group Definition of symptom remission (8 core symptoms rated as mild or less). Mental health service use was measured using medical records. Costs were based on the sites’ medical information systems. Functional outcomes were measured with multiple patient-reported measures and the clinician-rated Quality of Life Scale (QLS). Symptoms were measured using the Positive and Negative Syndrome Scale (PANSS). Outcomes for non-remitted and remitted patients were compared over time using mixed effects models for repeated measures or generalized estimating equations after adjusting for multiple baseline characteristics. Results At enrollment, most of the 2,284 study participants (76.1%) did not meet remission criteria. Non-remitted patients had significantly higher PANSS total scores at baseline, a lower likelihood of being Caucasian, a higher likelihood of hospitalization in the previous year, and a greater likelihood of a substance use diagnosis (all p < 0.05). Total mental health costs were significantly higher for non-remitted patients over the 3-year study (p = 0.008). Non-remitted patients were significantly more likely to be victims of crime, exhibit violent behavior, require emergency services, and lack paid employment during the 3-year study (all p < 0.05). Non-remitted patients also had significantly lower scores on the QLS, SF-12 Mental Component Summary Score, and Global Assessment of Functioning during the 3-year study. Conclusions In this post-hoc analysis of a 3-year prospective observational study, the failure to achieve symptomatic remission at enrollment was associated with higher subsequent healthcare costs and worse functional outcomes. Further examination of outcomes for schizophrenia patients who fail to achieve remission at initial assessment by their subsequent clinical status is warranted. PMID:23216976

Optimal Portfolio Selection Under Concave Price Impact

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

Ma Jin, E-mail: jinma@usc.edu; Song Qingshuo, E-mail: songe.qingshuo@cityu.edu.hk; Xu Jing, E-mail: xujing8023@yahoo.com.cn

2013-06-15

In this paper we study an optimal portfolio selection problem under instantaneous price impact. Based on some empirical analysis in the literature, we model such impact as a concave function of the trading size when the trading size is small. The price impact can be thought of as either a liquidity cost or a transaction cost, but the concavity nature of the cost leads to some fundamental difference from those in the existing literature. We show that the problem can be reduced to an impulse control problem, but without fixed cost, and that the value function is a viscosity solutionmore » to a special type of Quasi-Variational Inequality (QVI). We also prove directly (without using the solution to the QVI) that the optimal strategy exists and more importantly, despite the absence of a fixed cost, it is still in a 'piecewise constant' form, reflecting a more practical perspective.« less

School Cost Functions: A Meta-Regression Analysis

ERIC Educational Resources Information Center

Colegrave, Andrew D.; Giles, Margaret J.

2008-01-01

The education cost literature includes econometric studies attempting to determine economies of scale, or estimate an optimal school or district size. Not only do their results differ, but the studies use dissimilar data, techniques, and models. To derive value from these studies requires that the estimates be made comparable. One method to do…

Exergoeconomic analysis and optimization of an evaporator for a binary mixture of fluids in an organic Rankine cycle

NASA Astrophysics Data System (ADS)

Li, You-Rong; Du, Mei-Tang; Wang, Jian-Ning

2012-12-01

This paper focuses on the research of an evaporator with a binary mixture of organic working fluids in the organic Rankine cycle. Exergoeconomic analysis and performance optimization were performed based on the first and second laws of thermodynamics, and the exergoeconomic theory. The annual total cost per unit heat transfer rate was introduced as the objective function. In this model, the exergy loss cost caused by the heat transfer irreversibility and the capital cost were taken into account; however, the exergy loss due to the frictional pressure drops, heat dissipation to surroundings, and the flow imbalance were neglected. The variation laws of the annual total cost with respect to the number of transfer units and the temperature ratios were presented. Optimal design parameters that minimize the objective function had been obtained, and the effects of some important dimensionless parameters on the optimal performances had also been discussed for three types of evaporator flow arrangements. In addition, optimal design parameters of evaporators were compared with those of condensers.

Cost of illness and determinants of costs among patients with gout.

PubMed

Spaetgens, Bart; Wijnands, José M A; van Durme, Caroline; van der Linden, Sjef; Boonen, Annelies

2015-02-01

To estimate costs of illness in a cross-sectional cohort of patients with gout attending an outpatient rheumatology clinic, and to evaluate which factors contribute to higher costs. Altogether, 126 patients with gout were clinically assessed. They completed a series of questionnaires. Health resource use was collected using a self-report questionnaire that was cross-checked with the electronic patient file. Productivity loss was assessed by the Work Productivity and Activity Impairment Questionnaire, addressing absenteeism and presenteeism. Resource use and productivity loss were valued by real costs, and annual costs per patient were calculated. Factors contributing to incurring costs above the median were explored using logistic univariable and multivariable regression analysis. Mean (median) annual direct costs of gout were €5647 (€1148) per patient. Total costs increased to €6914 (€1279) or €10,894 (€1840) per patient per year when adding cost for absenteeism or both absenteeism and presenteeism, respectively. Factors independently associated with high direct and high indirect costs were a positive history of cardiovascular disease, functional limitations, and female sex. In addition, pain, gout concerns, and unmet gout treatment needs were associated with high direct costs. The direct and indirect costs-of-illness of gout are primarily associated with cardiovascular disease, functional limitations, and female sex.

Computational techniques for design optimization of thermal protection systems for the space shuttle vehicle. Volume 1: Final report

NASA Technical Reports Server (NTRS)

1971-01-01

Computational techniques were developed and assimilated for the design optimization. The resulting computer program was then used to perform initial optimization and sensitivity studies on a typical thermal protection system (TPS) to demonstrate its application to the space shuttle TPS design. The program was developed in Fortran IV for the CDC 6400 but was subsequently converted to the Fortran V language to be used on the Univac 1108. The program allows for improvement and update of the performance prediction techniques. The program logic involves subroutines which handle the following basic functions: (1) a driver which calls for input, output, and communication between program and user and between the subroutines themselves; (2) thermodynamic analysis; (3) thermal stress analysis; (4) acoustic fatigue analysis; and (5) weights/cost analysis. In addition, a system total cost is predicted based on system weight and historical cost data of similar systems. Two basic types of input are provided, both of which are based on trajectory data. These are vehicle attitude (altitude, velocity, and angles of attack and sideslip), for external heat and pressure loads calculation, and heating rates and pressure loads as a function of time.

LOGAM (Logistic Analysis Model). Volume 2. Users Manual.

DTIC Science & Technology

1982-08-01

as opposed to simulation models which represent a system’s behavior as a function of time. These latter classes of models are often complex. They...includes the cost of ammunition and missiles comsumed by the system being costed during unit training. Excluded is the cost of ammunition consumed during...data. The results obtained from sensitivity testing may be used to construct graphs which display the behavior of the maintenance concept over the range

The cost of a small membrane bioreactor.

PubMed

Lo, C H; McAdam, E; Judd, S

2015-01-01

The individual cost contributions to the mechanical components of a small membrane bioreactor (MBR) (100-2,500 m3/d flow capacity) are itemised and collated to generate overall capital and operating costs (CAPEX and OPEX) as a function of size. The outcomes are compared to those from previously published detailed cost studies provided for both very small containerised plants (<40 m3/day capacity) and larger municipal plants (2,200-19,000 m3/d). Cost curves, as a function of flow capacity, determined for OPEX, CAPEX and net present value (NPV) based on the heuristic data used indicate a logarithmic function for OPEX and a power-based one for the CAPEX. OPEX correlations were in good quantitative agreement with those reported in the literature. Disparities in the calculated CAPEX trend compared with reported data were attributed to differences in assumptions concerning cost contributions. More reasonable agreement was obtained with the reported membrane separation component CAPEX data from published studies. The heuristic approach taken appears appropriate for small-scale MBRs with minimal costs associated with installation. An overall relationship of net present value=(a tb)Q(-c lnt+d) was determined for the net present value where a=1.265, b=0.44, c=0.00385 and d=0.868 according to the dataset employed for the analysis.

Exergy & economic analysis of biogas fueled solid oxide fuel cell systems

NASA Astrophysics Data System (ADS)

Siefert, Nicholas S.; Litster, Shawn

2014-12-01

We present an exergy and an economic analysis of a power plant that uses biogas produced from a thermophilic anaerobic digester (AD) to fuel a solid oxide fuel cell (SOFC). We performed a 4-variable parametric analysis of the AD-SOFC system in order to determine the optimal design operation conditions, depending on the objective function of interest. We present results on the exergy efficiency (%), power normalized capital cost ( kW-1), and the internal rate of return on investment, IRR, (% yr-1) as a function of the current density, the stack pressure, the fuel utilization, and the total air stoichiometric ratio. To the authors' knowledge, this is the first AD-SOFC paper to include the cost of the AD when conducting economic optimization of the AD-SOFC plant. Our calculations show that adding a new AD-SOFC system to an existing waste water treatment (WWT) plant could yield positives values of IRR at today's average electricity prices and could significantly out-compete other options for using biogas to generate electricity. AD-SOFC systems could likely convert WWT plants into net generators of electricity rather than net consumers of electricity while generating economically viable rates of return on investment if the costs of SOFC systems are within a factor of two of the DOE/SECA cost targets.

Aeration costs in stirred-tank and bubble column bioreactors

DOE PAGES

Humbird, D.; Davis, R.; McMillan, J. D.

2017-08-10

To overcome knowledge gaps in the economics of large-scale aeration for production of commodity products, Aspen Plus is used to simulate steady-state oxygen delivery in both stirred-tank and bubble column bioreactors, using published engineering correlations for oxygen mass transfer as a function of aeration rate and power input, coupled with new equipment cost estimates developed in Aspen Capital Cost Estimator and validated against vendor quotations. Here, these simulations describe the cost efficiency of oxygen delivery as a function of oxygen uptake rate and vessel size, and show that capital and operating costs for oxygen delivery drop considerably moving from standard-sizemore » (200 m 3) to world-class size (500 m 3) reactors, but only marginally in further scaling up to hypothetically large (1000 m 3) reactors. Finally, this analysis suggests bubble-column reactor systems can reduce overall costs for oxygen delivery by 10-20% relative to stirred tanks at low to moderate oxygen transfer rates up to 150 mmol/L-h.« less

Aeration costs in stirred-tank and bubble column bioreactors

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

Humbird, D.; Davis, R.; McMillan, J. D.

To overcome knowledge gaps in the economics of large-scale aeration for production of commodity products, Aspen Plus is used to simulate steady-state oxygen delivery in both stirred-tank and bubble column bioreactors, using published engineering correlations for oxygen mass transfer as a function of aeration rate and power input, coupled with new equipment cost estimates developed in Aspen Capital Cost Estimator and validated against vendor quotations. Here, these simulations describe the cost efficiency of oxygen delivery as a function of oxygen uptake rate and vessel size, and show that capital and operating costs for oxygen delivery drop considerably moving from standard-sizemore » (200 m 3) to world-class size (500 m 3) reactors, but only marginally in further scaling up to hypothetically large (1000 m 3) reactors. Finally, this analysis suggests bubble-column reactor systems can reduce overall costs for oxygen delivery by 10-20% relative to stirred tanks at low to moderate oxygen transfer rates up to 150 mmol/L-h.« less

Active control of panel vibrations induced by boundary-layer flow

NASA Technical Reports Server (NTRS)

Chow, Pao-Liu

1991-01-01

Some problems in active control of panel vibration excited by a boundary layer flow over a flat plate are studied. In the first phase of the study, the optimal control problem of vibrating elastic panel induced by a fluid dynamical loading was studied. For a simply supported rectangular plate, the vibration control problem can be analyzed by a modal analysis. The control objective is to minimize the total cost functional, which is the sum of a vibrational energy and the control cost. By means of the modal expansion, the dynamical equation for the plate and the cost functional are reduced to a system of ordinary differential equations and the cost functions for the modes. For the linear elastic plate, the modes become uncoupled. The control of each modal amplitude reduces to the so-called linear regulator problem in control theory. Such problems can then be solved by the method of adjoint state. The optimality system of equations was solved numerically by a shooting method. The results are summarized.

Robust Team-Optimal and Leader-Follower Policies for Decision Making in C3 (Command, Control and Communications) Systems.

DTIC Science & Technology

1984-07-01

edition , Moscow: Nooka Publishing Co.. 1977; toelith translation of the Ilt edition : t ine with a specific cost structure, we have obtained Functional...651-666, September 1981. [131 L. W. Kantorovich and G. P. Akilov, Functional Analysis, 2nd edition , Moscow: Nauka Publishing Co., 1977; English...translation of the ist edition : Functional Analysis in Normed Spaces, New York: MacMillan, 1964. [14] J. Marschak and R. Radner, Economic Theory of Teams

A New Approach to Hospital Cost Functions and Some Issues in Revenue Regulation

PubMed Central

Friedman, Bernard; Pauly, Mark V.

1983-01-01

An important aspect of hospital revenue regulation at the State level is the use of retroactive allowances for changes in the volume of service. Arguments favoring non-proportional allowances have been based on statistical studies of marginal cost, together with concerns about fairness toward non-profit enterprises or concerns about various inflationary biases in hospital management. This article attempts to review and clarify the regulatory issues and choices, with the aid of new econometric work that explicitly allows for the effects of transitory as well as expected demand changes on hospital expense. The present analysis is also novel in treating length of stay as an endogenous variable in cost functions. We analyzed cost variation for a panel of over 800 hospitals that reported monthly to Hospital Administrative Services between 1973 and 1978. The central results are that marginal cost of unexpected admissions is about half of average cost, while marginal cost of forecasted admissions is about equal to average cost. We obtained relatively low estimates of the cost of an “empty bed.” The study tends to support proportional volume allowances in revenue regulation programs, with perhaps a residual role for selective case review. PMID:10309853

Application of advanced multidisciplinary analysis and optimization methods to vehicle design synthesis

NASA Technical Reports Server (NTRS)

Consoli, Robert David; Sobieszczanski-Sobieski, Jaroslaw

1990-01-01

Advanced multidisciplinary analysis and optimization methods, namely system sensitivity analysis and non-hierarchical system decomposition, are applied to reduce the cost and improve the visibility of an automated vehicle design synthesis process. This process is inherently complex due to the large number of functional disciplines and associated interdisciplinary couplings. Recent developments in system sensitivity analysis as applied to complex non-hierarchic multidisciplinary design optimization problems enable the decomposition of these complex interactions into sub-processes that can be evaluated in parallel. The application of these techniques results in significant cost, accuracy, and visibility benefits for the entire design synthesis process.

Pharmacoeconomics of parenteral nutrition in surgical and critically ill patients receiving structured triglycerides in China.

PubMed

Wu, Guo Hao; Ehm, Alexandra; Bellone, Marco; Pradelli, Lorenzo

2017-01-01

A prior meta-analysis showed favorable metabolic effects of structured triglyceride (STG) lipid emulsions in surgical and critically ill patients compared with mixed medium-chain/long-chain triglycerides (MCT/LCT) emulsions. Limited data on clinical outcomes precluded pharmacoeconomic analysis. We performed an updated meta-analysis and developed a cost model to compare overall costs for STGs vs MCT/LCTs in Chinese hospitals. We searched Medline, Embase, Wanfang Data, the China Hospital Knowledge Database, and Google Scholar for clinical trials comparing STGs to mixed MCT/LCTs in surgical or critically ill adults published between October 10, 2013 and September 19, 2015. Newly identified studies were pooled with the prior studies and an updated meta-analysis was performed. A deterministic simulation model was used to compare the effects of STGs and mixed MCT/LCT's on Chinese hospital costs. The literature search identified six new trials, resulting in a total of 27 studies in the updated meta-analysis. Statistically significant differences favoring STGs were observed for cumulative nitrogen balance, pre- albumin and albumin concentrations, plasma triglycerides, and liver enzymes. STGs were also associated with a significant reduction in the length of hospital stay (mean difference, -1.45 days; 95% confidence interval, -2.48 to -0.43; p=0.005) versus mixed MCT/LCTs. Cost analysis demonstrated a net cost benefit of ¥675 compared with mixed MCT/LCTs. STGs are associated with improvements in metabolic function and reduced length of hospitalization in surgical and critically ill patients compared with mixed MCT/LCT emulsions. Cost analysis using data from Chinese hospitals showed a corresponding cost benefit.

Economic Outcomes with Anatomic versus Functional Diagnostic Testing for Coronary Artery Disease

PubMed Central

Mark, Daniel B.; Federspiel, Jerome J.; Cowper, Patricia A.; Anstrom, Kevin J.; Hoffmann, Udo; Patel, Manesh R.; Davidson-Ray, Linda; Daniels, Melanie R.; Cooper, Lawton S.; Knight, J. David; Lee, Kerry L.; Douglas, Pamela S.

2016-01-01

Background The PROMISE trial found that initial use of ≥64-slice multidetector computed tomographic angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective Economic analysis of PROMISE, a major secondary aim. Design Prospective economic study from the US perspective. Comparisons were made by intention-to-treat. Confidence intervals were calculated using bootstrap methods. Setting 190 U.S. centers Patients 9649 U.S. patients enrolled in PROMISE. Enrollment began July 2010 and completed September 2013. Median follow-up was 25 months. Measurements Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-to-charge ratios. Physician fees were taken from the Medicare Fee Schedule. Costs were expressed in 2014 US dollars discounted at 3% and estimated out to 3 years using inverse probability weighting methods. Results The mean initial testing costs were: $174 for exercise ECG; $404 for CTA; $501 to $514 for (exercise, pharmacologic) stress echo; $946 to $1132 for (exercise, pharmacologic) stress nuclear. Mean costs at 90 days for the CTA strategy were $2494 versus $2240 for the functional strategy (mean difference $254, 95% CI −$634 to $906). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the arms out to 3 years remained small ($373). Limitations Cost weights for test strategies obtained from sources outside PROMISE. Conclusions CTA and functional diagnostic testing strategies in patients with suspected CAD have similar costs through three years of follow-up. PMID:27214597

Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy.

PubMed

Smith, William B; Steinberg, Joni; Scholtes, Stefan; Mcnamara, Iain R

2017-03-01

To compare the age-based cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO) for the treatment of medial compartment knee osteoarthritis (MCOA). A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70 years of age undergoing primary TKA, UKA, or HTO. Costs and outcomes associated with initial and subsequent interventions were estimated by following these virtual cohorts over a 10-year period. Revision and mortality rates, costs, and functional outcome data were estimated from a systematic review of the literature. Probabilistic analysis was conducted to accommodate these parameters' inherent uncertainty, and both discrete and probabilistic sensitivity analyses were utilized to assess the robustness of the model's outputs to changes in key variables. HTO was most likely to be cost-effective in cohorts under 60, and UKA most likely in those 60 and over. Probabilistic results did not indicate one intervention to be significantly more cost-effective than another. The model was exquisitely sensitive to changes in utility (functional outcome), somewhat sensitive to changes in cost, and least sensitive to changes in 10-year revision risk. HTO may be the most cost-effective option when treating MCOA in younger patients, while UKA may be preferred in older patients. Functional utility is the primary driver of the cost-effectiveness of these interventions. For the clinician, this study supports HTO as a competitive treatment option in young patient populations. It also validates each one of the three interventions considered as potentially optimal, depending heavily on patient preferences and functional utility derived over time.

College Remediation: What It Is, What It Costs, What's At Stake.

ERIC Educational Resources Information Center

Phipps, Ronald

This examination of remedial instruction in institutions of higher education provides an analysis of the functions and purposes of remediation; a discussion of the types of remediation, who participates, and how well it serves them; an examination of the financial costs of remediation; an appraisal of the economic and social consequences of not…

76 FR 28755 - Performance of Certain Functions by National Futures Association With Respect to Commodity Pool...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... the Commission orders otherwise. Nothing in this Order shall prevent the Commission from exercising... previous Orders issued by the Commission concerning Part 4. III. Cost-Benefit Analysis Section 15(a) of the Act \\11\\ requires the Commission to consider the costs and benefits of its actions before promulgating...

Revenue and Expenses of Ontario Universities, 1981-82. Volume IV, Physical Plant Operating Expenses.

ERIC Educational Resources Information Center

Council of Ontario Universities, Toronto. Research Div.

Results of an annual survey provide an analysis of physical plant costs by major functional area and object of expense, as reported in each university's operating fund. The principles observed in reporting, definitions, and explanatory comments on the cost categories and their scopes precede a series of summary tables for: total and percentage…

The evolution of cost-efficiency in neural networks during recovery from traumatic brain injury.

PubMed

Roy, Arnab; Bernier, Rachel A; Wang, Jianli; Benson, Monica; French, Jerry J; Good, David C; Hillary, Frank G

2017-01-01

A somewhat perplexing finding in the systems neuroscience has been the observation that physical injury to neural systems may result in enhanced functional connectivity (i.e., hyperconnectivity) relative to the typical network response. The consequences of local or global enhancement of functional connectivity remain uncertain and this is particularly true for the overall metabolic cost of the network. We examine the hyperconnectivity hypothesis in a sample of 14 individuals with TBI with data collected at approximately 3, 6, and 12 months following moderate and severe TBI. As anticipated, individuals with TBI showed increased network strength and cost early after injury, but by one-year post injury hyperconnectivity was more circumscribed to frontal DMN and temporal-parietal attentional control regions. Cost in these subregions was a significant predictor of cognitive performance. Cost-efficiency analysis in the Power 264 data parcellation suggested that at 6 months post injury the network requires higher cost connections to achieve high efficiency as compared to the network 12 months post injury. These results demonstrate that networks self-organize to re-establish connectivity while balancing cost-efficiency trade-offs.

The evolution of cost-efficiency in neural networks during recovery from traumatic brain injury

PubMed Central

Roy, Arnab; Bernier, Rachel A.; Wang, Jianli; Benson, Monica; French, Jerry J.; Good, David C.; Hillary, Frank G.

2017-01-01

A somewhat perplexing finding in the systems neuroscience has been the observation that physical injury to neural systems may result in enhanced functional connectivity (i.e., hyperconnectivity) relative to the typical network response. The consequences of local or global enhancement of functional connectivity remain uncertain and this is particularly true for the overall metabolic cost of the network. We examine the hyperconnectivity hypothesis in a sample of 14 individuals with TBI with data collected at approximately 3, 6, and 12 months following moderate and severe TBI. As anticipated, individuals with TBI showed increased network strength and cost early after injury, but by one-year post injury hyperconnectivity was more circumscribed to frontal DMN and temporal-parietal attentional control regions. Cost in these subregions was a significant predictor of cognitive performance. Cost-efficiency analysis in the Power 264 data parcellation suggested that at 6 months post injury the network requires higher cost connections to achieve high efficiency as compared to the network 12 months post injury. These results demonstrate that networks self-organize to re-establish connectivity while balancing cost-efficiency trade-offs. PMID:28422992

ECONOMIC EVALUATIONS OF INTERVENTIONS FOR TRANSTIBIAL AMPUTEES: A SCOPING REVIEW OF COMPARATIVE STUDIES.

PubMed

Highsmith, M Jason; Kahle, Jason T; Lewandowski, Amanda; Klenow, Tyler D; Orriola, John J; Miro, Rebecca M; Hill, Owen T; Raschke, Sylvia Ursula; Orendurff, Michael S; Highsmith, James T; Sutton, Bryce S

2016-09-01

Transtibial amputation (TTA) is life-altering emotionally, functionally, and economically. The economic impact to all stakeholders is largely unknown, as is the cost-effectiveness of prosthetic intervention. This scoping report's purpose was to determine if there is sufficient evidence to conduct a formal systematic review or meta-analysis in any particular prosthetic intervention area and to determine if any evidence statements could be synthesized relative to economic evaluation of interventions provided to patients with TTA. The scoping review revealed six articles representing three topical areas of transtibial care: Care Models, Prosthetic Treatment, and Prosthetic Sockets. All six articles were cost-identification or cost-consequence design and included a total of 704 subjects. Presently, it can be concluded with moderate confidence that specific weight-bearing and total-contact sockets for transtibial amputees are functionally and economically equivalent in the short term when costs, delivery time, and all stakeholder perspectives are considered. Long-term socket outcomes are relatively unexplored. Further primary research is needed beyond this to determine cost-effectiveness for other areas of transtibial prosthetic care although clinical outcomes are somewhat established through systematic review and meta-analysis in other areas of care. Conversely, evaluation of narrative economic reports relative to transtibial care may be sufficient to warrant further analysis. Guidance from the profession may also be useful in devising a strategy for how to assure economic analyses are a routine element of future prosthetic science.

A Predictive Model to Estimate Cost Savings of a Novel Diagnostic Blood Panel for Diagnosis of Diarrhea-predominant Irritable Bowel Syndrome.

PubMed

Pimentel, Mark; Purdy, Chris; Magar, Raf; Rezaie, Ali

2016-07-01

A high incidence of irritable bowel syndrome (IBS) is associated with significant medical costs. Diarrhea-predominant IBS (IBS-D) is diagnosed on the basis of clinical presentation and diagnostic test results and procedures that exclude other conditions. This study was conducted to estimate the potential cost savings of a novel IBS diagnostic blood panel that tests for the presence of antibodies to cytolethal distending toxin B and anti-vinculin associated with IBS-D. A cost-minimization (CM) decision tree model was used to compare the costs of a novel IBS diagnostic blood panel pathway versus an exclusionary diagnostic pathway (ie, standard of care). The probability that patients proceed to treatment was modeled as a function of sensitivity, specificity, and likelihood ratios of the individual biomarker tests. One-way sensitivity analyses were performed for key variables, and a break-even analysis was performed for the pretest probability of IBS-D. Budget impact analysis of the CM model was extrapolated to a health plan with 1 million covered lives. The CM model (base-case) predicted $509 cost savings for the novel IBS diagnostic blood panel versus the exclusionary diagnostic pathway because of the avoidance of downstream testing (eg, colonoscopy, computed tomography scans). Sensitivity analysis indicated that an increase in both positive likelihood ratios modestly increased cost savings. Break-even analysis estimated that the pretest probability of disease would be 0.451 to attain cost neutrality. The budget impact analysis predicted a cost savings of $3,634,006 ($0.30 per member per month). The novel IBS diagnostic blood panel may yield significant cost savings by allowing patients to proceed to treatment earlier, thereby avoiding unnecessary testing. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Diagnosis-related group-adjusted hospital costs are higher in older medical patients with lower functional status.

PubMed

Chuang, Kenneth H; Covinsky, Kenneth E; Sands, Laura P; Fortinsky, Richard H; Palmer, Robert M; Landefeld, C Seth

2003-12-01

To determine whether hospital costs are higher in patients with lower functional status at admission, defined as dependence in one or more activities of daily living (ADLs), after adjustment for Medicare Diagnosis-Related Group (DRG) payments. Prospective study. General medical service at a teaching hospital. One thousand six hundred twelve patients aged 70 and older. The hospital cost of care for each patient was determined using a cost management information system, which allocates all hospital costs to individual patients. Hospital costs were higher in patients dependent in ADLs on admission than in patients independent in ADLs on admission ($5,300 vs $4,060, P<.01). Mean hospital costs remained higher in ADL-dependent patients than in ADL-independent patients in an analysis that adjusted for DRG weight ($5,240 vs $4,140, P<.01), and in multivariate analyses adjusting for age, race, sex, Charlson comorbidity score, acute physiology and chronic health evaluation score, and admission from a nursing home as well as for DRG weight ($5,200 vs $4,220, P<.01). This difference represents a 23% (95% confidence interval=15-32%) higher cost to take care of older dependent patients. Hospital cost is higher in patients with worse ADL function, even after adjusting for DRG payments. If this finding is true in other hospitals, DRG-based payments provide hospitals a financial incentive to avoid patients dependent in ADLs and disadvantage hospitals with more patients dependent in ADLs.

Accounting for the cost of scaling-up health interventions.

PubMed

Johns, Benjamin; Baltussen, Rob

2004-11-01

Recent studies such as the Commission on Macroeconomics and Health have highlighted the need for expanding the coverage of services for HIV/AIDS, malaria, tuberculosis, immunisations and other diseases. In order for policy makers to plan for these changes, they need to analyse the change in costs when interventions are 'scaled-up' to cover greater percentages of the population. Previous studies suggest that applying current unit costs to an entire population can misconstrue the true costs of an intervention. This study presents the methodology used in WHO-CHOICE's generalised cost effectiveness analysis, which includes non-linear cost functions for health centres, transportation and supervision costs, as well as the presence of fixed costs of establishing a health infrastructure. Results show changing marginal costs as predicted by economic theory. 2004 John Wiley & Sons, Ltd.

75 FR 72845 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

... contract for future functional equivalence analyses of the GEPS 3 product. \\1\\ Notice of United States... analysis of the formulas, and certification of the Governors' vote; and Attachment 4--an application for... costing information and volume commitments, do not alter the contracts' functional equivalency. Id. at 3-4...

A cost-analysis of two approaches to infection control in a lung function laboratory.

PubMed

Side, E A; Harrington, G; Thien, F; Walters, E H; Johns, D P

1999-02-01

The Thoracic Society of Australia and New Zealand (TSANZ) guidelines for infection control in respiratory laboratories are based on a 'Universal Precautions' approach to patient care. This requires that one-way breathing valves, flow sensors, and other items, be cleaned and disinfected between patient use. However, this is impractical in a busy laboratory. The recent introduction of disposable barrier filters may provide a practical solution to this problem, although most consider this approach to be an expensive option. To compare the cost of implementing the TSANZ infection control guidelines with the cost of using disposable barrier filters. Costs were based on the standard tests and equipment currently used in the lung function laboratory at The Alfred Hospital. We have assumed that a barrier filter offers the same degree of protection against cross-infection between patients as the TSANZ infection control guidelines. Time and motion studies were performed on the dismantling, cleaning, disinfecting, reassembling and re-calibrating of equipment. Conservative estimates were made as to the frequency of replacing pneumotachographs and rubber mouthpieces based on previous equipment turnover. Labour costs for a scientist to reprocess the equipment was based on $20.86/hour. The cost of employing a casual cleaner at an hourly rate of $14.07 to assist in reprocessing equipment was also investigated. The new high efficiency HyperFilter disposable barrier filter, costing $2.95 was used in this cost-analysis. The cost of reprocessing equipment required for spirometry alone was $17.58 per test if a scientist reprocesses the equipment, and $15.56 per test if a casual cleaner is employed to assist the scientist in performing these duties. In contrast, using a disposable filter would cost only $2.95 per test. Using a filter was considerably less expensive than following the TSANZ guidelines for all tests and equipment used in this cost-analysis. The TSANZ infection control guidelines are expensive and impractical to implement. However, disposable barrier filters provide a practical and inexpensive method of infection control.

Cost Effectiveness of Monoclonal Antibody Therapy for Rare Diseases: A Systematic Review.

PubMed

Park, Taehwan; Griggs, Scott K; Suh, Dong-Churl

2015-08-01

Monoclonal antibody (mAb)-based orphan drugs have led to advances in the treatment of diseases by selectively targeting molecule functions. However, their high treatment costs impose a substantial cost burden on patients and society. The study aimed to systematically review cost-effectiveness evidence of mAb orphan drugs. Ovid MEDLINE(®), EMBASE(®), and PsycINFO(®) were searched in June 2014 and articles were selected if they conducted economic evaluations of the mAb orphan drugs that had received marketing approval in the USA. The quality of the selected studies was assessed using the Quality of Health Economic Studies (QHES) instrument. We reviewed 16 articles that included 24 economic evaluations of nine mAb orphan drugs. Six of these nine drugs were included in cost-utility analysis studies, whereas three drugs were included in cost-effectiveness analysis studies. Previous cost-utility analysis studies revealed that four mAb orphan drugs (cetuximab, ipilimumab, rituximab, and trastuzumab) were found to be cost effective; one drug (bevacizumab) was not cost effective; and one drug (infliximab) was not consistent across the studies. Prior cost-effectiveness analysis studies which included three mAb orphan drugs (adalimumab, alemtuzumab, and basiliximab) showed that the incremental cost per effectiveness gained for these drugs ranged from $US4669 to $Can52,536 Canadian dollars. The quality of the included studies was good or fair with the exception of one study. Some mAb orphan drugs were reported as cost effective under the current decision-making processes. Use of these expensive drugs, however, can raise an equity issue which concerns fairness in access to treatment. The issue of equal access to drugs needs to be considered alongside other societal values in making the final health policy decisions.

An analysis of disruptions in aerospace/defense organizations that affect the supply chain

NASA Astrophysics Data System (ADS)

Dickerson, Toscha L.

The purpose of this quantitative study was to determine whether or not functions of procurement organizations structures' and aerospace suppliers were perceived as disruptions and to identify their effects on lead time and costs within a supply chain. An analysis of employees' perception of centralized and decentralized procurement functions, aerospace and defense suppliers, lead times of goods and services, price increases, and schedule delays was conducted. Prior studies are limited in regards to understanding how specific procurement functions affects an organization procurement structure. This non-experimental quantitative study allowed for a survey to be administered to aerospace and defense companies throughout the United States to obtain information from sourcing and procurement professionals with 5 or more years of experience. The current study utilized a 10 question survey based on the 5- point Likert -type scale to determine the findings. Through descriptive and inferential statistics, using regression analysis, standard deviation, and P-value; findings indicated that the majority of the participants surveyed perceived both centralized and decentralized procurement functions affected lead time and cost of goods and services resulted in a positive effect and were considered as supply chain disruptions.

Cost decomposition of linear systems with application to model reduction

NASA Technical Reports Server (NTRS)

Skelton, R. E.

1980-01-01

A means is provided to assess the value or 'cst' of each component of a large scale system, when the total cost is a quadratic function. Such a 'cost decomposition' of the system has several important uses. When the components represent physical subsystems which can fail, the 'component cost' is useful in failure mode analysis. When the components represent mathematical equations which may be truncated, the 'component cost' becomes a criterion for model truncation. In this latter event component costs provide a mechanism by which the specific control objectives dictate which components should be retained in the model reduction process. This information can be valuable in model reduction and decentralized control problems.

Offshore Wind Plant Balance-of-Station Cost Drivers and Sensitivities (Poster)

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

Saur, G.; Maples, B.; Meadows, B.

2012-09-01

With Balance of System (BOS) costs contributing up to 70% of the installed capital cost, it is fundamental to understanding the BOS costs for offshore wind projects as well as potential cost trends for larger offshore turbines. NREL developed a BOS model using project cost estimates developed by GL Garrad Hassan. Aspects of BOS covered include engineering and permitting, ports and staging, transportation and installation, vessels, foundations, and electrical. The data introduce new scaling relationships for each BOS component to estimate cost as a function of turbine parameters and size, project parameters and size, and soil type. Based on themore » new BOS model, an analysis to understand the non-turbine costs associated with offshore turbine sizes ranging from 3 MW to 6 MW and offshore wind plant sizes ranging from 100 MW to 1000 MW has been conducted. This analysis establishes a more robust baseline cost estimate, identifies the largest cost components of offshore wind project BOS, and explores the sensitivity of the levelized cost of energy to permutations in each BOS cost element. This presentation shows results from the model that illustrates the potential impact of turbine size and project size on the cost of energy from US offshore wind plants.« less

Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR)

PubMed Central

Thalanany, Mariamma M; Mugford, Miranda; Hibbert, Clare; Cooper, Nicola J; Truesdale, Ann; Robinson, Steven; Tiruvoipati, Ravindranath; Elbourne, Diana R; Peek, Giles J; Clemens, Felicity; Hardy, Polly; Wilson, Andrew

2008-01-01

Background Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system. Methods/Design The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated. Discussion In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. Trial Registrations The CESAR trial registration number is ISRCTN47279827. PMID:18447931

Cost-effectiveness of unicondylar versus total knee arthroplasty: a Markov model analysis.

PubMed

Peersman, Geert; Jak, Wouter; Vandenlangenbergh, Tom; Jans, Christophe; Cartier, Philippe; Fennema, Peter

2014-01-01

Unicondylar knee arthroplasty (UKA) is believed to lead to less morbidity and enhanced functional outcomes when compared with total knee arthroplasty (TKA). Conversely, UKA is also associated with a higher revision risk than TKA. In order to further clarify the key differences between these separate procedures, the current study assessing the cost-effectiveness of UKA versus TKA was undertaken. A state-transition Markov model was developed to compare the cost-effectiveness of UKA versus TKA for unicondylar osteoarthritis using a Belgian payer's perspective. The model was designed to include the possibility of two revision procedures. Model estimates were obtained through literature review and revision rates were based on registry data. Threshold analysis and probabilistic sensitivity analysis were performed to assess the model's robustness. UKA was associated with a cost reduction of €2,807 and a utility gain of 0.04 quality-adjusted life years in comparison with TKA. Analysis determined that the model is sensitive to clinical effectiveness, and that a marginal reduction in the clinical performance of UKA would lead to TKA being the more cost-effective solution. UKA yields clear advantages in terms of costs and marginal advantages in terms of health effects, in comparison with TKA. © 2014 Elsevier B.V. All rights reserved.

Cost-effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis.

PubMed

Sevick, Mary A; Miller, Gary D; Loeser, Richard F; Williamson, Jeff D; Messier, Stephen P

2009-06-01

The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis (OA) enrolled in the Arthritis, Diet, and Physical Activity Promotion Trial (ADAPT). ADAPT was a single-blinded, controlled trial of 316 adults with knee OA, randomized to one of four groups: Healthy Lifestyle Control group, Diet group, Exercise group, or Exercise and Diet group. A cost analysis was performed from a payer perspective, incorporating those costs and benefits that would be realized by a managed care organization interested in maintaining the health and satisfaction of its enrollees while reducing unnecessary utilization of health care services. The Diet intervention was most cost-effective for reducing weight, at $35 for each percentage point reduction in baseline body weight. The Exercise intervention was most cost-effective for improving mobility, costing $10 for each percentage point improvement in a 6-min walking distance and $9 for each percentage point improvement in the timed stair climbing task. The Exercise and Diet intervention was most cost-effective for improving self-reported function and symptoms of arthritis, costing $24 for each percentage point improvement in subjective function, $20 for each percentage point improvement in self-reported pain, and $56 for each percentage point improvement in self-reported stiffness. The Exercise and Diet intervention consistently yielded the greatest improvements in weight, physical performance, and symptoms of knee OA. However, it was also the most expensive and was the most cost-effective approach only for the subjective outcomes of knee OA (self-reported function, pain, and stiffness). Perceived function and symptoms of knee OA are likely to be stronger drivers of downstream health service utilization than weight, or objective performance measures and may be the most cost-effective in the long term.

An Analysis of the Cost and Performance of Photovoltaic Systems as a Function of Module Area

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

Horowitz, Kelsey A.W.; Fu, Ran; Silverman, Tim

We investigate the potential effects of module area on the cost and performance of photovoltaic systems. Applying a bottom-up methodology, we analyzed the costs associated with mc-Si and thin-film modules and systems as a function of module area. We calculate a potential for savings of up to $0.04/W, $0.10/W, and $0.13/W in module manufacturing costs for mc-Si, CdTe, and CIGS respectively, with large area modules. We also find that an additional $0.05/W savings in balance-of-systems costs may be achieved. However, these savings are dependent on the ability to maintain efficiency and manufacturing yield as area scales. Lifetime energy yield mustmore » also be maintained to realize reductions in the levelized cost of energy. We explore the possible effects of module size on efficiency and energy production, and find that more research is required to understand these issues for each technology. Sensitivity of the $/W cost savings to module efficiency and manufacturing yield is presented. We also discuss non-cost barriers to adoption of large area modules.« less

A Class of Manifold Regularized Multiplicative Update Algorithms for Image Clustering.

PubMed

Yang, Shangming; Yi, Zhang; He, Xiaofei; Li, Xuelong

2015-12-01

Multiplicative update algorithms are important tools for information retrieval, image processing, and pattern recognition. However, when the graph regularization is added to the cost function, different classes of sample data may be mapped to the same subspace, which leads to the increase of data clustering error rate. In this paper, an improved nonnegative matrix factorization (NMF) cost function is introduced. Based on the cost function, a class of novel graph regularized NMF algorithms is developed, which results in a class of extended multiplicative update algorithms with manifold structure regularization. Analysis shows that in the learning, the proposed algorithms can efficiently minimize the rank of the data representation matrix. Theoretical results presented in this paper are confirmed by simulations. For different initializations and data sets, variation curves of cost functions and decomposition data are presented to show the convergence features of the proposed update rules. Basis images, reconstructed images, and clustering results are utilized to present the efficiency of the new algorithms. Last, the clustering accuracies of different algorithms are also investigated, which shows that the proposed algorithms can achieve state-of-the-art performance in applications of image clustering.

Earth Observatory Satellite system definition study. Report no. 3: Design/cost tradeoff studies. Appendix A: EOS program WBS dictionary. Appendix B: EOS mission functional analysis

NASA Technical Reports Server (NTRS)

1974-01-01

The work breakdown structure (WBS) dictionary for the Earth Observatory Satellite (EOS) is defined. The various elements of the EOS program are examined to include the aggregate of hardware, computer software, services, and data required to develop, produce, test, support, and operate the space vehicle and the companion ground data management system. A functional analysis of the EOS mission is developed. The operations for three typical EOS missions, Delta, Titan, and Shuttle launched are considered. The functions were determined for the top program elements, and the mission operations, function 2.0, was expanded to level one functions. Selection of ten level one functions for further analysis to level two and three functions were based on concern for the EOS operations and associated interfaces.

Outcomes and costs of incorporating a multibiomarker disease activity test in the management of patients with rheumatoid arthritis.

PubMed

Michaud, Kaleb; Strand, Vibeke; Shadick, Nancy A; Degtiar, Irina; Ford, Kerri; Michalopoulos, Steven N; Hornberger, John

2015-09-01

The multibiomarker disease activity (MBDA) blood test has been clinically validated as a measure of disease activity in patients with RA. We aimed to estimate the effect of the MBDA test on physical function for patients with RA (based on HAQ), quality-adjusted life years and costs over 10 years. A decision analysis was conducted to quantify the effect of using the MBDA test on RA-related outcomes and costs to private payers and employers. Results of a clinical management study reporting changes to anti-rheumatic drug recommendations after use of the MBDA test informed clinical utility. The effect of treatment changes on HAQ was derived from 5 tight-control and 13 treatment-switch trials. Baseline HAQ scores and the HAQ score relationship with medical costs and quality of life were derived from published National Data Bank for Rheumatic Diseases data. Use of the MBDA test is projected to improve HAQ scores by 0.09 units in year 1, declining to 0.02 units after 10 years. Over the 10 year time horizon, quality-adjusted life years increased by 0.08 years and costs decreased by US$457 (cost savings in disability-related medical costs, US$659; in productivity costs, US$2137). The most influential variable in the analysis was the effect of the MBDA test on clinician treatment recommendations and subsequent HAQ changes. The MBDA test aids in the assessment of disease activity in patients with RA by changing treatment decisions, improving the functional status of patients and cost savings. Further validation is ongoing and future longitudinal studies are warranted. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.

PubMed

Ramsey, Scott D; Berry, Kristin; Etzioni, Ruth; Kaplan, Robert M; Sullivan, Sean D; Wood, Douglas E

2003-05-22

The National Emphysema Treatment Trial, a randomized clinical trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema, included a prospective economic analysis. After pulmonary rehabilitation, 1218 patients at 17 medical centers were randomly assigned to lung-volume-reduction surgery or continued medical treatment. Costs for the use of medical care, medications, transportation, and time spent receiving treatment were derived from Medicare claims and data from the trial. Cost effectiveness was calculated over the duration of the trial and was estimated for 10 years of follow-up with the use of modeling based on observed trends in survival, cost, and quality of life. Interim analyses identified a group of patients with excess mortality and little chance of improved functional status after surgery. When these patients were excluded, the cost-effectiveness ratio for lung-volume-reduction surgery as compared with medical therapy was 190,000 dollars per quality-adjusted life-year gained at 3 years and 53,000 dollars per quality-adjusted life-year gained at 10 years. Subgroup analyses identified patients with predominantly upper-lobe emphysema and low exercise capacity after pulmonary rehabilitation who had lower mortality and better functional status than patients who received medical therapy. The cost-effectiveness ratio in this subgroup was 98,000 dollars per quality-adjusted life-year gained at 3 years and 21,000 dollars at 10 years. Bootstrap analysis revealed substantial uncertainty for the subgroup and 10-year estimates. Given its cost and benefits over three years of follow-up, lung-volume-reduction surgery is costly relative to medical therapy. Although the predictions are subject to substantial uncertainty, the procedure may be cost effective if benefits can be maintained over time. Copyright 2003 Massachusetts Medical Society

Cost-Effectiveness Analysis of Primary Arthrodesis Versus Open Reduction Internal Fixation for Primarily Ligamentous Lisfranc Injuries.

PubMed

Albright, Rachel H; Haller, Sarah; Klein, Erin; Baker, Jeffrey R; Weil, Lowell; Weil, Lowell S; Fleischer, Adam E

The purpose of the present study was to determine whether surgical intervention with open reduction internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries is more cost effective. We conducted a formal cost-effectiveness analysis using a Markov model and decision tree to explore the healthcare costs and health outcomes associated with a scenario of ORIF versus PA for 45 years postoperatively. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. The costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2017 price base. ORIF was always associated with greater costs compared with PA and was less effective in the long term. When calculating the cost required to gain 1 additional QALY, the PA group cost $1429/QALY and the ORIF group cost $3958/QALY. The group undergoing PA overall spent, on average, $43,192 less than the ORIF group, and PA was overall a more effective technique. Strong dominance compared with ORIF was demonstrated in multiple scenarios, and the model's conclusions were unchanged in the sensitivity analysis even after varying the key assumptions. ORIF failed to show functional or financial benefits. In conclusion, from a healthcare system's standpoint, PA would clearly be the preferred treatment strategy for predominantly ligamentous Lisfranc injuries and dislocations. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Blind separation of positive sources by globally convergent gradient search.

PubMed

Oja, Erkki; Plumbley, Mark

2004-09-01

The instantaneous noise-free linear mixing model in independent component analysis is largely a solved problem under the usual assumption of independent nongaussian sources and full column rank mixing matrix. However, with some prior information on the sources, like positivity, new analysis and perhaps simplified solution methods may yet become possible. In this letter, we consider the task of independent component analysis when the independent sources are known to be nonnegative and well grounded, which means that they have a nonzero pdf in the region of zero. It can be shown that in this case, the solution method is basically very simple: an orthogonal rotation of the whitened observation vector into nonnegative outputs will give a positive permutation of the original sources. We propose a cost function whose minimum coincides with nonnegativity and derive the gradient algorithm under the whitening constraint, under which the separating matrix is orthogonal. We further prove that in the Stiefel manifold of orthogonal matrices, the cost function is a Lyapunov function for the matrix gradient flow, implying global convergence. Thus, this algorithm is guaranteed to find the nonnegative well-grounded independent sources. The analysis is complemented by a numerical simulation, which illustrates the algorithm.

Identifying factors of activities of daily living important for cost and caregiver outcomes in Alzheimer's disease.

PubMed

Reed, Catherine; Belger, Mark; Vellas, Bruno; Andrews, Jeffrey Scott; Argimon, Josep M; Bruno, Giuseppe; Dodel, Richard; Jones, Roy W; Wimo, Anders; Haro, Josep Maria

2016-02-01

We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD). Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden. Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD. Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.

Communications network design and costing model users manual

NASA Technical Reports Server (NTRS)

Logan, K. P.; Somes, S. S.; Clark, C. A.

1983-01-01

The information and procedures needed to exercise the communications network design and costing model for performing network analysis are presented. Specific procedures are included for executing the model on the NASA Lewis Research Center IBM 3033 computer. The concepts, functions, and data bases relating to the model are described. Model parameters and their format specifications for running the model are detailed.

Laser System Reliability

DTIC Science & Technology

1977-03-01

system acquisition cycle since they provide necessary inputs to comparative analyses, cost/benefit trade -offs, and system simulations. In addition, the...Management Program from above performs the function of analyzing the system trade -offs with respect to reliability to determine a reliability goal...one encounters the problem of comparing present dollars with future dollars. In this analysis, we are trading off costs expended initially (or at

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis.

PubMed

Turner-Stokes, Lynne; Bavikatte, Ganesh; Williams, Heather; Bill, Alan; Sephton, Keith

2016-09-08

To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012-2015. Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale-version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: p<0.001). For the 180 (95%) patients with complete NPCNA data, the mean episode cost was £77 119 (bootstrapped 95% CI £70 614 to £83 894) and the mean reduction in 'weekly care costs' was £462/week (95% CI 349 to 582). The mean time to offset the cost of rehabilitation was 27.6 months (95% CI 13.2 to 43.8). Despite its relatively high initial cost, specialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A cost simulation for mammography examinations taking into account equipment failures and resource utilization characteristics.

PubMed

Coelli, Fernando C; Almeida, Renan M V R; Pereira, Wagner C A

2010-12-01

This work develops a cost analysis estimation for a mammography clinic, taking into account resource utilization and equipment failure rates. Two standard clinic models were simulated, the first with one mammography equipment, two technicians and one doctor, and the second (based on an actually functioning clinic) with two equipments, three technicians and one doctor. Cost data and model parameters were obtained by direct measurements, literature reviews and other hospital data. A discrete-event simulation model was developed, in order to estimate the unit cost (total costs/number of examinations in a defined period) of mammography examinations at those clinics. The cost analysis considered simulated changes in resource utilization rates and in examination failure probabilities (failures on the image acquisition system). In addition, a sensitivity analysis was performed, taking into account changes in the probabilities of equipment failure types. For the two clinic configurations, the estimated mammography unit costs were, respectively, US$ 41.31 and US$ 53.46 in the absence of examination failures. As the examination failures increased up to 10% of total examinations, unit costs approached US$ 54.53 and US$ 53.95, respectively. The sensitivity analysis showed that type 3 (the most serious) failure increases had a very large impact on the patient attendance, up to the point of actually making attendance unfeasible. Discrete-event simulation allowed for the definition of the more efficient clinic, contingent on the expected prevalence of resource utilization and equipment failures. © 2010 Blackwell Publishing Ltd.

Process-based Cost Estimation for Ramjet/Scramjet Engines

NASA Technical Reports Server (NTRS)

Singh, Brijendra; Torres, Felix; Nesman, Miles; Reynolds, John

2003-01-01

Process-based cost estimation plays a key role in effecting cultural change that integrates distributed science, technology and engineering teams to rapidly create innovative and affordable products. Working together, NASA Glenn Research Center and Boeing Canoga Park have developed a methodology of process-based cost estimation bridging the methodologies of high-level parametric models and detailed bottoms-up estimation. The NASA GRC/Boeing CP process-based cost model provides a probabilistic structure of layered cost drivers. High-level inputs characterize mission requirements, system performance, and relevant economic factors. Design alternatives are extracted from a standard, product-specific work breakdown structure to pre-load lower-level cost driver inputs and generate the cost-risk analysis. As product design progresses and matures the lower level more detailed cost drivers can be re-accessed and the projected variation of input values narrowed, thereby generating a progressively more accurate estimate of cost-risk. Incorporated into the process-based cost model are techniques for decision analysis, specifically, the analytic hierarchy process (AHP) and functional utility analysis. Design alternatives may then be evaluated not just on cost-risk, but also user defined performance and schedule criteria. This implementation of full-trade study support contributes significantly to the realization of the integrated development environment. The process-based cost estimation model generates development and manufacturing cost estimates. The development team plans to expand the manufacturing process base from approximately 80 manufacturing processes to over 250 processes. Operation and support cost modeling is also envisioned. Process-based estimation considers the materials, resources, and processes in establishing cost-risk and rather depending on weight as an input, actually estimates weight along with cost and schedule.

Factors associated with hospitalisation costs in patients with chronic obstructive pulmonary disease.

PubMed

Li, F; Sun, Z; Li, H; Yang, T; Shi, Z

2018-04-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admissions, which can result in a significant financial burden. To determine hospitalisation costs and factors associated with higher costs in patients with acute exacerbations of COPD (AE-COPD). Patients hospitalised for a whole year formed the study cohort. Demographic features, clinical data and hospitalisation bills were evaluated retrospectively. Student's t-test or the Mann-Whitney U-test were used to compare the mean values of variables between high-cost and low-cost groups. Logistic regression analysis was used to study the relationship between hospitalisation costs with clinical factors. A total of 188 patients were evaluated. The mean length of stay in hospital (LOSH) was 8.5 days. The mean cost of AE-COPD was US$1722.0. Costs were significantly associated with LOSH and the per cent predicted value of forced expiratory volume in one second. Age, sex, smoking index, partial oxygen pressure, partial carbon dioxide pressure, haemoglobin concentration and white blood cell counts were not associated with hospitalisation costs. Medications and laboratory services are the main drivers of hospitalisation costs in AE-COPD. Longer LOSH and reduced pulmonary function determine the high costs in hospitalised patients with AE-COPD admitted to a general ward. To reduce hospitalisation costs, more emphasis should be placed on shortening LOSH and preventing the worsening of pulmonary function.

Cost-effectiveness of sacubitril/valsartan in chronic heart-failure patients with reduced ejection fraction.

PubMed

Ademi, Zanfina; Pfeil, Alena M; Hancock, Elizabeth; Trueman, David; Haroun, Rola Haroun; Deschaseaux, Celine; Schwenkglenks, Matthias

2017-11-29

We aimed to assess the cost effectiveness of sacubitril/valsartan compared to angiotensin-converting enzyme inhibitors (ACEIs) for the treatment of individuals with chronic heart failure and reduced-ejection fraction (HFrEF) from the perspective of the Swiss health care system. The cost-effectiveness analysis was implemented as a lifelong regression-based cohort model. We compared sacubitril/valsartan with enalapril in chronic heart failure patients with HFrEF and New York-Heart Association Functional Classification II-IV symptoms. Regression models based on the randomised clinical phase III PARADIGM-HF trials were used to predict events (all-cause mortality, hospitalisations, adverse events and quality of life) for each treatment strategy modelled over the lifetime horizon, with adjustments for patient characteristics. Unit costs were obtained from Swiss public sources for the year 2014, and costs and effects were discounted by 3%. The main outcome of interest was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life years (QALYs) gained. Deterministic sensitivity analysis (DSA) and scenario and probabilistic sensitivity analysis (PSA) were performed. In the base-case analysis, the sacubitril/valsartan strategy showed a decrease in the number of hospitalisations (6.0% per year absolute reduction) and lifetime hospital costs by 8.0% (discounted) when compared with enalapril. Sacubitril/valsartan was predicted to improve overall and quality-adjusted survival by 0.50 years and 0.42 QALYs, respectively. Additional net-total costs were CHF 10 926. This led to an ICER of CHF 25 684. In PSA, the probability of sacubitril/valsartan being cost-effective at thresholds of CHF 50 000 was 99.0%. The treatment of HFrEF patients with sacubitril/valsartan versus enalapril is cost effective, if a willingness-to-pay threshold of CHF 50 000 per QALY gained ratio is assumed.

Replica Approach for Minimal Investment Risk with Cost

NASA Astrophysics Data System (ADS)

Shinzato, Takashi

2018-06-01

In the present work, the optimal portfolio minimizing the investment risk with cost is discussed analytically, where an objective function is constructed in terms of two negative aspects of investment, the risk and cost. We note the mathematical similarity between the Hamiltonian in the mean-variance model and the Hamiltonians in the Hopfield model and the Sherrington-Kirkpatrick model, show that we can analyze this portfolio optimization problem by using replica analysis, and derive the minimal investment risk with cost and the investment concentration of the optimal portfolio. Furthermore, we validate our proposed method through numerical simulations.

A low cost LST pointing control system

NASA Technical Reports Server (NTRS)

Glaese, J. R.; Kennel, H. F.; Nurre, G. S.; Seltzer, S. M.; Shelton, H. L.

1975-01-01

Vigorous efforts to reduce costs, coupled with changes in LST guidelines, took place in the Fall of 1974. These events made a new design of the LST and its Pointing and Attitude Control System possible. The major design changes are summarized as: an annular Support Systems Module; removal of image motion compensation; reaction wheels instead of CMG's; a magnetic torquer system to also perform the emergency and backup functions, eliminating the previously required mass expulsion system. Preliminary analysis indicates the Low Cost LST concept can meet the newly defined requirements and results in a significantly reduced development cost.

An economic systems analysis of land mobile radio telephone services

NASA Technical Reports Server (NTRS)

Leroy, B. E.; Stevenson, S. M.

1980-01-01

This paper deals with the economic interaction of the terrestrial and satellite land-mobile radio service systems. The cellular, trunked and satellite land-mobile systems are described. Parametric equations are formulated to allow examination of necessary user thresholds and growth rates as functions of system costs. Conversely, first order allowable systems costs are found as a function of user thresholds and growth rates. Transitions between satellite and terrestrial service systems are examined. User growth rate density (user/year/km squared) is shown to be a key parameter in the analysis of systems compatibility. The concept of system design matching the price demand curves is introduced and examples are given. The role of satellite systems is critically examined and the economic conditions necessary for the introduction of satellite service are identified.

Use of Model-Based Design Methods for Enhancing Resiliency Analysis of Unmanned Aerial Vehicles

NASA Astrophysics Data System (ADS)

Knox, Lenora A.

The most common traditional non-functional requirement analysis is reliability. With systems becoming more complex, networked, and adaptive to environmental uncertainties, system resiliency has recently become the non-functional requirement analysis of choice. Analysis of system resiliency has challenges; which include, defining resilience for domain areas, identifying resilience metrics, determining resilience modeling strategies, and understanding how to best integrate the concepts of risk and reliability into resiliency. Formal methods that integrate all of these concepts do not currently exist in specific domain areas. Leveraging RAMSoS, a model-based reliability analysis methodology for Systems of Systems (SoS), we propose an extension that accounts for resiliency analysis through evaluation of mission performance, risk, and cost using multi-criteria decision-making (MCDM) modeling and design trade study variability modeling evaluation techniques. This proposed methodology, coined RAMSoS-RESIL, is applied to a case study in the multi-agent unmanned aerial vehicle (UAV) domain to investigate the potential benefits of a mission architecture where functionality to complete a mission is disseminated across multiple UAVs (distributed) opposed to being contained in a single UAV (monolithic). The case study based research demonstrates proof of concept for the proposed model-based technique and provides sufficient preliminary evidence to conclude which architectural design (distributed vs. monolithic) is most resilient based on insight into mission resilience performance, risk, and cost in addition to the traditional analysis of reliability.

Airfoil Design and Optimization by the One-Shot Method

NASA Technical Reports Server (NTRS)

Kuruvila, G.; Taasan, Shlomo; Salas, M. D.

1995-01-01

An efficient numerical approach for the design of optimal aerodynamic shapes is presented in this paper. The objective of any optimization problem is to find the optimum of a cost function subject to a certain state equation (governing equation of the flow field) and certain side constraints. As in classical optimal control methods, the present approach introduces a costate variable (Lagrange multiplier) to evaluate the gradient of the cost function. High efficiency in reaching the optimum solution is achieved by using a multigrid technique and updating the shape in a hierarchical manner such that smooth (low-frequency) changes are done separately from high-frequency changes. Thus, the design variables are changed on a grid where their changes produce nonsmooth (high-frequency) perturbations that can be damped efficiently by the multigrid. The cost of solving the optimization problem is approximately two to three times the cost of the equivalent analysis problem.

Airfoil optimization by the one-shot method

NASA Technical Reports Server (NTRS)

Kuruvila, G.; Taasan, Shlomo; Salas, M. D.

1994-01-01

An efficient numerical approach for the design of optimal aerodynamic shapes is presented in this paper. The objective of any optimization problem is to find the optimum of a cost function subject to a certain state equation (Governing equation of the flow field) and certain side constraints. As in classical optimal control methods, the present approach introduces a costate variable (Language multiplier) to evaluate the gradient of the cost function. High efficiency in reaching the optimum solution is achieved by using a multigrid technique and updating the shape in a hierarchical manner such that smooth (low-frequency) changes are done separately from high-frequency changes. Thus, the design variables are changed on a grid where their changes produce nonsmooth (high-frequency) perturbations that can be damped efficiently by the multigrid. The cost of solving the optimization problem is approximately two to three times the cost of the equivalent analysis problem.

Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study.

PubMed

Saramago, Pedro; Cooper, Nicola J; Sutton, Alex J; Hayes, Mike; Dunn, Ken; Manca, Andrea; Kendrick, Denise

2014-05-16

The UK has one of the highest rates for deaths from fire and flames in children aged 0-14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of 'functioning' smoke alarms and consequently for the prevention of fire-related injuries in children in the UK. We carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection. Education and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household. Assessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.

Gait and Cognition in Parkinson's Disease: Cognitive Impairment Is Inadequately Reflected by Gait Performance during Dual Task.

PubMed

Gaßner, Heiko; Marxreiter, Franz; Steib, Simon; Kohl, Zacharias; Schlachetzki, Johannes C M; Adler, Werner; Eskofier, Bjoern M; Pfeifer, Klaus; Winkler, Jürgen; Klucken, Jochen

2017-01-01

Cognitive and gait deficits are common symptoms in Parkinson's disease (PD). Motor-cognitive dual tasks (DTs) are used to explore the interplay between gait and cognition. However, it is unclear if DT gait performance is indicative for cognitive impairment. Therefore, the aim of this study was to investigate if cognitive deficits are reflected by DT costs of spatiotemporal gait parameters. Cognitive function, single task (ST) and DT gait performance were investigated in 67 PD patients. Cognition was assessed by the Montreal Cognitive Assessment (MoCA) followed by a standardized, sensor-based gait test and the identical gait test while subtracting serial 3's. Cognitive impairment was defined by a MoCA score <26. DT costs in gait parameters [(DT - ST)/ST × 100] were calculated as a measure of DT effect on gait. Correlation analysis was used to evaluate the association between MoCA performance and gait parameters. In a linear regression model, DT gait costs and clinical confounders (age, gender, disease duration, motor impairment, medication, and depression) were correlated to cognitive performance. In a subgroup analysis, we compared matched groups of cognitively impaired and unimpaired PD patients regarding differences in ST, DT, and DT gait costs. Correlation analysis revealed weak correlations between MoCA score and DT costs of gait parameters ( r / r Sp  ≤ 0.3). DT costs of stride length, swing time variability, and maximum toe clearance (| r / r Sp | > 0.2) were included in a regression analysis. The parameters only explain 8% of the cognitive variance. In combination with clinical confounders, regression analysis showed that these gait parameters explained 30% of MoCA performance. Group comparison revealed strong DT effects within both groups (large effect sizes), but significant between-group effects in DT gait costs were not observed. These findings suggest that DT gait performance is not indicative for cognitive impairment in PD. DT effects on gait parameters were substantial in cognitively impaired and unimpaired patients, thereby potentially overlaying the effect of cognitive impairment on DT gait costs. Limits of the MoCA in detecting motor-function specific cognitive performance or variable individual response to the DT as influencing factors cannot be excluded. Therefore, DT gait parameters as marker for cognitive performance should be carefully interpreted in the clinical context.

Reliability and Validity in Hospital Case-Mix Measurement

PubMed Central

Pettengill, Julian; Vertrees, James

1982-01-01

There is widespread interest in the development of a measure of hospital output. This paper describes the problem of measuring the expected cost of the mix of inpatient cases treated in a hospital (hospital case-mix) and a general approach to its solution. The solution is based on a set of homogenous groups of patients, defined by a patient classification system, and a set of estimated relative cost weights corresponding to the patient categories. This approach is applied to develop a summary measure of the expected relative costliness of the mix of Medicare patients treated in 5,576 participating hospitals. The Medicare case-mix index is evaluated by estimating a hospital average cost function. This provides a direct test of the hypothesis that the relationship between Medicare case-mix and Medicare cost per case is proportional. The cost function analysis also provides a means of simulating the effects of classification error on our estimate of this relationship. Our results indicate that this general approach to measuring hospital case-mix provides a valid and robust measure of the expected cost of a hospital's case-mix. PMID:10309909

Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation

PubMed Central

2012-01-01

Purpose A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. Key messages (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. Conclusion (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care. PMID:22506504

Nursing home cost and ownership type: evidence of interaction effects.

PubMed

Arling, G; Nordquist, R H; Capitman, J A

1987-06-01

Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed.

Fixing the game: are between-silo differences in funding arrangements handicapping some interventions and giving others a head-start?

PubMed

Segal, Leonie; Dalziel, Kim; Mortimer, Duncan

2010-04-01

Given resource scarcity, not all potentially beneficial health services can be funded. Choices are made, if not explicitly, implicitly as some health services are funded and others are not. But what are the primary influences on those choices? We sought to test whether funding decisions are linked to cost effectiveness and to quantify the influence of funding arrangements and community values arguments. We tested this via empirical analysis of 245 Australian health-care interventions for which cost-effectiveness estimates had been published. The likelihood of government funding was modelled as a function of cost effectiveness, patient/target group characteristics, intervention characteristics and publication characteristics, using multiple regression analysis. We found that higher cost effectiveness ratios were a significant predictor of funding rejection, but that cost effectiveness was not related to the level of funding. Intervention characteristics linked to funding and delivery arrangements and community values arguments were significant predictors of funding outcomes. Our analysis supports the hypothesis that funding and delivery arrangements influence both whether an intervention is funded and funding level; even after controlling for community values and cost effectiveness. It suggests that adopting partial priority setting processes without regard to opportunity cost can have the perverse effect of compounding allocative inefficiencies. Copyright (c) 2009 John Wiley & Sons, Ltd.

Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation.

PubMed

Turner-Stokes, Lynne; Poppleton, Rob; Williams, Heather; Schoewenaars, Katie; Badwan, Derar

2012-01-01

A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a "real-life" application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.

Nursing home cost and ownership type: evidence of interaction effects.

PubMed Central

Arling, G; Nordquist, R H; Capitman, J A

1987-01-01

Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed. PMID:3301746

The Impact of Biomass Feedstock Supply Variability on the Delivered Price to a Biorefinery in the Peace River Region of Alberta, Canada

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

Stephen, Jamie; Sokhansanj, Shahabaddine; Bi, X.T.

2010-01-01

Agricultural residue feedstock availability in a given region can vary significantly over the 20 25 year lifetime of a biorefinery. Since delivered price of biomass feedstock to a biorefinery is related to the distance travelled and equipment optimization, and transportation distance increases as productivity decreases, productivity is a primary determinant of feedstock price. Using the Integrated Biomass Supply Analysis and Logistics (IBSAL) modeling environment and a standard round bale harvest and delivery scenario, harvest and delivery price were modelled for minimum, average, and maximum yields at four potential biorefinery sites in the Peace River region of Alberta, Canada. Biorefinery capacitiesmore » ranged from 50,000 to 500,000 tonnes per year. Delivery cost is a linear function of transportation distance and can be combined with a polynomial harvest function to create a generalized delivered cost function for agricultural residues. The range in delivered cost is substantial and is an important consideration for the operating costs of a biorefinery.« less

Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set.

PubMed

Turner-Stokes, Lynne; Williams, Heather; Bill, Alan; Bassett, Paul; Sephton, Keith

2016-02-24

To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency. A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010-2015. All 62 specialist (levels 1 and 2) rehabilitation services in England. Working-aged adults (16-65 years) with complex neurological disability. all episodes with length of stay (LOS) 8-400 days and complete outcome measures recorded on admission and discharge. Total N=5739: acquired brain injury n=4182 (73%); spinal cord injury n=506 (9%); peripheral neurological conditions n=282 (5%); progressive conditions n=769 (13%). Specialist inpatient multidisciplinary rehabilitation. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK Functional Independence Measure (FIM)+FAM). Cost-efficiency: (1) time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care, (2) FIM efficiency (FIM gain/LOS days), (3) FIM+FAM efficiency (FIM+FAM gain/LOS days). Patients were analysed in 3 groups of dependency. Mean LOS 90.1 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p<0.001). Mean reduction in 'weekly care costs' was greatest in the high-dependency group at £760/week (95% CI 726 to 794)), compared with the medium-dependency (£408/week (95% CI 370 to 445)), and low-dependency (£130/week (95% CI 82 to 178)), groups. Despite longer LOS, time taken to offset the cost of rehabilitation was 14.2 (95% CI 9.9 to 18.8) months in the high-dependency group, compared with 22.3 (95% CI 16.9 to 29.2) months (medium dependency), and 27.7 (95% CI 15.9 to 39.7) months (low dependency). FIM efficiency appeared greatest in medium-dependency patients (0.54), compared with the low-dependency (0.37) and high-dependency (0.38) groups. Broadly similar patterns were seen across all 4 diagnostic groups. Specialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cointegration of output, capital, labor, and energy

NASA Astrophysics Data System (ADS)

Stresing, R.; Lindenberger, D.; Kã¼mmel, R.

2008-11-01

Cointegration analysis is applied to the linear combinations of the time series of (the logarithms of) output, capital, labor, and energy for Germany, Japan, and the USA since 1960. The computed cointegration vectors represent the output elasticities of the aggregate energy-dependent Cobb-Douglas function. The output elasticities give the economic weights of the production factors capital, labor, and energy. We find that they are for labor much smaller and for energy much larger than the cost shares of these factors. In standard economic theory output elasticities equal cost shares. Our heterodox findings support results obtained with LINEX production functions.

An economic analysis of a commercial approach to the design and fabrication of a space power system

NASA Technical Reports Server (NTRS)

Putney, Z.; Been, J. F.

1979-01-01

A commercial approach to the design and fabrication of an economical space power system is presented. Cost reductions are projected through the conceptual design of a 2 kW space power system built with the capability for having serviceability. The approach to system costing that is used takes into account both the constraints of operation in space and commercial production engineering approaches. The cost of this power system reflects a variety of cost/benefit tradeoffs that would reduce system cost as a function of system reliability requirements, complexity, and the impact of rigid specifications. A breakdown of the system design, documentation, fabrication, and reliability and quality assurance cost estimates are detailed.

Integrated Analysis and Visualization of Group Differences in Structural and Functional Brain Connectivity: Applications in Typical Ageing and Schizophrenia.

PubMed

Langen, Carolyn D; White, Tonya; Ikram, M Arfan; Vernooij, Meike W; Niessen, Wiro J

2015-01-01

Structural and functional brain connectivity are increasingly used to identify and analyze group differences in studies of brain disease. This study presents methods to analyze uni- and bi-modal brain connectivity and evaluate their ability to identify differences. Novel visualizations of significantly different connections comparing multiple metrics are presented. On the global level, "bi-modal comparison plots" show the distribution of uni- and bi-modal group differences and the relationship between structure and function. Differences between brain lobes are visualized using "worm plots". Group differences in connections are examined with an existing visualization, the "connectogram". These visualizations were evaluated in two proof-of-concept studies: (1) middle-aged versus elderly subjects; and (2) patients with schizophrenia versus controls. Each included two measures derived from diffusion weighted images and two from functional magnetic resonance images. The structural measures were minimum cost path between two anatomical regions according to the "Statistical Analysis of Minimum cost path based Structural Connectivity" method and the average fractional anisotropy along the fiber. The functional measures were Pearson's correlation and partial correlation of mean regional time series. The relationship between structure and function was similar in both studies. Uni-modal group differences varied greatly between connectivity types. Group differences were identified in both studies globally, within brain lobes and between regions. In the aging study, minimum cost path was highly effective in identifying group differences on all levels; fractional anisotropy and mean correlation showed smaller differences on the brain lobe and regional levels. In the schizophrenia study, minimum cost path and fractional anisotropy showed differences on the global level and within brain lobes; mean correlation showed small differences on the lobe level. Only fractional anisotropy and mean correlation showed regional differences. The presented visualizations were helpful in comparing and evaluating connectivity measures on multiple levels in both studies.

Development of an Enhanced Payback Function for the Superior Energy Performance Program

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

Therkelsen, Peter; Rao, Prakash; McKane, Aimee

2015-08-03

The U.S. DOE Superior Energy Performance (SEP) program provides recognition to industrial and commercial facilities that achieve certification to the ISO 50001 energy management system standard and third party verification of energy performance improvements. Over 50 industrial facilities are participating and 28 facilities have been certified in the SEP program. These facilities find value in the robust, data driven energy performance improvement result that the SEP program delivers. Previous analysis of SEP certified facility data demonstrated the cost effectiveness of SEP and identified internal staff time to be the largest cost component related to SEP implementation and certification. This papermore » analyzes previously reported and newly collected data of costs and benefits associated with the implementation of an ISO 50001 and SEP certification. By disaggregating “sunk energy management system (EnMS) labor costs”, this analysis results in a more accurate and detailed understanding of the costs and benefits of SEP participation. SEP is shown to significantly improve and sustain energy performance and energy cost savings, resulting in a highly attractive return on investment. To illustrate these results, a payback function has been developed and is presented. On average facilities with annual energy spend greater than $2M can expect to implement SEP with a payback of less than 1.5 years. Finally, this paper also observes and details decreasing facility costs associated with implementing ISO 50001 and certifying to the SEP program, as the program has improved from pilot, to demonstration, to full launch.« less

Can home care services achieve cost savings in long-term care for older people?

PubMed

Greene, V L; Ondrich, J; Laditka, S

1998-07-01

To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis

PubMed Central

Turner-Stokes, Lynne; Bavikatte, Ganesh; Williams, Heather; Bill, Alan; Sephton, Keith

2016-01-01

Objectives To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. Design A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012–2015. Setting Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. Participants All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). Intervention Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. Outcome measures Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale—version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). Primary outcomes: (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. Results The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: p<0.001). For the 180 (95%) patients with complete NPCNA data, the mean episode cost was £77 119 (bootstrapped 95% CI £70 614 to £83 894) and the mean reduction in ‘weekly care costs’ was £462/week (95% CI 349 to 582). The mean time to offset the cost of rehabilitation was 27.6 months (95% CI 13.2 to 43.8). Conclusions Despite its relatively high initial cost, specialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services. PMID:27609852

How Root Cause Analysis Can Improve the Value Methodology

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

Wixson, James Robert

2002-05-01

Root cause analysis (RCA) is an important methodology that can be integrated with the VE Job Plan to generate superior results from the VE Methodology. The point at which RCA is most appropriate is after the function analysis and FAST Model have been built and functions for improvement have been chosen. These functions are then subjected to a simple, but, rigorous RCA to get to the root cause of their deficiencies, whether it is high cost/poor value, poor quality, or poor reliability. Once the most probable causes for these problems have been arrived at, better solutions for improvement can bemore » developed in the creativity phase because the team better understands the problems associated with these functions.« less

The Einstein Suite: A Web-Based Tool for Rapid and Collaborative Engineering Design and Analysis

NASA Technical Reports Server (NTRS)

Palmer, Richard S.

1997-01-01

Taken together the components of the Einstein Suite provide two revolutionary capabilities - they have the potential to change the way engineering and financial engineering are performed by: (1) providing currently unavailable functionality, and (2) providing a 10-100 times improvement over currently available but impractical or costly functionality.

Analysis of the proposed utilization of TDRS system by the HEAO-C satellite

NASA Technical Reports Server (NTRS)

Weathers, G.

1974-01-01

The primary function of the study was to assess the impact upon the HEAO telecommunications system of the proposed relay satellite-to-ground-link configuration. The system is designed to perform the function of most of the NASA ground tracking and communications network at a net cost savings for NASA.

A model-based analysis of the clinical and economic impact of personalising P2Y12-receptor inhibition with platelet function testing in acute coronary syndrome patients.

PubMed

Straub, Niels; Beivers, Andreas; Lenk, Ekaterina; Aradi, Daniel; Sibbing, Dirk

2014-02-01

Although some observational studies reported that the measured level of P2Y12-inhibition is predictive for thrombotic events, the clinical and economic benefit of incorporating PFT to personalize P2Y12-receptor directed antiplatelet treatment is unknown. Here, we assessed the clinical impact and cost-effectiveness of selecting P2Y12-inhibitors based on platelet function testing (PFT) in acute coronary syndrome (ACS) patients undergoing PCI. A decision model was developed to analyse the health economic effects of different strategies. PFT-guided treatment was compared with the three options of general clopidogrel, prasugrel or ticagrelor treatment. In the PFT arm, low responders to clopidogrel received prasugrel, while normal responders carried on with clopidogrel. The associated endpoints in the model were cardiovascular death, stent thrombosis and major bleeding. With a simulated cohort of 10,000 patients treated for one year, there were 93 less events in the PFT arm compared to general clopidogrel. In prasugrel and ticagrelor arms, 110 and 86 events were prevented compared to clopidogrel treatment, respectively. The total expected costs (including event costs, drug costs and PFT costs) for generic clopidogrel therapy were US$ 1,059/patient. In the PFT arm, total costs were US$ 1,494, while in the prasugrel and ticagrelor branches they were US$ 3,102 and US$ 3,771, respectively. The incremental-cost-effectiveness-ratio (ICER) was US$ 46,770 for PFT-guided therapy, US$ 185,783 for prasugrel and US$ 315,360 for ticagrelor. In this model-based analysis, a PFT-guided therapy may have fewer adverse outcomes than general treatment with clopidogrel and may be more cost-effective than prasugrel or ticagrelor treatment in ACS patients undergoing PCI.

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.

Guidance and Control Software,

DTIC Science & Technology

1980-05-01

commitments of function, cost, and schedule . The phrase "software engineering" was intended to contrast with the phrase "computer science" the latter aims...the software problems of cost, delivery schedule , and quality were gradually being recognized at the highest management levels. Thus, in a project... schedule dates. Although the analysis of software problems indicated that the entire software development process (figure 1) needed new methods, only

Techno-economic analysis of fuel cell auxiliary power units as alternative to idling

NASA Astrophysics Data System (ADS)

Jain, Semant; Chen, Hsieh-Yeh; Schwank, Johannes

This paper presents a techno-economic analysis of fuel-cell-based auxiliary power units (APUs), with emphasis on applications in the trucking industry and the military. The APU system is intended to reduce the need for discretionary idling of diesel engines or gas turbines. The analysis considers the options for on-board fuel processing of diesel and compares the two leading fuel cell contenders for automotive APU applications: proton exchange membrane fuel cell and solid oxide fuel cell. As options for on-board diesel reforming, partial oxidation and auto-thermal reforming are considered. Finally, using estimated and projected efficiency data, fuel consumption patterns, capital investment, and operating costs of fuel-cell APUs, an economic evaluation of diesel-based APUs is presented, with emphasis on break-even periods as a function of fuel cost, investment cost, idling time, and idling efficiency. The analysis shows that within the range of parameters studied, there are many conditions where deployment of an SOFC-based APU is economically viable. Our analysis indicates that at an APU system cost of 100 kW -1, the economic break-even period is within 1 year for almost the entire range of conditions. At 500 kW -1 investment cost, a 2-year break-even period is possible except for the lowest end of the fuel consumption range considered. However, if the APU investment cost is 3000 kW -1, break-even would only be possible at the highest fuel consumption scenarios. For Abram tanks, even at typical land delivered fuel costs, a 2-year break-even period is possible for APU investment costs as high as 1100 kW -1.

A Cognitive Engineering Analysis of the Vertical Navigation (VNAV) Function

NASA Technical Reports Server (NTRS)

Sherry, Lance; Feary, Michael; Polson, Peter; Mumaw, Randall; Palmer, Everett

2001-01-01

A cognitive engineering analysis of the Flight Management System (FMS) Vertical Navigation (VNAV) function has identified overloading of the VNAV button and overloading of the Flight Mode Annunciator (FMA) used by the VNAV function. These two types of overloading, resulting in modal input devices and ambiguous feedback, are well known sources of operator confusion, and explain, in part, the operational issues experienced by airline pilots using VNAV in descent and approach. A proposal to modify the existing VNAV design to eliminate the overloading is discussed. The proposed design improves pilot's situational awareness of the VNAV function, and potentially reduces the cost of software development and improves safety.

Re-Engineering JPL's Mission Planning Ground System Architecture for Cost Efficient Operations in the 21st Century

NASA Technical Reports Server (NTRS)

Fordyce, Jess

1996-01-01

Work carried out to re-engineer the mission analysis segment of JPL's mission planning ground system architecture is reported on. The aim is to transform the existing software tools, originally developed for specific missions on different support environments, into an integrated, general purpose, multi-mission tool set. The issues considered are: the development of a partnership between software developers and users; the definition of key mission analysis functions; the development of a consensus based architecture; the move towards evolutionary change instead of revolutionary replacement; software reusability, and the minimization of future maintenance costs. The current status and aims of new developments are discussed and specific examples of cost savings and improved productivity are presented.

Cost-effectiveness and cost-utility of combination therapy in early rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone. COBRA Trial Group. Combinatietherapie Bij Reumatoïde Artritis.

PubMed

Verhoeven, A C; Bibo, J C; Boers, M; Engel, G L; van der Linden, S

1998-10-01

Assessment of the cost-effectiveness and cost-utility of early intervention in rheumatoid arthritis (RA) patients, with combined step-down prednisolone, methotrexate and sulphasalazine, compared to sulphasalazine alone. Multicentre 56 week randomized double-blind trial with full economic analysis of direct costs and utility analysis with rating scale and standard gamble measurement techniques. The combined-treatment group included 76 patients and the sulphasalazine group 78 patients. The mean total costs per patient in the first 56 weeks of follow-up were $5519 for combined treatment and $6511 for treatment with sulphasalazine alone (P = 0.37). Out-patient care, in-patient care and non-health care each contributed about one-third to the total costs. The combined-treatment group appeared to generate savings in the length of hospital stay for RA, non-protocol drugs and costs of home help, but comparisons were not statistically significant. Protocol drugs and monitoring were slightly more expensive in the combined-treatment group. Clinical, radiographic and functional outcomes significantly favoured combined treatment at week 28 (radiography also at week 56). Utility scores also favoured combined treatment. Combined treatment is cost-effective due to enhanced efficacy at lower or equal direct costs.

Parametric Cost Models for Space Telescopes

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Henrichs, Todd; Dollinger, Courtney

2010-01-01

Multivariable parametric cost models for space telescopes provide several benefits to designers and space system project managers. They identify major architectural cost drivers and allow high-level design trades. They enable cost-benefit analysis for technology development investment. And, they provide a basis for estimating total project cost. A survey of historical models found that there is no definitive space telescope cost model. In fact, published models vary greatly [1]. Thus, there is a need for parametric space telescopes cost models. An effort is underway to develop single variable [2] and multi-variable [3] parametric space telescope cost models based on the latest available data and applying rigorous analytical techniques. Specific cost estimating relationships (CERs) have been developed which show that aperture diameter is the primary cost driver for large space telescopes; technology development as a function of time reduces cost at the rate of 50% per 17 years; it costs less per square meter of collecting aperture to build a large telescope than a small telescope; and increasing mass reduces cost.

Generalized shading analysis for paraboloidal collector fields

NASA Technical Reports Server (NTRS)

Osborn, D. B.

1980-01-01

This paper presents the development and results of a generalized shading analysis for a field of point-focus parabolic dish concentrators. Shading of one concentrator by another with attendant loss of energy is a function of the position of the sun and the relative locations of the concentrators within the field. A method is presented for determining the annualized energy loss which includes a trade-off of system life-cycle energy as a function of concentrator spacing and field geometric layout. System energy output is computed on an annualized basis, employing 15 minute-increment environmental data tapes for the year 1976 at Barstow, California. For a land cost of $5000 per acre, lowest system energy cost occurs at about a 25 percent packing fraction (concentrator area/land area) for a typical 1-MWe dish-Stirling solar thermal power plant. Basic equations are given for computing the shading and concomitant energy loss as a function of concentrator center-to-center spacing, field layout site location.

The global historical and future economic loss and cost of earthquakes during the production of adaptive worldwide economic fragility functions

NASA Astrophysics Data System (ADS)

Daniell, James; Wenzel, Friedemann

2014-05-01

Over the past decade, the production of economic indices behind the CATDAT Damaging Earthquakes Database has allowed for the conversion of historical earthquake economic loss and cost events into today's terms using long-term spatio-temporal series of consumer price index (CPI), construction costs, wage indices, and GDP from 1900-2013. As part of the doctoral thesis of Daniell (2014), databases and GIS layers for a country and sub-country level have been produced for population, GDP per capita, net and gross capital stock (depreciated and non-depreciated) using studies, census information and the perpetual inventory method. In addition, a detailed study has been undertaken to collect and reproduce as many historical isoseismal maps, macroseismic intensity results and reproductions of earthquakes as possible out of the 7208 damaging events in the CATDAT database from 1900 onwards. a) The isoseismal database and population bounds from 3000+ collected damaging events were compared with the output parameters of GDP and net and gross capital stock per intensity bound and administrative unit, creating a spatial join for analysis. b) The historical costs were divided into shaking/direct ground motion effects, and secondary effects costs. The shaking costs were further divided into gross capital stock related and GDP related costs for each administrative unit, intensity bound couplet. c) Costs were then estimated based on the optimisation of the function in terms of costs vs. gross capital stock and costs vs. GDP via the regression of the function. Losses were estimated based on net capital stock, looking at the infrastructure age and value at the time of the event. This dataset was then used to develop an economic exposure for each historical earthquake in comparison with the loss recorded in the CATDAT Damaging Earthquakes Database. The production of economic fragility functions for each country was possible using a temporal regression based on the parameters of macroseismic intensity, capital stock estimate, GDP estimate, year and the combined seismic building index (a created combination of the global seismic code index, building practice factor, building age and infrastructure vulnerability). The analysis provided three key results: a) The production of economic fragility functions from the 1900-2008 events showed very good correlation to the economic loss and cost from earthquakes from 2009-2013, in real-time. This methodology has been extended to other natural disaster types (typhoon, flood, drought). b) The reanalysis of historical earthquake events in order to check associated historical loss and costs versus the expected exposure in terms of intensities. The 1939 Chillan, 1948 Turkmenistan, 1950 Iran, 1972 Managua, 1980 Western Nepal and 1992 Erzincan earthquake events were seen as huge outliers compared with the modelled capital stock and GDP and thus additional studies were undertaken to check the original loss results. c) A worldwide GIS layer database of capital stock (gross and net), GDP, infrastructure age and economic indices over the period 1900-2013 have been created in conjunction with the CATDAT database in order to define correct economic loss and costs.

Latin American Clinical Epidemiology Network Series - Paper 4: Economic evaluation of Kangaroo Mother Care: cost utility analysis of results from a randomized controlled trial conducted in Bogotá.

PubMed

Ruiz, Juan Gabriel; Charpak, Nathalie; Castillo, Mario; Bernal, Astrid; Ríos, John; Trujillo, Tammy; Córdoba, María Adelaida

2017-06-01

Although kangaroo mother care (KMC) has been shown to be safe and effective in randomized controlled trials (RCTs), there are no published complete economic evaluations including the three components of the full intervention. A cost utility analysis performed on the results of an RCT conducted in Bogotá, Colombia between 1993 and 1996. Hospital and ambulatory costs were estimated by microcosting in a sample of preterm infants from a University Hospital in Bogotá in 2011 and at a KMC clinic in the same period. Utility scores were assigned by experts by means of (1) direct ordering and scoring discrete health states and (2) constructing a multi-attribute utility function. Ninety-five percent confidence intervals (CIs) for the incremental cost-utility ratios (ICURs) were computed by the Fiellers theorem method. One-way sensitivity analysis on price estimates for valuing costs was performed. ICUR at 1 year of corrected age was $ -1,546 per extra quality-adjusted life year gained using the KMC method (95% CI $ -7,963 to $ 4,910). In Bogotá, the use of KMC is dominant: more effective and cost-saving. Although results from an economic analysis should not be extrapolated to different systems and communities, this dominant result suggests that KMC could be cost-effective in similar low and middle income countries settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Functional Outcomes and Efficiency of Rehabilitation in a National Cohort of Patients with Guillain - Barré Syndrome and Other Inflammatory Polyneuropathies

PubMed Central

Alexandrescu, Roxana; Siegert, Richard John; Turner-Stokes, Lynne

2014-01-01

Objectives To describe functional outcomes, care needs and cost-efficiency of hospital rehabilitation for a UK cohort of inpatients with complex rehabilitation needs arising from inflammatory polyneuropathies. Subjects and Setting 186 patients consecutively admitted to specialist neurorehabilitation centres in England with Guillain-Barré Syndrome (n = 118 (63.4%)) or other inflammatory polyneuropathies, including chronic inflammatory demyelinating polyneuropathy (n = 15 (8.1%) or critical illness neuropathy (n = 32 (17.2%)). Methods Cohort analysis of data from the UK Rehabilitation Outcomes Collaborative national clinical dataset. Outcome measures include the UK Functional Assessment Measure, Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA). Patients were analysed in three groups of dependency based on their admission NPDS score: ‘low’ (NPDS<10), ‘medium’ (NPDS 10–24) and ‘high’ (NPDS ≥25). Cost-efficiency was measured as the time taken to offset the cost of rehabilitation by savings in NPCNA-estimated costs of on-going care in the community. Results The mean rehabilitation length of stay was 72.2 (sd = 66.6) days. Significant differences were seen between the diagnostic groups on admission, but all showed significant improvements between admission and discharge, in both motor and cognitive function (p<0.0001). Patients who were highly dependent on admission had the longest lengths of stay (mean 97.0 (SD 79.0) days), but also showed the greatest reduction in on-going care costs (£1049 per week (SD £994)), so that overall they were the most cost-efficient to treat. Conclusions Patients with polyneuropathies have both physical and cognitive disabilities that are amenable to change with rehabilitation, resulting in significant reduction in on-going care-costs, especially for highly dependent patients. PMID:25402491

Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review.

PubMed

Eamer, Gilgamesh; Saravana-Bawan, Bianka; van der Westhuizen, Brenden; Chambers, Thane; Ohinmaa, Arto; Khadaroo, Rachel G

2017-10-01

Seniors presenting with surgical disease face increased risk of postoperative morbidity and mortality and have increased treatment costs. Comprehensive Geriatric Assessment (CGA) is proposed to reduce morbidity, mortality, and the cost after surgery. A systematic review of CGA in emergency surgical patients was conducted. The primary outcome was cost-effectiveness; secondary outcomes were length of stay, return of function, and mortality. Inclusion and exclusion criteria were predefined. Systematic searches of MEDLINE, Embase, Cochrane, and National Health Service Economic Evaluation Database were performed. Text screening, bias assessment, and data extraction were performed by two authors. There were 560 articles identified; abstract review excluded 499 articles and full-text review excluded 53 articles. Eight studies were included; one nonorthopedic trauma and seven orthopedic trauma studies. Bias assessment revealed moderate to high risk of bias for all studies. Economic evaluation assessment identified two high-quality studies and six moderate or low quality studies. Pooled analysis from four studies assessed loss of function; loss of function decreased in the experimental arm (odds ratio 0.92, 95% confidence interval [CI]: 0.88-0.97). Pooled results for length of stay from five studies found a significant decrease (mean difference: -1.17, 95% CI: -1.63 to -0.71) after excluding the nonorthopedic trauma study. Pooled mortality was significantly decreased in seven studies (risk ratio: 0.78, 95% CI: 0.67-0.90). All studies decreased cost and improved health outcomes in a cost-effective manner. CGA improved return of function and mortality with reduced cost or improved utility. Our review suggests that CGA is economically dominant and the most cost-effective care model for orthogeriatric patients. Further research should examine other surgical fields. Copyright © 2017 Elsevier Inc. All rights reserved.

A rotor optimization using regression analysis

NASA Technical Reports Server (NTRS)

Giansante, N.

1984-01-01

The design and development of helicopter rotors is subject to the many design variables and their interactions that effect rotor operation. Until recently, selection of rotor design variables to achieve specified rotor operational qualities has been a costly, time consuming, repetitive task. For the past several years, Kaman Aerospace Corporation has successfully applied multiple linear regression analysis, coupled with optimization and sensitivity procedures, in the analytical design of rotor systems. It is concluded that approximating equations can be developed rapidly for a multiplicity of objective and constraint functions and optimizations can be performed in a rapid and cost effective manner; the number and/or range of design variables can be increased by expanding the data base and developing approximating functions to reflect the expanded design space; the order of the approximating equations can be expanded easily to improve correlation between analyzer results and the approximating equations; gradients of the approximating equations can be calculated easily and these gradients are smooth functions reducing the risk of numerical problems in the optimization; the use of approximating functions allows the problem to be started easily and rapidly from various initial designs to enhance the probability of finding a global optimum; and the approximating equations are independent of the analysis or optimization codes used.

Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.

PubMed

Mark, Daniel B; Federspiel, Jerome J; Cowper, Patricia A; Anstrom, Kevin J; Hoffmann, Udo; Patel, Manesh R; Davidson-Ray, Linda; Daniels, Melanie R; Cooper, Lawton S; Knight, J David; Lee, Kerry L; Douglas, Pamela S

2016-07-19

PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. To conduct an economic analysis for PROMISE (a major secondary aim of the study). Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550). 190 U.S. centers. 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, -$634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Cost weights for test strategies were obtained from sources outside PROMISE. Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up. National Heart, Lung, and Blood Institute.

Home inotropic therapy in advanced heart failure: cost analysis and clinical outcomes.

PubMed

Harjai, K J; Mehra, M R; Ventura, H O; Lapeyre, Y M; Murgo, J P; Stapleton, D D; Smart, F W

1997-11-05

This study was conducted to assess cost savings and clinical outcomes associated with the use of home i.v. inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure. Retrospective analysis. Tertiary care referral center. Twenty-four patients (13 men, 11 women; age, 61+/-12 years) with left ventricular ejection fraction <30% and heart failure refractory to oral agents required home i.v. inotropic therapy for at least 4 consecutive weeks between May 1994 and April 1996. Inotropic agents used included dobutamine (n=20; dose, 5.0+/-2.2 microg/kg/min) or milrinone (n=7; dose, 0.53+/-0.05 microg/kg/min). Cost of care and clinical outcomes (hospital admissions, length of hospital stay, NYHA functional class) were compared during the period of inotropic therapy (study period) and the immediate preceding period of equal duration (control period). In comparison to the control period, the study period (3.9+/-2.7 months) was associated with a 16% reduction in cost, amounting to a calculated savings of $5,700 per patient or $1,465 per patient per month. Concomitantly, a decrease in the number of hospital admissions from 2.7+/-2.6 to 1.3+/-1.3 (p=0.056) and length of hospital stay from 20.9+/-12.7 to 5.5+/-5.4 days (p=0.0004) was observed with improvement in NYHA functional class from 4.0+/-0.0 to 2.7+/-0.9 (p<0.0001). Eight patients (38%) died after 2.8+/-1.7 months of home i.v. inotropic therapy. Home i.v. inotropic therapy reduces hospital admissions, length of stay, and cost of care and improves functional class in patients with advanced (NYHA class IV) heart failure.

Analysis of hospital costs as a basis for pricing services in Mali.

PubMed

Audibert, Martine; Mathonnat, Jacky; Pareil, Delphine; Kabamba, Raymond

2007-01-01

In a move to achieve a better equity in the funding of access to health care, particularly for the poor, a better efficiency of hospital functioning and a better financial balance, the analysis of hospital costs in Mali brings several key elements to improve the pricing of medical services. The method utilized is the classical step-down process which takes into consideration the entire set of direct and indirect costs borne by the hospital. Although this approach does not allow to estimate the economic cost of consultations, it is a useful contribution to assess the financial activity of the hospital and improve its performance, financially speaking, through a more relevant user fees policy. The study shows that there are possibilities of cross-subsidies within the hospital or within services which improve the recovery of some of the current costs. It also leads to several proposals of pricing care while taking into account the constraints, the level of the hospital its specific conditions and equity. Copyright (c) 2007 John Wiley & Sons, Ltd.

Cost analysis in oral cavity and oropharyngeal reconstructions with microvascular and pedicled flaps.

PubMed

Deganello, A; Gitti, G; Parrinello, G; Muratori, E; Larotonda, G; Gallo, O

2013-12-01

Reconstructive surgery of the head and neck region has undergone tremendous advancement over the past three decades, and the success rate of free tissue transfers has risen to greater than 95%. It must always be considered that not all patients are ideal candidates for free flap reconstruction, and also that not every defect strictly requires a free flap transfer to achieve good functional results. At our institution, free flap reconstruction is first choice, although we use pedicled alternative flaps for most weak patients suffering from severe comorbidities, and for pretreated patients presenting a second primary or a recurrent cancer. From July 2006 to May 2010, 54 consecutive patients underwent soft tissue reconstruction of oral cavity and oropharyngeal defects. We divided the cohort in three groups: Group 1 (G1): 16 patients in good general conditions that received free radial forearm flap reconstruction; Group 2 (G2): 18 high-risk patients that received a reconstruction with infrahyoid flap; Group 3 (G3): 20 patients that received temporal flap (10 cases) or pectoral flap (10 cases) reconstruction. We must highlight that pedicled alternative flaps were used in elderly, unfavourable and weak patients, where usually the medical costs tend to rise rather than decrease. We compared the healthcare costs of the three groups, calculating real costs in each group from review of medical records and operating room registers, and calculating the corresponding DRG system reimbursement. For real costs, we found a statistically significant difference among groups: in G1 the average total cost per patient was € 22,924, in G2 it was € 18,037 and in G3 was € 19,872 (p = 0.043). The amount of the refund, based on the DRG system, was € 7,650 per patient, independently of the type of surgery. Our analysis shows that the use of alternative non-microvascular techniques, in high-risk patients, is functionally and oncologically sound, and can even produce a cost savings. In particular, the infrahyoid flap (G2) ensures excellent functional results, accompanied by the best economic savings in the worst group of patients. Our data reflect a large disconnection between the DRG system and actual treatment costs.

The Cost of Distribution System Upgrades to Accommodate Increasing Penetrations of Distributed Photovoltaic Systems on Real Feeders in the United States

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

Horowitz, Kelsey A; Ding, Fei; Mather, Barry A

The increasing deployment of distributed photovoltaic systems (DPV) can impact operations at the distribution level and the transmission level of the electric grid. It is important to develop and implement forward-looking approaches for calculating distribution upgrade costs that can be used to inform system planning, market and tariff design, cost allocation, and other policymaking as penetration levels of DPV increase. Using a bottom-up approach that involves iterative hosting capacity analysis, this report calculates distribution upgrade costs as a function of DPV penetration on three real feeders - two in California and one in the Northeastern United States.

Time-Series Modeling and Simulation for Comparative Cost-Effective Analysis in Cancer Chemotherapy: An Application to Platinum-Based Regimens for Advanced Non-small Cell Lung Cancer.

PubMed

Chisaki, Yugo; Nakamura, Nobuhiko; Yano, Yoshitaka

2017-01-01

The purpose of this study was to propose a time-series modeling and simulation (M&S) strategy for probabilistic cost-effective analysis in cancer chemotherapy using a Monte-Carlo method based on data available from the literature. The simulation included the cost for chemotherapy, for pharmaceutical care for adverse events (AEs) and other medical costs. As an application example, we describe the analysis for the comparison of four regimens, cisplatin plus irinotecan, carboplatin plus paclitaxel, cisplatin plus gemcitabine (GP), and cisplatin plus vinorelbine, for advanced non-small cell lung cancer. The factors, drug efficacy explained by overall survival or time to treatment failure, frequency and severity of AEs, utility value of AEs to determine QOL, the drugs' and other medical costs in Japan, were included in the model. The simulation was performed and quality adjusted life years (QALY) and incremental cost-effectiveness ratios (ICER) were calculated. An index, percentage of superiority (%SUP) which is the rate of the increased cost vs. QALY-gained plots within the area of positive QALY-gained and also below some threshold values of the ICER, was calculated as functions of threshold values of the ICER. An M&S process was developed, and for the simulation example, the GP regimen was the most cost-effective, in case of threshold values of the ICER=$70000/year, the %SUP for the GP are more than 50%. We developed an M&S process for probabilistic cost-effective analysis, this method would be useful for decision-making in choosing a cancer chemotherapy regimen in terms of pharmacoeconomic.

Is it time to rebalance the case mix? A portfolio analysis of direct catheterization laboratory costs over a 5-year period.

PubMed

Plehn, Gunnar; Butz, Thomas; Maagh, Petra; Oernek, Ahmet; Meissner, Axel; Plehn, Natalie

2016-11-03

Cardiac catheterization laboratories (CLL) have continued to function as profit centers for hospitals. Due to a high percentage of material and labor costs, they are natural targets for process improvement. Our study applied a contribution margin (CBM) concept to evaluate costs and cost dynamics over a 5-year period. We retrospectively analyzed all procedures performed at a tertiary heart center between 2007 and 2011. Total variable costs, including labor time, material, and maintenance-expenses, were allocated at a global as well as a procedural level. CBM and CBM ratios were calculated by integration of individual DRG revenues. Annual case volume increased from 1288 to 1545. In parallel, overall profitability improved as indicated by a 2% increase in CBM ratio and a higher CBM generated per hour of CLL working time (4325 vs. 5892 €, p < 0.001). Coronary angiography generated higher average CBMs per hour than coronary or electrophysiological interventions (5831 vs. 3458 vs. 1495 €; p < 0.001). The latter are characterized by relatively high per case material expenditures. On a procedural level, DRG-specific trends as a steady improvement of examination time or an increase in material costs were detectable. The CBM concept allows a comprehensive analysis of CLL costs and cost dynamics. From a health service providers view, its range of application includes global profitability analysis, portfolio evaluation, and a detailed cost analysis of specific service lines. From a healthcare payers perspective, it may help to monitor hospital activities and to provide a solid data basis in cases where inappropriate developments are suspected. The calculation principle is simple which may increase user acceptance and thus the motivation of team members.

Preference weights for cost-outcome analyses of schizophrenia treatments: comparison of four stakeholder groups.

PubMed

Shumway, Martha

2003-01-01

This study quantified preferences for schizophrenia outcomes in four stakeholder groups, tested the hypotheses that outcomes differ in importance and stakeholder groups have different preferences, and produced preference weights for seven outcomes for cost-outcome analysis. Fifty patients with schizophrenia, 50 clinicians, 41 family members of patients, and 50 members of the general public rated 16 schizophrenia-related health states, yielding preference weights for seven outcomes: positive symptoms, negative symptoms, extrapyramidal symptoms, tardive dyskinesia, social function, independent living, and vocational function. Outcomes differed in importance (F = 23.4, p < 0.01). All stakeholders rated positive symptoms and social functioning as more important than negative and extrapyramidal symptoms. Stakeholder groups had different preferences (F = 1.9, p = 0.01). Patients rated extrapyramidal symptoms as more important than did other groups (p < 0.01); clinicians rated social functioning as more important than did patients or family members (p < 0.05); and clinicians and family members rated vocational functioning as more important than did patients and the general public (p < 0.05). Results show that schizophrenia outcomes are not equally important and that stakeholder groups value outcomes differently, demonstrating the importance of incorporating stakeholder preferences in cost-outcome analyses and other treatment comparisons.

Cost-utility and budget impact analysis of drug treatments in pulmonary arterial hypertension associated with congenital heart diseases in Thailand.

PubMed

Thongsri, Watsamon; Bussabawalai, Thanaporn; Leelahavarong, Pattara; Wanitkun, Suthep; Durongpisitkul, Kritvikrom; Chaikledkaew, Usa; Teerawattananon, Yot

2016-08-01

This study aims to compare the lifetime costs and health outcomes of both first-line and sequential combination treatments with standard treatment for pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) (PAH-CHD) patients. A cost-utility analysis was performed using a Markov model based on a societal perspective. One-way and probabilistic sensitivity analyses were performed to investigate the effect of parameter uncertainty. As first-line treatments, both beraprost (incremental cost-effectiveness ratio (ICER) = 192,752 and 201,308 Thai baht (THB) per quality-adjusted life year (QALY) gained) and sildenafil (ICER = 249,770 and 226,802 THB per QALY gained) seemed cost-effective for PAH-CHD patients aged ≤30 years in functional classes II and III, respectively, while no treatment was cost-effective for the sequential combination therapy. Sildenafil should be included in the National Drug List of Essential Medicines as the first-line treatment for PAH-CHD, and its price per dose should be negotiated to be reduced by 43-57%.

Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up.

PubMed

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

2014-05-29

Providing additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay, yet the economic implications are not known. The aim of this study was to determine from a health service perspective if the provision of rehabilitation to inpatients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone. Cost utility and cost effectiveness analyses were undertaken alongside a multi-center, single-blind randomized controlled trial with a 30-day follow up after discharge. Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday. Incremental cost utility ratio was reported as cost per quality adjusted life year (QALY) gained and an incremental cost effectiveness ratio (ICER) was reported as cost for a minimal clinically important difference (MCID) in functional independence. 996 patients (mean age 74 (standard deviation 13) years) were randomly assigned to the intervention (n = 496) or the control group (n = 500). Mean difference in cost of AUD$1,673 (95% confidence interval (CI) -271 to 3,618) was a saving in favor of the intervention group. The incremental cost utility ratio found a saving of AUD$41,825 (95% CI -2,817 to 74,620) per QALY gained for the intervention group. The ICER found a saving of AUD$16,003 (95% CI -3,074 to 87,361) in achieving a MCID in functional independence for the intervention group. If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96% and 95%, respectively. A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome. From a health service perspective, the provision of rehabilitation to inpatients on a Saturday in addition to Monday to Friday, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per QALY gained and for a MCID in functional independence. Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213.

Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis.

PubMed

Ramponi, Francesco; Ronco, Claudio; Mason, Giacomo; Rettore, Enrico; Marcelli, Daniele; Martino, Francesca; Neri, Mauro; Martin-Malo, Alejandro; Canaud, Bernard; Locatelli, Francesco

2016-01-01

Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD. The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different risk profiles, for example, by age (patients aged 40, 50, and 60 years), sex, and diabetic status. Scatter plots of simulations in the cost-effectiveness plane were produced, incremental cost-effectiveness ratios were estimated, and cost-effectiveness acceptability curves were computed. An incremental cost-effectiveness ratio of €6,982/quality-adjusted life years (QALY) was estimated for the baseline cohort of 50-year-old male patients. Given the commonly accepted threshold of €40,000/QALY, HDF is cost-effective. The probabilistic sensitivity analysis showed that HDF is cost-effective with a probability of ~81% at a threshold of €40,000/QALY. It is fundamental to measure the outcome also in terms of quality of life. HDF is more cost-effective for younger patients. HDF can be considered cost-effective compared to HF-HD.

Affordable Design: A Methodolgy to Implement Process-Based Manufacturing Cost into the Traditional Performance-Focused Multidisciplinary Design Optimization

NASA Technical Reports Server (NTRS)

Bao, Han P.; Samareh, J. A.

2000-01-01

The primary objective of this paper is to demonstrate the use of process-based manufacturing and assembly cost models in a traditional performance-focused multidisciplinary design and optimization process. The use of automated cost-performance analysis is an enabling technology that could bring realistic processbased manufacturing and assembly cost into multidisciplinary design and optimization. In this paper, we present a new methodology for incorporating process costing into a standard multidisciplinary design optimization process. Material, manufacturing processes, and assembly processes costs then could be used as the objective function for the optimization method. A case study involving forty-six different configurations of a simple wing is presented, indicating that a design based on performance criteria alone may not necessarily be the most affordable as far as manufacturing and assembly cost is concerned.

Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis.

PubMed

Nygård, R; Norum, J; Due, J

2001-01-01

We have today two treatment alternatives (orchiectomy or LHRH-analogue) in metastatic prostate cancer offering the same expectations of survival. This study documents the quality of life (QoL) and cost-effectiveness of these alternatives. 65 consecutive patients treated at the University Hospital of Tromsø (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue--15 patients, orchiectomy--30 patients) were alive and included in the QoL-study (EORTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and included in the cost-analysis. Costs were calculated for a 36-month interval and converted to British pounds (1 Pound = 13 NOK). A 5% d.r. was employed. The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-100 scale). Constipation, urinating problems, fatigue, pain and loss of sexual functioning were the dominant symptoms. The treatment costs per patient treated were 8,895 Pounds (orchiectomy) and 10,937 Pounds (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rate (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion. Orchiectomy is the treatment of choice when life expectancy is more than two years.

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.

Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

PubMed

Bertoldi, Eduardo G; Stella, Steffen F; Rohde, Luis Eduardo P; Polanczyk, Carisi A

2017-05-04

The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation's public healthcare system. Hypothetical cohort of patients with pretest probability of CAD between 20% and 70%. The primary outcome is cost per correct diagnosis of CAD. Proportion of false-positive or false-negative tests and number of unnecessary tests performed were also evaluated. Strategies using Ex-ECG as initial test were the least costly alternatives but generated more frequent false-positive initial tests and false-negative final diagnosis. Strategies based on CTA or ECHO as initial test were the most attractive and resulted in similar cost-effectiveness ratios (I$ 286 and I$ 305 per correct diagnosis, respectively). A strategy based on C-MRI was highly effective for diagnosing stable CAD, but its high cost resulted in unfavourable incremental cost-effectiveness (ICER) in moderate-risk and high-risk scenarios. Non-invasive strategies based on SPECT have been dominated. An anatomical diagnostic strategy based on CTA is a cost-effective option for CAD diagnosis. Functional strategies performed equally well when based on ECHO. C-MRI yielded acceptable ICER only at low pretest probability, and SPECT was not cost-effective in our analysis. © 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.

Cost-effectiveness of intensive psychiatric community care for high users of inpatient services.

PubMed

Rosenheck, R A; Neale, M S

1998-05-01

This 2-year experimental study evaluated the effectiveness and cost of 10 intensive psychiatric community care (IPCC) programs at Department of Veterans Affairs medical centers in the northeastern United States. High users of inpatient services were randomly assigned to either IPCC or standard Department of Veterans Affairs care at 6 general medical and surgical hospitals (n=271 vs 257) and 4 neuropsychiatric hospitals (n=183 vs 162). Patient interviews every 6 months and national computerized data were used to assess clinical outcomes, health service use, health care costs, and non-health care costs. There was only 1 significant clinical difference between groups across follow-up periods: IPCC patients at general medical and surgical sites had higher community living skills. However, at the final interview, IPCC patients at general medical and surgical sites showed significantly lower symptoms, higher functioning, and greater satisfaction with services. Treatment with IPCC significantly reduced hospital use only at neuropsychiatric sites (320 vs 513 days, P<.001). Total societal costs, including the cost of IPCC, were lower for IPCC at neuropsychiatric sites ($82,454 vs $116,651, P<.001), but greater at general medical and surgical sites ($51,537 vs $46,491, P<.01). When 2 sites that incompletely implemented the model were dropped from the analysis, costs at general medical and surgical sites were $38 lower for IPCC (P=.26). At acute care hospitals, IPCC treatment is associated with greater long-term clinical improvement and, when fully implemented, is cost-neutral. At long-stay hospitals treating older, less-functional patients, it is not associated with clinical or functional improvement but generates substantial cost savings. Intensive psychiatric community care thus has beneficial, but somewhat different, outcome profiles at different types of hospitals.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Technical Reports Server (NTRS)

Brown, K. W.

1992-01-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Astrophysics Data System (ADS)

Brown, K. W.

1992-10-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

An accurate cost effective DFT approach to study the sensing behaviour of polypyrrole towards nitrate ions in gas and aqueous phases.

PubMed

Wasim, Fatima; Mahmood, Tariq; Ayub, Khurshid

2016-07-28

Density functional theory (DFT) calculations have been performed to study the response of polypyrrole towards nitrate ions in gas and aqueous phases. First, an accurate estimate of interaction energies is obtained by methods calibrated against the gold standard CCSD(T) method. Then, a number of low cost DFT methods are also evaluated for their ability to accurately estimate the binding energies of polymer-nitrate complexes. The low cost methods evaluated here include dispersion corrected potential (DCP), Grimme's D3 correction, counterpoise correction of the B3LYP method, and Minnesota functionals (M05-2X). The interaction energies calculated using the counterpoise (CP) correction and DCP methods at the B3LYP level are in better agreement with the interaction energies calculated using the calibrated methods. The interaction energies of an infinite polymer (polypyrrole) with nitrate ions are calculated by a variety of low cost methods in order to find the associated errors. The electronic and spectroscopic properties of polypyrrole oligomers nPy (where n = 1-9) and nPy-NO3(-) complexes are calculated, and then extrapolated for an infinite polymer through a second degree polynomial fit. Charge analysis, frontier molecular orbital (FMO) analysis and density of state studies also reveal the sensing ability of polypyrrole towards nitrate ions. Interaction energies, charge analysis and density of states analyses illustrate that the response of polypyrrole towards nitrate ions is considerably reduced in the aqueous medium (compared to the gas phase).

Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial.

PubMed

Redeker, Nancy S; Knies, Andrea K; Hollenbeak, Christopher; Klar Yaggi, H; Cline, John; Andrews, Laura; Jacoby, Daniel; Sullivan, Anna; O'Connell, Meghan; Iennaco, Joanne; Finoia, Lisa; Jeon, Sangchoon

2017-04-01

Chronic insomnia is associated with disabling symptoms and decrements in functional performance. It may contribute to the development of heart failure (HF) and incident mortality. In our previous work, cognitive-behavioral therapy for insomnia (CBT-I), compared to HF self-management education, provided as an attention control condition, was feasible, acceptable, and had large effects on insomnia and fatigue among HF patients. The purpose of this randomized controlled trial (RCT) is to evaluate the sustained effects of group CBT-I compared with HF self-management education (attention control) on insomnia severity, sleep characteristics, daytime symptoms, symptom clusters, functional performance, and health care utilization among patients with stable HF. We will estimate the cost-effectiveness of CBT-I and explore the effects of CBT-I on event-free survival (EFS). Two hundred participants will be randomized in clusters to a single center parallel group (CBT-I vs. attention control) RCT. Wrist actigraphy and self-report will elicit insomnia, sleep characteristics, symptoms, and functional performance. We will use the psychomotor vigilance test to evaluate sleep loss effects and the Six Minute Walk Test to evaluate effects on daytime function. Medical record review and interviews will elicit health care utilization and EFS. Statistical methods will include general linear mixed models and latent transition analysis. Stochastic cost-effectiveness analysis with a competing risk approach will be employed to conduct the cost-effectiveness analysis. The results will be generalizable to HF patients with chronic comorbid insomnia and pave the way for future research focused on the dissemination and translation of CBT-I into HF settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimal design of solidification processes

NASA Technical Reports Server (NTRS)

Dantzig, Jonathan A.; Tortorelli, Daniel A.

1991-01-01

An optimal design algorithm is presented for the analysis of general solidification processes, and is demonstrated for the growth of GaAs crystals in a Bridgman furnace. The system is optimal in the sense that the prespecified temperature distribution in the solidifying materials is obtained to maximize product quality. The optimization uses traditional numerical programming techniques which require the evaluation of cost and constraint functions and their sensitivities. The finite element method is incorporated to analyze the crystal solidification problem, evaluate the cost and constraint functions, and compute the sensitivities. These techniques are demonstrated in the crystal growth application by determining an optimal furnace wall temperature distribution to obtain the desired temperature profile in the crystal, and hence to maximize the crystal's quality. Several numerical optimization algorithms are studied to determine the proper convergence criteria, effective 1-D search strategies, appropriate forms of the cost and constraint functions, etc. In particular, we incorporate the conjugate gradient and quasi-Newton methods for unconstrained problems. The efficiency and effectiveness of each algorithm is presented in the example problem.

Data on cost analysis of drilling mud displacement during drilling operation.

PubMed

Okoro, Emeka Emmanuel; Dosunmu, Adewale; Iyuke, Sunny E

2018-08-01

The focus of this research was to present a data article for analyzing the cost of displacing a drilling fluid during the drilling operation. The cost of conventional Spud, KCl and Pseudo Oil base (POBM) muds used in drilling oil and gas wells are compared with that of a Reversible Invert Emulsion Mud. The cost analysis is limited to three sections for optimum and effective Comparison. To optimize drilling operations, it is important that we specify the yardstick by which drilling performance is measured. The most relevant yardstick is the cost per foot drilled. The data have shown that the prices for drilling mud systems are a function of the mud system formulation cost for that particular mud weight and maintenance per day. These costs for different mud systems and depend on the base fluid. The Reversible invert emulsion drilling fluid, eliminates the cost acquired in displacing Pseudo Oil Based mud (POBM) from the well, possible formation damage (permeability impairment) resulting from the use of viscous pill in displacing the POBM from the wellbore, and also eliminates the risk of taking a kick during mud change-over. With this reversible mud system, the costs of special fluids that are rarely applied for the well-completion purpose (cleaning of thick mud filter cake) may be reduced to the barest minimum.

Demonstration Advanced Avionics System (DAAS). Phase 1 report

NASA Technical Reports Server (NTRS)

1981-01-01

An integrated avionics system which provides expanded functional capabilities that significantly enhance the utility and safety of general aviation at a cost commensurate with the general aviation market is discussed. Displays and control were designed so that the pilot can use the system after minimum training. Functional and hardware descriptions, operational evaluation and failure modes effects analysis are included.

Technology Candidates for Air-to-Air and Air-to-Ground Data Exchange

NASA Technical Reports Server (NTRS)

Haynes, Brian D.

2015-01-01

Technology Candidates for Air-to-Air and Air-to-Ground Data Exchange is a two-year research effort to visualize the U. S. aviation industry at a point 50 years in the future, and to define potential communication solutions to meet those future data exchange needs. The research team, led by XCELAR, was tasked with identifying future National Airspace System (NAS) scenarios, determining requirements and functions (including gaps), investigating technical and business issues for air, ground, & air-to-ground interactions, and reporting on the results. The project was conducted under technical direction from NASA and in collaboration with XCELAR's partner, National Institute of Aerospace, and NASA technical representatives. Parallel efforts were initiated to define the information exchange functional needs of the future NAS, and specific communication link technologies to potentially serve those needs. Those efforts converged with the mapping of each identified future NAS function to potential enabling communication solutions; those solutions were then compared with, and ranked relative to, each other on a technical basis in a structured analysis process. The technical solutions emerging from that process were then assessed from a business case perspective to determine their viability from a real-world adoption and deployment standpoint. The results of that analysis produced a proposed set of future solutions and most promising candidate technologies. Gap analyses were conducted at two points in the process, the first examining technical factors, and the second as part of the business case analysis. In each case, no gaps or unmet needs were identified in applying the solutions evaluated to the requirements identified. The future communication solutions identified in the research comprise both specific link technologies and two enabling technologies that apply to most or all specific links. As a result, the research resulted in a new analysis approach, viewing the underlying architecture of ground-air and air-air communications as a whole, rather than as simple "link to function" paired solutions. For the business case analysis, a number of "reference architectures" were developed for both the future technologies and the current systems, based on three typical configurations of current aircraft. Current and future costs were assigned, and various comparisons made between the current and future architectures. In general, it was assumed that if a future architecture offers lower cost than the current typical architecture, while delivering equivalent or better performance, it is likely that the future solution will gain industry acceptance. Conversely, future architectures presenting higher costs than their current counterparts must present a compelling benefit case in other areas or risk a lack of industry acceptance. The business case analysis consistently indicated lower costs for the proposed future architectures, and in most cases, significantly so. The proposed future solutions were found to offer significantly greater functionality, flexibility, and growth potential over time, at lower cost, than current systems. This was true for overall, fleet-wide equipage for domestic and oceanic air carriers, as well as for single, General Aviation (GA) aircraft. The overall research results indicate that all identified requirements can be met by the proposed solutions with significant capacity for future growth. Results also illustrate that the majority of the future communication needs can be met using currently allocated aviation RF spectrum, if used in more effective ways than it is today. A combination of such optimized aviation-specific links and commercial communication systems meets all identified needs for the 50-year future and beyond, with the caveat that a new, overall function will be needed to manage all information exchange, individual links, security, cost, and other factors. This function was labeled "Delivery Manager" (DM) within this research. DM employs a distributed client/server architecture, for both airborne and ground communications architectures. Final research results included identifying the most promising candidate technologies for the future system, conclusions and recommendations, and identifying areas where further research should be considered.

Solid rocket motor cost model

NASA Technical Reports Server (NTRS)

Harney, A. G.; Raphael, L.; Warren, S.; Yakura, J. K.

1972-01-01

A systematic and standardized procedure for estimating life cycle costs of solid rocket motor booster configurations. The model consists of clearly defined cost categories and appropriate cost equations in which cost is related to program and hardware parameters. Cost estimating relationships are generally based on analogous experience. In this model the experience drawn on is from estimates prepared by the study contractors. Contractors' estimates are derived by means of engineering estimates for some predetermined level of detail of the SRM hardware and program functions of the system life cycle. This method is frequently referred to as bottom-up. A parametric cost analysis is a useful technique when rapid estimates are required. This is particularly true during the planning stages of a system when hardware designs and program definition are conceptual and constantly changing as the selection process, which includes cost comparisons or trade-offs, is performed. The use of cost estimating relationships also facilitates the performance of cost sensitivity studies in which relative and comparable cost comparisons are significant.

Cost analysis of conventional facial reconstruction procedures followed by face transplantation.

PubMed

Siemionow, M; Gatherwright, J; Djohan, R; Papay, F

2011-02-01

For the first time, this study analyzes the cost of multiple conventional reconstructions and face transplantation in a single patient. This patient is a 46-year-old female victim of a shotgun blast resulting in loss of multiple functional and aesthetic subunits. For over 5 years, she underwent multiple conventional reconstructions with suboptimal results. In December 2008, she became the recipient of the first U.S. face transplant. This has provided the unique opportunity to present the cost of 23 separate conventional reconstructive procedures and the first face transplant in the United States. The combined cost of conventional reconstructive procedures and the first U.S. face transplant was calculated to be $353 480 and $349 959, respectively. The combined cost posttransplant totaled $115 463. The direct cost pretransplant was $206 646, $232 893 peritransplant and $74 236 posttransplant. The two largest areas of cost utilization were surgical ($79 625; 38.5%) and nursing ($55 860; 27%), followed by anesthesia ($24 808; 12%) and pharmacy ($16 581; 8%). This study demonstrates that the cost of the first U.S. face transplant is similar to multiple conventional reconstructions. Although the cost of facial transplantation is considerable, the alleviation of psychological and physiological suffering, exceptional functional recovery and fulfillment of long-lasting hope for social reintegration may be priceless. ©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Flow assignment model for quantitative analysis of diverting bulk freight from road to railway

PubMed Central

Liu, Chang; Wang, Jiaxi; Xiao, Jie; Liu, Siqi; Wu, Jianping; Li, Jian

2017-01-01

Since railway transport possesses the advantage of high volume and low carbon emissions, diverting some freight from road to railway will help reduce the negative environmental impacts associated with transport. This paper develops a flow assignment model for quantitative analysis of diverting truck freight to railway. First, a general network which considers road transportation, railway transportation, handling and transferring is established according to all the steps in the whole transportation process. Then general functions which embody the factors which the shippers will pay attention to when choosing mode and path are formulated. The general functions contain the congestion cost on road, the capacity constraints of railways and freight stations. Based on the general network and general cost function, a user equilibrium flow assignment model is developed to simulate the flow distribution on the general network under the condition that all shippers choose transportation mode and path independently. Since the model is nonlinear and challenging, we adopt a method that uses tangent lines to constitute envelope curve to linearize it. Finally, a numerical example is presented to test the model and show the method of making quantitative analysis of bulk freight modal shift between road and railway. PMID:28771536

Development of Regional Supply Functions and a Least-Cost Model for Allocating Water Resources in Utah: A Parametric Linear Programming Approach.

DTIC Science & Technology

SYSTEMS ANALYSIS, * WATER SUPPLIES, MATHEMATICAL MODELS, OPTIMIZATION, ECONOMICS, LINEAR PROGRAMMING, HYDROLOGY, REGIONS, ALLOCATIONS, RESTRAINT, RIVERS, EVAPORATION, LAKES, UTAH, SALVAGE, MINES(EXCAVATIONS).

Reliability, Risk and Cost Trade-Offs for Composite Designs

NASA Technical Reports Server (NTRS)

Shiao, Michael C.; Singhal, Surendra N.; Chamis, Christos C.

1996-01-01

Risk and cost trade-offs have been simulated using a probabilistic method. The probabilistic method accounts for all naturally-occurring uncertainties including those in constituent material properties, fabrication variables, structure geometry and loading conditions. The probability density function of first buckling load for a set of uncertain variables is computed. The probabilistic sensitivity factors of uncertain variables to the first buckling load is calculated. The reliability-based cost for a composite fuselage panel is defined and minimized with respect to requisite design parameters. The optimization is achieved by solving a system of nonlinear algebraic equations whose coefficients are functions of probabilistic sensitivity factors. With optimum design parameters such as the mean and coefficient of variation (representing range of scatter) of uncertain variables, the most efficient and economical manufacturing procedure can be selected. In this paper, optimum values of the requisite design parameters for a predetermined cost due to failure occurrence are computationally determined. The results for the fuselage panel analysis show that the higher the cost due to failure occurrence, the smaller the optimum coefficient of variation of fiber modulus (design parameter) in longitudinal direction.

Accounting for the economic risk caused by variation in disease severity in fungicide dose decisions, exemplified for Mycosphaerella graminicola on winter wheat.

PubMed

Te Beest, D E; Paveley, N D; Shaw, M W; van den Bosch, F

2013-07-01

A method is presented to calculate economic optimum fungicide doses accounting for the risk aversion of growers responding to variability in disease severity between crops. Simple dose-response and disease-yield loss functions are used to estimate net disease-related costs (fungicide cost plus disease-induced yield loss) as a function of dose and untreated severity. With fairly general assumptions about the shapes of the probability distribution of disease severity and the other functions involved, we show that a choice of fungicide dose which minimizes net costs, on average, across seasons results in occasional large net costs caused by inadequate control in high disease seasons. This may be unacceptable to a grower with limited capital. A risk-averse grower can choose to reduce the size and frequency of such losses by applying a higher dose as insurance. For example, a grower may decide to accept "high-loss" years 1 year in 10 or 1 year in 20 (i.e., specifying a proportion of years in which disease severity and net costs will be above a specified level). Our analysis shows that taking into account disease severity variation and risk aversion will usually increase the dose applied by an economically rational grower. The analysis is illustrated with data on Septoria tritici leaf blotch of wheat caused by Mycosphaerella graminicola. Observations from untreated field plots at sites across England over 3 years were used to estimate the probability distribution of disease severities at mid-grain filling. In the absence of a fully reliable disease forecasting scheme, reducing the frequency of high-loss years requires substantially higher doses to be applied to all crops. Disease-resistant cultivars reduce both the optimal dose at all levels of risk and the disease-related costs at all doses.

Alternative communication network designs for an operational Plato 4 CAI system

NASA Technical Reports Server (NTRS)

Mobley, R. E., Jr.; Eastwood, L. F., Jr.

1975-01-01

The cost of alternative communications networks for the dissemination of PLATO IV computer-aided instruction (CAI) was studied. Four communication techniques are compared: leased telephone lines, satellite communication, UHF TV, and low-power microwave radio. For each network design, costs per student contact hour are computed. These costs are derived as functions of student population density, a parameter which can be calculated from census data for one potential market for CAI, the public primary and secondary schools. Calculating costs in this way allows one to determine which of the four communications alternatives can serve this market least expensively for any given area in the U.S. The analysis indicates that radio distribution techniques are cost optimum over a wide range of conditions.

The clinical and cost-benefits of investing in neurobehavioural rehabilitation: a multi-centre study.

PubMed

Oddy, Michael; da Silva Ramos, Sara

2013-01-01

The aim of this study was to investigate the cost-benefits of a residential post-acute neurobehavioural rehabilitation programme and its effects on care needs and social participation of adults with acquired brain injury. Retrospective multi-centre design. Data on occupation, adaptability and level of support required were collected at admission, discharge and 6-months follow-up. Cost analysis was performed on cost estimates based on level of support. Significant gains were observed in all areas of functioning, with individuals progressing towards higher levels of independence and more participation in society upon discharge. Cost-benefits of up to £1.13 million were demonstrated for individuals admitted to rehabilitation within a year of sustaining a brain injury and of up to £0.86 million for those admitted more than 1 year after injury. Functional gains and reductions in levels of care required upon discharge were maintained 6 months later. These results demonstrate that post-acute neurobehavioural rehabilitation can have a positive impact on the lives of individuals with brain injury and that the associated costs are off-set by significant savings in the longer-term.

The clinical and cost-benefits of investing in neurobehavioural rehabilitation: A multi-centre study

PubMed Central

Oddy, Michael

2013-01-01

Primary objective The aim of this study was to investigate the cost-benefits of a residential post-acute neurobehavioural rehabilitation programme and its effects on care needs and social participation of adults with acquired brain injury. Research design Retrospective multi-centre design. Methods and procedures Data on occupation, adaptability and level of support required were collected at admission, discharge and 6-months follow-up. Cost analysis was performed on cost estimates based on level of support. Main outcomes and results Significant gains were observed in all areas of functioning, with individuals progressing towards higher levels of independence and more participation in society upon discharge. Conclusions Cost-benefits of up to £1.13 million were demonstrated for individuals admitted to rehabilitation within a year of sustaining a brain injury and of up to £0.86 million for those admitted more than 1 year after injury. Functional gains and reductions in levels of care required upon discharge were maintained 6 months later. These results demonstrate that post-acute neurobehavioural rehabilitation can have a positive impact on the lives of individuals with brain injury and that the associated costs are off-set by significant savings in the longer-term. PMID:24087973

[GIS and scenario analysis aid to water pollution control planning of river basin].

PubMed

Wang, Shao-ping; Cheng, Sheng-tong; Jia, Hai-feng; Ou, Zhi-dan; Tan, Bin

2004-07-01

The forward and backward algorithms for watershed water pollution control planning were summarized in this paper as well as their advantages and shortages. The spatial databases of water environmental function region, pollution sources, monitoring sections and sewer outlets were built with ARCGIS8.1 as the platform in the case study of Ganjiang valley, Jiangxi province. Based on the principles of the forward algorithm, four scenarios were designed for the watershed pollution control. Under these scenarios, ten sets of planning schemes were generated to implement cascade pollution source control. The investment costs of sewage treatment for these schemes were estimated by means of a series of cost-effective functions; with pollution source prediction, the water quality was modeled with CSTR model for each planning scheme. The modeled results of different planning schemes were visualized through GIS to aid decision-making. With the results of investment cost and water quality attainment as decision-making accords and based on the analysis of the economic endurable capacity for water pollution control in Ganjiang river basin, two optimized schemes were proposed. The research shows that GIS technology and scenario analysis can provide a good guidance to the synthesis, integrity and sustainability aspects for river basin water quality planning.

Are larger dental practices more efficient? An analysis of dental services production.

PubMed Central

Lipscomb, J; Douglass, C W

1986-01-01

Whether cost-efficiency in dental services production increases with firm size is investigated through application of an activity analysis production function methodology to data from a national survey of dental practices. Under this approach, service delivery in a dental practice is modeled as a linear programming problem that acknowledges distinct input-output relationships for each service. These service-specific relationships are then combined to yield projections of overall dental practice productivity, subject to technical and organizational constraints. The activity analysis reported here represents arguably the most detailed evaluation yet of the relationship between dental practice size and cost-efficiency, controlling for such confounding factors as fee and service-mix differences across firms. We conclude that cost-efficiency does increase with practice size, over the range from solo to four-dentist practices. Largely because of data limitations, we were unable to test satisfactorily for scale economies in practices with five or more dentists. Within their limits, our findings are generally consistent with results from the neoclassical production function literature. From the standpoint of consumer welfare, the critical question raised (but not resolved) here is whether these apparent production efficiencies of group practice are ultimately translated by the market into lower fees, shorter queues, or other nonprice benefits. PMID:3102404

Excess costs from functional somatic syndromes in Germany - An analysis using entropy balancing.

PubMed

Grupp, Helen; Kaufmann, Claudia; König, Hans-Helmut; Bleibler, Florian; Wild, Beate; Szecsenyi, Joachim; Herzog, Wolfgang; Schellberg, Dieter; Schäfert, Rainer; Konnopka, Alexander

2017-06-01

The aim of this study was to calculate disorder-specific excess costs in patients with functional somatic syndromes (FSS). We compared 6-month direct and indirect costs in a patient group with FSS (n=273) to a control group of the general adult population in Germany without FSS (n=2914). Data on the patient group were collected between 2007 and 2009 in a randomized controlled trial (speciAL). Data on the control group were obtained from a telephone survey, representative for the general German population, conducted in 2014. Covariate balance between the patient group and the control group was achieved using entropy balancing. Excess costs were calculated by estimating generalized linear models and two-part models for direct costs and indirect costs. Further, we estimated excess costs according to the level of somatic symptom severity (SSS). FSS patients differed significantly from the control group regarding 6-month costs of outpatient physicians (+€280) and other outpatient providers (+€74). According to SSS, significantly higher outpatient physician costs were found for mild (+€151), moderate (+€306) and severe (+€376) SSS. We also found significantly higher costs of other outpatient providers in patients with mild, moderate and severe SSS. Regarding costs of rehabilitation and hospital treatments, FSS patients did not differ significantly from the control group for any level of SSS. Indirect costs were significantly higher in patients with severe SSS (+€760). FSS were of major importance in the outpatient sector. Further, we found significantly higher indirect costs in patients with severe SSS. Copyright © 2017 Elsevier Inc. All rights reserved.

The cost and analysis of nonuse of cochlear implants.

PubMed

Raine, Christopher H; Summerfield, Quentin; Strachan, David R; Martin, Jane M; Totten, Catherine

2008-02-01

Analysis of the cost implications and reasons for nonuse of cochlear implants in an established cochlear implant unit. Clinical data were analyzed retrospectively to construct a table of cochlear implant use over time to identify nonuse and to suggest the reasons for this. Yorkshire Cochlear Implant Service is a tertiary referral center. Three hundred forty consecutively implanted patients from 1990 to 2005. Life table analysis showed that most children used their implant (p = 0.7 during 11 yr). However, 11 of 155 children and 2 of 185 adults became nonusers during the period of study. The 11 children stopped because of age at implant, educational placement, and family support. Two adults stopped because of psychological issues and inability to adapt to the signal. Surgical and implant costs have initial impact, with subsequent years' costs reflecting programming issues and maintenance. When considering nonuse, there are 2 effects: first, no more costs are incurred, and second, no more years of use are accumulated. Thus, nonuse reduces both costs and years. Costs of gaining a year of use as a function of time showed that there was little financial impact from the 11 children nonusers. As a ratio of "no nonuse" and observed "nonuse" in children, the ratio is 1.07 by 13 years of implantation (7%). The adult group was too few to analyze. The nonuse added 7% to the average cost. Retrospective audit identifies that patient selection by a multidisciplinary team is crucial to reducing nonuse.

[Impact of disease progression on health status, quality of life and costs in rheumatoid arthritis in Hungary].

PubMed

Péntek, Márta; Szekanecz, Zoltán; Czirják, László; Poór, Gyula; Rojkovich, Bernadette; Polgár, Anna; Genti, György; Kiss, Csaba György; Sándor, Zsuzsa; Májer, István; Brodszky, Valentin; Gulácsi, László

2008-04-20

Rheumatoid arthritis (RA) is a chronic, progressive polyarthritis leading to substantial disability. Standardised data on consequences of disease progression are needed for clinical assessments and also for cost-effectiveness models. To analyse the impact of disease progression on health status, disease specific quality of life and costs in Hungary. A cross-sectional survey was performed between April and August, 2004, involving consecutive RA patients of 6 hospital based rheumatology outpatient centres. Self-completed questionnaires were used to assess functional (HAQ) and health status (EQ-5D), quality of life (RAQoL). Disease activity (DAS) and costs were also surveyed, statistical analysis was performed. 255 patients were involved [mean age 55.5 +/- 12.3 years; disease duration 9.0 +/- 9.3 years; HAQ 1.38 +/- 0.76; EQ-5D 0.46 +/- 0.33; RAQoL 16.2 +/- 8.1; DAS 5.09 +/- 1.42; costs 1,043,163 (+/- 844,750) HUF/patient/year, conversion 1 Euro = 250 HUF]. Correlation was significant between the parameters ( p < 0.01): EQ-5D index = 1.014 - 0.25 x HAQ-0.041 x DAS; HAQ = 0.314 + 0.065 x RAQoL. Analysis by disease severity levels (HAQ groups 0.5 difference) revealed that health status worsens (mean EQ-5D: 0.784; 0.576; 0.504; 0.367; 0.211; 0.022) and costs increase (mean 628,280; 888,187; 953,759; 1,291,218; 1,346,112; 1,371,674 HUF/patient/year) with disease progression. Minimally important worsening of functional ability (0.25 HAQ increase) corresponds to -0.0705 EQ-5D and +1.884 RAQoL change. Lower health status difference (EQ-5D -0.05725) was calculated in patients with lower disease activity (DAS < 5.1). Correlation between disease progression, health status, quality of life and costs does not differ significantly from international results. The amount of costs is much lower in all disease severity levels than in developed European countries. Our study serves baseline data for health economic analysis in RA in Hungary.

The effect of recombinant activated factor VII in the treatment of intracerebral hemorrhage on health plan budgets.

PubMed

Earnshaw, Stephanie R; Wilson, Michele R; Joshi, Ashish V

2006-11-01

Treating patients with intracerebral hemorrhage (ICH) using recombinant activated factor VII (rFVIla) has been found to improve survival and functional outcome. To examine how the introduction of rFVIla 80 microg/kg as a treatment for ICH affects the budget of a health plan, a decision-analysis model was developed which considered both short-term hospitalization costs and long-term management of disability. Assuming a health plan enrollment of 1 million members and initial rFVIla uptake of 50% in appropriate patients, the annual health plan cost may be expected to increase by dollar 64,781 (dollar 0.005 per-member per-month). With a 5% increase in uptake each year, the annual health plan's cost may decrease compared with the current budget within three years. The implications for this sample health plan's budget are modest in the first year, and a reduction in costs is expected within three years owing to improved functional outcomes of patients.

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

PubMed

Fatoye, Francis; Haigh, Carol

2016-05-01

To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. Economic evaluation based on cost-utility analysis. Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle sprains. © 2016 John Wiley & Sons Ltd.

Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure.

PubMed

Reed, Shelby D; Neilson, Matthew P; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H; Polsky, Daniel E; Graham, Felicia L; Bowers, Margaret T; Paul, Sara C; Granger, Bradi B; Schulman, Kevin A; Whellan, David J; Riegel, Barbara; Levy, Wayne C

2015-11-01

Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying Seattle Heart Failure Model scores. The model can be used to evaluate parallel-group and single-cohort study designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. The Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Wixson, J. R.

Root cause analysis (RCA) is an important methodology that can be integrated with the VE Job Plan to generate superior results from the VE Methodology. The point at which RCA is most appropriate is after the function analysis and FAST Model have been built and functions for improvement have been chosen. These functions are then subjected to a simple, but, rigorous RCA to get to the root cause of their deficiencies, whether it is high cost/poor value, poor quality, or poor reliability. Once the most probable causes for these problems have been arrived at, better solutions for improvement can bemore » developed in the creativity phase because the team better understands the problems associated with these functions.« less

Clinical and cost-effectiveness of non-medical prescribing: A systematic review of randomised controlled trials

PubMed Central

Marriott, John; Graham-Clarke, Emma; Shirley, Debra; Rushton, Alison

2018-01-01

Objective To evaluate the clinical and cost-effectiveness of non-medical prescribing (NMP). Design Systematic review. Two reviewers independently completed searches, eligibility assessment and assessment of risk of bias. Data sources Pre-defined search terms/combinations were utilised to search electronic databases. In addition, hand searches of reference lists, key journals and grey literature were employed alongside consultation with authors/experts. Eligibility criteria for included studies Randomised controlled trials (RCTs) evaluating clinical or cost-effectiveness of NMP. Measurements reported on one or more outcome(s) of: pain, function, disability, health, social impact, patient-safety, costs-analysis, quality adjusted life years (QALYs), patient satisfaction, clinician perception of clinical and functional outcomes. Results Three RCTs from two countries were included (n = 932 participants) across primary and tertiary care settings. One RCT was assessed as low risk of bias, one as high risk of bias and one as unclear risk of bias. All RCTs evaluated clinical effectiveness with one also evaluating cost-effectiveness. Clinical effectiveness was evaluated using a range of safety and patient-reported outcome measures. Participants demonstrated significant improvement in outcomes when receiving NMP compared to treatment as usual (TAU) in all RCTs. An associated cost analysis showed NMP to be more expensive than TAU (regression coefficient p = 0.0000), however experimental groups generated increased QALYs compared to TAU. Conclusion Limited evidence with overall unclear risk of bias exists evaluating clinical and cost-effectiveness of NMP across all professions and clinical settings. GRADE assessment revealed moderate quality evidence. Evidence suggests that NMP is safe and can provide beneficial clinical outcomes. Benefits to the health economy remain unclear, with the cost-effectiveness of NMP assessed by a single pilot RCT of low risk of bias. Adequately powered low risk of bias RCTs evaluating clinical and cost effectiveness are required to evaluate NMP across clinical specialities, professions and settings. Registration PROSPERO (CRD42015017212). PMID:29509763

Cost function approach for estimating derived demand for composite wood products

Treesearch

T. C. Marcin

1991-01-01

A cost function approach was examined for using the concept of duality between production and input factor demands. A translog cost function was used to represent residential construction costs and derived conditional factor demand equations. Alternative models were derived from the translog cost function by imposing parameter restrictions.

The costs of heparin-induced thrombocytopenia: a patient-based cost of illness analysis.

PubMed

Wilke, T; Tesch, S; Scholz, A; Kohlmann, T; Greinacher, A

2009-05-01

SUMMARY BACKGROUND AND OBJECTIVES: Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. Patients diagnosed with HIT (1995-2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. One hundred and thirty HIT cases with a 4T-score >or=4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 euro. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies.

Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals.

PubMed

Bryan, Stirling; Williams, Iestyn; McIver, Shirley

2007-02-01

Resource scarcity is the raison d'être for the discipline of economics. Thus, the primary purpose of economic analysis is to help decision-makers when addressing problems arising due to the scarcity problem. The research reported here was concerned with how cost-effectiveness information is used by the National Institute for Health & Clinical Excellence (NICE) in national technology coverage decisions in the UK, and how its impact might be increased. The research followed a qualitative case study methodology with semi-structured interviews, supported by observation and analysis of secondary sources. Our research highlights that the technology appraisal function of NICE represents an important progression for the UK health economics community: new cost-effectiveness work is commissioned for each technology and that work directly informs national health policy. However, accountability in policy decisions necessitates that the information upon which decisions are based (including cost-effectiveness analysis, CEA) is accessible. This was found to be a serious problem and represents one of the main ongoing challenges. Other issues highlighted include perceived weaknesses in analysis methods and the poor alignment between the health maximisation objectives assumed in economic analyses and the range of other objectives facing decision-makers in reality. Copyright (c) 2006 John Wiley & Sons, Ltd.

Portable electronic vision enhancement systems in comparison with optical magnifiers for near vision activities: an economic evaluation alongside a randomized crossover trial.

PubMed

Bray, Nathan; Brand, Andrew; Taylor, John; Hoare, Zoe; Dickinson, Christine; Edwards, Rhiannon T

2017-08-01

To determine the incremental cost-effectiveness of portable electronic vision enhancement system (p-EVES) devices compared with optical low vision aids (LVAs), for improving near vision visual function, quality of life and well-being of people with a visual impairment. An AB/BA randomized crossover trial design was used. Eighty-two participants completed the study. Participants were current users of optical LVAs who had not tried a p-EVES device before and had a stable visual impairment. The trial intervention was the addition of a p-EVES device to the participant's existing optical LVA(s) for 2 months, and the control intervention was optical LVA use only, for 2 months. Cost-effectiveness and cost-utility analyses were conducted from a societal perspective. The mean cost of the p-EVES intervention was £448. Carer costs were £30 (4.46 hr) less for the p-EVES intervention compared with the LVA only control. The mean difference in total costs was £417. Bootstrapping gave an incremental cost-effectiveness ratio (ICER) of £736 (95% CI £481 to £1525) for a 7% improvement in near vision visual function. Cost per quality-adjusted life year (QALY) ranged from £56 991 (lower 95% CI = £19 801) to £66 490 (lower 95% CI = £23 055). Sensitivity analysis varying the commercial price of the p-EVES device reduced ICERs by up to 75%, with cost per QALYs falling below £30 000. Portable electronic vision enhancement system (p-EVES) devices are likely to be a cost-effective use of healthcare resources for improving near vision visual function, but this does not translate into cost-effective improvements in quality of life, capability or well-being. © 2016 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation and European Association for Vision & Eye Research.

Development of a funding, cost, and spending model for satellite projects

NASA Technical Reports Server (NTRS)

Johnson, Jesse P.

1989-01-01

The need for a predictive budget/funging model is obvious. The current models used by the Resource Analysis Office (RAO) are used to predict the total costs of satellite projects. An effort to extend the modeling capabilities from total budget analysis to total budget and budget outlays over time analysis was conducted. A statistical based and data driven methodology was used to derive and develop the model. Th budget data for the last 18 GSFC-sponsored satellite projects were analyzed and used to build a funding model which would describe the historical spending patterns. This raw data consisted of dollars spent in that specific year and their 1989 dollar equivalent. This data was converted to the standard format used by the RAO group and placed in a database. A simple statistical analysis was performed to calculate the gross statistics associated with project length and project cost ant the conditional statistics on project length and project cost. The modeling approach used is derived form the theory of embedded statistics which states that properly analyzed data will produce the underlying generating function. The process of funding large scale projects over extended periods of time is described by Life Cycle Cost Models (LCCM). The data was analyzed to find a model in the generic form of a LCCM. The model developed is based on a Weibull function whose parameters are found by both nonlinear optimization and nonlinear regression. In order to use this model it is necessary to transform the problem from a dollar/time space to a percentage of total budget/time space. This transformation is equivalent to moving to a probability space. By using the basic rules of probability, the validity of both the optimization and the regression steps are insured. This statistically significant model is then integrated and inverted. The resulting output represents a project schedule which relates the amount of money spent to the percentage of project completion.

Factors Influencing Laboratory Information System Effectiveness Through Strategic Planning in Shiraz Teaching Hospitals.

PubMed

Bahador, Fateme; Sharifian, Roxana; Farhadi, Payam; Jafari, Abdosaleh; Nematolahi, Mohtram; Shokrpour, Nasrin

This study aimed to develop and test a research model that examined 7effective factors on the effectiveness of laboratory information system (LIS) through strategic planning. This research was carried out on total laboratory staff, information technology staff, and laboratory managers in Shiraz (a city in the south of Iran) teaching hospitals by structural equation modeling approach in 2015. The results revealed that there was no significant positive relationship between decisions based on cost-benefit analysis and LIS functionality with LIS effectiveness, but there was a significant positive relationship between other factors and LIS effectiveness. As expected, high levels of strategic information system planning result in increasing LIS effectiveness. The results also showed that the relationship between cost-benefit analysis, LIS functionality, end-user involvement, and information technology-business alignment with strategic information system planning was significant and positive.

A method for the inclusion of physical activity-related health benefits in cost-benefit analysis of built environment initiatives.

PubMed

Zapata-Diomedi, Belen; Gunn, Lucy; Giles-Corti, Billie; Shiell, Alan; Lennert Veerman, J

2018-01-01

The built environment has a significant influence on population levels of physical activity (PA) and therefore health. However, PA-related health benefits are seldom considered in transport and urban planning (i.e. built environment interventions) cost-benefit analysis. Cost-benefit analysis implies that the benefits of any initiative are valued in monetary terms to make them commensurable with costs. This leads to the need for monetised values of the health benefits of PA. The aim of this study was to explore a method for the incorporation of monetised PA-related health benefits in cost-benefit analysis of built environment interventions. Firstly, we estimated the change in population level of PA attributable to a change in the built environment due to the intervention. Then, changes in population levels of PA were translated into monetary values. For the first step we used estimates from the literature for the association of built environment features with physical activity outcomes. For the second step we used the multi-cohort proportional multi-state life table model to predict changes in health-adjusted life years and health care costs as a function of changes in PA. Finally, we monetised health-adjusted life years using the value of a statistical life year. Future research could adapt these methods to assess the health and economic impacts of specific urban development scenarios by working in collaboration with urban planners. Copyright © 2017 Elsevier Inc. All rights reserved.

A Cost Estimation Analysis of U.S. Navy Ship Fuel-Savings Techniques and Technologies

DTIC Science & Technology

2009-09-01

readings to the boiler operator. The PLC will provide constant automatic trimming of the excess oxygen based upon real time SGA readings. An SCD...the author): The Aegis Combat System is controlled by an advanced, automatic detect-and-track, multi-function three-dimensional passive...subsequently offloaded. An Online Wash System would reduce these maintenance costs and improve fuel efficiency of these engines by keeping the engines

Department of Defense Costing References Web. Phase 1. Establishing the Foundation.

DTIC Science & Technology

1997-03-01

a functional economic analysis under one set of constraints and having to repeat the entire process for the MAISRC. Recommendations for automated...MAISRC s acquisition oversight process . The cost and cycle time for each iteration can be in the order of $300,000 and 6 months, respectively...Institute resources were expected to become available at the conclusion of another BPR project. The contents list for the first Business Process

Cost effectiveness of etanercept (Enbrel) in combination with methotrexate in the treatment of active rheumatoid arthritis based on the TEMPO trial.

PubMed

Kobelt, G; Lindgren, P; Singh, A; Klareskog, L

2005-08-01

To estimate the cost effectiveness of combination treatment with etanercept plus methotrexate in comparison with monotherapies in patients with active rheumatoid arthritis (RA) using a new model that incorporates both functional status and disease activity. Effectiveness data were based on a 2 year trial in 682 patients with active RA (TEMPO). Data on resource consumption and utility related to function and disease activity were obtained from a survey of 616 patients in Sweden. A Markov model was constructed with five states according to functional status (Health Assessment Questionnaire (HAQ)) subdivided into high and low disease activity. The cost for each quality adjusted life year (QALY) gained was estimated by Monte Carlo simulation. Disease activity had a highly significant effect on utilities, independently of HAQ. For resource consumption, only HAQ was a significant predictor, with the exception of sick leave. Compared with methotrexate alone, etanercept plus methotrexate over 2 years increased total costs by 14,221 euros and led to a QALY gain of 0.38. When treatment was continued for 10 years, incremental costs were 42,148 euros for a QALY gain of 0.91. The cost per QALY gained was 37,331 euros and 46,494 euros, respectively. The probability that the cost effectiveness ratio is below a threshold of 50,000 euros/QALY is 88%. Incorporating the influence of disease activity into this new model allows better assessment of the effects of anti-tumour necrosis factor treatment on patients' general wellbeing. In this analysis, the cost per QALY gained with combination treatment with etanercept plus methotrexate compared with methotrexate alone falls within the acceptable range.

Cost effectiveness of conventional versus LANDSAT use data for hydrologic modeling

NASA Technical Reports Server (NTRS)

George, T. S.; Taylor, R. S.

1982-01-01

Six case studies were analyzed to investigate the cost effectiveness of using land use data obtained from LANDSAT as opposed to conventionally obtained data. A procedure was developed to determine the relative effectiveness of the two alternative means of acquiring data for hydrological modelling. The cost of conventionally acquired data ranged between $3,000 and $16,000 for the six test basins. Information based on LANDSAT imagery cost between $2,000 and $5,000. Results of the effectiveness analysis shows the differences between the two methods are insignificant. From the cost comparison and the act that each method, conventional and LANDSAT, is shown to be equally effective in developing land use data for hydrologic studies, the cost effectiveness of the conventional or LANDSAT method is found to be a function of basin size for the six test watersheds analyzed. The LANDSAT approach is cost effective for areas containing more than 10 square miles.

A planning model for the short-term management of cash.

PubMed

Broyles, Robert W; Mattachione, Steven; Khaliq, Amir

2011-02-01

This paper develops a model that enables the health administrator to identify the balance that minimizes the projected cost of holding cash. Adopting the principles of mathematical expectation, the model estimates the expected total costs of adopting each of the several strategies concerning the cash balance that the organization might maintain. Expected total costs consist of anticipated short costs, resulting from a potential shortage of funds. Long costs are associated with a potential surplus of funds and an opportunity cost represented by foregone investment income. Of importance to the model is the potential for the health service organization to realize a surplus of funds during periods characterized by a net cash disbursement. The paper also develops an interactive spreadsheet that enables the administrator to perform sensitivity analysis and examine the response of the desired or target cash balance to changes in the parameters that define the expected long and short cost functions.

How to Compare the Security Quality Requirements Engineering (SQUARE) Method with Other Methods

DTIC Science & Technology

2007-08-01

Attack Trees for Modeling and Analysis 10 2.8 Misuse and Abuse Cases 10 2.9 Formal Methods 11 2.9.1 Software Cost Reduction 12 2.9.2 Common...modern or efficient techniques. • Requirements analysis typically is either not performed at all (identified requirements are directly specified without...any analysis or modeling) or analysis is restricted to functional re- quirements and ignores quality requirements, other nonfunctional requirements

HSI top-down requirements analysis for ship manpower reduction

NASA Astrophysics Data System (ADS)

Malone, Thomas B.; Bost, J. R.

2000-11-01

U.S. Navy ship acquisition programs such as DD 21 and CVNX are increasingly relying on top down requirements analysis (TDRA) to define and assess design approaches for workload and manpower reduction, and for ensuring required levels of human performance, reliability, safety, and quality of life at sea. The human systems integration (HSI) approach to TDRA begins with a function analysis which identifies the functions derived from the requirements in the Operational Requirements Document (ORD). The function analysis serves as the function baseline for the ship, and also supports the definition of RDT&E and Total Ownership Cost requirements. A mission analysis is then conducted to identify mission scenarios, again based on requirements in the ORD, and the Design Reference Mission (DRM). This is followed by a mission/function analysis which establishes the function requirements to successfully perform the ship's missions. Function requirements of major importance for HSI are information, performance, decision, and support requirements associated with each function. An allocation of functions defines the roles of humans and automation in performing the functions associated with a mission. Alternate design concepts, based on function allocation strategies, are then described, and task networks associated with the concepts are developed. Task network simulations are conducted to assess workloads and human performance capabilities associated with alternate concepts. An assessment of the affordability and risk associated with alternate concepts is performed, and manning estimates are developed for feasible design concepts.

On a cost functional for H2/H(infinity) minimization

NASA Technical Reports Server (NTRS)

Macmartin, Douglas G.; Hall, Steven R.; Mustafa, Denis

1990-01-01

A cost functional is proposed and investigated which is motivated by minimizing the energy in a structure using only collocated feedback. Defined for an H(infinity)-norm bounded system, this cost functional also overbounds the H2 cost. Some properties of this cost functional are given, and preliminary results on the procedure for minimizing it are presented. The frequency domain cost functional is shown to have a time domain representation in terms of a Stackelberg non-zero sum differential game.

Optimization of conventional water treatment plant using dynamic programming.

PubMed

Mostafa, Khezri Seyed; Bahareh, Ghafari; Elahe, Dadvar; Pegah, Dadras

2015-12-01

In this research, the mathematical models, indicating the capability of various units, such as rapid mixing, coagulation and flocculation, sedimentation, and the rapid sand filtration are used. Moreover, cost functions were used for the formulation of conventional water and wastewater treatment plant by applying Clark's formula (Clark, 1982). Also, by applying dynamic programming algorithm, it is easy to design a conventional treatment system with minimal cost. The application of the model for a case reduced the annual cost. This reduction was approximately in the range of 4.5-9.5% considering variable limitations. Sensitivity analysis and prediction of system's feedbacks were performed for different alterations in proportion from parameters optimized amounts. The results indicated (1) that the objective function is more sensitive to design flow rate (Q), (2) the variations in the alum dosage (A), and (3) the sand filter head loss (H). Increasing the inflow by 20%, the total annual cost would increase to about 12.6%, while 20% reduction in inflow leads to 15.2% decrease in the total annual cost. Similarly, 20% increase in alum dosage causes 7.1% increase in the total annual cost, while 20% decrease results in 7.9% decrease in the total annual cost. Furthermore, the pressure decrease causes 2.95 and 3.39% increase and decrease in total annual cost of treatment plants. © The Author(s) 2013.

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment

PubMed Central

Lee, Christine; Tu, Hong Anh; Weir, Mark; Holubowich, Corinne

2016-01-01

Background Retinitis pigmentosa is a group of genetic disorders that involves the breakdown and loss of photoreceptors in the retina, resulting in progressive retinal degeneration and eventual blindness. The Argus II Retinal Prosthesis System is the only currently available surgical implantable device approved by Health Canada. It has been shown to improve visual function in patients with severe visual loss from advanced retinitis pigmentosa. The objective of this analysis was to examine the clinical effectiveness, cost-effectiveness, budget impact, and safety of the Argus II system in improving visual function, as well as exploring patient experiences with the system. Methods We performed a systematic search of the literature for studies examining the effects of the Argus II retinal prosthesis system in patients with advanced retinitis pigmentosa, and appraised the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria, focusing on visual function, functional outcomes, quality of life, and adverse events. We developed a Markov decision-analytic model to assess the cost-effectiveness of the Argus II system compared with standard care over a 10-year time horizon. We also conducted a 5-year budget impact analysis. We used a qualitative design and an interview methodology to examine patients’ lived experience, and we used a modified grounded theory methodology to analyze information from interviews. Transcripts were coded, and themes were compared against one another. Results One multicentre international study and one single-centre study were included in the clinical review. In both studies, patients showed improved visual function with the Argus II system. However, the sight-threatening surgical complication rate was substantial. In the base-case analysis, the Argus II system was cost-effective compared with standard care only if willingness-to-pay was more than $207,616 per quality-adjusted life-year. The 5-year budget impact of funding the Argus II system ranged from $800,404 to $837,596. Retinitis pigmentosa significantly affects people's ability to navigate physical and virtual environments. Argus II was described as enabling the fundamental elements of sight. As such, it had a positive impact on quality of life for people with retinitis pigmentosa. Conclusions Based on evidence of moderate quality, patients with advanced retinitis pigmentosa who were implanted with the Argus II retinal prosthesis system showed significant improvement in visual function, real-life functional outcomes, and quality of life, but there were complications associated with the surgery that could be managed through standard ophthalmologic treatments. The costs for the technology are high. PMID:27468325

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment.

PubMed

2016-01-01

Retinitis pigmentosa is a group of genetic disorders that involves the breakdown and loss of photoreceptors in the retina, resulting in progressive retinal degeneration and eventual blindness. The Argus II Retinal Prosthesis System is the only currently available surgical implantable device approved by Health Canada. It has been shown to improve visual function in patients with severe visual loss from advanced retinitis pigmentosa. The objective of this analysis was to examine the clinical effectiveness, cost-effectiveness, budget impact, and safety of the Argus II system in improving visual function, as well as exploring patient experiences with the system. We performed a systematic search of the literature for studies examining the effects of the Argus II retinal prosthesis system in patients with advanced retinitis pigmentosa, and appraised the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria, focusing on visual function, functional outcomes, quality of life, and adverse events. We developed a Markov decision-analytic model to assess the cost-effectiveness of the Argus II system compared with standard care over a 10-year time horizon. We also conducted a 5-year budget impact analysis. We used a qualitative design and an interview methodology to examine patients' lived experience, and we used a modified grounded theory methodology to analyze information from interviews. Transcripts were coded, and themes were compared against one another. One multicentre international study and one single-centre study were included in the clinical review. In both studies, patients showed improved visual function with the Argus II system. However, the sight-threatening surgical complication rate was substantial. In the base-case analysis, the Argus II system was cost-effective compared with standard care only if willingness-to-pay was more than $207,616 per quality-adjusted life-year. The 5-year budget impact of funding the Argus II system ranged from $800,404 to $837,596. Retinitis pigmentosa significantly affects people's ability to navigate physical and virtual environments. Argus II was described as enabling the fundamental elements of sight. As such, it had a positive impact on quality of life for people with retinitis pigmentosa. Based on evidence of moderate quality, patients with advanced retinitis pigmentosa who were implanted with the Argus II retinal prosthesis system showed significant improvement in visual function, real-life functional outcomes, and quality of life, but there were complications associated with the surgery that could be managed through standard ophthalmologic treatments. The costs for the technology are high.

Wavelength routing beyond the standard graph coloring approach

NASA Astrophysics Data System (ADS)

Blankenhorn, Thomas

2004-04-01

When lightpaths are routed in the planning stage of transparent optical networks, the textbook approach is to use algorithms that try to minimize the overall number of wavelengths used in the . We demonstrate that this method cannot be expected to minimize actual costs when the marginal cost of instlling more wavelengths is a declining function of the number of wavelengths already installed, as is frequently the case. We further demonstrate how cost optimization can theoretically be improved with algorithms based on Prim"s algorithm. Finally, we test this theory with simulaion on a series of actual network topologies, which confirm the theoretical analysis.

Heavy Metal Adsorption onto Kappaphycus sp. from Aqueous Solutions: The Use of Error Functions for Validation of Isotherm and Kinetics Models

PubMed Central

Rahman, Md. Sayedur; Sathasivam, Kathiresan V.

2015-01-01

Biosorption process is a promising technology for the removal of heavy metals from industrial wastes and effluents using low-cost and effective biosorbents. In the present study, adsorption of Pb2+, Cu2+, Fe2+, and Zn2+ onto dried biomass of red seaweed Kappaphycus sp. was investigated as a function of pH, contact time, initial metal ion concentration, and temperature. The experimental data were evaluated by four isotherm models (Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich) and four kinetic models (pseudo-first-order, pseudo-second-order, Elovich, and intraparticle diffusion models). The adsorption process was feasible, spontaneous, and endothermic in nature. Functional groups in the biomass involved in metal adsorption process were revealed as carboxylic and sulfonic acids and sulfonate by Fourier transform infrared analysis. A total of nine error functions were applied to validate the models. We strongly suggest the analysis of error functions for validating adsorption isotherm and kinetic models using linear methods. The present work shows that the red seaweed Kappaphycus sp. can be used as a potentially low-cost biosorbent for the removal of heavy metal ions from aqueous solutions. Further study is warranted to evaluate its feasibility for the removal of heavy metals from the real environment. PMID:26295032

Heavy Metal Adsorption onto Kappaphycus sp. from Aqueous Solutions: The Use of Error Functions for Validation of Isotherm and Kinetics Models.

PubMed

Rahman, Md Sayedur; Sathasivam, Kathiresan V

2015-01-01

Biosorption process is a promising technology for the removal of heavy metals from industrial wastes and effluents using low-cost and effective biosorbents. In the present study, adsorption of Pb(2+), Cu(2+), Fe(2+), and Zn(2+) onto dried biomass of red seaweed Kappaphycus sp. was investigated as a function of pH, contact time, initial metal ion concentration, and temperature. The experimental data were evaluated by four isotherm models (Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich) and four kinetic models (pseudo-first-order, pseudo-second-order, Elovich, and intraparticle diffusion models). The adsorption process was feasible, spontaneous, and endothermic in nature. Functional groups in the biomass involved in metal adsorption process were revealed as carboxylic and sulfonic acids and sulfonate by Fourier transform infrared analysis. A total of nine error functions were applied to validate the models. We strongly suggest the analysis of error functions for validating adsorption isotherm and kinetic models using linear methods. The present work shows that the red seaweed Kappaphycus sp. can be used as a potentially low-cost biosorbent for the removal of heavy metal ions from aqueous solutions. Further study is warranted to evaluate its feasibility for the removal of heavy metals from the real environment.

Optimization of structures on the basis of fracture mechanics and reliability criteria

NASA Technical Reports Server (NTRS)

Heer, E.; Yang, J. N.

1973-01-01

Systematic summary of factors which are involved in optimization of given structural configuration is part of report resulting from study of analysis of objective function. Predicted reliability of performance of finished structure is sharply dependent upon results of coupon tests. Optimization analysis developed by study also involves expected cost of proof testing.

Digital Avionics Information System (DAIS): Training Requirements Analysis Model Users Guide. Final Report.

ERIC Educational Resources Information Center

Czuchry, Andrew J.; And Others

This user's guide describes the functions, logical operations and subroutines, input data requirements, and available outputs of the Training Requirements Analysis Model (TRAMOD), a computerized analytical life cycle cost modeling system for use in the early stages of system design. Operable in a stand-alone mode, TRAMOD can be used for the…

Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2.

PubMed

Leivo, Tiina; Sarikkola, Anna-Ulrika; Uusitalo, Risto J; Hellstedt, Timo; Ess, Sirje-Linda; Kivelä, Tero

2011-06-01

To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Functional form and risk adjustment of hospital costs: Bayesian analysis of a Box-Cox random coefficients model.

PubMed

Hollenbeak, Christopher S

2005-10-15

While risk-adjusted outcomes are often used to compare the performance of hospitals and physicians, the most appropriate functional form for the risk adjustment process is not always obvious for continuous outcomes such as costs. Semi-log models are used most often to correct skewness in cost data, but there has been limited research to determine whether the log transformation is sufficient or whether another transformation is more appropriate. This study explores the most appropriate functional form for risk-adjusting the cost of coronary artery bypass graft (CABG) surgery. Data included patients undergoing CABG surgery at four hospitals in the midwest and were fit to a Box-Cox model with random coefficients (BCRC) using Markov chain Monte Carlo methods. Marginal likelihoods and Bayes factors were computed to perform model comparison of alternative model specifications. Rankings of hospital performance were created from the simulation output and the rankings produced by Bayesian estimates were compared to rankings produced by standard models fit using classical methods. Results suggest that, for these data, the most appropriate functional form is not logarithmic, but corresponds to a Box-Cox transformation of -1. Furthermore, Bayes factors overwhelmingly rejected the natural log transformation. However, the hospital ranking induced by the BCRC model was not different from the ranking produced by maximum likelihood estimates of either the linear or semi-log model. Copyright (c) 2005 John Wiley & Sons, Ltd.

Does the use of Nintendo Wii SportsTM improve arm function? Trial of WiiTM in Stroke: a randomized controlled trial and economics analysis.

PubMed

Adie, Katja; Schofield, Christine; Berrow, Margie; Wingham, Jennifer; Humfryes, John; Pritchard, Colin; James, Martin; Allison, Rhoda

2017-02-01

The Trial of Wii™ in Stroke investigated the efficacy of using the Nintendo Wii Sports™ (Wii TM ) to improve affected arm function after stroke. Multicentre, pragmatic, parallel group, randomized controlled trial. Home-based rehabilitation. A total of 240 participants aged 24-90 years with arm weakness following a stroke within the previous six months. Participants were randomly assigned to exercise daily for six weeks using the Wii TM or arm exercises at home. Primary outcome was change in the affected arm function at six weeks follow-up using the Action Research Arm Test. Secondary outcomes included occupational performance, quality of life, arm function at six months and a cost effectiveness analysis. The study was completed by 209 participants (87.1%). There was no significant difference in the primary outcome of affected arm function at six weeks follow-up (mean difference -1.7, 95% CI -3.9 to 0.5, p = 0.12) and no significant difference in secondary outcomes, including occupational performance, quality of life or arm function at six months, between the two groups. No serious adverse events related to the study treatment were reported. The cost effectiveness analysis showed that the Wii TM was more expensive than arm exercises £1106 (SD 1656) vs. £730 (SD 829) (probability 0.866). The trial showed that the Wii TM was not superior to arm exercises in home-based rehabilitation for stroke survivors with arm weakness. The Wii TM was well tolerated but more expensive than arm exercises.

Life cycle cost modeling of conceptual space vehicles

NASA Technical Reports Server (NTRS)

Ebeling, Charles

1993-01-01

This paper documents progress to date by the University of Dayton on the development of a life cycle cost model for use during the conceptual design of new launch vehicles and spacecraft. This research is being conducted under NASA Research Grant NAG-1-1327. This research effort changes the focus from that of the first two years in which a reliability and maintainability model was developed to the initial development of a life cycle cost model. Cost categories are initially patterned after NASA's three axis work breakdown structure consisting of a configuration axis (vehicle), a function axis, and a cost axis. The focus will be on operations and maintenance costs and other recurring costs. Secondary tasks performed concurrent with the development of the life cycle costing model include continual support and upgrade of the R&M model. The primary result of the completed research will be a methodology and a computer implementation of the methodology to provide for timely cost analysis in support of the conceptual design activities. The major objectives of this research are: to obtain and to develop improved methods for estimating manpower, spares, software and hardware costs, facilities costs, and other cost categories as identified by NASA personnel; to construct a life cycle cost model of a space transportation system for budget exercises and performance-cost trade-off analysis during the conceptual and development stages; to continue to support modifications and enhancements to the R&M model; and to continue to assist in the development of a simulation model to provide an integrated view of the operations and support of the proposed system.

A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China.

PubMed

Cui, Ming; Tu, Chen Chen; Chen, Er Zhen; Wang, Xiao Li; Tan, Seng Chuen; Chen, Can

2016-09-01

There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China. This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate, and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs, and utility values were estimated from official reports, published literature, and analysis of the patient-level insurance data in China. To assess the impact of parameters' uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters, and probabilistic sensitivity analysis (PSA) was conducted using the Monte Carlo simulation. The therapy of clopidogrel plus ASA is a cost-effective option in comparison with ASA alone for the treatment of NSTEACS in China, leading to 0.0548 life years (LYs) and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus ASA is associated with an incremental cost of 43,340 China Yuan (CNY) per QALY gained and 41,030 CNY per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 CYN per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold. This analysis suggests that treatment with clopidogrel plus ASA for up to 1 year for patients with NSTEACS is cost effective in the local context of China from a public payers' perspective. Sanofi China.

Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial.

PubMed

Zanaboni, Paolo; Landolina, Maurizio; Marzegalli, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Guenzati, Giuseppe; Curnis, Antonio; Valsecchi, Sergio; Borghetti, Francesca; Borghi, Gabriella; Masella, Cristina

2013-05-30

Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).

Road weather management performance measures : 2012 update.

DOT National Transportation Integrated Search

1997-01-01

The goal of the cost analysis of the ITS National Architecture program is twofold. First, the evaluation is to produce a high-level estimate of the expenditures associated with implementing the physical elements and the functional capabilities of ITS...

Space Biology Initiative. Trade Studies, volume 2

NASA Technical Reports Server (NTRS)

1989-01-01

The six studies which are the subjects of this report are entitled: Design Modularity and Commonality; Modification of Existing Hardware (COTS) vs. New Hardware Build Cost Analysis; Automation Cost vs. Crew Utilization; Hardware Miniaturization versus Cost; Space Station Freedom/Spacelab Modules Compatibility vs. Cost; and Prototype Utilization in the Development of Space Hardware. The product of these six studies was intended to provide a knowledge base and methodology that enables equipment produced for the Space Biology Initiative program to meet specific design and functional requirements in the most efficient and cost effective form consistent with overall mission integration parameters. Each study promulgates rules of thumb, formulas, and matrices that serves as a handbook for the use and guidance of designers and engineers in design, development, and procurement of Space Biology Initiative (SBI) hardware and software.

Space Biology Initiative. Trade Studies, volume 1

NASA Technical Reports Server (NTRS)

1989-01-01

The six studies which are addressed are entitled: Design Modularity and Commonality; Modification of Existing Hardware (COTS) vs. New Hardware Build Cost Analysis; Automation Cost vs. Crew Utilization; Hardware Miniaturization versus Cost; Space Station Freedom/Spacelab Modules Compatibility vs. Cost; and Prototype Utilization in the Development of Space Hardware. The product of these six studies was intended to provide a knowledge base and methodology that enables equipment produced for the Space Biology Initiative program to meet specific design and functional requirements in the most efficient and cost effective form consistent with overall mission integration parameters. Each study promulgates rules of thumb, formulas, and matrices that serves has a handbook for the use and guidance of designers and engineers in design, development, and procurement of Space Biology Initiative (SBI) hardware and software.

Optical Metrology for CIGS Solar Cell Manufacturing and its Cost Implications

NASA Astrophysics Data System (ADS)

Sunkoju, Sravan Kumar

Solar energy is a promising source of renewable energy which can meet the demand for clean energy in near future with advances in research in the field of photovoltaics and cost reduction by commercialization. Availability of a non-contact, in-line, real time robust process control strategies can greatly aid in reducing the gap between cell and module efficiencies, thereby leading to cost-effective large-scale manufacturing of high efficiency CIGS solar cells. In order to achieve proper process monitoring and control for the deposition of the functional layers of CuIn1-xGaxSe 2 (CIGS) based thin film solar cell, optical techniques such as spectroscopic reflectometry and polarimetry are advantageous because they can be set up in an unobtrusive manner in the manufacturing line, and collect data in-line and in-situ. The use of these techniques requires accurate optical models that correctly represent the properties of the layers being deposited. In this study, Spectroscopic ellipsometry (SE) has been applied for the characterization of each individual stage of CIGS layers deposited using the 3-stage co-evaporation process along with the other functional layers. Dielectric functions have been determined for the energy range from 0.7 eV to 5.1 eV. Critical-point line-shape analysis was used in this study to determine the critical point energies of the CIGS based layers. To control the compositional and thickness uniformity of all the functional layers during the fabrication of CIGS solar cells over large areas, multilayer photovoltaics (PV) stack optical models were developed with the help of extracted dielectric functions. In this study, mapping capability of RC2 spectroscopic ellipsometer was used to map all the functional layer thicknesses of a CIGS solar cell in order to probe the spatial non-uniformities that can affect the performance of a cell. The optical functions for each of the stages of CIGS 3-stage deposition process along with buffer layer and transparent conducting oxide (TCO) bi-layer, thus derived were used in a fiber optic-based spectroscopic reflectometry optical monitoring system installed in the pilot line at the PVMC's Halfmoon facility. Results obtained from this study show that the use of regular fiber optics, instead of polarization-maintaining fiber optics, is sufficient for the purpose of process monitoring. Also, the technique does not need to be used "in-situ", but the measurements can be taken in-line, and are applicable to a variety of deposition techniques used for different functional layers deposited on rigid or flexible substrates. In addition, effect of Cu concentration on the CIGS optical properties has been studied. Mixed CIGS/Cu2-xSe phase was observed at the surface at the end of the second stage of 3-stage deposition process, under Cu-rich conditions. A significant change in optical behavior of CIGS due to Cu2-xSe at the surface was observed under Cu-rich conditions, which can be used as end-point detection method to move from 2nd stage to 3rd stage in the deposition process. Developed optical functions were applied to in-line reflectance measurements not only to identify the Cu2-xSe phase at the surface but also to measure the thickness of the mixed CIGS/Cu2-xSe layer. This spectroscopic reflectometry based in-line process control technique can be used for end-point detection as well as to control thickness during the preparation of large area CIGS films. These results can assist in the development of optical process-control tools for the manufacturing of high quality CIGS based photovoltaic cells, increasing the uptime and yield of the production line. Finally, to understand the cost implications, low cost potential of two different deposition technologies has been studied on both rigid and flexible substrates with the help of cost analysis. Cost advantages of employing a contactless optics based process control technique have been investigated in order to achieve a low cost of < 0.5 $/W for CIGS module production. Based on cost analysis, one of the best strategies for achieving the low cost targets would be increasing manufacturing throughput, using roll-to-roll thin-film module manufacturing, with co-evaporation and chemical bath deposition processes for absorber and buffer layer respectively, while applying a low-cost process control technique such as spectroscopic reflectometry to improve module efficiencies and maintain high yield.

Carbon/graphite fiber risk analysis and assessment study: Assessment of risk to the Lockheed Model L-1011 commercial transport aircraft

NASA Technical Reports Server (NTRS)

Daniledes, J.; Koch, J. R.

1980-01-01

The risk associated with the accidental release of carbon/graphite fibers (CF) from fires on commercial transport aircraft incorporating composite materials was assessed. Data are developed to evaluate the potential for CF damage to electrical and electronic equipment, assess the cost risk, and evaluate the hazard to continued operation. The subjects covered include identification of susceptible equipments, determination of infiltration transfer functions, analysis of airport operations, calculation of probabilities of equipment failures, assessment of the cost risk, and evaluation of the hazard to continued operation. The results show the risks associated with CF contamination are negligible through 1993.

Mission definition study for Stanford relativity satellite. Volume 3: Appendices

NASA Technical Reports Server (NTRS)

1971-01-01

An analysis is presented for the cost of the mission as a function of the following variables: amount of redundancy in the spacecraft, amount of care taken in building the spacecraft (functional and environmental tests, screening of components, quality control, etc), and the number of flights necessary to accomplish the mission. Thermal analysis and mathematical models for the experimental components are presented. The results of computer structural and stress analyses for support and cylinders are discussed. Reliability, quality control, and control system simulation by computer are also considered.

A Two-Dimensional Variational Analysis Method for NSCAT Ambiguity Removal: Methodology, Sensitivity, and Tuning

NASA Technical Reports Server (NTRS)

Hoffman, R. N.; Leidner, S. M.; Henderson, J. M.; Atlas, R.; Ardizzone, J. V.; Bloom, S. C.; Atlas, Robert (Technical Monitor)

2001-01-01

In this study, we apply a two-dimensional variational analysis method (2d-VAR) to select a wind solution from NASA Scatterometer (NSCAT) ambiguous winds. 2d-VAR determines a "best" gridded surface wind analysis by minimizing a cost function. The cost function measures the misfit to the observations, the background, and the filtering and dynamical constraints. The ambiguity closest in direction to the minimizing analysis is selected. 2d-VAR method, sensitivity and numerical behavior are described. 2d-VAR is compared to statistical interpolation (OI) by examining the response of both systems to a single ship observation and to a swath of unique scatterometer winds. 2d-VAR is used with both NSCAT ambiguities and NSCAT backscatter values. Results are roughly comparable. When the background field is poor, 2d-VAR ambiguity removal often selects low probability ambiguities. To avoid this behavior, an initial 2d-VAR analysis, using only the two most likely ambiguities, provides the first guess for an analysis using all the ambiguities or the backscatter data. 2d-VAR and median filter selected ambiguities usually agree. Both methods require horizontal consistency, so disagreements occur in clumps, or as linear features. In these cases, 2d-VAR ambiguities are often more meteorologically reasonable and more consistent with satellite imagery.

Modified complementary ensemble empirical mode decomposition and intrinsic mode functions evaluation index for high-speed train gearbox fault diagnosis

NASA Astrophysics Data System (ADS)

Chen, Dongyue; Lin, Jianhui; Li, Yanping

2018-06-01

Complementary ensemble empirical mode decomposition (CEEMD) has been developed for the mode-mixing problem in Empirical Mode Decomposition (EMD) method. Compared to the ensemble empirical mode decomposition (EEMD), the CEEMD method reduces residue noise in the signal reconstruction. Both CEEMD and EEMD need enough ensemble number to reduce the residue noise, and hence it would be too much computation cost. Moreover, the selection of intrinsic mode functions (IMFs) for further analysis usually depends on experience. A modified CEEMD method and IMFs evaluation index are proposed with the aim of reducing the computational cost and select IMFs automatically. A simulated signal and in-service high-speed train gearbox vibration signals are employed to validate the proposed method in this paper. The results demonstrate that the modified CEEMD can decompose the signal efficiently with less computation cost, and the IMFs evaluation index can select the meaningful IMFs automatically.

Event-Triggered Adaptive Dynamic Programming for Continuous-Time Systems With Control Constraints.

PubMed

Dong, Lu; Zhong, Xiangnan; Sun, Changyin; He, Haibo

2016-08-31

In this paper, an event-triggered near optimal control structure is developed for nonlinear continuous-time systems with control constraints. Due to the saturating actuators, a nonquadratic cost function is introduced and the Hamilton-Jacobi-Bellman (HJB) equation for constrained nonlinear continuous-time systems is formulated. In order to solve the HJB equation, an actor-critic framework is presented. The critic network is used to approximate the cost function and the action network is used to estimate the optimal control law. In addition, in the proposed method, the control signal is transmitted in an aperiodic manner to reduce the computational and the transmission cost. Both the networks are only updated at the trigger instants decided by the event-triggered condition. Detailed Lyapunov analysis is provided to guarantee that the closed-loop event-triggered system is ultimately bounded. Three case studies are used to demonstrate the effectiveness of the proposed method.

The use of spirometry to evaluate pulmonary function in olive ridley sea turtles (Lepidochelys olivacea) with positive buoyancy disorders.

PubMed

Schmitt, Todd L; Munns, Suzanne; Adams, Lance; Hicks, James

2013-09-01

This study utilized computed spirometry to compare the pulmonary function of two stranded olive ridley sea turtles (Lepidochelys olivacea) presenting with a positive buoyancy disorder with two healthy captive olive ridley sea turtles held in a large public aquarium. Pulmonary function test (PFT) measurements demonstrated that the metabolic cost of breathing was much greater for animals admitted with positive buoyancy than for the normal sea turtles. Positively buoyant turtles had higher tidal volumes and significantly lower breathing-frequency patterns with significantly higher expiration rates, typical of gasp-type breathing. The resulting higher energetic cost of breathing in the diseased turtles may have a significant impact on their long-term survival. The findings represent a method for clinical respiratory function analysis for an individual animal to assist with diagnosis, therapy, and prognosis. This is the first study, to our knowledge, to evaluate objectively sea turtles presenting with positive buoyancy and respiratory disease using pulmonary function tests.

Ecosystem Services in Conservation Planning: Targeted Benefits vs. Co-Benefits or Costs?

PubMed Central

Chan, Kai M. A.; Hoshizaki, Lara; Klinkenberg, Brian

2011-01-01

There is growing support for characterizing ecosystem services in order to link conservation and human well-being. However, few studies have explicitly included ecosystem services within systematic conservation planning, and those that have follow two fundamentally different approaches: ecosystem services as intrinsically-important targeted benefits vs. substitutable co-benefits. We present a first comparison of these two approaches in a case study in the Central Interior of British Columbia. We calculated and mapped economic values for carbon storage, timber production, and recreational angling using a geographical information system (GIS). These ‘marginal’ values represent the difference in service-provision between conservation and managed forestry as land uses. We compared two approaches to including ecosystem services in the site-selection software Marxan: as Targeted Benefits, and as Co-Benefits/Costs (in Marxan's cost function); we also compared these approaches with a Hybrid approach (carbon and angling as targeted benefits, timber as an opportunity cost). For this analysis, the Co-Benefit/Cost approach yielded a less costly reserve network than the Hybrid approach (1.6% cheaper). Including timber harvest as an opportunity cost in the cost function resulted in a reserve network that achieved targets equivalently, but at 15% lower total cost. We found counter-intuitive results for conservation: conservation-compatible services (carbon, angling) were positively correlated with each other and biodiversity, whereas the conservation-incompatible service (timber) was negatively correlated with all other networks. Our findings suggest that including ecosystem services within a conservation plan may be most cost-effective when they are represented as substitutable co-benefits/costs, rather than as targeted benefits. By explicitly valuing the costs and benefits associated with services, we may be able to achieve meaningful biodiversity conservation at lower cost and with greater co-benefits. PMID:21915318

Uncertainty importance analysis using parametric moment ratio functions.

PubMed

Wei, Pengfei; Lu, Zhenzhou; Song, Jingwen

2014-02-01

This article presents a new importance analysis framework, called parametric moment ratio function, for measuring the reduction of model output uncertainty when the distribution parameters of inputs are changed, and the emphasis is put on the mean and variance ratio functions with respect to the variances of model inputs. The proposed concepts efficiently guide the analyst to achieve a targeted reduction on the model output mean and variance by operating on the variances of model inputs. The unbiased and progressive unbiased Monte Carlo estimators are also derived for the parametric mean and variance ratio functions, respectively. Only a set of samples is needed for implementing the proposed importance analysis by the proposed estimators, thus the computational cost is free of input dimensionality. An analytical test example with highly nonlinear behavior is introduced for illustrating the engineering significance of the proposed importance analysis technique and verifying the efficiency and convergence of the derived Monte Carlo estimators. Finally, the moment ratio function is applied to a planar 10-bar structure for achieving a targeted 50% reduction of the model output variance. © 2013 Society for Risk Analysis.

Skill Mix, Experience, and Readiness.

DTIC Science & Technology

1983-10-01

percent less manpower at a life -cycle cost savings of 12 percent. The squadron-effectiveness analysis balances the cost and effec- tiveness of people...Function," Journal of PoliticalEconomy, Vol. 76, 1971 [4] Naval Personnel Research and Development Center, SR 80-7, " Life Cycle Navy Enlisted Billet...Approach"e to Attrition Ieuation Moels," 5 pp., Fob 1962, AD Al 12 462 Matnaganat," 30 PP., Jan I992 AD A112 910 Uiversity of Minnesota PP 331*alhniversity

Medical technology management: from planning to application.

PubMed

David, Y; Jahnke, E

2005-01-01

Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively manage their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for optimizing costs of ownership of all equipment. Clinical engineers can identify technological solutions based on the matching of new medical equipment with hospital's objectives. They can review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with cost accounting analysis, will objectively guide the capital assets decision-making process. Cost accounting analysis is a multivariate function that includes determining the amount, based upon a strategic plan and financial resources, of funding to be allocated annually for medical equipment acquisition and replacement. Often this function works closely with clinical engineering to establish equipment useful life and prioritization of acquisition, upgrade, and replacement of inventory within budget confines and without conducting time consuming, individual financial capital project evaluations.

Combined EDL-Mobility Planning for Planetary Missions

NASA Technical Reports Server (NTRS)

Kuwata, Yoshiaki; Balaram, Bob

2011-01-01

This paper presents an analysis framework for planetary missions that have coupled mobility and EDL (Entry-Descent-Landing) systems. Traditional systems engineering approaches to mobility missions such as MERs (Mars Exploration Rovers) and MSL (Mars Science Laboratory) independently study the EDL system and the mobility system, and does not perform explicit trade-off between them or risk minimization of the overall system. A major challenge is that EDL operation is inherently uncertain and its analysis results such as landing footprint are described using PDF (Probability Density Function). The proposed approach first builds a mobility cost-to-go map that encodes the driving cost of any point on the map to a science target location. The cost could include variety of metrics such as traverse distance, time, wheel rotation on soft soil, and closeness to hazards. It then convolves the mobility cost-to-go map with the landing PDF given by the EDL system, which provides a histogram of driving cost, which can be used to evaluate the overall risk of the mission. By capturing the coupling between EDL and mobility explicitly, this analysis framework enables quantitative tradeoff between EDL and mobility system performance, as well as the characterization of risks in a statistical way. The simulation results are presented with a realistic Mars terrain data

Comprehensive, Quantitative Risk Assessment of CO{sub 2} Geologic Sequestration

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

Lepinski, James

2013-09-30

A Quantitative Failure Modes and Effects Analysis (QFMEA) was developed to conduct comprehensive, quantitative risk assessments on CO{sub 2} capture, transportation, and sequestration or use in deep saline aquifers, enhanced oil recovery operations, or enhanced coal bed methane operations. The model identifies and characterizes potential risks; identifies the likely failure modes, causes, effects and methods of detection; lists possible risk prevention and risk mitigation steps; estimates potential damage recovery costs, mitigation costs and costs savings resulting from mitigation; and ranks (prioritizes) risks according to the probability of failure, the severity of failure, the difficulty of early failure detection and themore » potential for fatalities. The QFMEA model generates the necessary information needed for effective project risk management. Diverse project information can be integrated into a concise, common format that allows comprehensive, quantitative analysis, by a cross-functional team of experts, to determine: What can possibly go wrong? How much will damage recovery cost? How can it be prevented or mitigated? What is the cost savings or benefit of prevention or mitigation? Which risks should be given highest priority for resolution? The QFMEA model can be tailored to specific projects and is applicable to new projects as well as mature projects. The model can be revised and updated as new information comes available. It accepts input from multiple sources, such as literature searches, site characterization, field data, computer simulations, analogues, process influence diagrams, probability density functions, financial analysis models, cost factors, and heuristic best practices manuals, and converts the information into a standardized format in an Excel spreadsheet. Process influence diagrams, geologic models, financial models, cost factors and an insurance schedule were developed to support the QFMEA model. Comprehensive, quantitative risk assessments were conducted on three (3) sites using the QFMEA model: (1) SACROC Northern Platform CO{sub 2}-EOR Site in the Permian Basin, Scurry County, TX, (2) Pump Canyon CO{sub 2}-ECBM Site in the San Juan Basin, San Juan County, NM, and (3) Farnsworth Unit CO{sub 2}-EOR Site in the Anadarko Basin, Ochiltree County, TX. The sites were sufficiently different from each other to test the robustness of the QFMEA model.« less

Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care.

PubMed

Panman, Cmcr; Wiegersma, M; Kollen, B J; Berger, M Y; Lisman-Van Leeuwen, Y; Vermeulen, K M; Dekker, J H

2017-02-01

To compare effects and cost-effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. Randomised controlled trial. Dutch general practice. Women (≥55 years) with symptomatic mild prolapse, identified by screening. Linear multilevel analysis. Primary outcome was change of pelvic floor symptoms (Pelvic-Floor-Distress-Inventory-20 [PFDI-20]) during 24 months. Secondary outcomes were condition-specific and general quality of life, costs, sexual functioning, prolapse stage, pelvic floor muscle function and women's perceived improvement of symptoms. PFMT (n = 145) resulted in a 12.2-point (95% CI 7.2-17.2, P < 0.001) greater improvement in PFDI-20 score during 24 months compared with watchful waiting (n = 142). Participants randomised to PFMT more often reported improved symptoms (43% versus 14% for watchful waiting). Direct medical costs per person were €330 for PFMT and €91 for watchful waiting but costs for absorbent pads were lower in the PFMT group (€40 versus €77). Other secondary outcomes did not differ between groups. Post-hoc subgroup analysis demonstrated that PFMT was more effective in women experiencing higher pelvic floor symptom distress at baseline. PFMT resulted in greater pelvic floor symptom improvement compared with watchful waiting. The difference was statistically significant, but below the presumed level of clinical relevance (15 points). PFMT more often led to women's perceived improvement of symptoms, lower absorbent pads costs, and was more effective in women experiencing higher pelvic floor symptom distress. Therefore, PFMT could be advised in women with bothersome symptoms of mild prolapse. Pelvic floor muscle training can be effective in women with bothersome symptoms of mild prolapse. © 2016 Royal College of Obstetricians and Gynaecologists.

Does integration of HIV and SRH services achieve economies of scale and scope in practice? A cost function analysis of the Integra Initiative.

PubMed

Obure, Carol Dayo; Guinness, Lorna; Sweeney, Sedona; Initiative, Integra; Vassall, Anna

2016-03-01

Policy-makers have long argued about the potential efficiency gains and cost savings from integrating HIV and sexual reproductive health (SRH) services, particularly in resource-constrained settings with generalised HIV epidemics. However, until now, little empirical evidence exists on whether the hypothesised efficiency gains associated with such integration can be achieved in practice. We estimated a quadratic cost function using data obtained from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The quadratic specification enables us to determine the existence of economies of scale and scope. The empirical results reveal that at the current output levels, only HIV counselling and testing services are characterised by service-specific economies of scale. However, no overall economies of scale exist as all outputs are increased. The results also indicate cost complementarities between cervical cancer screening and HIV care; post-natal care and HIV care and family planning and sexually transmitted infection treatment combinations only. The results from this analysis reveal that contrary to expectation, efficiency gains from the integration of HIV and SRH services, if any, are likely to be modest. Efficiency gains are likely to be most achievable in settings that are currently delivering HIV and SRH services at a low scale with high levels of fixed costs. The presence of cost complementarities for only three service combinations implies that careful consideration of setting-specific clinical practices and the extent to which they can be combined should be made when deciding which services to integrate. NCT01694862. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Does integration of HIV and SRH services achieve economies of scale and scope in practice? A cost function analysis of the Integra Initiative

PubMed Central

Obure, Carol Dayo; Guinness, Lorna; Sweeney, Sedona; Initiative, Integra; Vassall, Anna

2016-01-01

Objective Policy-makers have long argued about the potential efficiency gains and cost savings from integrating HIV and sexual reproductive health (SRH) services, particularly in resource-constrained settings with generalised HIV epidemics. However, until now, little empirical evidence exists on whether the hypothesised efficiency gains associated with such integration can be achieved in practice. Methods We estimated a quadratic cost function using data obtained from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The quadratic specification enables us to determine the existence of economies of scale and scope. Findings The empirical results reveal that at the current output levels, only HIV counselling and testing services are characterised by service-specific economies of scale. However, no overall economies of scale exist as all outputs are increased. The results also indicate cost complementarities between cervical cancer screening and HIV care; post-natal care and HIV care and family planning and sexually transmitted infection treatment combinations only. Conclusions The results from this analysis reveal that contrary to expectation, efficiency gains from the integration of HIV and SRH services, if any, are likely to be modest. Efficiency gains are likely to be most achievable in settings that are currently delivering HIV and SRH services at a low scale with high levels of fixed costs. The presence of cost complementarities for only three service combinations implies that careful consideration of setting-specific clinical practices and the extent to which they can be combined should be made when deciding which services to integrate. Trial registration number NCT01694862. PMID:26438349

Dietary fibre intakes and reduction in functional constipation rates among Canadian adults: a cost-of-illness analysis

PubMed Central

Abdullah, Mohammad M. H.; Gyles, Collin L.; Marinangeli, Christopher P. F.; Carlberg, Jared G.; Jones, Peter J. H.

2015-01-01

Background Evidence-based research highlights beneficial impacts of dietary fibre on several aspects of the gut pathophysiology that are accompanied by a considerable financial burden in healthcare services. Recommended intakes of dietary fibre may thus associate with financial benefits at a population level. Objective We sought to systematically assess the potential annual savings in healthcare costs that would follow the reduction in rates of functional constipation and irregularity with increased dietary fibre intakes among Canadian adults. Design A cost-of-illness analysis was developed on the basis of current and recommended levels of fibre intake in Canada, constipation reduction per 1 g fibre intake, proportion of adults who are likely to consume fibre-rich diets, and population expected to respond to fibre intake. Sensitivity analyses covering a range of assumptions were further implemented within the economic simulation. Results Our literature searches assumed a 1.8% reduction in constipation rates with each 1 g/day increase in fibre intake. With intakes corresponding to the Institute of Medicine's adequate levels of 38 g/day for men and 25 g/day for women, among 5 and 100% of the adult populations, anywhere between CAD$1.5 and CAD$31.9 million could be saved on constipation-related healthcare costs annually. Each 1 g/day increase in dietary fibre was estimated to result in total annual healthcare cost savings that ranged between CAD$0.1 and CAD$2.5 million. Conclusions The present research suggests an economic value of increasing dietary fibre intake beyond its well-known health benefits. Healthy-eating behaviours consistent with the recommended intakes of dietary fibre by the general public should hence be advocated as a practical approach for reducing costs associated with the management of constipation in Canada. PMID:26652739

Toward a revised evolutionary adaptationist analysis of depression: the social navigation hypothesis.

PubMed

Watson, Paul J; Andrews, Paul W

2002-10-01

Evolutionary biologists use Darwinian theory and functional design ("reverse engineering") analyses, to develop and test hypotheses about the adaptive functions of traits. Based upon a consideration of human social life and a functional design analysis of depression's core symptomatology we offer a comprehensive theory of its adaptive significance called the Social Navigation Hypothesis (SNH). The SNH attempts to account for all intensities of depression based on standard evolutionary theories of sociality, communication and psychological pain. The SNH suggests that depression evolved to perform two complimentary social problem-solving functions. First, depression induces cognitive changes that focus and enhance capacities for the accurate analysis and solution of key social problems, suggesting a social rumination function. Second, the costs associated with the anhedonia and psychomotor perturbation of depression can persuade reluctant social partners to provide help or make concessions via two possible mechanisms, namely, honest signaling and passive, unintentional fitness extortion. Thus it may also have a social motivation function.

Feasibility and Supply Analysis of U.S. Geothermal District Heating and Cooling System

NASA Astrophysics Data System (ADS)

He, Xiaoning

Geothermal energy is a globally distributed sustainable energy with the advantages of a stable base load energy production with a high capacity factor and zero SOx, CO, and particulates emissions. It can provide a potential solution to the depletion of fossil fuels and air pollution problems. The geothermal district heating and cooling system is one of the most common applications of geothermal energy, and consists of geothermal wells to provide hot water from a fractured geothermal reservoir, a surface energy distribution system for hot water transmission, and heating/cooling facilities to provide water and space heating as well as air conditioning for residential and commercial buildings. To gain wider recognition for the geothermal district heating and cooling (GDHC) system, the potential to develop such a system was evaluated in the western United States, and in the state of West Virginia. The geothermal resources were categorized into identified hydrothermal resources, undiscovered hydrothermal resources, near hydrothermal enhanced geothermal system (EGS), and deep EGS. Reservoir characteristics of the first three categories were estimated individually, and their thermal potential calculated. A cost model for such a system was developed for technical performance and economic analysis at each geothermally active location. A supply curve for the system was then developed, establishing the quantity and the cost of potential geothermal energy which can be used for the GDHC system. A West Virginia University (WVU) case study was performed to compare the competiveness of a geothermal energy system to the current steam based system. An Aspen Plus model was created to simulate the year-round campus heating and cooling scenario. Five cases of varying water flow rates and temperatures were simulated to find the lowest levelized cost of heat (LCOH) for the WVU case study. The model was then used to derive a levelized cost of heat as a function of the population density at a constant geothermal gradient. By use of such functions in West Virginia at a census tract level, the most promising census tracts in WV for the development of geothermal district heating and cooling systems were mapped. This study is unique in that its purpose was to utilize supply analyses for the GDHC systems and determine an appropriate economic assessment of the viability and sustainability of the systems. It was found that the market energy demand, production temperature, and project lifetime have negative effects on the levelized cost, while the drilling cost, discount rate, and capital cost have positive effects on the levelized cost by sensitivity analysis. Moreover, increasing the energy demand is the most effective way to decrease the levelized cost. The derived levelized cost function shows that for EGS based systems, the population density has a strong negative effect on the LCOH at any geothermal gradient, while the gradient only has a negative effect on the LCOH at a low population density.

Large-Scale Network Analysis of Whole-Brain Resting-State Functional Connectivity in Spinal Cord Injury: A Comparative Study.

PubMed

Kaushal, Mayank; Oni-Orisan, Akinwunmi; Chen, Gang; Li, Wenjun; Leschke, Jack; Ward, Doug; Kalinosky, Benjamin; Budde, Matthew; Schmit, Brian; Li, Shi-Jiang; Muqeet, Vaishnavi; Kurpad, Shekar

2017-09-01

Network analysis based on graph theory depicts the brain as a complex network that allows inspection of overall brain connectivity pattern and calculation of quantifiable network metrics. To date, large-scale network analysis has not been applied to resting-state functional networks in complete spinal cord injury (SCI) patients. To characterize modular reorganization of whole brain into constituent nodes and compare network metrics between SCI and control subjects, fifteen subjects with chronic complete cervical SCI and 15 neurologically intact controls were scanned. The data were preprocessed followed by parcellation of the brain into 116 regions of interest (ROI). Correlation analysis was performed between every ROI pair to construct connectivity matrices and ROIs were categorized into distinct modules. Subsequently, local efficiency (LE) and global efficiency (GE) network metrics were calculated at incremental cost thresholds. The application of a modularity algorithm organized the whole-brain resting-state functional network of the SCI and the control subjects into nine and seven modules, respectively. The individual modules differed across groups in terms of the number and the composition of constituent nodes. LE demonstrated statistically significant decrease at multiple cost levels in SCI subjects. GE did not differ significantly between the two groups. The demonstration of modular architecture in both groups highlights the applicability of large-scale network analysis in studying complex brain networks. Comparing modules across groups revealed differences in number and membership of constituent nodes, indicating modular reorganization due to neural plasticity.

C-5M Fuel Efficiency Through MFOQA Data Analysis

DTIC Science & Technology

2015-03-26

deterioration of commercial high-bypass ratio turbofan engines. ( No. 801118).SAE Technical Paper. Mirtich, J. M. (2011). Cost index flying. (Unpublished...D. L. (2010). Constrained kalman filtering via density function truncation for turbofan engine health estimation. International Journal of Systems

Satellite services system analysis study. Volume 2, part 2: Study results

NASA Technical Reports Server (NTRS)

1981-01-01

The development of an effective satellite services system was investigated. Satek Satellite user market, design reference missions, satellite service functions, service equipment, and cost estimates are discussed. Extensive program plans for a satellite service system implementation are included.

Estimation of Damage Costs Associated with Flood Events

NASA Astrophysics Data System (ADS)

Andrews, T. A.; Wauthier, C.; Zipp, K.

2017-12-01

This study investigates the possibility of creating a mathematical function that enables the estimation of flood-damage costs. We begin by examining the costs associated with past flood events in the United States. The data on these tropical storms and hurricanes are provided by the National Oceanic and Atmospheric Administration. With the location, extent of flooding, and damage reparation costs identified, we analyze variables such as: number of inches rained, land elevation, type of landscape, region development in regards to building density and infrastructure, and population concentration. We seek to identify the leading drivers of high flood-damage costs and understand which variables play a large role in the costliness of these weather events. Upon completion of our mathematical analysis, we turn out attention to the 2017 natural disaster of Texas. We divide the region, as we did above, by land elevation, type of landscape, region development in regards to building density and infrastructure, and population concentration. Then, we overlay the number of inches rained in those regions onto the divided landscape and apply our function. We hope to use these findings to estimate the potential flood-damage costs of Hurricane Harvey. This information is then transformed into a hazard map that could provide citizens and businesses of flood-stricken zones additional resources for their insurance selection process.

Backward assembly planning with DFA analysis

NASA Technical Reports Server (NTRS)

Lee, Sukhan (Inventor)

1995-01-01

An assembly planning system that operates based on a recursive decomposition of assembly into subassemblies, and analyzes assembly cost in terms of stability, directionality, and manipulability to guide the generation of preferred assembly plans is presented. The planning in this system incorporates the special processes, such as cleaning, testing, labeling, etc. that must occur during the assembly, and handles nonreversible as well as reversible assembly tasks through backward assembly planning. In order to increase the planning efficiency, the system avoids the analysis of decompositions that do not correspond to feasible assembly tasks. This is achieved by grouping and merging those parts that can not be decomposable at the current stage of backward assembly planning due to the requirement of special processes and the constraint of interconnection feasibility. The invention includes methods of evaluating assembly cost in terms of the number of fixtures (or holding devices) and reorientations required for assembly, through the analysis of stability, directionality, and manipulability. All these factors are used in defining cost and heuristic functions for an AO* search for an optimal plan.

Crystal structure prediction supported by incomplete experimental data

NASA Astrophysics Data System (ADS)

Tsujimoto, Naoto; Adachi, Daiki; Akashi, Ryosuke; Todo, Synge; Tsuneyuki, Shinji

2018-05-01

We propose an efficient theoretical scheme for structure prediction on the basis of the idea of combining methods, which optimize theoretical calculation and experimental data simultaneously. In this scheme, we formulate a cost function based on a weighted sum of interatomic potential energies and a penalty function which is defined with partial experimental data totally insufficient for conventional structure analysis. In particular, we define the cost function using "crystallinity" formulated with only peak positions within the small range of the x-ray-diffraction pattern. We apply this method to well-known polymorphs of SiO2 and C with up to 108 atoms in the simulation cell and show that it reproduces the correct structures efficiently with very limited information of diffraction peaks. This scheme opens a new avenue for determining and predicting structures that are difficult to determine by conventional methods.

The Cost of Ankylosing Spondylitis in the UK Using Linked Routine and Patient-Reported Survey Data

PubMed Central

Cooksey, Roxanne; Husain, Muhammad J.; Brophy, Sinead; Davies, Helen; Rahman, Muhammad A.; Atkinson, Mark D.; Phillips, Ceri J.; Siebert, Stefan

2015-01-01

Background Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. Previous studies examining the cost of AS have relied on patient-reported questionnaires based on recall. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK. Methods Participants in an existing AS cohort study (n = 570) completed questionnaires regarding work status, out-of-pocket expenses, visits to health professionals and disease severity. Participants gave consent for their data to be linked to routine primary and secondary care clinical datasets. Health resource costs were calculated using a bottom-up micro-costing approach. Human capital costs methods were used to estimate work productivity loss costs, particularly relating to work and early retirement. Regression analyses were used to account for age, gender, disease activity. Results The total cost of AS in the UK is estimated at £19016 per patient per year, calculated to include GP attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-NHS costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs. The majority of the cost (>80%) was as a result of work-related costs. Conclusion The major cost of AS is as a result of loss of working hours, early retirement and unpaid carer’s time. Therefore, much of AS costs are hidden and not easy to quantify. Functional impairment is the main factor associated with increased cost of AS. Interventions which keep people in work to retirement age and reduce functional impairment would have the greatest impact on reducing costs of AS. The combination of patient-reported and linked routine data significantly enhanced the health economic analysis and this methodology that can be applied to other chronic conditions. PMID:26185984

The Cost of Ankylosing Spondylitis in the UK Using Linked Routine and Patient-Reported Survey Data.

PubMed

Cooksey, Roxanne; Husain, Muhammad J; Brophy, Sinead; Davies, Helen; Rahman, Muhammad A; Atkinson, Mark D; Phillips, Ceri J; Siebert, Stefan

2015-01-01

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. Previous studies examining the cost of AS have relied on patient-reported questionnaires based on recall. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK. Participants in an existing AS cohort study (n = 570) completed questionnaires regarding work status, out-of-pocket expenses, visits to health professionals and disease severity. Participants gave consent for their data to be linked to routine primary and secondary care clinical datasets. Health resource costs were calculated using a bottom-up micro-costing approach. Human capital costs methods were used to estimate work productivity loss costs, particularly relating to work and early retirement. Regression analyses were used to account for age, gender, disease activity. The total cost of AS in the UK is estimated at £19016 per patient per year, calculated to include GP attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-NHS costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs. The majority of the cost (>80%) was as a result of work-related costs. The major cost of AS is as a result of loss of working hours, early retirement and unpaid carer's time. Therefore, much of AS costs are hidden and not easy to quantify. Functional impairment is the main factor associated with increased cost of AS. Interventions which keep people in work to retirement age and reduce functional impairment would have the greatest impact on reducing costs of AS. The combination of patient-reported and linked routine data significantly enhanced the health economic analysis and this methodology that can be applied to other chronic conditions.

Optimum swimming pathways of fish spawning migrations in rivers

USGS Publications Warehouse

McElroy, Brandon; DeLonay, Aaron; Jacobson, Robert

2012-01-01

Fishes that swim upstream in rivers to spawn must navigate complex fluvial velocity fields to arrive at their ultimate locations. One hypothesis with substantial implications is that fish traverse pathways that minimize their energy expenditure during migration. Here we present the methodological and theoretical developments necessary to test this and similar hypotheses. First, a cost function is derived for upstream migration that relates work done by a fish to swimming drag. The energetic cost scales with the cube of a fish's relative velocity integrated along its path. By normalizing to the energy requirements of holding a position in the slowest waters at the path's origin, a cost function is derived that depends only on the physical environment and not on specifics of individual fish. Then, as an example, we demonstrate the analysis of a migration pathway of a telemetrically tracked pallid sturgeon (Scaphirhynchus albus) in the Missouri River (USA). The actual pathway cost is lower than 105 random paths through the surveyed reach and is consistent with the optimization hypothesis. The implication—subject to more extensive validation—is that reproductive success in managed rivers could be increased through manipulation of reservoir releases or channel morphology to increase abundance of lower-cost migration pathways.

A parameter optimization approach to controller partitioning for integrated flight/propulsion control application

NASA Technical Reports Server (NTRS)

Schmidt, Phillip; Garg, Sanjay; Holowecky, Brian

1992-01-01

A parameter optimization framework is presented to solve the problem of partitioning a centralized controller into a decentralized hierarchical structure suitable for integrated flight/propulsion control implementation. The controller partitioning problem is briefly discussed and a cost function to be minimized is formulated, such that the resulting 'optimal' partitioned subsystem controllers will closely match the performance (including robustness) properties of the closed-loop system with the centralized controller while maintaining the desired controller partitioning structure. The cost function is written in terms of parameters in a state-space representation of the partitioned sub-controllers. Analytical expressions are obtained for the gradient of this cost function with respect to parameters, and an optimization algorithm is developed using modern computer-aided control design and analysis software. The capabilities of the algorithm are demonstrated by application to partitioned integrated flight/propulsion control design for a modern fighter aircraft in the short approach to landing task. The partitioning optimization is shown to lead to reduced-order subcontrollers that match the closed-loop command tracking and decoupling performance achieved by a high-order centralized controller.

A parameter optimization approach to controller partitioning for integrated flight/propulsion control application

NASA Technical Reports Server (NTRS)

Schmidt, Phillip H.; Garg, Sanjay; Holowecky, Brian R.

1993-01-01

A parameter optimization framework is presented to solve the problem of partitioning a centralized controller into a decentralized hierarchical structure suitable for integrated flight/propulsion control implementation. The controller partitioning problem is briefly discussed and a cost function to be minimized is formulated, such that the resulting 'optimal' partitioned subsystem controllers will closely match the performance (including robustness) properties of the closed-loop system with the centralized controller while maintaining the desired controller partitioning structure. The cost function is written in terms of parameters in a state-space representation of the partitioned sub-controllers. Analytical expressions are obtained for the gradient of this cost function with respect to parameters, and an optimization algorithm is developed using modern computer-aided control design and analysis software. The capabilities of the algorithm are demonstrated by application to partitioned integrated flight/propulsion control design for a modern fighter aircraft in the short approach to landing task. The partitioning optimization is shown to lead to reduced-order subcontrollers that match the closed-loop command tracking and decoupling performance achieved by a high-order centralized controller.

Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods.

PubMed

Kauvar, Arielle N B; Cronin, Terrence; Roenigk, Randall; Hruza, George; Bennett, Richard

2015-05-01

Basal cell carcinoma (BCC) is the most common cancer in the US population affecting approximately 2.8 million people per year. Basal cell carcinomas are usually slow-growing and rarely metastasize, but they do cause localized tissue destruction, compromised function, and cosmetic disfigurement. To provide clinicians with guidelines for the management of BCC based on evidence from a comprehensive literature review, and consensus among the authors. An extensive review of the medical literature was conducted to evaluate the optimal treatment methods for cutaneous BCC, taking into consideration cure rates, recurrence rates, aesthetic and functional outcomes, and cost-effectiveness of the procedures. Surgical approaches provide the best outcomes for BCCs. Mohs micrographic surgery provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis. Mohs micrographic surgery is an efficient and cost-effective procedure and remains the treatment of choice for high-risk BCCs and for those in cosmetically sensitive locations. Nonsurgical modalities may be used for low-risk BCCs when surgery is contraindicated or impractical, but the cure rates are lower.

Probabilistic distance-based quantizer design for distributed estimation

NASA Astrophysics Data System (ADS)

Kim, Yoon Hak

2016-12-01

We consider an iterative design of independently operating local quantizers at nodes that should cooperate without interaction to achieve application objectives for distributed estimation systems. We suggest as a new cost function a probabilistic distance between the posterior distribution and its quantized one expressed as the Kullback Leibler (KL) divergence. We first present the analysis that minimizing the KL divergence in the cyclic generalized Lloyd design framework is equivalent to maximizing the logarithmic quantized posterior distribution on the average which can be further computationally reduced in our iterative design. We propose an iterative design algorithm that seeks to maximize the simplified version of the posterior quantized distribution and discuss that our algorithm converges to a global optimum due to the convexity of the cost function and generates the most informative quantized measurements. We also provide an independent encoding technique that enables minimization of the cost function and can be efficiently simplified for a practical use of power-constrained nodes. We finally demonstrate through extensive experiments an obvious advantage of improved estimation performance as compared with the typical designs and the novel design techniques previously published.

KOSMOS: a universal morph server for nucleic acids, proteins and their complexes.

PubMed

Seo, Sangjae; Kim, Moon Ki

2012-07-01

KOSMOS is the first online morph server to be able to address the structural dynamics of DNA/RNA, proteins and even their complexes, such as ribosomes. The key functions of KOSMOS are the harmonic and anharmonic analyses of macromolecules. In the harmonic analysis, normal mode analysis (NMA) based on an elastic network model (ENM) is performed, yielding vibrational modes and B-factor calculations, which provide insight into the potential biological functions of macromolecules based on their structural features. Anharmonic analysis involving elastic network interpolation (ENI) is used to generate plausible transition pathways between two given conformations by optimizing a topology-oriented cost function that guarantees a smooth transition without steric clashes. The quality of the computed pathways is evaluated based on their various facets, including topology, energy cost and compatibility with the NMA results. There are also two unique features of KOSMOS that distinguish it from other morph servers: (i) the versatility in the coarse-graining methods and (ii) the various connection rules in the ENM. The models enable us to analyze macromolecular dynamics with the maximum degrees of freedom by combining a variety of ENMs from full-atom to coarse-grained, backbone and hybrid models with one connection rule, such as distance-cutoff, number-cutoff or chemical-cutoff. KOSMOS is available at http://bioengineering.skku.ac.kr/kosmos.

A generic, cost-effective, and scalable cell lineage analysis platform

PubMed Central

Biezuner, Tamir; Spiro, Adam; Raz, Ofir; Amir, Shiran; Milo, Lilach; Adar, Rivka; Chapal-Ilani, Noa; Berman, Veronika; Fried, Yael; Ainbinder, Elena; Cohen, Galit; Barr, Haim M.; Halaban, Ruth; Shapiro, Ehud

2016-01-01

Advances in single-cell genomics enable commensurate improvements in methods for uncovering lineage relations among individual cells. Current sequencing-based methods for cell lineage analysis depend on low-resolution bulk analysis or rely on extensive single-cell sequencing, which is not scalable and could be biased by functional dependencies. Here we show an integrated biochemical-computational platform for generic single-cell lineage analysis that is retrospective, cost-effective, and scalable. It consists of a biochemical-computational pipeline that inputs individual cells, produces targeted single-cell sequencing data, and uses it to generate a lineage tree of the input cells. We validated the platform by applying it to cells sampled from an ex vivo grown tree and analyzed its feasibility landscape by computer simulations. We conclude that the platform may serve as a generic tool for lineage analysis and thus pave the way toward large-scale human cell lineage discovery. PMID:27558250

Development of Cost Benefit Methodology for Scientific and Technical Information Communication and Application to Information Analysis Centers. Final Report.

ERIC Educational Resources Information Center

Mason, Robert M.; And Others

This document presents a research effort intended to improve the economic information available for formulating politics and making decisions related to Information Analysis Centers (IAC's) and IAC services. The project used a system of IAC information activities to analyze the functional aspects of IAC services, calculate the present value of net…

Design Criteria For Networked Image Analysis System

NASA Astrophysics Data System (ADS)

Reader, Cliff; Nitteberg, Alan

1982-01-01

Image systems design is currently undergoing a metamorphosis from the conventional computing systems of the past into a new generation of special purpose designs. This change is motivated by several factors, notably among which is the increased opportunity for high performance with low cost offered by advances in semiconductor technology. Another key issue is a maturing in understanding of problems and the applicability of digital processing techniques. These factors allow the design of cost-effective systems that are functionally dedicated to specific applications and used in a utilitarian fashion. Following an overview of the above stated issues, the paper presents a top-down approach to the design of networked image analysis systems. The requirements for such a system are presented, with orientation toward the hospital environment. The three main areas are image data base management, viewing of image data and image data processing. This is followed by a survey of the current state of the art, covering image display systems, data base techniques, communications networks and software systems control. The paper concludes with a description of the functional subystems and architectural framework for networked image analysis in a production environment.

Managerial innovation in the hospital: an analysis of the diffusion of hospital cost-accounting systems.

PubMed

Counte, M A; Glandon, G L

1988-01-01

Currently much interest is focused on the uses of cost-accounting systems within the hospital industry. Proponents frequently contend that such systems will help hospitals successfully adapt to new methods of financial reimbursement because they are essential to a number of major management functions, including competitive bidding, cost management, pricing, and profitability assessment. This article reports the results of a study conducted to examine the extent to which hospitals in a major market are actually beginning to use standard cost-accounting systems and identify factors that either aid or hinder the diffusion of these methods. Chief financial officers from 94 hospitals (83 percent response rate) participated in the study during the summer of 1986 where less than half of the hospitals (43 percent) had recently purchased a cost-accounting system. Detailed information about the interface of cost-accounting systems with other application systems and their specific management uses is reported.

Complementary effect of patient volume and quality of care on hospital cost efficiency.

PubMed

Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

2017-06-01

This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

Bearing faults identification and resonant band demodulation based on wavelet de-noising methods and envelope analysis

NASA Astrophysics Data System (ADS)

Abdelrhman, Ahmed M.; Sei Kien, Yong; Salman Leong, M.; Meng Hee, Lim; Al-Obaidi, Salah M. Ali

2017-07-01

The vibration signals produced by rotating machinery contain useful information for condition monitoring and fault diagnosis. Fault severities assessment is a challenging task. Wavelet Transform (WT) as a multivariate analysis tool is able to compromise between the time and frequency information in the signals and served as a de-noising method. The CWT scaling function gives different resolutions to the discretely signals such as very fine resolution at lower scale but coarser resolution at a higher scale. However, the computational cost increased as it needs to produce different signal resolutions. DWT has better low computation cost as the dilation function allowed the signals to be decomposed through a tree of low and high pass filters and no further analysing the high-frequency components. In this paper, a method for bearing faults identification is presented by combing Continuous Wavelet Transform (CWT) and Discrete Wavelet Transform (DWT) with envelope analysis for bearing fault diagnosis. The experimental data was sampled by Case Western Reserve University. The analysis result showed that the proposed method is effective in bearing faults detection, identify the exact fault’s location and severity assessment especially for the inner race and outer race faults.

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post–Myocardial Infarction Medicare Beneficiaries

PubMed Central

Choudhry, Niteesh K.; Patrick, Amanda R.; Antman, Elliott M.; Avorn, Jerry; Shrank, William H.

2009-01-01

Background Effective therapies for the secondary prevention of coronary heart disease–related events are significantly underused, and attempts to improve adherence have often yielded disappointing results. Elimination of patient out-of-pocket costs may be an effective strategy to enhance medication use. We sought to estimate the incremental cost-effectiveness of providing full coverage for aspirin, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins (combination pharmacotherapy) to individuals enrolled in the Medicare drug benefit program after acute myocardial infarction. Methods and Results We created a Markov cost-effectiveness model to estimate the incremental cost-effectiveness of providing Medicare beneficiaries with full coverage for combination pharmacotherapy compared with current coverage under the Medicare Part D program. Our analysis was conducted from the societal perspective and considered a lifetime time horizon. In a sensitivity analysis, we repeated our analysis from the perspective of Medicare. In the model, post–myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8.21 quality-adjusted life-years after their initial event, incurring coronary heart disease–related medical costs of $114 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8.56 quality-adjusted life-years and incurred $111 600 in coronary heart disease–related costs. Compared with current prescription drug coverage, full coverage for post–myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0.35 quality-adjusted life-year) and less resource use ($2500). From the perspective of Medicare, full drug coverage was highly cost-effective ($7182/quality-adjusted life-year) but not cost saving. Conclusions Our analysis suggests that providing full coverage for combination therapy to post–myocardial infarction Medicare beneficiaries would save both lives and money from the societal perspective. PMID:18285564

Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

PubMed

Hastrup, Lene Halling; Kronborg, Christian; Bertelsen, Mette; Jeppesen, Pia; Jorgensen, Per; Petersen, Lone; Thorup, Anne; Simonsen, Erik; Nordentoft, Merete

2013-01-01

Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%. The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.

Upon Accounting for the Impact of Isoenzyme Loss, Gene Deletion Costs Anticorrelate with Their Evolutionary Rates.

PubMed

Jacobs, Christopher; Lambourne, Luke; Xia, Yu; Segrè, Daniel

2017-01-01

System-level metabolic network models enable the computation of growth and metabolic phenotypes from an organism's genome. In particular, flux balance approaches have been used to estimate the contribution of individual metabolic genes to organismal fitness, offering the opportunity to test whether such contributions carry information about the evolutionary pressure on the corresponding genes. Previous failure to identify the expected negative correlation between such computed gene-loss cost and sequence-derived evolutionary rates in Saccharomyces cerevisiae has been ascribed to a real biological gap between a gene's fitness contribution to an organism "here and now" and the same gene's historical importance as evidenced by its accumulated mutations over millions of years of evolution. Here we show that this negative correlation does exist, and can be exposed by revisiting a broadly employed assumption of flux balance models. In particular, we introduce a new metric that we call "function-loss cost", which estimates the cost of a gene loss event as the total potential functional impairment caused by that loss. This new metric displays significant negative correlation with evolutionary rate, across several thousand minimal environments. We demonstrate that the improvement gained using function-loss cost over gene-loss cost is explained by replacing the base assumption that isoenzymes provide unlimited capacity for backup with the assumption that isoenzymes are completely non-redundant. We further show that this change of the assumption regarding isoenzymes increases the recall of epistatic interactions predicted by the flux balance model at the cost of a reduction in the precision of the predictions. In addition to suggesting that the gene-to-reaction mapping in genome-scale flux balance models should be used with caution, our analysis provides new evidence that evolutionary gene importance captures much more than strict essentiality.

Cost-effectiveness analysis of liver resection versus transplantation for early hepatocellular carcinoma within the Milan criteria.

PubMed

Lim, Kheng Choon; Wang, Vivian W; Siddiqui, Fahad J; Shi, Luming; Chan, Edwin S Y; Oh, Hong Choon; Tan, Say Beng; Chow, Pierce K H

2015-01-01

Both liver resection (LR) and cadaveric liver transplantation (CLT) are potentially curative treatments for patients with hepatocellular carcinoma (HCC) within the Milan criteria and with adequate liver function. Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of LR against CLT for patients with HCC within the Milan criteria using a decision analytic model. A Markov cohort model was developed to simulate a cohort of patients aged 55 years with HCC within the Milan criteria and Child-Pugh A/B cirrhosis, undergoing LR or CLT, and followed up over their remaining life expectancy. Analysis was performed in different geographical cost settings: the USA, Switzerland and Singapore. Transition probabilities were obtained from systematic literature reviews, supplemented by databases from Singapore and the Organ Procurement and Transplantation Network (USA). Utility and cost data were obtained from open sources. LR produced 3.9 quality-adjusted life years (QALYs) while CLT had an additional 1.4 QALYs. The incremental cost-effectiveness ratio (ICER) of CLT versus LR ranged from $111,821/QALY in Singapore to $156,300/QALY in Switzerland, and was above thresholds for cost-effectiveness in all three countries. Sensitivity analysis revealed that CLT-related 5-year cumulative survival, one-time cost of CLT, and post-LR 5-year cumulative recurrence rates were the most sensitive parameters in all cost scenarios. ICERs were reduced below threshold when CLT-related 5-year cumulative survival exceeded 84.9% and 87.6% in Singapore and the USA, respectively. For Switzerland, the ICER remained above the cost-effectiveness threshold regardless of the variations. In patients with HCC within the Milan criteria and Child-Pugh A/B cirrhosis, LR is more cost-effective than CLT across three different costing scenarios: the USA, Switzerland, Singapore. © 2014 by the American Association for the Study of Liver Diseases.

Risk factor and cost accounting analysis for dialysis patients in Taiwan.

PubMed

Su, Bin-Guang; Tsai, Kai-Li; Yeh, Shu-Hsing; Ho, Yi-Yi; Liu, Shin-Yi; Rivers, Patrick A

2010-05-01

According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients with high blood lipids incurred significant differences in cost of oral medication. This study identified the relationship between cost and risk factors of dialysis procedures for ESRD patients based on average variable costs for each dialysis treatment. The results show that certain risk factors (e.g. aged 75 and older, hypertension, bile-duct disease, cancer and high blood lipids) are associated with higher cost. The results from this study could enable health policy makers and the National Health Insurance Bureau to design a fairer and more convincible reimbursement system for dialysis procedures. This study also provides a better understanding of what risk factors play more influential roles in affecting ESRD patients to receive haemodialysis treatment. It will help policy makers and health-care providers in better control or even prevent the disease and manage the distribution of the treatment. In addition, with the results from the analysis of cost information, we can tell which risk factors have more impacts on the dialysis cost. It will further help us control the cost for those high-risk dialysis patients more efficiently.

Asbestos Utilization Costs on the Example of Functioning Landfill of Hazardous Waste

NASA Astrophysics Data System (ADS)

Polek, Daria

2017-12-01

Asbestos is a trademark of mineral fibres, which are the natural minerals found in nature. Products containing asbestos fibres, in accordance with the national and EU legislation, are covered by the production prohibition and forced to be removed. In Poland, the asbestos removal process started with the adaptation of the EU law by the Council of Ministers Treatment Program of the National Asbestos for the years 2009-2032. The purpose of the dissertation was to analyse the costs associated with the disposal of the costs of collection, transport and disposal of waste. Methodology consisted in obtaining information on the raw materials needed to produce asbestos sheets. The analysis allowed us to determine the asbestos removal cost and include state subsidies in the calculations.

Features of spatial and functional segregation and integration of the primate connectome revealed by trade-off between wiring cost and efficiency

PubMed Central

Chen, Yuhan; Wang, Shengjun

2017-01-01

The primate connectome, possessing a characteristic global topology and specific regional connectivity profiles, is well organized to support both segregated and integrated brain function. However, the organization mechanisms shaping the characteristic connectivity and its relationship to functional requirements remain unclear. The primate brain connectome is shaped by metabolic economy as well as functional values. Here, we explored the influence of two competing factors and additional advanced functional requirements on the primate connectome employing an optimal trade-off model between neural wiring cost and the representative functional requirement of processing efficiency. Moreover, we compared this model with a generative model combining spatial distance and topological similarity, with the objective of statistically reproducing multiple topological features of the network. The primate connectome indeed displays a cost-efficiency trade-off and that up to 67% of the connections were recovered by optimal combination of the two basic factors of wiring economy and processing efficiency, clearly higher than the proportion of connections (56%) explained by the generative model. While not explicitly aimed for, the trade-off model captured several key topological features of the real connectome as the generative model, yet better explained the connectivity of most regions. The majority of the remaining 33% of connections unexplained by the best trade-off model were long-distance links, which are concentrated on few cortical areas, termed long-distance connectors (LDCs). The LDCs are mainly non-hubs, but form a densely connected group overlapping on spatially segregated functional modalities. LDCs are crucial for both functional segregation and integration across different scales. These organization features revealed by the optimization analysis provide evidence that the demands of advanced functional segregation and integration among spatially distributed regions may play a significant role in shaping the cortical connectome, in addition to the basic cost-efficiency trade-off. These findings also shed light on inherent vulnerabilities of brain networks in diseases. PMID:28961235

Features of spatial and functional segregation and integration of the primate connectome revealed by trade-off between wiring cost and efficiency.

PubMed

Chen, Yuhan; Wang, Shengjun; Hilgetag, Claus C; Zhou, Changsong

2017-09-01

The primate connectome, possessing a characteristic global topology and specific regional connectivity profiles, is well organized to support both segregated and integrated brain function. However, the organization mechanisms shaping the characteristic connectivity and its relationship to functional requirements remain unclear. The primate brain connectome is shaped by metabolic economy as well as functional values. Here, we explored the influence of two competing factors and additional advanced functional requirements on the primate connectome employing an optimal trade-off model between neural wiring cost and the representative functional requirement of processing efficiency. Moreover, we compared this model with a generative model combining spatial distance and topological similarity, with the objective of statistically reproducing multiple topological features of the network. The primate connectome indeed displays a cost-efficiency trade-off and that up to 67% of the connections were recovered by optimal combination of the two basic factors of wiring economy and processing efficiency, clearly higher than the proportion of connections (56%) explained by the generative model. While not explicitly aimed for, the trade-off model captured several key topological features of the real connectome as the generative model, yet better explained the connectivity of most regions. The majority of the remaining 33% of connections unexplained by the best trade-off model were long-distance links, which are concentrated on few cortical areas, termed long-distance connectors (LDCs). The LDCs are mainly non-hubs, but form a densely connected group overlapping on spatially segregated functional modalities. LDCs are crucial for both functional segregation and integration across different scales. These organization features revealed by the optimization analysis provide evidence that the demands of advanced functional segregation and integration among spatially distributed regions may play a significant role in shaping the cortical connectome, in addition to the basic cost-efficiency trade-off. These findings also shed light on inherent vulnerabilities of brain networks in diseases.

The Design-To-Cost Manifold

NASA Technical Reports Server (NTRS)

Dean, Edwin B.

1990-01-01

Design-to-cost is a popular technique for controlling costs. Although qualitative techniques exist for implementing design to cost, quantitative methods are sparse. In the launch vehicle and spacecraft engineering process, the question whether to minimize mass is usually an issue. The lack of quantification in this issue leads to arguments on both sides. This paper presents a mathematical technique which both quantifies the design-to-cost process and the mass/complexity issue. Parametric cost analysis generates and applies mathematical formulas called cost estimating relationships. In their most common forms, they are continuous and differentiable. This property permits the application of the mathematics of differentiable manifolds. Although the terminology sounds formidable, the application of the techniques requires only a knowledge of linear algebra and ordinary differential equations, common subjects in undergraduate scientific and engineering curricula. When the cost c is expressed as a differentiable function of n system metrics, setting the cost c to be a constant generates an n-1 dimensional subspace of the space of system metrics such that any set of metric values in that space satisfies the constant design-to-cost criterion. This space is a differentiable manifold upon which all mathematical properties of a differentiable manifold may be applied. One important property is that an easily implemented system of ordinary differential equations exists which permits optimization of any function of the system metrics, mass for example, over the design-to-cost manifold. A dual set of equations defines the directions of maximum and minimum cost change. A simplified approximation of the PRICE H(TM) production-production cost is used to generate this set of differential equations over [mass, complexity] space. The equations are solved in closed form to obtain the one dimensional design-to-cost trade and design-for-cost spaces. Preliminary results indicate that cost is relatively insensitive to changes in mass and that the reduction of complexity, both in the manufacturing process and of the spacecraft, is dominant in reducing cost.

Uso de recursos y costos de hospitalizaciones por insufi ciencia card í aca: un estudio retrospective multic é ntrico en Argentina.

PubMed

Augustovski, Federico; Caporale, Joaquín; Fosco, Matías; Alcaraz, Andrea; Diez, Mirta; Thierer, Jorge; Peradejordi, Margarita; Pichon Riviere, Andrés

2017-12-01

Heart failure has a great impact on health budget, mainly due to the cost of hospitalizations. Our aim was to describe health resource use and costs of heart failure admissions in three important institutions in Argentina. Multi-center retrospective cohort study, with descriptive and analytical analysis by subgroups of ejection fraction, blood pressure and renal function at admission. Generalized linear models were used to assess the association of independent variables to main outcomes. We included 301 subjects; age 75.3±11.8 years; 37% women; 57% with depressed ejection fraction; 46% of coronary etiology. Blood pressure at admission was 129.8±29.7 mmHg; renal function 57.9±26.2 ml/min/1.73 m 2 . Overall mortality was 7%. Average length of stay was 7.82±7.06 days (median 5.69), and was significantly longer in patients with renal impairment (8.9 vs. 8.18; p=0.03) and shorter in those with high initial blood pressure (6.08±4.03; p=0.009). Mean cost per patient was AR$68,861±96,066 (US$=8,071; 1US$=AR$8.532); 71% attributable to hospital stay, 20% to interventional procedures and 6.7% to diagnostic studies. Variables independently associated with higher costs were depressed ejection fraction, presence of valvular disease, and impaired renal function. Resource use and costs associated to hospitalizations for heart failure is high, and the highest proportion is attributable to the costs related to hospital stay. Copyright © 2017. Published by Elsevier Inc.

[Changes of agroecosystem services value under effects of land consolidation].

PubMed

Zhang, Zhen; Gao, Jin-Quan; Wei, Chao-Fu

2010-03-01

This paper quantitatively described the changes of agroecosystem functions before (2003) and after (2007) the implementation of Gaolong land consolidation project in Hechuan of Chongqing. Engineering design and shadow price were integrated to quantify the effects of the project on the functions, and cost-benefit analysis was used to further explain the economic meanings of the functions, and to analyze the changes of the agroecosystem services value under effects of the project. Compared with that before the land consolidation, the agroecosystem services value after the land consolidation was somewhat improved, with the largest increment of nutrient cycling function and the smallest change of soil conservation function. In the implementation of the project, the changes of the agroecosystem services value induced by farmland water conservancy, field road building, and land-leveling engineering mainly manifested in the change of disturbance function. From the 7th to 35th year after the project, the cost benefit would have a rapid increase, and tended to be stable after then, giving a weak ecological pressure and little services value loss, and benefiting the improvement of regional ecological environment.

Cost-effectiveness analysis of different embryo transfer strategies in England.

PubMed

Dixon, S; Faghih Nasiri, F; Ledger, W L; Lenton, E A; Duenas, A; Sutcliffe, P; Chilcott, J B

2008-05-01

The objective of this study was to assess the cost-effectiveness of different embryo transfer strategies for a single cycle when two embryos are available, and taking the NHS cost perspective. Cost-effectiveness model. Five in vitro fertilisation (IVF) centres in England between 2003/04 and 2004/05. Women with two embryos available for transfer in three age groups (<30, 30-35 and 36-39 years). A decision analytic model was constructed using observational data collected from a sample of fertility centres in England. Costs and adverse outcomes are estimated up to 5 years after the birth. Incremental cost per live birth was calculated for different embryo transfer strategies and for three separate age groups: less than 30, 30-35 and 36-39 years. Premature birth, neonatal intensive care unit admissions and days, cerebral palsy and incremental cost-effectiveness ratios. Single fresh embryo transfer (SET) plus frozen single embryo transfer (fzSET) is the more costly in terms of IVF costs, but the lower rates of multiple births mean that in terms of total costs, it is less costly than double embryo transfer (DET). Adverse events increase when moving from SET to SET+fzSET to DET. The probability of SET+fzSET being cost-effective decreases with age. When SET is included in the analysis, SET+fzSET no longer becomes a cost-effective option at any threshold value for all age groups studied. The analyses show that the choice of embryo transfer strategy is a function of four factors: the age of the mother, the relevance of the SET option, the value placed on a live birth and the relative importance placed on adverse outcomes. For each patient group, the choice of strategy is a trade-off between the value placed on a live birth and cost.

Abort Options for Human Missions to Earth-Moon Halo Orbits

NASA Technical Reports Server (NTRS)

Jesick, Mark C.

2013-01-01

Abort trajectories are optimized for human halo orbit missions about the translunar libration point (L2), with an emphasis on the use of free return trajectories. Optimal transfers from outbound free returns to L2 halo orbits are numerically optimized in the four-body ephemeris model. Circumlunar free returns are used for direct transfers, and cislunar free returns are used in combination with lunar gravity assists to reduce propulsive requirements. Trends in orbit insertion cost and flight time are documented across the southern L2 halo family as a function of halo orbit position and free return flight time. It is determined that the maximum amplitude southern halo incurs the lowest orbit insertion cost for direct transfers but the maximum cost for lunar gravity assist transfers. The minimum amplitude halo is the most expensive destination for direct transfers but the least expensive for lunar gravity assist transfers. The on-orbit abort costs for three halos are computed as a function of abort time and return time. Finally, an architecture analysis is performed to determine launch and on-orbit vehicle requirements for halo orbit missions.

Multidisciplinary Design Optimization for Glass-Fiber Epoxy-Matrix Composite 5 MW Horizontal-Axis Wind-Turbine Blades

NASA Astrophysics Data System (ADS)

Grujicic, M.; Arakere, G.; Pandurangan, B.; Sellappan, V.; Vallejo, A.; Ozen, M.

2010-11-01

A multi-disciplinary design-optimization procedure has been introduced and used for the development of cost-effective glass-fiber reinforced epoxy-matrix composite 5 MW horizontal-axis wind-turbine (HAWT) blades. The turbine-blade cost-effectiveness has been defined using the cost of energy (CoE), i.e., a ratio of the three-blade HAWT rotor development/fabrication cost and the associated annual energy production. To assess the annual energy production as a function of the blade design and operating conditions, an aerodynamics-based computational analysis had to be employed. As far as the turbine blade cost is concerned, it is assessed for a given aerodynamic design by separately computing the blade mass and the associated blade-mass/size-dependent production cost. For each aerodynamic design analyzed, a structural finite element-based and a post-processing life-cycle assessment analyses were employed in order to determine a minimal blade mass which ensures that the functional requirements pertaining to the quasi-static strength of the blade, fatigue-controlled blade durability and blade stiffness are satisfied. To determine the turbine-blade production cost (for the currently prevailing fabrication process, the wet lay-up) available data regarding the industry manufacturing experience were combined with the attendant blade mass, surface area, and the duration of the assumed production run. The work clearly revealed the challenges associated with simultaneously satisfying the strength, durability and stiffness requirements while maintaining a high level of wind-energy capture efficiency and a lower production cost.

Integrated Glass Coating Manufacturing Line

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

Brophy, Brenor

2015-09-30

This project aims to enable US module manufacturers to coat glass with Enki’s state of the art tunable functionalized AR coatings at the lowest possible cost and highest possible performance by encapsulating Enki’s coating process in an integrated tool that facilitates effective process improvement through metrology and data analysis for greater quality and performance while reducing footprint, operating and capital costs. The Phase 1 objective was a fully designed manufacturing line, including fully specified equipment ready for issue of purchase requisitions; a detailed economic justification based on market prices at the end of Phase 1 and projected manufacturing costs andmore » a detailed deployment plan for the equipment.« less

41 CFR 109-1.5204 - Review and approval of a designated contractor's personal property management system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... overhaul; and (2) An analysis of the cost to implement the overhaul within a year versus a proposed... be based on a formal comprehensive appraisal or a series of formal appraisals of the functional...

Recycled-tire pyrolytic carbon made functional: A high-arsenite [As(III)] uptake material PyrC350®.

PubMed

Mouzourakis, E; Georgiou, Y; Louloudi, M; Konstantinou, I; Deligiannakis, Y

2017-03-15

A novel material, PyrC 350 ® , has been developed from pyrolytic-tire char (PyrC), as an efficient low-cost Arsenite [As(III)] adsorbent from water. PyrC 350 ® achieves 31mgg -1 As(III) uptake, that remains unaltered at pH=4-8.5. A theoretical Surface Complexation Model has been developed that explains the adsorption mechanism, showing that in situ formed Fe 3 C, ZnS particles act cooperatively with the carbon matrix for As(III) adsorption. Addressing the key-issue of cost-effectiveness, we provide a comparison of As(III)-uptake effectiveness in conjunction with a cost analysis, showing that PyrC 350 ® stands in the top of [effectiveness/cost] vs. existing carbon-based, low-cost materials. Copyright © 2016 Elsevier B.V. All rights reserved.

Combining Water Quality and Cost-Benefit Analysis to Examine the Implications of Agricultural Best Management Practices

NASA Astrophysics Data System (ADS)

Rao, N. S.; Easton, Z. M.; Lee, D. R.; Steenhuis, T. S.

2007-12-01

Nutrient runoff from agricultural fields threatens water quality and can impair habitats in many watersheds. Agencies consider these potential risks as they determine acceptable levels of nutrient loading. For example, in the New York City (NYC) watershed, the Environmental Protection Agency's Total Maximum Daily Load (TMDL) for phosphorus (P) has been set at 15μg P L-1 to protect against eutrophication and bacterial outbreaks. In the NYC watersheds agricultural Best Management Practices (BMPs) are the primary means to control nonpoint source P loading. BMPs include riparian buffers, filter strips, manure storage facilities, crop rotation, stripcropping, tree planting and nutrient management plans (NMPs). Water quality research on BMPs to date has included studies on site-specificity of different BMPs, short and long term BMP efficacy, and placement of BMPs with respect to critical source areas. A necessary complement to studies addressing water quality aspects of different BMPs are studies examining the cost-benefit aspects of BMPs. In general, there are installment, maintenance and opportunity costs associated with each BMP, and there are benefits, including cost share agreements between farmers and farm agencies, and increased efficiency of farm production and maintenance. Combining water quality studies and related cost-benefit analyses would help planners and watershed managers determine how best improve water quality. Our research examines the costs-benefit structure associated with BMP scenarios on a one-farm headwater watershed in the Catskill Mountains of NY. The different scenarios include "with and without" BMPs, combinations of BMPs, and different BMP placements across agricultural fields. The costs associated with each BMP scenarios are determined using information from farm agencies and watershed planning agencies. With these data we perform a cost-benefit analysis for the different BMP scenarios and couple the water quality modeling using the Variable Source Loading Function (VSLF) model (Schneiderman et al., 2007) with the cost-benefit analysis to look at the specific water quality and economic consequences of different watershed management scenarios. The results of our study will be useful for planners and watershed managers in determining how best to reduce nonpoint source pollution in a cost-effective manner. References Schneiderman, E.M., T.S. Steenhuis, D.J. Thongs, Z.M. Easton, M.S. Zion, G.F. Mendoza, M.T. Walter, and A.C. Neal. 2007. Incorporating variable source area hydrology into curve number based watershed loading functions. Hydrol. Proc. (In Press).

What Do Cost Functions Tell Us about the Cost of an Adequate Education?

ERIC Educational Resources Information Center

Costrell, Robert M.; Hanushek, Eric; Loeb, Susanna

2008-01-01

Econometric cost functions have begun to appear in education adequacy cases with greater frequency. Cost functions are superficially attractive because they give the impression of objectivity, holding out the promise of scientifically estimating the cost of achieving specified levels of performance from actual data on spending. By contrast, the…

Economic analysis of standard interface modules for use with the multi-mission spacecraft. Volume 2: Appendices and drawings

NASA Technical Reports Server (NTRS)

Greenberg, J. S.; Miller, B. P.; Russell, S.; Becar, N.

1976-01-01

The cost savings that could be obtained by the use of SIM to perform certain sensor electrical interfacing functions that were historically an integral part of the sensor are evaluated. Reduction in both the nonrecurring and recurring costs of this sensor interface hardware could be achieved through the use of SIM, and the study concludes that the development and use of certain power conditioning and data handling SIM units are economically justified.

Polysilicon for everything?

NASA Astrophysics Data System (ADS)

Ward, M. C. L.; McNie, Mark E.; Bunyan, Robert J.; King, David O.; Carline, Roger T.; Wilson, Rebecca; Gillham, J. P.

1998-09-01

We review some of the attractive attributes of microengineering and relate them to features of the highly successful silicon microelectronics industry. We highlight the need for cost effective functionality rather than ultimate performance as a driver for success and review key examples of polysilicon devices from this point of view. The effective exploitation of the data generated by the cost effective polysilicon sensors is also considered and we conclude that `non traditional' data analysis will need to be exploited if full use is to be made of polysilicon devices.

Concepts. The Journal of Defense Systems Acquisition Management. Spring 1981. Volume 4. Number 2. Special Issue - Cost Analysis

DTIC Science & Technology

1981-01-01

Headquarters U.S. Air Force; Mr. Joseph T. Kammerer, Director of Cost Estimating, Head- quarters Naval Material Command; and Dr. Michael Sovereign...different functional, but related responsibilities. l SIR I SECTION stimating in the 80s: 23 Panelist Presentation 11 Joseph T. Kammerer My...rates used in DOD are developed by the Office of the Secretary of Defense under the direction of the Office of Management and Budget (OMB). Joseph T

Assessing efficiency of spatial sampling using combined coverage analysis in geographical and feature spaces

NASA Astrophysics Data System (ADS)

Hengl, Tomislav

2015-04-01

Efficiency of spatial sampling largely determines success of model building. This is especially important for geostatistical mapping where an initial sampling plan should provide a good representation or coverage of both geographical (defined by the study area mask map) and feature space (defined by the multi-dimensional covariates). Otherwise the model will need to extrapolate and, hence, the overall uncertainty of the predictions will be high. In many cases, geostatisticians use point data sets which are produced using unknown or inconsistent sampling algorithms. Many point data sets in environmental sciences suffer from spatial clustering and systematic omission of feature space. But how to quantify these 'representation' problems and how to incorporate this knowledge into model building? The author has developed a generic function called 'spsample.prob' (Global Soil Information Facilities package for R) and which simultaneously determines (effective) inclusion probabilities as an average between the kernel density estimation (geographical spreading of points; analysed using the spatstat package in R) and MaxEnt analysis (feature space spreading of points; analysed using the MaxEnt software used primarily for species distribution modelling). The output 'iprob' map indicates whether the sampling plan has systematically missed some important locations and/or features, and can also be used as an input for geostatistical modelling e.g. as a weight map for geostatistical model fitting. The spsample.prob function can also be used in combination with the accessibility analysis (cost of field survey are usually function of distance from the road network, slope and land cover) to allow for simultaneous maximization of average inclusion probabilities and minimization of total survey costs. The author postulates that, by estimating effective inclusion probabilities using combined geographical and feature space analysis, and by comparing survey costs to representation efficiency, an optimal initial sampling plan can be produced which satisfies both criteria: (a) good representation (i.e. within a tolerance threshold), and (b) minimized survey costs. This sampling analysis framework could become especially interesting for generating sampling plans in new areas e.g. for which no previous spatial prediction model exists. The presentation includes data processing demos with standard soil sampling data sets Ebergotzen (Germany) and Edgeroi (Australia), also available via the GSIF package.

Safe Upper-Bounds Inference of Energy Consumption for Java Bytecode Applications

NASA Technical Reports Server (NTRS)

Navas, Jorge; Mendez-Lojo, Mario; Hermenegildo, Manuel V.

2008-01-01

Many space applications such as sensor networks, on-board satellite-based platforms, on-board vehicle monitoring systems, etc. handle large amounts of data and analysis of such data is often critical for the scientific mission. Transmitting such large amounts of data to the remote control station for analysis is usually too expensive for time-critical applications. Instead, modern space applications are increasingly relying on autonomous on-board data analysis. All these applications face many resource constraints. A key requirement is to minimize energy consumption. Several approaches have been developed for estimating the energy consumption of such applications (e.g. [3, 1]) based on measuring actual consumption at run-time for large sets of random inputs. However, this approach has the limitation that it is in general not possible to cover all possible inputs. Using formal techniques offers the potential for inferring safe energy consumption bounds, thus being specially interesting for space exploration and safety-critical systems. We have proposed and implemented a general frame- work for resource usage analysis of Java bytecode [2]. The user defines a set of resource(s) of interest to be tracked and some annotations that describe the cost of some elementary elements of the program for those resources. These values can be constants or, more generally, functions of the input data sizes. The analysis then statically derives an upper bound on the amount of those resources that the program as a whole will consume or provide, also as functions of the input data sizes. This article develops a novel application of the analysis of [2] to inferring safe upper bounds on the energy consumption of Java bytecode applications. We first use a resource model that describes the cost of each bytecode instruction in terms of the joules it consumes. With this resource model, we then generate energy consumption cost relations, which are then used to infer safe upper bounds. How energy consumption for each bytecode instruction is measured is beyond the scope of this paper. Instead, this paper is about how to infer safe energy consumption estimations assuming that those energy consumption costs are provided. For concreteness, we use a simplified version of an existing resource model [1] in which an energy consumption cost for individual Java opcodes is defined.

Cost component analysis.

PubMed

Lörincz, András; Póczos, Barnabás

2003-06-01

In optimizations the dimension of the problem may severely, sometimes exponentially increase optimization time. Parametric function approximatiors (FAPPs) have been suggested to overcome this problem. Here, a novel FAPP, cost component analysis (CCA) is described. In CCA, the search space is resampled according to the Boltzmann distribution generated by the energy landscape. That is, CCA converts the optimization problem to density estimation. Structure of the induced density is searched by independent component analysis (ICA). The advantage of CCA is that each independent ICA component can be optimized separately. In turn, (i) CCA intends to partition the original problem into subproblems and (ii) separating (partitioning) the original optimization problem into subproblems may serve interpretation. Most importantly, (iii) CCA may give rise to high gains in optimization time. Numerical simulations illustrate the working of the algorithm.

Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions

PubMed Central

2017-01-01

Background A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. Objective The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. Methods We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. Results We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Conclusions Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR system use, and costs associated with PHR data storage and analytics. PMID:29141839

Household cost of out-patient treatment of Buruli ulcer in Ghana: a case study of Obom in Ga South Municipality

PubMed Central

2013-01-01

Background The economic burden of diseases has become increasingly relevant to policy makers as healthcare expenditure keep rising in the face of limited and competing resources. Buruli ulcer (BU), a neglected but treatable tropical disease caused by Mycobacterium ulcerans, the only known environmental mycobacterium is capable of causing long term disability when left untreated. However, most BU studies have tended to focused on its bacteriology, epidemiology, entomology and other social determinants to the neglect of its economic evaluation. This paper reports estimated the household economic costs of BU and describe the intangible cost suffered by BU patients in an endemic area. Methods Retrospective one year cost data was used. A total of 63 confirmed BU cases were randomly sampled for the study. Economic cost and cost burden of BU were estimated. Sensitivity analysis was conducted to test the robustness of the cost estimates. Intangible cost measured stigmatization, pain, functional limitation and social isolation of children. Results The annual total household economic cost was US$35,915.98, of which about 65% was cost incurred by children with a mean cost of US$521.04. The mean annual household cost was US$570.09. The direct cost was 96% of the total cost. Non-medical cost accounts for about 97% of the direct cost with a mean cost of US$529.27. The mean medical cost was US$18.94. The main cost drivers of the household costs were transportation (78%) and food (12%). Caregivers and adult patients lost a total of 535 productive days seeking care, which gives an indirect cost valued at US$1,378.67 with a mean of US$21.88. A total of 365 school days (about 1 year) were lost by 19 BU patients (mean, 19.2 days). Functional loss and pain were low, and stigma rated moderate. Most children suffering from BU (84%) were socially isolated. Conclusion Household cost burden of out-patient BU ulcer treatment was high. Household cost of BU is therefore essential in the design of its intervention. BU afflicted children experience social isolation. PMID:24313975

Function after spinal treatment, exercise, and rehabilitation: cost-effectiveness analysis based on a randomized controlled trial.

PubMed

Morris, Stephen; Morris, Tim P; McGregor, Alison H; Doré, Caroline J; Jamrozik, Konrad

2011-10-01

Cost-effectiveness analysis alongside a factorial randomized controlled trial. To assess the cost-effectiveness of a rehabilitation program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery. There is little knowledge about the cost-effectiveness of postoperative management of patients after spinal surgery. A total of 338 patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehabilitation only, booklet only, rehabilitation plus booklet, or usual care only. Interactions between booklet and rehabilitation were nonsignificant; hence, we compare booklet versus no booklet and rehabilitation versus no rehabilitation. We adopt an English National Health Service and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A 1-year time horizon was used. Outcomes were measured in terms of quality-adjusted life years. Health-related quality of life was reported by patients using the EuroQol-5D (EQ-5D). A comprehensive range of health service contacts were included in the cost analysis. There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean quality-adjusted life years gained per patient of booklet versus no booklet were -£87 (95% CI: -£1221 to £1047) and -0.023 (95% CI: -0.068 to 0.023), respectively. Figures for rehabilitation versus no rehabilitation were £160 (95% CI: -£984 to £1304) and 0.002 (95% CI: -0.044 to 0.048), respectively. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English National Health Service. Cost-effectiveness evidence does not support use of booklet over no booklet or rehabilitation over no rehabilitation for the postoperative management of patients after spinal surgery.

Weight and the Future of Space Flight Hardware Cost Modeling

NASA Technical Reports Server (NTRS)

Prince, Frank A.

2003-01-01

Weight has been used as the primary input variable for cost estimating almost as long as there have been parametric cost models. While there are good reasons for using weight, serious limitations exist. These limitations have been addressed by multi-variable equations and trend analysis in models such as NAFCOM, PRICE, and SEER; however, these models have not be able to address the significant time lags that can occur between the development of similar space flight hardware systems. These time lags make the cost analyst's job difficult because insufficient data exists to perform trend analysis, and the current set of parametric models are not well suited to accommodating process improvements in space flight hardware design, development, build and test. As a result, people of good faith can have serious disagreement over the cost for new systems. To address these shortcomings, new cost modeling approaches are needed. The most promising approach is process based (sometimes called activity) costing. Developing process based models will require a detailed understanding of the functions required to produce space flight hardware combined with innovative approaches to estimating the necessary resources. Particularly challenging will be the lack of data at the process level. One method for developing a model is to combine notional algorithms with a discrete event simulation and model changes to the total cost as perturbations to the program are introduced. Despite these challenges, the potential benefits are such that efforts should be focused on developing process based cost models.

Mixed kernel function support vector regression for global sensitivity analysis

NASA Astrophysics Data System (ADS)

Cheng, Kai; Lu, Zhenzhou; Wei, Yuhao; Shi, Yan; Zhou, Yicheng

2017-11-01

Global sensitivity analysis (GSA) plays an important role in exploring the respective effects of input variables on an assigned output response. Amongst the wide sensitivity analyses in literature, the Sobol indices have attracted much attention since they can provide accurate information for most models. In this paper, a mixed kernel function (MKF) based support vector regression (SVR) model is employed to evaluate the Sobol indices at low computational cost. By the proposed derivation, the estimation of the Sobol indices can be obtained by post-processing the coefficients of the SVR meta-model. The MKF is constituted by the orthogonal polynomials kernel function and Gaussian radial basis kernel function, thus the MKF possesses both the global characteristic advantage of the polynomials kernel function and the local characteristic advantage of the Gaussian radial basis kernel function. The proposed approach is suitable for high-dimensional and non-linear problems. Performance of the proposed approach is validated by various analytical functions and compared with the popular polynomial chaos expansion (PCE). Results demonstrate that the proposed approach is an efficient method for global sensitivity analysis.

MESA - A new approach to low cost scientific spacecraft

NASA Astrophysics Data System (ADS)

Keyes, G. W.; Case, C. M.

1982-09-01

Today, the greatest obstacle to science and exploration in space is its cost. The present investigation is concerned with approaches for reducing this cost. Trends in the scientific spacecraft market are examined, and a description is presented for the MESA space platform concept. The cost drivers are considered, taking into account planning, technical aspects, and business factors. It is pointed out that the primary function of the MESA concept is to provide a satellite system at the lowest possible price. In order to reach this goal an attempt is made to benefit from all of the considered cost drivers. It is to be tried to work with the customer early in the mission analysis stage in order to assist in finding the right compromise between mission cost and return. A three phase contractual arrangement is recommended for MESA platforms. The phases are related to mission feasibility, specification definition, and design and development. Modular kit design promotes flexibility at low cost.

Cost-Utility and Cost-Effectiveness Analyses of Face-to-Face Versus Telephone-Based Nonpharmacologic Multidisciplinary Treatments for Patients With Generalized Osteoarthritis.

PubMed

Cuperus, Nienke; van den Hout, Wilbert B; Hoogeboom, Thomas J; van den Hoogen, Frank H J; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M

2016-04-01

To evaluate, from a societal perspective, the cost utility and cost effectiveness of a nonpharmacologic face-to-face treatment program compared with a telephone-based treatment program for patients with generalized osteoarthritis (GOA). An economic evaluation was carried out alongside a randomized clinical trial involving 147 patients with GOA. Program costs were estimated from time registrations. One-year medical and nonmedical costs were estimated using cost questionnaires. Quality-adjusted life years (QALYs) were estimated using the EuroQol (EQ) classification system, EQ rating scale, and the Short Form 6D (SF-6D). Daily function was measured using the Health Assessment Questionnaire (HAQ) disability index (DI). Cost and QALY/effect differences were analyzed using multilevel regression analysis and cost-effectiveness acceptability curves. Medical costs of the face-to-face treatment and telephone-based treatment were estimated at €387 and €252, respectively. The difference in total societal costs was nonsignificantly in favor of the face-to-face program (difference €708; 95% confidence interval [95% CI] -€5,058, €3,642). QALYs were similar for both groups according to the EQ, but were significantly in favor of the face-to-face group, according to the SF-6D (difference 0.022 [95% CI 0.000, 0.045]). Daily function was similar according to the HAQ DI. Since both societal costs and QALYs/effects were in favor of the face-to-face program, the economic assessment favored this program, regardless of society's willingness to pay. There was a 65-90% chance that the face-to-face program had better cost utility and a 60-70% chance of being cost effective. This economic evaluation from a societal perspective showed that a nonpharmacologic, face-to-face treatment program for patients with GOA was likely to be cost effective, relative to a telephone-based program. © 2016, American College of Rheumatology.

Specialty hospitals emulating focused factories: a case study.

PubMed

Kumar, Sameer

2010-01-01

For 15 years general hospital managers faced new competition from for-profit specialty hospitals that operate on a "focused factory" model, which threaten to siphon-off the most profitable patients. This paper aims to discuss North American specialty hospitals and to review rising costs impact on general hospital operations. The focus is to discover whether specialty hospitals are more efficient than general hospitals; if so, how significant is the difference and also what can general hospitals do in light of the rising specialty hospitals. The case study involves stochastic frontier regression analysis using Cobb-Douglas and Translog cost functions to compare Minnesota general and specialty hospital efficiency. Analysis is based on data from 117 general and 19 specialty hospitals. The results suggest that specialty hospitals are significantly more efficient than general hospitals. Overall, general hospitals were found to be more than twice as inefficient compared with specialty hospitals in the sample. Some cost-cutting factors highlighted can be implemented to trim rising costs. The case study highlights some managerial levers that general hospital operational managers might use to control rising costs. This also helps them compete with specialty hospitals by reducing overheads and other major costs. The study is based on empirical modeling for an important healthcare operational challenge and provides additional in-depth information that has health policy implications. The analysis and findings enable healthcare managers to guide their institutions in a new direction during a time of change within the industry.

The cost of sustaining a patient-centered medical home: experience from 2 states.

PubMed

Magill, Michael K; Ehrenberger, David; Scammon, Debra L; Day, Julie; Allen, Tatiana; Reall, Andreu J; Sides, Rhonda W; Kim, Jaewhan

2015-09-01

As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these "advanced primary care" functions. A key required input is personnel effort. This study's objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. © 2015 Annals of Family Medicine, Inc.

The Cost of Sustaining a Patient-Centered Medical Home: Experience From 2 States

PubMed Central

Magill, Michael K.; Ehrenberger, David; Scammon, Debra L.; Day, Julie; Allen, Tatiana; Reall, Andreu J.; Sides, Rhonda W.; Kim, Jaewhan

2015-01-01

PURPOSE As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. METHODS We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. RESULTS Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. CONCLUSIONS Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. PMID:26371263

Steering of Frequency Standards by the Use of Linear Quadratic Gaussian Control Theory

NASA Technical Reports Server (NTRS)

Koppang, Paul; Leland, Robert

1996-01-01

Linear quadratic Gaussian control is a technique that uses Kalman filtering to estimate a state vector used for input into a control calculation. A control correction is calculated by minimizing a quadratic cost function that is dependent on both the state vector and the control amount. Different penalties, chosen by the designer, are assessed by the controller as the state vector and control amount vary from given optimal values. With this feature controllers can be designed to force the phase and frequency differences between two standards to zero either more or less aggressively depending on the application. Data will be used to show how using different parameters in the cost function analysis affects the steering and the stability of the frequency standards.

Welfare implications of energy and environmental policies: A general equilibrium approach

NASA Astrophysics Data System (ADS)

Iqbal, Mohammad Qamar

Government intervention and implementation of policies can impose a financial and social cost. To achieve a desired goal there could be several different alternative policies or routes, and government would like to choose the one which imposes the least social costs or/and generates greater social benefits. Therefore, applied welfare economics plays a vital role in public decision making. This paper recasts welfare measure such as equivalent variation, in terms of the prices of factors of production rather than product prices. This is made possible by using duality theory within a general equilibrium framework and by deriving alternative forms of indirect utility functions and expenditure functions in factor prices. Not only we are able to recast existing welfare measures in factor prices, we are able to perform a true cost-benefit analysis of government policies using comparative static analysis of different equilibria and breaking up monetary measure of welfare change such as equivalent variation into its components. A further advantage of our research is demonstrated by incorporating externalities and public goods in the utility function. It is interesting that under a general equilibrium framework optimal income tax tends to reduce inequalities. Results show that imposition of taxes at socially optimal rates brings a net gain to the society. It was also seen that even though a pollution tax may reduce GDP, it leads to an increase in the welfare of the society if it is imposed at an optimal rate.

Cost-Effectiveness of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease

PubMed Central

Erickson, Kevin F.; Chertow, Glenn M.; Goldhaber-Fiebert, Jeremy D.

2014-01-01

Background: In the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and its Outcomes (TEMPO) trial, tolvaptan significantly reduced expansion of kidney volume and loss of kidney function. Objective: To determine how benefits observed in the TEMPO trial might relate to longer-term health outcomes such as progression to end-stage renal disease (ESRD) and mortality in addition to its cost-effectiveness. Design: A decision-analytic model. Data Sources: Published literature. Target Population: Persons with early Autosomal Dominant Polycystic Kidney Disease (ADPKD). Time Horizon: Lifetime. Perspective: Societal. Interventions: We compared a strategy where patients receive tolvaptan therapy until death, development of ESRD, or liver complications to one where they do not receive tolvaptan. Outcome Measures: Median age at ESRD onset, life expectancy, discounted quality-adjusted life years (QALYs) and lifetime costs (in 2010 USD), and incremental cost-effectiveness ratios. Results of Base Case Analysis: Tolvaptan prolonged the median age at ESRD onset by 6.5 years and increased life expectancy by 2.6 years. At a drug cost of $5,760 per month, tolvaptan cost $744,100 per QALY gained compared to standard care. Results of Sensitivity Analysis: For patients with ADPKD progressing more slowly, tolvaptan’s cost per QALY gained was even higher. Limitations: Although the TEMPO trial followed patients for 3 years, our main analysis assumed that the clinical benefits of tolvaptan persisted over patients’ lifetimes. Conclusions and Relevance: Assuming that tolvaptan’s benefits persist longer term, the drug may slow progression to ESRD and reduce mortality. However, barring an approximately 95% reduction in the price of tolvaptan, its cost-effectiveness does not compare favorably with many other commonly accepted medical interventions. PMID:24042366

Error and Uncertainty Analysis for Ecological Modeling and Simulation

DTIC Science & Technology

2001-12-01

management (LRAM) accounting for environmental, training, and economic factors. In the ELVS methodology, soil erosion status is used as a quantitative...Monte-Carlo approach. The optimization is realized through economic functions or on decision constraints, such as, unit sample cost, number of samples... nitrate flux to the Gulf of Mexico. Nature (Brief Communication) 414: 166-167. (Uncertainty analysis done with SERDP software) Gertner, G., G

A Comparative Analysis for Wilderness User Fee Policy.

ERIC Educational Resources Information Center

Leuschner, William A.; And Others

1987-01-01

Two similar wilderness areas, one of which charges user fees, were sampled in order to compare user characteristics, trip characteristics, and travel cost demand functions. The purpose was to examine the effect fees had on user behavior and choices of area. Results are presented. (MT)

76 FR 52533 - Personnel Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

... financial impact on agencies. Another commenter stated that the OPM's Enterprise Human Resource Integration..., statistical analysis, and raw data used to justify the rule and the human capital cost increase to implement... activities that are properly considered functions of agency human resources offices and thus ensure that an...

Scalable Low-Cost Fabrication of Disposable Paper Sensors for DNA Detection

PubMed Central

2015-01-01

Controlled integration of features that enhance the analytical performance of a sensor chip is a challenging task in the development of paper sensors. A critical issue in the fabrication of low-cost biosensor chips is the activation of the device surface in a reliable and controllable manner compatible with large-scale production. Here, we report stable, well-adherent, and repeatable site-selective deposition of bioreactive amine functionalities and biorepellant polyethylene glycol-like (PEG) functionalities on paper sensors by aerosol-assisted, atmospheric-pressure, plasma-enhanced chemical vapor deposition. This approach requires only 20 s of deposition time, compared to previous reports on cellulose functionalization, which takes hours. A detailed analysis of the near-edge X-ray absorption fine structure (NEXAFS) and its sensitivity to the local electronic structure of the carbon and nitrogen functionalities. σ*, π*, and Rydberg transitions in C and N K-edges are presented. Application of the plasma-processed paper sensors in DNA detection is also demonstrated. PMID:25423585

Scalable Low-Cost Fabrication of Disposable Paper Sensors for DNA Detection

DOE PAGES

Gandhiraman, Ram P.; Nordlund, Dennis; Jayan, Vivek; ...

2014-11-25

Controlled integration of features that enhance the analytical performance of a sensor chip is a challenging task in the development of paper sensors. A critical issue in the fabrication of low-cost biosensor chips is the activation of the device surface in a reliable and controllable manner compatible with large-scale production. Here, we report stable, well-adherent, and repeatable site-selective deposition of bioreactive amine functionalities and biorepellant polyethylene glycol-like (PEG) functionalities on paper sensors by aerosol-assisted, atmospheric-pressure, plasma-enhanced chemical vapor deposition. This approach requires only 20 s of deposition time, compared to previous reports on cellulose functionalization, which takes hours. We presentmore » a detailed analysis of the near-edge X-ray absorption fine structure (NEXAFS) and its sensitivity to the local electronic structure of the carbon and nitrogen functionalities. σ*, π*, and Rydberg transitions in C and N K-edges. Lastly, application of the plasma-processed paper sensors in DNA detection is also demonstrated.« less

Candidate Mission from Planet Earth control and data delivery system architecture

NASA Technical Reports Server (NTRS)

Shapiro, Phillip; Weinstein, Frank C.; Hei, Donald J., Jr.; Todd, Jacqueline

1992-01-01

Using a structured, experienced-based approach, Goddard Space Flight Center (GSFC) has assessed the generic functional requirements for a lunar mission control and data delivery (CDD) system. This analysis was based on lunar mission requirements outlined in GSFC-developed user traffic models. The CDD system will facilitate data transportation among user elements, element operations, and user teams by providing functions such as data management, fault isolation, fault correction, and link acquisition. The CDD system for the lunar missions must not only satisfy lunar requirements but also facilitate and provide early development of data system technologies for Mars. Reuse and evolution of existing data systems can help to maximize system reliability and minimize cost. This paper presents a set of existing and currently planned NASA data systems that provide the basic functionality. Reuse of such systems can have an impact on mission design and significantly reduce CDD and other system development costs.

Operations planning and analysis handbook for NASA/MSFC phase B development projects

NASA Technical Reports Server (NTRS)

Batson, Robert C.

1986-01-01

Current operations planning and analysis practices on NASA/MSFC Phase B projects were investigated with the objectives of (1) formalizing these practices into a handbook and (2) suggesting improvements. The study focused on how Science and Engineering (S&E) Operational Personnel support Program Development (PD) Task Teams. The intimate relationship between systems engineering and operations analysis was examined. Methods identified for use by operations analysts during Phase B include functional analysis, interface analysis methods to calculate/allocate such criteria as reliability, Maintainability, and operations and support cost.

Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial

PubMed Central

Landolina, Maurizio; Marzegalli, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Guenzati, Giuseppe; Curnis, Antonio; Valsecchi, Sergio; Borghetti, Francesca; Borghi, Gabriella; Masella, Cristina

2013-01-01

Background Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods Two hundred patients implanted with a wireless transmission–enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Conclusions Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. Trial Registration ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f). PMID:23722666

Early neurologically focused follow-up after cardiac arrest is cost-effective: A trial-based economic evaluation.

PubMed

Moulaert, Véronique R M; Goossens, Mariëlle; Heijnders, Irene L C; Verbunt, Jeanine A; Heugten, Caroline M van

2016-09-01

To evaluate the cost-effectiveness of an early intervention service for cardiac arrest survivors called 'Stand still …, and move on' from a societal perspective. This concise nursing intervention consists of screening for cognitive and emotional problems, information provision and support, self-management promotion, and further referral if necessary. Earlier research confirmed the feasibility of the intervention and its effectiveness in improving emotional functioning and quality of life. In this multicentre randomized controlled trial with one year follow-up 185 patients were included between April 2007 and December 2010. The experimental group received the intervention, the control group received care-as-usual. Intervention costs, other direct healthcare costs (e.g. hospital care, rehabilitation, medication, home care) and indirect costs (productivity loss) were measured during ten months using monthly cost-diaries. The economic evaluation comprised a cost-utility analysis (SF-36) and a cost-effectiveness analysis (QOLIBRI) using bootstrapping (5000 replications) to quantify uncertainty concerning the incremental cost effectiveness ratio (ICER), and the probability of the intervention being cost-effective was estimated. To check the robustness of the findings, two sensitivity analyses were performed using the EQ-5D and the complete cases respectively. Of 136 (74%) participants sufficient data concerning costs were collected to be included in this economic evaluation. Intervention costs were on average €127 (SD 85). No significant differences between groups were found with regard to overall costs. The ICERs of the cost-utility and the cost-effectiveness analyses supported the cost-effectiveness of the intervention. The probability of the intervention being cost-effective was 54-76% for the SF-36 and 94% for the QOLIBRI. Findings were robust. The intervention 'Stand still …, and move on' has positive societal economic effects and has a high probability to be cost-effective. Implementation in regular healthcare is recommended. ISRCTN74835019. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Precursor systems analyses of automated highway systems. Activity area p preliminary cost/benefit factors analysis. Volume 4. Roadway costs. Final report, September 1993-November 1994

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

NONE

1995-06-01

This report gives a preliminary cost benefit factor analysis for Automatic Highway Systems (AHS) implementation on a representative section of existing highway. The text describes the approach used to develop cost associated with the roadway portion of AHS and gives cost estimates for 5 basic implementation options: install `transparent equipment in roadway` that will give performance gains to those vehicles equipped to `see` it (e.g. magnetic nails); move towards separated roadway for AHS rumble strips or paint, then fully separated with either continuous barriers with dedicated entry/exit ramps or separate facility such an elevated structure; expand AHS capabilities further somore » AHS traffic can now use existing roadways with other traffic and formerly dedicated facilities can be converted to higher speed through traffic. However, the actual implementation will necessarily be a function of local roadway geometry, system demand, and a complex combination of other factors. Very few existing roadways can accommodate these specific conversions directly. Therefore, we have generated roadway retrofit options that can be used depending on local geometry to support this general evolution philosophy.« less

Thermodynamic analysis of energy density in pressure retarded osmosis: The impact of solution volumes and costs

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

Reimund, Kevin K.; McCutcheon, Jeffrey R.; Wilson, Aaron D.

A general method was developed for estimating the volumetric energy efficiency of pressure retarded osmosis via pressure-volume analysis of a membrane process. The resulting model requires only the osmotic pressure, π, and mass fraction, w, of water in the concentrated and dilute feed solutions to estimate the maximum achievable specific energy density, uu, as a function of operating pressure. The model is independent of any membrane or module properties. This method utilizes equilibrium analysis to specify the volumetric mixing fraction of concentrated and dilute solution as a function of operating pressure, and provides results for the total volumetric energy densitymore » of similar order to more complex models for the mixing of seawater and riverwater. Within the framework of this analysis, the total volumetric energy density is maximized, for an idealized case, when the operating pressure is π/(1+√w⁻¹), which is lower than the maximum power density operating pressure, Δπ/2, derived elsewhere, and is a function of the solute osmotic pressure at a given mass fraction. It was also found that a minimum 1.45 kmol of ideal solute is required to produce 1 kWh of energy while a system operating at “maximum power density operating pressure” requires at least 2.9 kmol. Utilizing this methodology, it is possible to examine the effects of volumetric solution cost, operation of a module at various pressure, and operation of a constant pressure module with various feed.« less

Cost-utility of a specific collaborative group intervention for patients with functional somatic syndromes.

PubMed

Konnopka, Alexander; König, Hans-Helmut; Kaufmann, Claudia; Egger, Nina; Wild, Beate; Szecsenyi, Joachim; Herzog, Wolfgang; Schellberg, Dieter; Schaefert, Rainer

2016-11-01

Collaborative group intervention (CGI) in patients with functional somatic syndromes (FSS) has been shown to improve mental quality of life. To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS. An economic evaluation alongside a cluster-randomised controlled trial was performed. 35 general practitioners (GPs) recruited 300 FSS patients. Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline. Costs were assessed via questionnaire. Quality adjusted life years (QALYs) were calculated using the SF-6D index, derived from the 36-item short-form health survey (SF-36). We calculated patients' net-monetary-benefit (NMB), estimated the treatment effect via regression, and generated cost-effectiveness acceptability curves. Using intention-to-treat analysis, total costs during the 12-month study period were 5777EUR in the intervention, and 6858EUR in the control group. Controlling for possible confounders, we found a small, but significant positive intervention effect on QALYs (+0.017; p=0.019) and an insignificant cost saving resulting from a cost-increase in the control group (-10.5%; p=0.278). NMB regression showed that the probability of CGI to be cost-effective was 69% for a willingness to pay (WTP) of 0EUR/QALY, increased to 92% for a WTP of 50,000EUR/QALY and reached the level of 95% at a WTP of 70,375EUR/QALY. Subgroup analyses yielded that CGI was only cost-effective in severe somatic symptom severity (PHQ-15≥15). CGI has a high probability to be a cost-effective treatment for FSS, in particular for patients with severe somatic symptom severity. Copyright © 2016 Elsevier Inc. All rights reserved.

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

Granderson, G.D.

The purpose of the dissertation is to examine the impact of rate-of-return regulation on the cost of transporting natural gas in interstate commerce. Of particular interest is the effect of the regulation on the input choice of a firm. Does regulation induce a regulated firm to produce its selected level of output at greater than minimum cost The theoretical model is based on the work of Rolf Faere and James Logan who investigate the duality relationship between the cost and production functions of a rate-of-return regulated firm. Faere and Logan derive the cost function for a regulated firm as themore » minimum cost of producing the firm's selected level of output, subject to the regulatory constraint. The regulated cost function is used to recover the unregulated cost function. A firm's unregulated cost function is the minimum cost of producing its selected level of output. Characteristics of the production technology are obtained from duality between the production and unregulated cost functions. Using data on 20 pipeline companies from 1977 to 1987, the author estimates a random effects model that consists of a regulated cost function and its associated input share equations. The model is estimated as a set of seemingly unrelated regressions. The empirical results are used to test the Faere and Logan theory and the traditional Averch-Johnson hypothesis of overcapitalization. Parameter estimates are used to recover the unregulated cost function and to calculate the amount by which transportation costs are increased by the regulation of the industry. Empirical results show that a firm's transportation cost decreases as the allowed rate of return increases and the regulatory constraint becomes less tight. Elimination of the regulatory constraint would lead to a reduction in costs on average of 5.278%. There is evidence that firms overcapitalize on pipeline capital. There is inconclusive evidence on whether firms overcapitalized on compressor station capital.« less

Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives

PubMed Central

Wong, Matthew; Katzman, Debra K.; Akseer, Nadia; Steinegger, Cathleen; Hancock-Howard, Rebecca L.; Coyte, Peter C.

2015-01-01

Background Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs. Methods We used micro-costing methods for this cohort study involving all adolescent patients (age 12–18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs. Results We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p < 0.001). For every unit increase in BMI, we saw a 15.7% decrease in hospital cost. In addition, we found higher BMI (p < 0.001) and younger age (p < 0.05) to be significant negative predictors of caregiver costs. Interpretation The economic burden of inpatient treatment for adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs. PMID:26389097

A class of solution-invariant transformations of cost functions for minimum cost flow phase unwrapping.

PubMed

Hubig, Michael; Suchandt, Steffen; Adam, Nico

2004-10-01

Phase unwrapping (PU) represents an important step in synthetic aperture radar interferometry (InSAR) and other interferometric applications. Among the different PU methods, the so called branch-cut approaches play an important role. In 1996 M. Costantini [Proceedings of the Fringe '96 Workshop ERS SAR Interferometry (European Space Agency, Munich, 1996), pp. 261-272] proposed to transform the problem of correctly placing branch cuts into a minimum cost flow (MCF) problem. The crucial point of this new approach is to generate cost functions that represent the a priori knowledge necessary for PU. Since cost functions are derived from measured data, they are random variables. This leads to the question of MCF solution stability: How much can the cost functions be varied without changing the cheapest flow that represents the correct branch cuts? This question is partially answered: The existence of a whole linear subspace in the space of cost functions is shown; this subspace contains all cost differences by which a cost function can be changed without changing the cost difference between any two flows that are discharging any residue configuration. These cost differences are called strictly stable cost differences. For quadrangular nonclosed networks (the most important type of MCF networks for interferometric purposes) a complete classification of strictly stable cost differences is presented. Further, the role of the well-known class of node potentials in the framework of strictly stable cost differences is investigated, and information on the vector-space structure representing the MCF environment is provided.

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

PubMed

Khan, Ashiya; Amitava, Abadan Khan; Rizvi, Syed Ali Raza; Siddiqui, Ziya; Kumari, Namita; Grover, Shivani

2015-06-01

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Prospective randomized controlled trial. Tertiary care hospital setting. A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [-0.05-0.11]), VF-14 score (7.92 [-1.03-16.86]) and QALYs (1.14 [-0.89-3.16]). However, with significantly lower costs (INR 3228 [2700-3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.30]) than PE. MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

Population-level consequences of antipredator behavior: a metaphysiological model based on the functional ecology of the leaf-eared mouse.

PubMed

Ramos-Jiliberto, Rodrigo; González-Olivares, Eduardo; Bozinovic, Francisco

2002-08-01

We present a predator-prey metaphysiological model, based on the available behavioral and physiological information of the sigmodontine rodent Phyllotis darwini. The model is focused on the population-level consequences of the antipredator behavior, performed by the rodent population, which is assumed to be an inducible response of predation avoidance. The decrease in vulnerability is explicitly considered to have two associated costs: a decreasing foraging success and an increasing metabolic loss. The model analysis was carried out on a reduced form of the system by means of numerical and analytical tools. We evaluated the stability properties of equilibrium points in the phase plane, and carried out bifurcation analyses of rodent equilibrium density under varying conditions of three relevant parameters. The bifurcation parameters chosen represent predator avoidance effectiveness (A), foraging cost of antipredator behavior (C(1)'), and activity-metabolism cost (C(4)'). Our analysis suggests that the trade-offs involved in antipredator behavior plays a fundamental role in the stability properties of the system. Under conditions of high foraging cost, stability decreases as antipredator effectiveness increases. Under the complementary scenario (not considering the highest foraging costs), the equilibria are either stable when both costs are low, or unstable when both costs are higher, independent of antipredator effectiveness. No evidence of stabilizing effects of antipredator behavior was found. Copyright 2002 Elsevier Science (USA).

Cost inefficiency under financial strain: a stochastic frontier analysis of hospitals in Washington State through the Great Recession.

PubMed

Izón, Germán M; Pardini, Chelsea A

2017-06-01

The importance of increasing cost efficiency for community hospitals in the United States has been underscored by the Great Recession and the ever-changing health care reimbursement environment. Previous studies have shown mixed evidence with regards to the relationship between linking hospitals' reimbursement to quality of care and cost efficiency. Moreover, current evidence suggests that not only inherently financially disadvantaged hospitals (e.g., safety-net providers), but also more financially stable providers, experienced declines to their financial viability throughout the recession. However, little is known about how hospital cost efficiency fared throughout the Great Recession. This study contributes to the literature by using stochastic frontier analysis to analyze cost inefficiency of Washington State hospitals between 2005 and 2012, with controls for patient burden of illness, hospital process of care quality, and hospital outcome quality. The quality measures included in this study function as central measures for the determination of recently implemented pay-for-performance programs. The average estimated level of hospital cost inefficiency before the Great Recession (10.4 %) was lower than it was during the Great Recession (13.5 %) and in its aftermath (14.1 %). Further, the estimated coefficients for summary process of care quality indexes for three health conditions (acute myocardial infarction, pneumonia, and heart failure) suggest that higher quality scores are associated with increased cost inefficiency.

Computational approaches for drug discovery.

PubMed

Hung, Che-Lun; Chen, Chi-Chun

2014-09-01

Cellular proteins are the mediators of multiple organism functions being involved in physiological mechanisms and disease. By discovering lead compounds that affect the function of target proteins, the target diseases or physiological mechanisms can be modulated. Based on knowledge of the ligand-receptor interaction, the chemical structures of leads can be modified to improve efficacy, selectivity and reduce side effects. One rational drug design technology, which enables drug discovery based on knowledge of target structures, functional properties and mechanisms, is computer-aided drug design (CADD). The application of CADD can be cost-effective using experiments to compare predicted and actual drug activity, the results from which can used iteratively to improve compound properties. The two major CADD-based approaches are structure-based drug design, where protein structures are required, and ligand-based drug design, where ligand and ligand activities can be used to design compounds interacting with the protein structure. Approaches in structure-based drug design include docking, de novo design, fragment-based drug discovery and structure-based pharmacophore modeling. Approaches in ligand-based drug design include quantitative structure-affinity relationship and pharmacophore modeling based on ligand properties. Based on whether the structure of the receptor and its interaction with the ligand are known, different design strategies can be seed. After lead compounds are generated, the rule of five can be used to assess whether these have drug-like properties. Several quality validation methods, such as cost function analysis, Fisher's cross-validation analysis and goodness of hit test, can be used to estimate the metrics of different drug design strategies. To further improve CADD performance, multi-computers and graphics processing units may be applied to reduce costs. © 2014 Wiley Periodicals, Inc.

Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain.

PubMed

Villa, Guillermo; Sánchez-Álvarez, Emilio; Cuervo, Jesús; Fernández-Ortiz, Lucía; Rebollo, Pablo; Ortega, Francisco

2012-08-16

A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %). Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients' survival rates and health-related quality of life at an affordable cost. Spanish Public Health authorities might therefore promote the inclusion of specific recommendations for this group of patients within the existing clinical guidelines.

Optimality of cycle time and inventory decisions in a two echelon inventory system with exponential price dependent demand under credit period

NASA Astrophysics Data System (ADS)

Krugon, Seelam; Nagaraju, Dega

2017-05-01

This work describes and proposes an two echelon inventory system under supply chain, where the manufacturer offers credit period to the retailer with exponential price dependent demand. The model is framed as demand is expressed as exponential function of retailer’s unit selling price. Mathematical model is framed to demonstrate the optimality of cycle time, retailer replenishment quantity, number of shipments, and total relevant cost of the supply chain. The major objective of the paper is to provide trade credit concept from the manufacturer to the retailer with exponential price dependent demand. The retailer would like to delay the payments of the manufacturer. At the first stage retailer and manufacturer expressions are expressed with the functions of ordering cost, carrying cost, transportation cost. In second stage combining of the manufacturer and retailer expressions are expressed. A MATLAB program is written to derive the optimality of cycle time, retailer replenishment quantity, number of shipments, and total relevant cost of the supply chain. From the optimality criteria derived managerial insights can be made. From the research findings, it is evident that the total cost of the supply chain is decreased with the increase in credit period under exponential price dependent demand. To analyse the influence of the model parameters, parametric analysis is also done by taking with help of numerical example.

The migraine ACE model: evaluating the impact on time lost and medical resource Use.

PubMed

Caro, J J; Caro, G; Getsios, D; Raggio, G; Burrows, M; Black, L

2000-04-01

To describe the Migraine Adaptive Cost-Effectiveness Model in the context of an analysis of a simulated population of Canadian patients with migraine. The high prevalence of migraine and its substantial impact on patients' ability to function normally present a significant economic burden to society. In light of the recent availability of improved pharmaceutical treatments, a model was developed to assess their economic impact. The Migraine Adaptive Cost-Effectiveness Model incorporates the costs of time lost from both work and nonwork activities, as well as medical resource and medication use. Using Monte Carlo techniques, the model simulates the experience of a population of patients with migraine over the course of 1 year. As an example, analyses of a Canadian population were carried out using data from a multinational trial, surveys, national statistics, and the available literature. Using customary therapy, mean productivity losses (amounting to 84 hours of paid work time, 48 hours of unpaid work time, and 113 hours of leisure time lost) were estimated to cost $1949 (in 1997 Canadian dollars) per patient, with medical expenditures adding an average of $280 to the cost of illness. With customary treatment patterns, the costs of migraine associated with reduced functional capacity are substantial. The migraine model represents a flexible tool for the economic evaluation of different migraine treatments in various populations.

CYP2C19 LOF and GOF-Guided Antiplatelet Therapy in Patients with Acute Coronary Syndrome: A Cost-Effectiveness Analysis.

PubMed

Jiang, Minghuan; You, Joyce H S

2017-02-01

This study aimed to examine the cost-effectiveness of CYP2C19 loss-of-function and gain-of-function allele guided (LOF/GOF-guided) antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A life-long decision-analytic model was designed to simulate outcomes of three strategies: universal clopidogrel (75 mg daily), universal alternative P2Y 12 inhibitor (prasugrel 10 mg daily or ticagrelor 90 mg twice daily), and LOF/GOF-guided therapy (LOF/GOF allele carriers receiving alternative P2Y 12 inhibitor, wild-type patients receiving clopidogrel). Model outcomes included clinical event rates, quality-adjusted life-years (QALYs) gained and direct medical costs from perspective of US healthcare provider. Base-case analysis found nonfatal myocardial infarction (5.62%) and stent thrombosis (1.2%) to be the lowest in universal alternative P2Y 12 inhibitor arm, whereas nonfatal stroke (0.72%), cardiovascular death (2.42%), and major bleeding (2.73%) were lowest in LOF/GOF-guided group. LOF/GOF-guided arm gained the highest QALYs (7.5301 QALYs) at lowest life-long cost (USD 76,450). One-way sensitivity analysis showed base-case results were subject to the hazard ratio of cardiovascular death in carriers versus non-carriers of LOF allele and hazard ratio of cardiovascular death in non-carriers of LOF allele versus general patients. In probabilistic sensitivity analysis of 10,000 Monte Carlo simulations, LOF/GOF-guided therapy, universal alternative P2Y 12 inhibitor, and universal clopidogrel were the preferred strategy (willingness-to-pay threshold = 50,000 USD/QALY) in 99.07%, 0.04%, and 0.89% of time, respectively. Using both CYP2C19 GOF and LOF alleles to select antiplatelet therapy appears to be the preferred antiplatelet strategy over universal clopidogrel and universal alternative P2Y 12 inhibitor therapy for ACS patients with PCI.

Risk management and lessons learned solutions for satellite product assurance

NASA Astrophysics Data System (ADS)

Larrère, Jean-Luc

2004-08-01

The historic trend of the space industry towards lower cost programmes and more generally a better economic efficiency raises a difficult question to the quality assurance community: how to achieve the same—or better—mission success rate while drastically reducing the cost of programmes, hence the cost and level of quality assurance activities. EADS Astrium Earth Observation and Science (France) Business Unit have experimented Risk Management and Lessons Learned on their satellite programmes to achieve this goal. Risk analysis and management are deployed from the programme proposal phase through the development and operations phases. Results of the analysis and the corresponding risk mitigation actions are used to tailor the product assurance programme and activities. Lessons learned have been deployed as a systematic process to collect positive and negative experience from past and on-going programmes and feed them into new programmes. Monitoring and justification of their implementation in programmes is done under supervision from the BU quality assurance function. Control of the system is ensured by the company internal review system. Deployment of these methods has shown that the quality assurance function becomes more integrated in the programme team and development process and that its tasks gain focus and efficiency while minimising the risks associated with new space programmes.

Removing Barriers for Effective Deployment of Intermittent Renewable Generation

NASA Astrophysics Data System (ADS)

Arabali, Amirsaman

The stochastic nature of intermittent renewable resources is the main barrier to effective integration of renewable generation. This problem can be studied from feeder-scale and grid-scale perspectives. Two new stochastic methods are proposed to meet the feeder-scale controllable load with a hybrid renewable generation (including wind and PV) and energy storage system. For the first method, an optimization problem is developed whose objective function is the cost of the hybrid system including the cost of renewable generation and storage subject to constraints on energy storage and shifted load. A smart-grid strategy is developed to shift the load and match the renewable energy generation and controllable load. Minimizing the cost function guarantees minimum PV and wind generation installation, as well as storage capacity selection for supplying the controllable load. A confidence coefficient is allocated to each stochastic constraint which shows to what degree the constraint is satisfied. In the second method, a stochastic framework is developed for optimal sizing and reliability analysis of a hybrid power system including renewable resources (PV and wind) and energy storage system. The hybrid power system is optimally sized to satisfy the controllable load with a specified reliability level. A load-shifting strategy is added to provide more flexibility for the system and decrease the installation cost. Load shifting strategies and their potential impacts on the hybrid system reliability/cost analysis are evaluated trough different scenarios. Using a compromise-solution method, the best compromise between the reliability and cost will be realized for the hybrid system. For the second problem, a grid-scale stochastic framework is developed to examine the storage application and its optimal placement for the social cost and transmission congestion relief of wind integration. Storage systems are optimally placed and adequately sized to minimize the sum of operation and congestion costs over a scheduling period. A technical assessment framework is developed to enhance the efficiency of wind integration and evaluate the economics of storage technologies and conventional gas-fired alternatives. The proposed method is used to carry out a cost-benefit analysis for the IEEE 24-bus system and determine the most economical technology. In order to mitigate the financial and technical concerns of renewable energy integration into the power system, a stochastic framework is proposed for transmission grid reinforcement studies in a power system with wind generation. A multi-stage multi-objective transmission network expansion planning (TNEP) methodology is developed which considers the investment cost, absorption of private investment and reliability of the system as the objective functions. A Non-dominated Sorting Genetic Algorithm (NSGA II) optimization approach is used in combination with a probabilistic optimal power flow (POPF) to determine the Pareto optimal solutions considering the power system uncertainties. Using a compromise-solution method, the best final plan is then realized based on the decision maker preferences. The proposed methodology is applied to the IEEE 24-bus Reliability Tests System (RTS) to evaluate the feasibility and practicality of the developed planning strategy.

Protection for the Consumer; Business Education: 6463.07.

ERIC Educational Resources Information Center

Finora, Daniel

This course is designed to acquaint the student with the functions, criticisms, costs, and consumer analysis of advertising; Federal and State regulations of industry operation and advertising; Federal, State, and city agencies for consumer protection; private and business-sponsored organizations for consumer protection; and rights and…

Joint brain connectivity estimation from diffusion and functional MRI data

NASA Astrophysics Data System (ADS)

Chu, Shu-Hsien; Lenglet, Christophe; Parhi, Keshab K.

2015-03-01

Estimating brain wiring patterns is critical to better understand the brain organization and function. Anatomical brain connectivity models axonal pathways, while the functional brain connectivity characterizes the statistical dependencies and correlation between the activities of various brain regions. The synchronization of brain activity can be inferred through the variation of blood-oxygen-level dependent (BOLD) signal from functional MRI (fMRI) and the neural connections can be estimated using tractography from diffusion MRI (dMRI). Functional connections between brain regions are supported by anatomical connections, and the synchronization of brain activities arises through sharing of information in the form of electro-chemical signals on axon pathways. Jointly modeling fMRI and dMRI data may improve the accuracy in constructing anatomical connectivity as well as functional connectivity. Such an approach may lead to novel multimodal biomarkers potentially able to better capture functional and anatomical connectivity variations. We present a novel brain network model which jointly models the dMRI and fMRI data to improve the anatomical connectivity estimation and extract the anatomical subnetworks associated with specific functional modes by constraining the anatomical connections as structural supports to the functional connections. The key idea is similar to a multi-commodity flow optimization problem that minimizes the cost or maximizes the efficiency for flow configuration and simultaneously fulfills the supply-demand constraint for each commodity. In the proposed network, the nodes represent the grey matter (GM) regions providing brain functionality, and the links represent white matter (WM) fiber bundles connecting those regions and delivering information. The commodities can be thought of as the information corresponding to brain activity patterns as obtained for instance by independent component analysis (ICA) of fMRI data. The concept of information flow is introduced and used to model the propagation of information between GM areas through WM fiber bundles. The link capacity, i.e., ability to transfer information, is characterized by the relative strength of fiber bundles, e.g., fiber count gathered from the tractography of dMRI data. The node information demand is considered to be proportional to the correlation between neural activity at various cortical areas involved in a particular functional mode (e.g. visual, motor, etc.). These two properties lead to the link capacity and node demand constraints in the proposed model. Moreover, the information flow of a link cannot exceed the demand from either end node. This is captured by the feasibility constraints. Two different cost functions are considered in the optimization formulation in this paper. The first cost function, the reciprocal of fiber strength represents the unit cost for information passing through the link. In the second cost function, a min-max (minimizing the maximal link load) approach is used to balance the usage of each link. Optimizing the first cost function selects the pathway with strongest fiber strength for information propagation. In the second case, the optimization procedure finds all the possible propagation pathways and allocates the flow proportionally to their strength. Additionally, a penalty term is incorporated with both the cost functions to capture the possible missing and weak anatomical connections. With this set of constraints and the proposed cost functions, solving the network optimization problem recovers missing and weak anatomical connections supported by the functional information and provides the functional-associated anatomical subnetworks. Feasibility is demonstrated using realistic diffusion and functional MRI phantom data. It is shown that the proposed model recovers the maximum number of true connections, with fewest number of false connections when compared with the connectivity derived from a joint probabilistic model using the expectation-maximization (EM) algorithm presented in a prior work. We also apply the proposed method to data provided by the Human Connectome Project (HCP).

Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Health Technology Assessment

PubMed Central

2016-01-01

Background In Ontario, current treatment for eligible patients who have an acute ischemic stroke is intravenous thrombolysis (IVT). However, there are some limitations and contraindications to IVT, and outcomes may not be favourable for patients with stroke caused by a proximal intracranial occlusion. An alternative is mechanical thrombectomy with newer devices, and a number of recent studies have suggested that this treatment is more effective for improving functional independence and clinical outcomes. The objective of this health technology assessment was to evaluate the clinical effectiveness and cost-effectiveness of new-generation mechanical thrombectomy devices (with or without IVT) compared to IVT alone (if eligible) in patients with acute ischemic stroke. Methods We conducted a systematic review of the literature, limited to randomized controlled trials that examined the effectiveness of mechanical thrombectomy using stent retrievers and thromboaspiration devices for patients with acute ischemic stroke. We assessed the quality of the evidence using the GRADE approach. We developed a Markov decision-analytic model to assess the cost-effectiveness of mechanical thrombectomy (with or without IVT) versus IVT alone (if eligible), calculated incremental cost-effectiveness ratios using a 5-year time horizon, and conducted sensitivity analyses to examine the robustness of the estimates. Results There was a substantial, statistically significant difference in rate of functional independence (GRADE: high quality) between those who received mechanical thrombectomy (with or without IVT) and IVT alone (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.88–3.04). We did not observe a difference in mortality (GRADE: moderate quality) (OR 0.80, 95% CI 0.60–1.07) or symptomatic intracerebral hemorrhage (GRADE: moderate quality) (OR 1.11, 95% CI 0.66–1.87). In the base-case cost-utility analysis, which had a 5 year time horizon, the costs and effectiveness for mechanical thrombectomy were $126,939 and 1.484 quality-adjusted life-years (QALYs) (2.969 life-years). The costs and effectiveness for IVT alone were $124,419 and 1.273 QALYs (2.861 life-years), respectively. Mechanical thrombectomy was associated with an incremental cost-effectiveness ratio of $11,990 per QALY gained. Probabilistic sensitivity analysis showed that the probability of mechanical thrombectomy being cost-effective was 57.5%, 89.7%, and 99.6%, at thresholds of $20,000, $50,000, and $100,000 per QALY gained, respectively. We estimated that adopting mechanical thrombectomy would lead to a cost increase of approximately $1 to 2 million. Conclusions High quality evidence showed that mechanical thrombectomy significantly improved functional independence and appeared to be cost-effective compared to IVT alone for patients with acute ischemic stroke. PMID:27026799

Exercise and self-management for people with chronic knee, hip or lower back pain: a cluster randomised controlled trial of clinical and cost-effectiveness. Study protocol.

PubMed

Walsh, Nicola; Cramp, Fiona; Palmer, Shea; Pollock, Jon; Hampson, Lisa; Gooberman-Hill, Rachael; Green, Colin; Jones, Louise; Phillips, Sonia; Johnson, Liz; Hurley, Mike

2013-12-01

Chronic musculoskeletal pain and osteoarthritis can significantly limit the functional independence of individuals, and given that 25% of the population experience these problems, the socioeconomic impact is immense. Exercise and self-management have proven benefits for these conditions, but most trials tailor interventions for specific joints. Epidemiological data demonstrates that many older people with degenerative joint problems experience pain and functional difficulty in other joints, seeking further healthcare input when these present. Managing multiple joint presentations simultaneously could potentially reduce the need for repeat visits to healthcare professionals as advice is frequently the same for differing site presentations. This single-blind cluster randomised controlled trial will determine the clinical and cost-effectiveness of an exercise and self-management intervention delivered to people over-50 with either hip, knee or lower back pain, compared to 'standard' GP care. A qualitative analysis will also establish the acceptability of the intervention. 352 people with chronic degenerative musculoskeletal pain of the hip, knee or lower back will be recruited from primary care. GP surgeries will be randomised to either the intervention or control arms. Participants in the intervention arm will receive a 6-week group exercise and self-management programme facilitated by a physiotherapist in primary care. Participants allocated to the control arm will continue under 'standard' GP care. The primary outcome measure is the Dysfunction Index of the Short Musculoskeletal Functional Assessment (SMFA). Individual patient responses will be modelled using a mixed effects linear regression, allowing for the clustering effects. Resource use and related intervention costs will be estimated and broader resource use data will be collected using a version of the Client Service Receipt Inventory adapted for musculoskeletal relevance. In addition, a cost-utility analysis will be undertaken to present an estimate of the incremental cost per QALY. A qualitative analysis investigating the acceptability of the intervention to participants and healthcare professionals will also be undertaken and thematically analysed. Ethical approval was received from South West 4 REC, identification number 11/SW/0053. Study findings will be disseminated via conference and journal presentation; via arthritis charitable organisations; and through local GP consortia. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

The economic cost of Alzheimer's disease: Family or public health burden?

PubMed Central

Castro, Diego M.; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F.

2010-01-01

Alzheimer’s disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options. PMID:29213697

The economic cost of Alzheimer's disease: Family or public health burden?

PubMed

Castro, Diego M; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F

2010-01-01

Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

Documentation of the analysis of the benefits and costs of aeronautical research and technology models, volume 1

NASA Technical Reports Server (NTRS)

Bobick, J. C.; Braun, R. L.; Denny, R. E.

1979-01-01

The analysis of the benefits and costs of aeronautical research and technology (ABC-ART) models are documented. These models were developed by NASA for use in analyzing the economic feasibility of applying advanced aeronautical technology to future civil aircraft. The methodology is composed of three major modules: fleet accounting module, airframe manufacturing module, and air carrier module. The fleet accounting module is used to estimate the number of new aircraft required as a function of time to meet demand. This estimation is based primarily upon the expected retirement age of existing aircraft and the expected change in revenue passenger miles demanded. Fuel consumption estimates are also generated by this module. The airframe manufacturer module is used to analyze the feasibility of the manufacturing the new aircraft demanded. The module includes logic for production scheduling and estimating manufacturing costs. For a series of aircraft selling prices, a cash flow analysis is performed and a rate of return on investment is calculated. The air carrier module provides a tool for analyzing the financial feasibility of an airline purchasing and operating the new aircraft. This module includes a methodology for computing the air carrier direct and indirect operating costs, performing a cash flow analysis, and estimating the internal rate of return on investment for a set of aircraft purchase prices.

The effect of simulating weight gain on the energy cost of walking in unimpaired children and children with cerebral palsy.

PubMed

Plasschaert, Frank; Jones, Kim; Forward, Malcolm

2008-12-01

To examine the effect of simulating weight gain on the energy cost of walking in children with cerebral palsy (CP) compared with unimpaired children. Repeated measures, matched subjects, controlled. University hospital clinical gait and movement analysis laboratory. Children (n=42) with CP and unimpaired children (n=42). Addition of 10% of body mass in weight belt. Energy cost of walking parameters consisting of walking speed, Physiological Cost Index, Total Heart Beat Index, oxygen uptake (VO2), gross oxygen cost, nondimensional net oxygen cost, and net oxygen cost with speed normalized to height were measured by using a breath-by-breath gas analysis system (K4b2) and a light beam timing gate system arranged around a figure 8 track. Two walking trials were performed in random order, with and the other without wearing a weighted belt. Children with CP and their unimpaired counterparts responded in fundamentally different ways to weight gain. The unimpaired population maintained speed and VO2 but the children with CP trended toward a drop in their speed and an increase in their VO2. The oxygen consumption of children with CP showed a greater dependence on mass than the unimpaired group (P=.043). An increase of a relatively small percentage in body mass began to significantly impact the energy cost of walking in children with CP. This result highlights the need for weight control to sustain the level of functional walking in these children.

KOSMOS: a universal morph server for nucleic acids, proteins and their complexes

PubMed Central

Seo, Sangjae; Kim, Moon Ki

2012-01-01

KOSMOS is the first online morph server to be able to address the structural dynamics of DNA/RNA, proteins and even their complexes, such as ribosomes. The key functions of KOSMOS are the harmonic and anharmonic analyses of macromolecules. In the harmonic analysis, normal mode analysis (NMA) based on an elastic network model (ENM) is performed, yielding vibrational modes and B-factor calculations, which provide insight into the potential biological functions of macromolecules based on their structural features. Anharmonic analysis involving elastic network interpolation (ENI) is used to generate plausible transition pathways between two given conformations by optimizing a topology-oriented cost function that guarantees a smooth transition without steric clashes. The quality of the computed pathways is evaluated based on their various facets, including topology, energy cost and compatibility with the NMA results. There are also two unique features of KOSMOS that distinguish it from other morph servers: (i) the versatility in the coarse-graining methods and (ii) the various connection rules in the ENM. The models enable us to analyze macromolecular dynamics with the maximum degrees of freedom by combining a variety of ENMs from full-atom to coarse-grained, backbone and hybrid models with one connection rule, such as distance-cutoff, number-cutoff or chemical-cutoff. KOSMOS is available at http://bioengineering.skku.ac.kr/kosmos. PMID:22669912

Socioeconomic impact of road traffic injuries in West Africa: exploratory data from Nigeria.

PubMed

Juillard, Catherine; Labinjo, Mariam; Kobusingye, Olive; Hyder, Adnan A

2010-12-01

Road traffic injuries (RTIs) are increasingly contributing to the burden of disease in sub-Saharan Africa, yet little is known about the economic consequences and disability associated with them. To explore cost and disability consequences of RTIs in Nigeria. A population-based survey using two-stage stratified cluster sampling. SUBJECT/SETTING: Information on care-seeking choice, cost of treatment, ability to work, reduction in earnings, and disability were collected on 127 subjects who had suffered an RTI, of 3082 study subjects in seven Nigerian states. Univariate analysis was used to estimate frequency of disability, types of care sought, and trends for work lost, functional ability and cost of treatment. Unadjusted bivariate analysis was performed to explore care-seeking, cost of care, and work lost among disabled and non-disabled people. RTIs resulted in disability for 29.1% of subjects, while 13.5% were unable to return to work. Of the disabled people, 67.6% were unable to perform activities of daily living, 16.7% consequently lost their jobs, and 88.6% had a reduction in earnings. Private physician and hospital treatment were the most common forms of initial treatment sought, but traditional treatment was the most common second form of care sought. Average direct costs of informal and formal treatment were US$6.65 and US$35.64, respectively. Disabled people were more likely to seek formal care (p=0.003) and be unable to work (p=0.002). Economic and functional ramifications must be included in the spectrum of consequences of RTIs to fully appreciate the extent of the burden of disease, implying that health systems should not only address the clinical consequences of RTIs, but the financial ones as well.

Economic Estimation of the Losses Caused by Surface Water Pollution Accidents in China From the Perspective of Water Bodies’ Functions

PubMed Central

Yao, Hong; You, Zhen; Liu, Bo

2016-01-01

The number of surface water pollution accidents (abbreviated as SWPAs) has increased substantially in China in recent years. Estimation of economic losses due to SWPAs has been one of the focuses in China and is mentioned many times in the Environmental Protection Law of China promulgated in 2014. From the perspective of water bodies’ functions, pollution accident damages can be divided into eight types: damage to human health, water supply suspension, fishery, recreational functions, biological diversity, environmental property loss, the accident’s origin and other indirect losses. In the valuation of damage to people’s life, the procedure for compensation of traffic accidents in China was used. The functional replacement cost method was used in economic estimation of the losses due to water supply suspension and loss of water’s recreational functions. Damage to biological diversity was estimated by recovery cost analysis and damage to environmental property losses were calculated using pollutant removal costs. As a case study, using the proposed calculation procedure the economic losses caused by the major Songhuajiang River pollution accident that happened in China in 2005 have been estimated at 2263 billion CNY. The estimated economic losses for real accidents can sometimes be influenced by social and political factors, such as data authenticity and accuracy. Besides, one or more aspects in the method might be overestimated, underrated or even ignored. The proposed procedure may be used by decision makers for the economic estimation of losses in SWPAs. Estimates of the economic losses of pollution accidents could help quantify potential costs associated with increased risk sources along lakes/rivers but more importantly, highlight the value of clean water to society as a whole. PMID:26805869

Economic Estimation of the Losses Caused by Surface Water Pollution Accidents in China From the Perspective of Water Bodies' Functions.

PubMed

Yao, Hong; You, Zhen; Liu, Bo

2016-01-22

The number of surface water pollution accidents (abbreviated as SWPAs) has increased substantially in China in recent years. Estimation of economic losses due to SWPAs has been one of the focuses in China and is mentioned many times in the Environmental Protection Law of China promulgated in 2014. From the perspective of water bodies' functions, pollution accident damages can be divided into eight types: damage to human health, water supply suspension, fishery, recreational functions, biological diversity, environmental property loss, the accident's origin and other indirect losses. In the valuation of damage to people's life, the procedure for compensation of traffic accidents in China was used. The functional replacement cost method was used in economic estimation of the losses due to water supply suspension and loss of water's recreational functions. Damage to biological diversity was estimated by recovery cost analysis and damage to environmental property losses were calculated using pollutant removal costs. As a case study, using the proposed calculation procedure the economic losses caused by the major Songhuajiang River pollution accident that happened in China in 2005 have been estimated at 2263 billion CNY. The estimated economic losses for real accidents can sometimes be influenced by social and political factors, such as data authenticity and accuracy. Besides, one or more aspects in the method might be overestimated, underrated or even ignored. The proposed procedure may be used by decision makers for the economic estimation of losses in SWPAs. Estimates of the economic losses of pollution accidents could help quantify potential costs associated with increased risk sources along lakes/rivers but more importantly, highlight the value of clean water to society as a whole.

Design of surface-water data networks for regional information

USGS Publications Warehouse

Moss, Marshall E.; Gilroy, E.J.; Tasker, Gary D.; Karlinger, M.R.

1982-01-01

This report describes a technique, Network Analysis of Regional Information (NARI), and the existing computer procedures that have been developed for the specification of the regional information-cost relation for several statistical parameters of streamflow. The measure of information used is the true standard error of estimate of a regional logarithmic regression. The cost is a function of the number of stations at which hydrologic data are collected and the number of years for which the data are collected. The technique can be used to obtain either (1) a minimum cost network that will attain a prespecified accuracy and reliability or (2) a network that maximizes information given a set of budgetary and time constraints.

Multimission Telemetry Visualization (MTV) system: A mission applications project from JPL's Multimedia Communications Laboratory

NASA Technical Reports Server (NTRS)

Koeberlein, Ernest, III; Pender, Shaw Exum

1994-01-01

This paper describes the Multimission Telemetry Visualization (MTV) data acquisition/distribution system. MTV was developed by JPL's Multimedia Communications Laboratory (MCL) and designed to process and display digital, real-time, science and engineering data from JPL's Mission Control Center. The MTV system can be accessed using UNIX workstations and PC's over common datacom and telecom networks from worldwide locations. It is designed to lower data distribution costs while increasing data analysis functionality by integrating low-cost, off-the-shelf desktop hardware and software. MTV is expected to significantly lower the cost of real-time data display, processing, distribution, and allow for greater spacecraft safety and mission data access.

Cost-effectiveness of early versus delayed functional restoration for chronic disabling occupational musculoskeletal disorders.

PubMed

Theodore, Brian R; Mayer, Tom G; Gatchel, Robert J

2015-06-01

Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR. A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4-8 months of disability, N = 373), intermediate duration (ID: 9-18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness. At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88%), work retention (overall 80%), and additional healthcare utilization (overall, 2.2% of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64% in medical costs, and up to 80% in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56% lower when administered early. Overall, ER resulted in estimated cost savings of up to 72% (or almost $170,000 per claim). Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of "last resort".

Utility of functioning in predicting costs of care for patients with mood and anxiety disorders: a prospective cohort study

PubMed Central

Cieza, Alarcos; Baldwin, David S.

2017-01-01

Development of payment systems for mental health services has been hindered by limited evidence for the utility of diagnosis or symptoms in predicting costs of care. We investigated the utility of functioning information in predicting costs for patients with mood and anxiety disorders. This was a prospective cohort study involving 102 adult patients attending a tertiary referral specialist clinic for mood and anxiety disorders. The main outcome was total costs, calculated by applying unit costs to healthcare use data. After adjusting for covariates, a significant total costs association was yielded for functioning (eβ=1.02; 95% confidence interval: 1.01–1.03), but not depressive symptom severity or anxiety symptom severity. When we accounted for the correlations between the main independent variables by constructing an abridged functioning metric, a significant total costs association was again yielded for functioning (eβ=1.04; 95% confidence interval: 1.01–1.09), but not symptom severity. The utility of functioning in predicting costs for patients with mood and anxiety disorders was supported. Functioning information could be useful within mental health payment systems. PMID:28383309

The Conundrum of Functional Brain Networks: Small-World Efficiency or Fractal Modularity

PubMed Central

Gallos, Lazaros K.; Sigman, Mariano; Makse, Hernán A.

2012-01-01

The human brain has been studied at multiple scales, from neurons, circuits, areas with well-defined anatomical and functional boundaries, to large-scale functional networks which mediate coherent cognition. In a recent work, we addressed the problem of the hierarchical organization in the brain through network analysis. Our analysis identified functional brain modules of fractal structure that were inter-connected in a small-world topology. Here, we provide more details on the use of network science tools to elaborate on this behavior. We indicate the importance of using percolation theory to highlight the modular character of the functional brain network. These modules present a fractal, self-similar topology, identified through fractal network methods. When we lower the threshold of correlations to include weaker ties, the network as a whole assumes a small-world character. These weak ties are organized precisely as predicted by theory maximizing information transfer with minimal wiring costs. PMID:22586406

Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men

PubMed Central

Chen, Anders; Hoover, Karen W.; Kelly, Jane; Dowdy, David; Sharifi, Parastu; Sullivan, Patrick S.; Rosenberg, Eli S.

2017-01-01

Introduction Men who have sex with men (MSM) are disproportionately affected by HIV due to their increased risk of infection. Oral pre-exposure prophylaxis (PrEP) is a highly effictive HIV-prevention strategy for MSM. Despite evidence of its effectiveness, PrEP uptake in the United States has been slow, in part due to its cost. As jurisdictions and health organizations begin to think about PrEP scale-up, the high cost to society needs to be understood. Methods We modified a previously-described decision-analysis model to estimate the cost per quality-adjusted life-year (QALY) gained, over a 1-year duration of PrEP intervention and lifetime time horizon. Using updated parameter estimates, we calculated: 1) the cost per QALY gained, stratified over 4 strata of PrEP cost (a function of both drug cost and provider costs); and 2) PrEP drug cost per year required to fall at or under 4 cost per QALY gained thresholds. Results When PrEP drug costs were reduced by 60% (with no sexual disinhibition) to 80% (assuming 25% sexual disinhibition), PrEP was cost-effective (at <$100,000 per QALY averted) in all scenarios of base-case or better adherence, as long as the background HIV prevalence was greater than 10%. For PrEP to be cost saving at base-case adherence/efficacy levels and at a background prevalence of 20%, drug cost would need to be reduced to $8,021 per year with no disinhibition, and to $2,548 with disinhibition. Conclusion Results from our analysis suggest that PrEP drug costs need to be reduced in order to be cost-effective across a range of background HIV prevalence. Moreover, our results provide guidance on the pricing of generic emtricitabine/tenofovir disoproxil fumarate, in order to provide those at high risk for HIV an affordable prevention option without financial burden on individuals or jurisdictions scaling-up coverage. PMID:28570572

Relationship between functional disability and costs one and two years post stroke

PubMed Central

Lekander, Ingrid; Willers, Carl; von Euler, Mia; Lilja, Mikael; Sunnerhagen, Katharina S.; Pessah-Rasmussen, Hélène; Borgström, Fredrik

2017-01-01

Background and purpose Stroke affects mortality, functional ability, quality of life and incurs costs. The primary objective of this study was to estimate the costs of stroke care in Sweden by level of disability and stroke type (ischemic (IS) or hemorrhagic stroke (ICH)). Method Resource use during first and second year following a stroke was estimated based on a research database containing linked data from several registries. Costs were estimated for the acute and post-acute management of stroke, including direct (health care consumption and municipal services) and indirect (productivity losses) costs. Resources and costs were estimated per stroke type and functional disability categorised by Modified Rankin Scale (mRS). Results The results indicated that the average costs per patient following a stroke were 350,000SEK/€37,000–480,000SEK/€50,000, dependent on stroke type and whether it was the first or second year post stroke. Large variations were identified between different subgroups of functional disability and stroke type, ranging from annual costs of 100,000SEK/€10,000–1,100,000SEK/€120,000 per patient, with higher costs for patients with ICH compared to IS and increasing costs with more severe functional disability. Conclusion Functional outcome is a major determinant on costs of stroke care. The stroke type associated with worse outcome (ICH) was also consistently associated to higher costs. Measures to improve function are not only important to individual patients and their family but may also decrease the societal burden of stroke. PMID:28384164

Development and application of a model for the analysis of trades between space launch system operations and acquisition costs

NASA Astrophysics Data System (ADS)

Nix, Michael B.

2005-12-01

Early design decisions in the development of space launch systems determine the costs to acquire and operate launch systems. Some sources indicate that as much as 90% of life cycle costs are fixed by the end of the critical design review phase. System characteristics determined by these early decisions are major factors in the acquisition cost of flight hardware elements and facilities and influence operations costs through the amount of maintenance and support labor required to sustain system function. Operations costs are also dependent on post-development management decisions regarding how much labor will be deployed to meet requirements of market demand and ownership profit. The ability to perform early trade-offs between these costs is vital to the development of systems that have the necessary capacity to provide service and are profitable to operate. An Excel-based prototype model was developed for making early analyses of trade-offs between the costs to operate a space launch system and to acquire the necessary assets to meet a given set of operational requirements. The model, integrating input from existing models and adding missing capability, allows the user to make such trade-offs across a range of operations concepts (required flight rates, staffing levels, shifts per workday, workdays per week and per year, unreliability, wearout and depot maintenance) and the number, type and capability of assets (flight hardware elements, processing and supporting facilities and infrastructure). The costs and capabilities of hypothetical launch systems can be modeled as a function of interrelated turnaround times and labor resource levels, and asset loss and retirement. The number of flight components and facilities required can be calculated and the operations and acquisition costs compared for a specified scenario. Findings, based on the analysis of a hypothetical two stage to orbit, reusable, unmanned launch system, indicate that the model is suitable for the trade-off analyses desired. The minimum turnaround time/maximum labor allocation for specific hardware configurations and characteristics and corresponding asset requirements can be estimated. Either turnaround time or resources can be varied and the resulting operations and acquisition costs can be compared. Asset reliability, wearout and depot maintenance intervals and durations can be varied as well to analyze the effects on costs. Likewise, the effects on operations and acquisitions costs of the introduction of alternative technologies that affect reliability, maintainability and supportability in various hardware configurations can be evaluated.

Cost implications of organizing nursing home workforce in teams.

PubMed

Mukamel, Dana B; Cai, Shubing; Temkin-Greener, Helena

2009-08-01

To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.

A Systems Engineering Approach to Address Human Capital Management Issues in the Shipbuilding Industry

DTIC Science & Technology

2008-09-01

gathering and prioritization of their inputs, system development and implementation would become chaotic at best, and the developmental cost 74...for shipbuilding. This study investigated current DoD Human Capital Management (HCM) strategies for attracting, developing , retaining and managing...employed by these stakeholders. The result of the analysis was the development , via a functional analysis, of a notional HCM architecture for the

Digital Imaging

NASA Technical Reports Server (NTRS)

1986-01-01

Digital Imaging is the computer processed numerical representation of physical images. Enhancement of images results in easier interpretation. Quantitative digital image analysis by Perceptive Scientific Instruments, locates objects within an image and measures them to extract quantitative information. Applications are CAT scanners, radiography, microscopy in medicine as well as various industrial and manufacturing uses. The PSICOM 327 performs all digital image analysis functions. It is based on Jet Propulsion Laboratory technology, is accurate and cost efficient.

18 CFR 11.12 - Determination of section 10(f) costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... costs of the project. (2) If power is not an authorized function of the headwater project, the section... costs designated as the joint-use power cost, derived by deeming a power function at the project. The value of the benefits assigned to the deemed power function, for purposes of determining the value of...

18 CFR 11.12 - Determination of section 10(f) costs.

Code of Federal Regulations, 2012 CFR

2012-04-01

... costs of the project. (2) If power is not an authorized function of the headwater project, the section... costs designated as the joint-use power cost, derived by deeming a power function at the project. The value of the benefits assigned to the deemed power function, for purposes of determining the value of...

18 CFR 11.12 - Determination of section 10(f) costs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... costs of the project. (2) If power is not an authorized function of the headwater project, the section... costs designated as the joint-use power cost, derived by deeming a power function at the project. The value of the benefits assigned to the deemed power function, for purposes of determining the value of...

18 CFR 11.12 - Determination of section 10(f) costs.

Code of Federal Regulations, 2014 CFR

2014-04-01

... costs of the project. (2) If power is not an authorized function of the headwater project, the section... costs designated as the joint-use power cost, derived by deeming a power function at the project. The value of the benefits assigned to the deemed power function, for purposes of determining the value of...

18 CFR 11.12 - Determination of section 10(f) costs.

Code of Federal Regulations, 2013 CFR

2013-04-01

... costs of the project. (2) If power is not an authorized function of the headwater project, the section... costs designated as the joint-use power cost, derived by deeming a power function at the project. The value of the benefits assigned to the deemed power function, for purposes of determining the value of...

Cost-Effectiveness Analysis of Preoperative Versus Postoperative Radiation Therapy in Extremity Soft Tissue Sarcoma

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

Qu, Xuanlu M.; Louie, Alexander V.; Ashman, Jonathan

Purpose: Surgery combined with radiation therapy (RT) is the cornerstone of multidisciplinary management of extremity soft tissue sarcoma (STS). Although RT can be given in either the preoperative or the postoperative setting with similar local recurrence and survival outcomes, the side effect profiles, costs, and long-term functional outcomes are different. The aim of this study was to use decision analysis to determine optimal sequencing of RT with surgery in patients with extremity STS. Methods and Materials: A cost-effectiveness analysis was conducted using a state transition Markov model, with quality-adjusted life years (QALYs) as the primary outcome. A time horizon ofmore » 5 years, a cycle length of 3 months, and a willingness-to-pay threshold of $50,000/QALY was used. One-way deterministic sensitivity analyses were performed to determine the thresholds at which each strategy would be preferred. The robustness of the model was assessed by probabilistic sensitivity analysis. Results: Preoperative RT is a more cost-effective strategy ($26,633/3.00 QALYs) than postoperative RT ($28,028/2.86 QALYs) in our base case scenario. Preoperative RT is the superior strategy with either 3-dimensional conformal RT or intensity-modulated RT. One-way sensitivity analyses identified the relative risk of chronic adverse events as having the greatest influence on the preferred timing of RT. The likelihood of preoperative RT being the preferred strategy was 82% on probabilistic sensitivity analysis. Conclusions: Preoperative RT is more cost effective than postoperative RT in the management of resectable extremity STS, primarily because of the higher incidence of chronic adverse events with RT in the postoperative setting.« less

Backward assembly planning with DFA analysis

NASA Technical Reports Server (NTRS)

Lee, Sukhan (Inventor)

1992-01-01

An assembly planning system that operates based on a recursive decomposition of assembly into subassemblies is presented. The planning system analyzes assembly cost in terms of stability, directionality, and manipulability to guide the generation of preferred assembly plans. The planning in this system incorporates the special processes, such as cleaning, testing, labeling, etc., that must occur during the assembly. Additionally, the planning handles nonreversible, as well as reversible, assembly tasks through backward assembly planning. In order to decrease the planning efficiency, the system avoids the analysis of decompositions that do not correspond to feasible assembly tasks. This is achieved by grouping and merging those parts that can not be decomposable at the current stage of backward assembly planning due to the requirement of special processes and the constraint of interconnection feasibility. The invention includes methods of evaluating assembly cost in terms of the number of fixtures (or holding devices) and reorientations required for assembly, through the analysis of stability, directionality, and manipulability. All these factors are used in defining cost and heuristic functions for an AO* search for an optimal plan.

Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease.

PubMed

Quist-Paulsen, Petter; Lydersen, Stian; Bakke, Per S; Gallefoss, Frode

2006-04-01

Smoking cessation is probably the most important action to reduce mortality after a coronary event. Smoking cessation programs are not widely implemented in patients with coronary heart disease, however, possibly because they are thought not to be worth their costs. Our objectives were to estimate the cost effectiveness of a smoking cessation program, and to compare it with other treatment modalities in cardiovascular medicine. A cost-effectiveness analysis was performed on the basis of a recently conducted randomized smoking cessation intervention trial in patients admitted for coronary heart disease. The cost per life year gained by the smoking cessation program was derived from the resources necessary to implement the program, the number needed to treat to get one additional quitter from the program, and the years of life gained if quitting smoking. The cost effectiveness was estimated in a low-risk group (i.e. patients with stable coronary heart disease) and a high-risk group (i.e. patients after myocardial infarction or unstable angina), using survival data from previously published investigations, and with life-time extrapolation of the survival curves by survival function modeling. In a lifetime perspective, the incremental cost per year of life gained by the smoking cessation program was euro 280 and euro 110 in the low and high-risk group, respectively (2000 prices). These costs compare favorably to other treatment modalities in patients with coronary heart disease, being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group. In a sensitivity analysis, the costs remained low in a wide range of assumptions. A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease.

Infection after fracture fixation of the tibia: Analysis of healthcare utilization and related costs.

PubMed

Metsemakers, Willem-Jan; Smeets, Bart; Nijs, Stefaan; Hoekstra, Harm

2017-06-01

One of the most challenging complications in musculoskeletal trauma surgery is the development of infection after fracture fixation (IAFF). It can delay healing, lead to permanent functional loss, or even amputation of the affected limb. The main goal of this study was to investigate the total healthcare costs and length-of-stay (LOS) related to the surgical treatment of tibia fractures and furthermore identify the subset of clinical variables driving these costs within the Belgian healthcare system. The hypothesis was that deep infection would be the most important driver for total healthcare costs. Overall, 358 patients treated operatively for AO/OTA type 41, 42, and 43 tibia fractures between January 1, 2009 and January 1, 2014 were included in this study. A total of 26 clinical and process variables were defined. Calculated costs were limited to hospital care covered by the Belgian healthcare financing system. The five main cost categories studied were: honoraria, materials, hospitalization, day care admission, and pharmaceuticals. Multivariate analysis showed that deep infection was the most significant characteristic driving total healthcare costs and LOS related to the surgical treatment of tibia fractures. Furthermore, this complication resulted in the highest overall increase in total healthcare costs and LOS. Treatment costs were approximately 6.5-times higher compared to uninfected patients. This study shows the enormous hospital-related healthcare costs associated with IAFF of the tibia. Treatment costs for patients with deep infection are higher than previously mentioned in the literature. Therefore, future research should focus more on prevention rather than treatment strategies, not only to reduce patient morbidity but also to reduce the socio-economic impact. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy.

PubMed

Bijlani, Akash; Hebert, April E; Davitian, Mike; May, Holly; Speers, Mark; Leung, Robert; Mohamed, Nihal E; Sacks, Henry S; Tewari, Ashutosh

2016-06-01

The economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses. The objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives. We performed a model-based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients' postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars. Because of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy. Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

MetAMOS: a modular and open source metagenomic assembly and analysis pipeline

PubMed Central

2013-01-01

We describe MetAMOS, an open source and modular metagenomic assembly and analysis pipeline. MetAMOS represents an important step towards fully automated metagenomic analysis, starting with next-generation sequencing reads and producing genomic scaffolds, open-reading frames and taxonomic or functional annotations. MetAMOS can aid in reducing assembly errors, commonly encountered when assembling metagenomic samples, and improves taxonomic assignment accuracy while also reducing computational cost. MetAMOS can be downloaded from: https://github.com/treangen/MetAMOS. PMID:23320958

Proposed Functional Architecture and Associated Benefits Analysis of a Common Ground Control Station for Unmanned Aircraft Systems

DTIC Science & Technology

2010-03-01

143 Table 12. High Level Analysis of O&S Costs of Different Training Options...Station On station 24/7 ( ETOS 80%) On station 24/7 for 30 consecutive days ( ETOS 95%) Mission Radius ≥ 2,000 nm ≥ 3,000 nm Net Ready-KPP COMMON...Training with As-Is Unique GCS Architectures 143 The results of the analysis for BUQs I-IV are shown in Table 11. The data shows that

How much does a tokamak reactor cost?

NASA Astrophysics Data System (ADS)

Freidberg, J.; Cerfon, A.; Ballinger, S.; Barber, J.; Dogra, A.; McCarthy, W.; Milanese, L.; Mouratidis, T.; Redman, W.; Sandberg, A.; Segal, D.; Simpson, R.; Sorensen, C.; Zhou, M.

2017-10-01

The cost of a fusion reactor is of critical importance to its ultimate acceptability as a commercial source of electricity. While there are general rules of thumb for scaling both overnight cost and levelized cost of electricity the corresponding relations are not very accurate or universally agreed upon. We have carried out a series of scaling studies of tokamak reactor costs based on reasonably sophisticated plasma and engineering models. The analysis is largely analytic, requiring only a simple numerical code, thus allowing a very large number of designs. Importantly, the studies are aimed at plasma physicists rather than fusion engineers. The goals are to assess the pros and cons of steady state burning plasma experiments and reactors. One specific set of results discusses the benefits of higher magnetic fields, now possible because of the recent development of high T rare earth superconductors (REBCO); with this goal in mind, we calculate quantitative expressions, including both scaling and multiplicative constants, for cost and major radius as a function of central magnetic field.

CUDAICA: GPU Optimization of Infomax-ICA EEG Analysis

PubMed Central

Raimondo, Federico; Kamienkowski, Juan E.; Sigman, Mariano; Fernandez Slezak, Diego

2012-01-01

In recent years, Independent Component Analysis (ICA) has become a standard to identify relevant dimensions of the data in neuroscience. ICA is a very reliable method to analyze data but it is, computationally, very costly. The use of ICA for online analysis of the data, used in brain computing interfaces, results are almost completely prohibitive. We show an increase with almost no cost (a rapid video card) of speed of ICA by about 25 fold. The EEG data, which is a repetition of many independent signals in multiple channels, is very suitable for processing using the vector processors included in the graphical units. We profiled the implementation of this algorithm and detected two main types of operations responsible of the processing bottleneck and taking almost 80% of computing time: vector-matrix and matrix-matrix multiplications. By replacing function calls to basic linear algebra functions to the standard CUBLAS routines provided by GPU manufacturers, it does not increase performance due to CUDA kernel launch overhead. Instead, we developed a GPU-based solution that, comparing with the original BLAS and CUBLAS versions, obtains a 25x increase of performance for the ICA calculation. PMID:22811699

Modelling and genetic algorithm based optimisation of inverse supply chain

NASA Astrophysics Data System (ADS)

Bányai, T.

2009-04-01

The design and control of recycling systems of products with environmental risk have been discussed in the world already for a long time. The main reasons to address this subject are the followings: reduction of waste volume, intensification of recycling of materials, closing the loop, use of less resource, reducing environmental risk [1, 2]. The development of recycling systems is based on the integrated solution of technological and logistic resources and know-how [3]. However the financial conditions of recycling systems is partly based on the recovery, disassembly and remanufacturing options of the used products [4, 5, 6], but the investment and operation costs of recycling systems can be characterised with high logistic costs caused by the geographically wide collection system with more collection level and a high number of operation points of the inverse supply chain. The reduction of these costs is a popular area of the logistics researches. These researches include the design and implementation of comprehensive environmental waste and recycling program to suit business strategies (global system), design and supply all equipment for production line collection (external system), design logistics process to suit the economical and ecological requirements (external system) [7]. To the knowledge of the author, there has been no research work on supply chain design problems that purpose is the logistics oriented optimisation of inverse supply chain in the case of non-linear total cost function consisting not only operation costs but also environmental risk cost. The antecedent of this research is, that the author has taken part in some research projects in the field of closed loop economy ("Closing the loop of electr(on)ic products and domestic appliances from product planning to end-of-life technologies), environmental friendly disassembly (Concept for logistical and environmental disassembly technologies) and design of recycling systems of household appliances (Recycling of household appliances with emphasis on reuse options). The purpose of this paper is the presentation of a possible method for avoiding the unnecessary environmental risk and landscape use through unprovoked large supply chain of collection systems of recycling processes. In the first part of the paper the author presents the mathematical model of recycling related collection systems (applied especially for wastes of electric and electronic products) and in the second part of the work a genetic algorithm based optimisation method will be demonstrated, by the aid of which it is possible to determine the optimal structure of the inverse supply chain from the point of view economical, ecological and logistic objective functions. The model of the inverse supply chain is based on a multi-level, hierarchical collection system. In case of this static model it is assumed that technical conditions are permanent. The total costs consist of three parts: total infrastructure costs, total material handling costs and environmental risk costs. The infrastructure-related costs are dependent only on the specific fixed costs and the specific unit costs of the operation points (collection, pre-treatment, treatment, recycling and reuse plants). The costs of warehousing and transportation are represented by the material handling related costs. The most important factors determining the level of environmental risk cost are the number of out of time recycled (treated or reused) products, the number of supply chain objects and the length of transportation routes. The objective function is the minimization of the total cost taking into consideration the constraints. However a lot of research work discussed the design of supply chain [8], but most of them concentrate on linear cost functions. In the case of this model non-linear cost functions were used. The non-linear cost functions and the possible high number of objects of the inverse supply chain leaded to the problem of choosing a possible solution method. By the aid of analytical methods, the problem can not be solved, so a genetic algorithm based heuristic optimisation method was chosen to find the optimal solution. The input parameters of the optimisation are the followings: specific fixed, unit and environmental risk costs of the collection points of the inverse supply chain, specific warehousing and transportation costs and environmental risk costs of transportation. The output parameters are the followings: the number of objects in the different hierarchical levels of the collection system, infrastructure costs, logistics costs and environmental risk costs from used infrastructures, transportation and number of products recycled out of time. The next step of the research work was the application of the above mentioned method. The developed application makes it possible to define the input parameters of the real system, the graphical view of the chosen optimal solution in the case of the given input parameters, graphical view of the cost structure of the optimal solution, determination of the parameters of the algorithm (e.g. number of individuals, operators and termination conditions). The sensibility analysis of the objective function and the test results showed that the structure of the inverse supply chain depends on the proportion of the specific costs. Especially the proportion of the specific environmental risk costs influences the structure of the system and the number of objects at each hierarchical level of the collection system. The sensitivity analysis of the total cost function was performed in three cases. In the first case the effect of the proportion of specific infrastructure and logistics costs were analysed. If the infrastructure costs are significantly lower than the total costs of warehousing and transportation, then almost all objects of the first hierarchical level of the collection (collection directly from the users) were set up. In the other case of the proportion of costs the first level of the collection is not necessary, because it is replaceable by the more expensive transportation directly to the objects of the second or lower hierarchical level. In the second case the effect of the proportion of the logistics and environmental risk costs were analysed. In this case the analysis resulted to the followings: if the logistics costs are significantly higher than the total environmental risk costs, then because of the constant infrastructure costs the preference of logistics operations depends on the proportion of the environmental risk costs caused by of out of time recycled products and transportation. In the third case of the analysis the effect of the proportion of infrastructure and environmental risk costs were examined. If the infrastructure costs are significantly lower than the environmental risk costs, then almost all objects of the first hierarchical level of the collection (collection directly from the users) were set up. In the other case of the proportion of costs the first collection phase will be shifted near to the last hierarchical level of the supply chain to avoid a very high infrastructure set up and operation cost. The advantages of the presented model and solution method can be summarised in the followings: the model makes it possible to decide the structure of the inverse supply chain (which object to open or close); reduces infrastructure cost, especially for supply chain with high specific fixed costs; reduces the environmental risk cost through finding an optimal balance between number of objects of the system and out of time recycled products, reduces the logistics costs through determining the optimal quantitative parameters of material flow operations. The future of this research work is the use of differentiated lead-time, which makes it possible to take into consideration the above mentioned non-linear infrastructure, transportation, warehousing and environmental risk costs in the case of a given product portfolio segmented by lead-time. This publication was supported by the National Office for Research and Technology within the frame of Pázmány Péter programme. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Office for Research and Technology. Literature: [1] H. F. Lund: McGraw-Hill Recycling Handbook. McGraw-Hill. 2000. [2] P. T. Williams: Waste Treatment and Disposal. John Wiley and Sons Ltd. 2005. [3] M. Christopher: Logistics & Supply Chain Management: creating value-adding networks. Pearson Education [4] A. Gungor, S. M. Gupta: Issues in environmentally conscious manufacturing and product recovery: a survey. Computers & Industrial Engineering. Volume 36. Issue 4. 1999. pp. 811-853. [5] H. C. Zhang, T. C. Kuo, H. Lu, S. H. Huang: Environmentally conscious design and manufacturing: A state-of-the-art survey. Journal of Manufacturing Systems. Volume 16. Issue 5. 1997. pp. 352-371. [6] P. Veerakamolmal, S. Gupta: Design for Disassembly, Reuse, and Recycling. Green Electronics/Green Bottom Line. 2000. pp. 69-82. [7] A. Rushton, P. Croucher, P. Baker: The Handbook of Logistics and Distribution Management. Kogan P.page Limited. 2006. [8] H. Stadtler, C. Kilger: Supply Chain Management and Advanced Planning: Concepts, Models, Software, and Case Studies. Springer. 2005.

Analysis of Traffic Crashes Involving Pedestrians Using Big Data: Investigation of Contributing Factors and Identification of Hotspots.

PubMed

Xie, Kun; Ozbay, Kaan; Kurkcu, Abdullah; Yang, Hong

2017-08-01

This study aims to explore the potential of using big data in advancing the pedestrian risk analysis including the investigation of contributing factors and the hotspot identification. Massive amounts of data of Manhattan from a variety of sources were collected, integrated, and processed, including taxi trips, subway turnstile counts, traffic volumes, road network, land use, sociodemographic, and social media data. The whole study area was uniformly split into grid cells as the basic geographical units of analysis. The cell-structured framework makes it easy to incorporate rich and diversified data into risk analysis. The cost of each crash, weighted by injury severity, was assigned to the cells based on the relative distance to the crash site using a kernel density function. A tobit model was developed to relate grid-cell-specific contributing factors to crash costs that are left-censored at zero. The potential for safety improvement (PSI) that could be obtained by using the actual crash cost minus the cost of "similar" sites estimated by the tobit model was used as a measure to identify and rank pedestrian crash hotspots. The proposed hotspot identification method takes into account two important factors that are generally ignored, i.e., injury severity and effects of exposure indicators. Big data, on the one hand, enable more precise estimation of the effects of risk factors by providing richer data for modeling, and on the other hand, enable large-scale hotspot identification with higher resolution than conventional methods based on census tracts or traffic analysis zones. © 2017 Society for Risk Analysis.

Looking within to Improve Office Organization

ERIC Educational Resources Information Center

Malinowski, Matthew J.

2009-01-01

When tough economic times set in, school business administrators heighten their normal zeal in finding ways to reduce costs and improve efficiency. The author's school district recently underwent a yearlong internal self-analysis to examine and determine the proper staffing levels for the administrative functions within the school district's…

Analyzing cost-effectiveness of ulnar and median nerve transfers to regain forearm flexion.

PubMed

Wali, Arvin R; Park, Charlie C; Brown, Justin M; Mandeville, Ross

2017-03-01

OBJECTIVE Peripheral nerve transfers to regain elbow flexion via the ulnar nerve (Oberlin nerve transfer) and median nerves are surgical options that benefit patients. Prior studies have assessed the comparative effectiveness of ulnar and median nerve transfers for upper trunk brachial plexus injury, yet no study has examined the cost-effectiveness of this surgery to improve quality-adjusted life years (QALYs). The authors present a cost-effectiveness model of the Oberlin nerve transfer and median nerve transfer to restore elbow flexion in the adult population with upper brachial plexus injury. METHODS Using a Markov model, the authors simulated ulnar and median nerve transfers and conservative measures in terms of neurological recovery and improvements in quality of life (QOL) for patients with upper brachial plexus injury. Transition probabilities were collected from previous studies that assessed the surgical efficacy of ulnar and median nerve transfers, complication rates associated with comparable surgical interventions, and the natural history of conservative measures. Incremental cost-effectiveness ratios (ICERs), defined as cost in dollars per QALY, were calculated. Incremental cost-effectiveness ratios less than $50,000/QALY were considered cost-effective. One-way and 2-way sensitivity analyses were used to assess parameter uncertainty. Probabilistic sampling was used to assess ranges of outcomes across 100,000 trials. RESULTS The authors' base-case model demonstrated that ulnar and median nerve transfers, with an estimated cost of $5066.19, improved effectiveness by 0.79 QALY over a lifetime compared with conservative management. Without modeling the indirect cost due to loss of income over lifetime associated with elbow function loss, surgical treatment had an ICER of $6453.41/QALY gained. Factoring in the loss of income as indirect cost, surgical treatment had an ICER of -$96,755.42/QALY gained, demonstrating an overall lifetime cost savings due to increased probability of returning to work. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about cost of surgery, probability of good surgical outcome, and spontaneous recovery of neurological function with conservative treatment. Two-way sensitivity analysis demonstrated that surgical intervention was cost-effective with an ICER of $18,828.06/QALY even with the authors' most conservative parameters with surgical costs at $50,000 and probability of success of 50% when considering the potential income recovered through returning to work. Probabilistic sampling demonstrated that surgical intervention was cost-effective in 76% of cases at a willingness-to-pay threshold of $50,000/QALY gained. CONCLUSIONS The authors' model demonstrates that ulnar and median nerve transfers for upper brachial plexus injury improves QALY in a cost-effective manner.

Beyond Worst-Case Analysis in Privacy and Clustering: Exploiting Explicit and Implicit Assumptions

DTIC Science & Technology

2013-08-01

Dwork et al [63]. Given a query function f , the curator first estimates the global sensitivity of f , denoted GS(f) = maxD,D′ f(D)− f(D′), then outputs f...Ostrovsky et al [121]. Ostrovsky et al study instances in which the ratio between the cost of the optimal (k − 1)-means solu- tion and the cost of the...k-median objective. We also build on the work of Balcan et al [25] that investigate the connection between point-wise approximations of the target

Actions to Align Defense Contract Management Agency and Defense Contract Audit Agency Functions

DTIC Science & Technology

2012-11-13

1’he netual 5aviqg~ for all c:ost trPe proposal reviews are generally limited lo tlie negotiated ree percentages applfed to the costs questioned...such time as a businc:ss case analysts can suppon that any change lo Do() procurcmem and actiUisition pOlicy will tJrolc:ct the intdrests of the...mo.vc forward and If that analysis shows better uses for the DC AA re.<:l> uroes ·or benerways to-efficiently support contrncting officers. DPAP will

An EOQ model for weibull distribution deterioration with time-dependent cubic demand and backlogging

NASA Astrophysics Data System (ADS)

Santhi, G.; Karthikeyan, K.

2017-11-01

In this article we introduce an economic order quantity model with weibull deterioration and time dependent cubic demand rate where holding costs as a linear function of time. Shortages are allowed in the inventory system are partially and fully backlogging. The objective of this model is to minimize the total inventory cost by using the optimal order quantity and the cycle length. The proposed model is illustrated by numerical examples and the sensitivity analysis is performed to study the effect of changes in parameters on the optimum solutions.

Application of Microchip Electrophoresis for Clinical Tests

NASA Astrophysics Data System (ADS)

Yatsushiro, Shouki; Kataoka, Masatoshi

Microchip electrophoresis has recently attracted much attention in the field of nuclear acid analysis due to its high efficiency, ease of operation, low consumption of samples and reagents, and relatively low costs. In addition, the analysis has expanded to an analytical field like not only the analysis of DNA but also the analysis of RNA, the protein, the sugar chain, and the cellular function, etc. In this report, we showed that high-performance monitoring systems for human blood glucose levels and α-amylase activity in human plasma using microchip electrophoresis.

Opportunities in SMR Emergency Planning

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

Moe, Wayne L.

2014-10-01

Using year 2014 cost information gathered from twenty different locations within the current commercial nuclear power station fleet, an assessment was performed concerning compliance costs associated with the offsite emergency Planning Standards contained in 10 CFR 50.47(b). The study was conducted to quantitatively determine the potential cost benefits realized if an emergency planning zone (EPZ) were reduced in size according to the lowered risks expected to accompany small modular reactors (SMR). Licensees are required to provide a technical basis when proposing to reduce the surrounding EPZ size to less than the 10 mile plume exposure and 50 mile ingestion pathwaymore » distances currently being used. To assist licensees in assessing the savings that might be associated with such an action, this study established offsite emergency planning costs in connection with four discrete EPZ boundary distances, i.e., site boundary, 2 miles, 5 miles and 10 miles. The boundary selected by the licensee would be based on where EPA Protective Action Guidelines are no longer likely to be exceeded. Additional consideration was directed towards costs associated with reducing the 50 mile ingestion pathway EPZ. The assessment methodology consisted of gathering actual capital costs and annual operating and maintenance costs for offsite emergency planning programs at the surveyed sites, partitioning them according to key predictive factors, and allocating those portions to individual emergency Planning Standards as a function of EPZ size. Two techniques, an offsite population-based approach and an area-based approach, were then employed to calculate the scaling factors which enabled cost projections as a function of EPZ size. Site-specific factors that influenced source data costs, such as the effects of supplemental funding to external state and local agencies for offsite response organization activities, were incorporated into the analysis to the extent those factors could be representatively apportioned.« less

Cost-effectiveness of vaccination against herpes zoster in adults aged over 60 years in Belgium.

PubMed

Bilcke, Joke; Marais, Christiaan; Ogunjimi, Benson; Willem, Lander; Hens, Niel; Beutels, Philippe

2012-01-11

To assess the cost-effectiveness of vaccinating all or subgroups of adults aged 60 to 85 years against herpes zoster. A deterministic compartmental static model was developed (in freeware R), in which cohorts can acquire herpes zoster according to their age in years. Surveys and database analyses were conducted to obtain as much as possible Belgian age-specific estimates for input parameters. Direct costs and Quality-Adjusted Life-Year (QALY) losses were estimated as a function of standardised Severity Of Illness (SOI) scores (i.e. as a function of the duration and severity of herpes zoster disease). Uncertainty about the average SOI score for a person with herpes zoster, the duration of protection from the vaccine, and the population that can benefit from the vaccine, exerts a major impact on the results: under assumptions least in favour of vaccination, vaccination is not cost-effective (i.e. incremental cost per QALY gained >€48,000 for all ages considered) at the expected vaccine price of €90 per dose. At the same price, but under assumptions most in favour of vaccination, vaccination is found to be cost-effective (i.e. incremental cost per QALY gained <€5500 for all ages considered). Vaccination of age cohort 60 seems more cost-effective than vaccination of any older age cohort in Belgium. If the vaccine price per dose drops to €45, HZ vaccination of adults aged 60-64 years is likely to be cost-effective in Belgium, even under assumptions least in favour of vaccination. Unlike previous studies, our analysis acknowledged major methodological and model uncertainties simultaneously and presented outcomes for 26 different target ages at which vaccination can be considered (ages 60-85). Copyright © 2011 Elsevier Ltd. All rights reserved.

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

Cost-benefit and cost-savings analyses of antiarrhythmic medication monitoring.

PubMed

Snider, Melissa; Carnes, Cynthia; Grover, Janel; Davis, Rich; Kalbfleisch, Steven

2012-09-15

The economic impact of pharmacist-managed antiarrhythmic drug therapy monitoring on an academic medical center's electrophysiology (EP) program was investigated. Data were collected for the initial two years of patient visits (n = 816) to a pharmacist-run clinic for antiarrhythmic drug therapy monitoring. A retrospective cost analysis was conducted to assess the direct costs associated with three appointment models: (1) a clinic office visit only, (2) a clinic visit involving electrocardiography and basic laboratory tests, and (3) a clinic visit including pulmonary function testing and chest x-rays in addition to electrocardiography and laboratory testing. A subset of patient cases (n = 18) were included in a crossover analysis comparing pharmacist clinic care and usual care in an EP physician clinic. The primary endpoints were the cost benefits and cost savings associated with pharmacy-clinic care versus usual care. A secondary endpoint was improvement of overall EP program efficiency. The payer mix was 61.6% (n = 498) Medicare, 33.2% (n = 268) managed care, and 5.2% (n = 42) other. Positive contribution margins were demonstrated for all appointment models. The pharmacist-managed clinic also yielded cost savings by reducing overall patient care charges by 21% relative to usual care. By the second year, the pharmacy clinic improved EP program efficiency by scheduling an average of 24 patients per week, in effect freeing up one day per week of EP physician time to spend on other clinical activities. Pharmacist monitoring of antiarrhythmic drug therapy in an out-patient clinic provided cost benefits, cost savings, and improved overall EP program efficiency.

Cost-Effectiveness of Sensor-Augmented Pump Therapy with Low Glucose Suspend Versus Standard Insulin Pump Therapy in Two Different Patient Populations with Type 1 Diabetes in France.

PubMed

Roze, Stéphane; Smith-Palmer, Jayne; Valentine, William; Payet, Vincent; de Portu, Simona; Papo, Natalie; Cucherat, Michel; Hanaire, Helene

2016-02-01

Sensor-augmented pump therapy (SAP) provides a useful adjunct relative to continuous subcutaneous insulin infusion (CSII) alone. It can provide early warning of the onset of hyperglycemia and hypoglycemia and has the functionality to suspend insulin delivery if sensor glucose levels fall below a predefined threshold. The aim was to assess the cost-effectiveness of SAP with low glucose suspend (LGS) versus CSII alone in type 1 diabetes. Cost-effectiveness analysis was performed using the CORE Diabetes Model, using published clinical input data. The analysis was performed in two cohorts: one with uncontrolled glycated hemoglobin at baseline and one at elevated risk for hypoglycemic events. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon; future costs and clinical outcomes were discounted at 4% per annum. In patients with uncontrolled glycated hemoglobin at baseline, SAP + LGS resulted in improved discounted quality-adjusted life expectancy (QALE) versus CSII (10.55 quality-adjusted life-years [QALYs] vs. 9.36 QALYs) but higher mean lifetime direct costs (€84,972 vs. €49,171) resulting in an incremental cost-effectiveness ratio (ICER) of €30,163 per QALY gained. In patients at elevated risk for hypoglycemia, the ICER was €22,005 per QALY gained for SAP + LGS versus CSII as lifetime costs were higher (€88,680 vs. €57,097), but QALE was also higher (18.46 QALYs vs. 18.30 QALYs). In France, projected improvements in outcomes with SAP + LGS versus CSII translated into an ICER generally considered as good value for money, particularly in patients who experience frequent and/or problematic hypoglycemic events.

[Value(s)].

PubMed

Vanbelle, G

2006-01-01

After a short explanation of the word value, the (cultural) value of teeth, the economic evaluation of dentistry and the payment criteria are being presented. The specific situation of health care as a service which deviates in quite a few aspects from the standard demand-supply model is being pointed out. Attention is drawn to key characteristics of the liberal professions such as the obligation to perform to the best of one's ability, not to a specific result. Function classification appears to offer possibilities for cataloguing the wide variation in practice settings. The well-known wage calculation of Professor De Lembre is being reviewed. Subsequently the analysis of cost variation and induced demand by extra services and profile shaping is being elaborated. Cost-benefit-analysis is the concluding item.

Multiple kernel learning using single stage function approximation for binary classification problems

NASA Astrophysics Data System (ADS)

Shiju, S.; Sumitra, S.

2017-12-01

In this paper, the multiple kernel learning (MKL) is formulated as a supervised classification problem. We dealt with binary classification data and hence the data modelling problem involves the computation of two decision boundaries of which one related with that of kernel learning and the other with that of input data. In our approach, they are found with the aid of a single cost function by constructing a global reproducing kernel Hilbert space (RKHS) as the direct sum of the RKHSs corresponding to the decision boundaries of kernel learning and input data and searching that function from the global RKHS, which can be represented as the direct sum of the decision boundaries under consideration. In our experimental analysis, the proposed model had shown superior performance in comparison with that of existing two stage function approximation formulation of MKL, where the decision functions of kernel learning and input data are found separately using two different cost functions. This is due to the fact that single stage representation helps the knowledge transfer between the computation procedures for finding the decision boundaries of kernel learning and input data, which inturn boosts the generalisation capacity of the model.

On the Convergence Analysis of the Optimized Gradient Method.

PubMed

Kim, Donghwan; Fessler, Jeffrey A

2017-01-01

This paper considers the problem of unconstrained minimization of smooth convex functions having Lipschitz continuous gradients with known Lipschitz constant. We recently proposed the optimized gradient method for this problem and showed that it has a worst-case convergence bound for the cost function decrease that is twice as small as that of Nesterov's fast gradient method, yet has a similarly efficient practical implementation. Drori showed recently that the optimized gradient method has optimal complexity for the cost function decrease over the general class of first-order methods. This optimality makes it important to study fully the convergence properties of the optimized gradient method. The previous worst-case convergence bound for the optimized gradient method was derived for only the last iterate of a secondary sequence. This paper provides an analytic convergence bound for the primary sequence generated by the optimized gradient method. We then discuss additional convergence properties of the optimized gradient method, including the interesting fact that the optimized gradient method has two types of worstcase functions: a piecewise affine-quadratic function and a quadratic function. These results help complete the theory of an optimal first-order method for smooth convex minimization.

On the Convergence Analysis of the Optimized Gradient Method

PubMed Central

Kim, Donghwan; Fessler, Jeffrey A.

2016-01-01

This paper considers the problem of unconstrained minimization of smooth convex functions having Lipschitz continuous gradients with known Lipschitz constant. We recently proposed the optimized gradient method for this problem and showed that it has a worst-case convergence bound for the cost function decrease that is twice as small as that of Nesterov’s fast gradient method, yet has a similarly efficient practical implementation. Drori showed recently that the optimized gradient method has optimal complexity for the cost function decrease over the general class of first-order methods. This optimality makes it important to study fully the convergence properties of the optimized gradient method. The previous worst-case convergence bound for the optimized gradient method was derived for only the last iterate of a secondary sequence. This paper provides an analytic convergence bound for the primary sequence generated by the optimized gradient method. We then discuss additional convergence properties of the optimized gradient method, including the interesting fact that the optimized gradient method has two types of worstcase functions: a piecewise affine-quadratic function and a quadratic function. These results help complete the theory of an optimal first-order method for smooth convex minimization. PMID:28461707

Analysis of Seasonal Chlorophyll-a Using An Adjoint Three-Dimensional Ocean Carbon Cycle Model

NASA Astrophysics Data System (ADS)

Tjiputra, J.; Winguth, A.; Polzin, D.

2004-12-01

The misfit between numerical ocean model and observations can be reduced using data assimilation. This can be achieved by optimizing the model parameter values using adjoint model. The adjoint model minimizes the model-data misfit by estimating the sensitivity or gradient of the cost function with respect to initial condition, boundary condition, or parameters. The adjoint technique was used to assimilate seasonal chlorophyll-a data from the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) satellite to a marine biogeochemical model HAMOCC5.1. An Identical Twin Experiment (ITE) was conducted to test the robustness of the model and the non-linearity level of the forward model. The ITE experiment successfully recovered most of the perturbed parameter to their initial values, and identified the most sensitive ecosystem parameters, which contribute significantly to model-data bias. The regional assimilations of SeaWiFS chlorophyll-a data into the model were able to reduce the model-data misfit (i.e. the cost function) significantly. The cost function reduction mostly occurred in the high latitudes (e.g. the model-data misfit in the northern region during summer season was reduced by 54%). On the other hand, the equatorial regions appear to be relatively stable with no strong reduction in cost function. The optimized parameter set is used to forecast the carbon fluxes between marine ecosystem compartments (e.g. Phytoplankton, Zooplankton, Nutrients, Particulate Organic Carbon, and Dissolved Organic Carbon). The a posteriori model run using the regional best-fit parameterization yields approximately 36 PgC/yr of global net primary productions in the euphotic zone.

Placebo effect of medication cost in Parkinson disease: a randomized double-blind study.

PubMed

Espay, Alberto J; Norris, Matthew M; Eliassen, James C; Dwivedi, Alok; Smith, Matthew S; Banks, Christi; Allendorfer, Jane B; Lang, Anthony E; Fleck, David E; Linke, Michael J; Szaflarski, Jerzy P

2015-02-24

To examine the effect of cost, a traditionally "inactive" trait of intervention, as contributor to the response to therapeutic interventions. We conducted a prospective double-blind study in 12 patients with moderate to severe Parkinson disease and motor fluctuations (mean age 62.4 ± 7.9 years; mean disease duration 11 ± 6 years) who were randomized to a "cheap" or "expensive" subcutaneous "novel injectable dopamine agonist" placebo (normal saline). Patients were crossed over to the alternate arm approximately 4 hours later. Blinded motor assessments in the "practically defined off" state, before and after each intervention, included the Unified Parkinson's Disease Rating Scale motor subscale, the Purdue Pegboard Test, and a tapping task. Measurements of brain activity were performed using a feedback-based visual-motor associative learning functional MRI task. Order effect was examined using stratified analysis. Although both placebos improved motor function, benefit was greater when patients were randomized first to expensive placebo, with a magnitude halfway between that of cheap placebo and levodopa. Brain activation was greater upon first-given cheap but not upon first-given expensive placebo or by levodopa. Regardless of order of administration, only cheap placebo increased activation in the left lateral sensorimotor cortex and other regions. Expensive placebo significantly improved motor function and decreased brain activation in a direction and magnitude comparable to, albeit less than, levodopa. Perceptions of cost are capable of altering the placebo response in clinical studies. This study provides Class III evidence that perception of cost is capable of influencing motor function and brain activation in Parkinson disease. © 2015 American Academy of Neurology.

The role of ground water in water-supply emergency planning

NASA Astrophysics Data System (ADS)

Reichard, E. G.; Li, Z.; Hermans, C.

2008-12-01

Catastrophic events, such as earthquakes or floods, can result in water-supply disruptions. Such disruptions can cause large economic losses and pose threats to public health. Water managers seek to develop cost- effective strategies for reducing these risks and ensuring water security. In many areas, ground water can play an important role in such water-supply emergency planning. We present a probabilistic framework for estimating the hydraulic impacts and associated costs of using ground water as a backup supply in the event of a disruption in imported-water deliveries. We also estimate the benefits of ground-water management strategies, such as artificial recharge, in terms of reduced costs of responding to water-supply emergencies. The magnitude of these benefits will depend on the expected severity and duration of the imported-water disruption, the functioning of the hydrogeologic system, and economic parameters. We apply the framework to address water-supply emergency planning in the Los Angeles area. A simulation model is used to generate response functions, which relate emergency ground-water pumpage to potential adverse effects, such as increased pumping lifts, subsidence, and seawater intrusion. These response functions are incorporated into a Monte Carlo analysis, along with cost coefficients and information on the probable severity of the disruption. Disruption severity is represented by a probability distribution, which can be elicited from water managers. In the example, the primary emergency-related benefits of artificial recharge are reductions in potential subsidence costs. The framework could be extended to consider additional engineering factors (e.g., well capacities and integrity of local distribution systems), institutional arrangements, and regulatory requirements.

Lumbosacral Dorsal Rhizotomy for Spastic Cerebral Palsy: A Health Technology Assessment

PubMed Central

Pron, Gaylene; Chan, Brian; Tu, Hong Anh; Xie, Xuanqian; Weir, Mark; Wells, David; Higgins, Caroline

2017-01-01

Background Cerebral palsy, a spectrum of neuromuscular conditions caused by abnormal brain development or early damage to the brain, is the most common cause of childhood physical disability. Lumbosacral dorsal rhizotomy is a neurosurgical procedure that permanently decreases spasticity and is always followed by physical therapy. The objectives of this health technology assessment were to evaluate the clinical effectiveness, safety, cost effectiveness, and family perspectives of dorsal rhizotomy. Methods We performed a systematic literature search until December 2015 with auto-alerts until December 2016. Search strategies were developed by medical librarians, and a single reviewer reviewed the abstracts. The health technology assessment included a clinical review based on functional outcomes, safety, and treatment satisfaction; an economic study reviewing cost-effective literature; a budget impact analysis; and interviews with families evaluating the intervention. Results Eighty-four studies (1 meta-analysis, 5 randomized controlled studies [RCTs], 75 observational pre-post studies, and 3 case reports) were reviewed. A meta-analysis of RCTs involving dorsal rhizotomy and physical therapy versus physical therapy confirmed reduced lower-limb spasticity and increased gross motor function (4.5%, P = .002). Observational studies reported statistically significant improvements in gross motor function over 2 years or less (12 studies, GRADE moderate) and over more than 2 years (10 studies, GRADE moderate) as well as improvements in functional independence in the short term (10 studies, GRADE moderate) and long term (4 studies, GRADE low). Major operative complications, were infrequently reported (4 studies). Bony abnormalities and instabilities monitored radiologically in the spine (15 studies) and hip (8 studies) involved minimal or clinically insignificant changes after surgery. No studies evaluated the cost effectiveness of dorsal rhizotomy. The budget impact of funding dorsal rhizotomy for treatment of Ontario children with cerebral palsy was $1.3 million per year. Families reported perceived improvements in their children and expressed satisfaction with treatment. Ontario families reported inadequate medical information on benefits or risk to make an informed decision, enormous financial burdens, and lack rehabilitation support after surgery. Conclusions Lumbrosacral dorsal rhizotomy and physical therapy effectively reduces lower-limb spasticity in children with spastic cerebral palsy and significantly improves their gross motor function and functional independence. Major peri-operative complications were infrequently reported. Families reported perceived improvements with dorsal rhizotomy, and surgery and post-operative rehabilitation were intensive and demanding. PMID:28757906

Lumbosacral Dorsal Rhizotomy for Spastic Cerebral Palsy: A Health Technology Assessment.

PubMed

2017-01-01

Cerebral palsy, a spectrum of neuromuscular conditions caused by abnormal brain development or early damage to the brain, is the most common cause of childhood physical disability. Lumbosacral dorsal rhizotomy is a neurosurgical procedure that permanently decreases spasticity and is always followed by physical therapy. The objectives of this health technology assessment were to evaluate the clinical effectiveness, safety, cost effectiveness, and family perspectives of dorsal rhizotomy. We performed a systematic literature search until December 2015 with auto-alerts until December 2016. Search strategies were developed by medical librarians, and a single reviewer reviewed the abstracts. The health technology assessment included a clinical review based on functional outcomes, safety, and treatment satisfaction; an economic study reviewing cost-effective literature; a budget impact analysis; and interviews with families evaluating the intervention. Eighty-four studies (1 meta-analysis, 5 randomized controlled studies [RCTs], 75 observational pre-post studies, and 3 case reports) were reviewed. A meta-analysis of RCTs involving dorsal rhizotomy and physical therapy versus physical therapy confirmed reduced lower-limb spasticity and increased gross motor function (4.5%, P = .002). Observational studies reported statistically significant improvements in gross motor function over 2 years or less (12 studies, GRADE moderate) and over more than 2 years (10 studies, GRADE moderate) as well as improvements in functional independence in the short term (10 studies, GRADE moderate) and long term (4 studies, GRADE low). Major operative complications, were infrequently reported (4 studies). Bony abnormalities and instabilities monitored radiologically in the spine (15 studies) and hip (8 studies) involved minimal or clinically insignificant changes after surgery. No studies evaluated the cost effectiveness of dorsal rhizotomy. The budget impact of funding dorsal rhizotomy for treatment of Ontario children with cerebral palsy was $1.3 million per year. Families reported perceived improvements in their children and expressed satisfaction with treatment. Ontario families reported inadequate medical information on benefits or risk to make an informed decision, enormous financial burdens, and lack rehabilitation support after surgery. Lumbrosacral dorsal rhizotomy and physical therapy effectively reduces lower-limb spasticity in children with spastic cerebral palsy and significantly improves their gross motor function and functional independence. Major peri-operative complications were infrequently reported. Families reported perceived improvements with dorsal rhizotomy, and surgery and post-operative rehabilitation were intensive and demanding.

Suture Button Fixation Versus Syndesmotic Screws in Supination-External Rotation Type 4 Injuries: A Cost-Effectiveness Analysis.

PubMed

Neary, Kaitlin C; Mormino, Matthew A; Wang, Hongmei

2017-01-01

In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question. This study aimed to examine the cost-effectiveness of the suture button and determine whether suture button fixation is more cost-effective than two 3.5-mm syndesmotic screws not removed on a routine postoperative basis. Economic and decision analysis; Level of evidence, 2. Studies with the highest evidence levels in the available literature were used to estimate the hardware removal and failure rates for syndesmotic screws and suture button fixation. Costs were determined by examining the average costs for patients who underwent surgery for unstable SER IV ankle fractures at a single level-1 trauma institution. A decision analysis model that allowed comparison of the 2 fixation methods was developed. Using a 20% screw hardware removal rate and a 4% suture button hardware removal rate, the total cost for 2 syndesmotic screws was US$20,836 and the total effectiveness was 5.846. This yielded a total cost of $3564 per quality-adjusted life-year (QALY) over an 8-year time period. The total cost for suture button fixation was $19,354 and the total effectiveness was 5.904, resulting in a total cost of $3294 per QALY over the same time period. A sensitivity analysis was then conducted to assess suture button fixation costs as well as screw and suture button hardware removal rates. Other possible treatment scenarios were also examined, including 1 screw and 2 suture buttons for operative fixation of the syndesmosis. To become more cost-effective, the screw hardware removal rate would have to be reduced to less than 10%. Furthermore, fixation with a single suture button continued to be the dominant treatment strategy compared with 2 suture buttons, 1 screw, and 2 screws for syndesmotic fixation. This cost-effectiveness analysis suggests that for unstable SER IV ankle fractures, suture button fixation is more cost-effective than syndesmotic screws not removed on a routine basis. Suture button fixation was a dominant treatment strategy, because patients spent on average $1482 less and had a higher quality of life by 0.058 QALYs compared with patients who received fixation with 2 syndesmotic screws. Assuming that functional outcomes and failure rates were equivalent, screw fixation only became more cost-effective when the screw hardware removal rate was reduced to less than 10% or when the suture button cost exceeded $2000. In addition, fixation with a single suture button device proved more cost-effective than fixation with either 1 or 2 syndesmotic screws.

A novel methodology for estimating upper limits of major cost drivers for profitable conceptual launch system architectures

NASA Astrophysics Data System (ADS)

Rhodes, Russel E.; Byrd, Raymond J.

1998-01-01

This paper presents a ``back of the envelope'' technique for fast, timely, on-the-spot, assessment of affordability (profitability) of commercial space transportation architectural concepts. The tool presented here is not intended to replace conventional, detailed costing methodology. The process described enables ``quick look'' estimations and assumptions to effectively determine whether an initial concept (with its attendant cost estimating line items) provides focus for major leapfrog improvement. The Cost Charts Users Guide provides a generic sample tutorial, building an approximate understanding of the basic launch system cost factors and their representative magnitudes. This process will enable the user to develop a net ``cost (and price) per payload-mass unit to orbit'' incorporating a variety of significant cost drivers, supplemental to basic vehicle cost estimates. If acquisition cost and recurring cost factors (as a function of cost per payload-mass unit to orbit) do not meet the predetermined system-profitability goal, the concept in question will be clearly seen as non-competitive. Multiple analytical approaches, and applications of a variety of interrelated assumptions, can be examined in a quick, (on-the-spot) cost approximation analysis as this tool has inherent flexibility. The technique will allow determination of concept conformance to system objectives.

FEL for the polymer processing industries

NASA Astrophysics Data System (ADS)

Kelley, Michael J.

1997-05-01

Polymers are everywhere in modern life because of their unique combination of end-use functionalities, ease of processing, recycling potential and modest cost. The physical and economic scope of the infrastructure committed to present polymers makes the introduction of entirely new chemistry unlikely. Rather, the breadth of commercial offerings more likely to shrink in the face of the widening mandate for recycling, especially of packaging. Improved performance and new functionality must therefore come by routes such as surface modification. However they must come with little environmental impact and at painfully low cost. Processing with strongly absorbed light offers unique advantages. The journal and patent literatures disclose a number of examples of benefits that can be achieved, principally by use of excimer lasers or special UV lamps. Examples of commercialization are few, however, because of the unit cost and maximum scale of existing light sources. A FEL, however, offers unique advantages: tunability to the optimum wavelength, potential for scale up to high average power, and a path to attractively low unit cost of light. A business analysis of prospective applications defines the technical and economic requirements a FEL for polymer surface processing must meet. These are compared to FEL technology as it now stands and as it is envisioned.

Adopting epidemic model to optimize medication and surgical intervention of excess weight

NASA Astrophysics Data System (ADS)

Sun, Ruoyan

2017-01-01

We combined an epidemic model with an objective function to minimize the weighted sum of people with excess weight and the cost of a medication and surgical intervention in the population. The epidemic model is consisted of ordinary differential equations to describe three subpopulation groups based on weight. We introduced an intervention using medication and surgery to deal with excess weight. An objective function is constructed taking into consideration the cost of the intervention as well as the weight distribution of the population. Using empirical data, we show that fixed participation rate reduces the size of obese population but increases the size for overweight. An optimal participation rate exists and decreases with respect to time. Both theoretical analysis and empirical example confirm the existence of an optimal participation rate, u*. Under u*, the weighted sum of overweight (S) and obese (O) population as well as the cost of the program is minimized. This article highlights the existence of an optimal participation rate that minimizes the number of people with excess weight and the cost of the intervention. The time-varying optimal participation rate could contribute to designing future public health interventions of excess weight.

Are Education Cost Functions Ready for Prime Time? An Examination of Their Validity and Reliability

ERIC Educational Resources Information Center

Duncombe, William; Yinger, John

2011-01-01

This article makes the case that cost functions are the best available methodology for ensuring consistency between a state's educational accountability system and its education finance system. Because they are based on historical data and well-known statistical methods, cost functions are a particularly flexible and low-cost way to forecast what…

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

PubMed

Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K

2008-09-01

To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

Economic evaluation of Cardio inCode®, a clinical-genetic function for coronary heart disease risk assessment.

PubMed

Ramírez de Arellano, A; Coca, A; de la Figuera, M; Rubio-Terrés, C; Rubio-Rodríguez, D; Gracia, A; Boldeanu, A; Puig-Gilberte, J; Salas, E

2013-10-01

A clinical–genetic function (Cardio inCode®) was generated using genetic variants associated with coronary heart disease (CHD), but not with classical CHD risk factors, to achieve a more precise estimation of the CHD risk of individuals by incorporating genetics into risk equations [Framingham and REGICOR (Registre Gironí del Cor)]. The objective of this study was to conduct an economic analysis of the CHD risk assessment with Cardio inCode®, which incorporates the patient’s genetic risk into the functions of REGICOR and Framingham, compared with the standard method (using only the functions). A Markov model was developed with seven states of health (low CHD risk, moderate CHD risk, high CHD risk, CHD event, recurrent CHD, chronic CHD, and death). The reclassification of CHD risk derived from genetic information and transition probabilities between states was obtained from a validation study conducted in cohorts of REGICOR (Spain) and Framingham (USA). It was assumed that patients classified as at moderate risk by the standard method were the best candidates to test the risk reclassification with Cardio inCode®. The utilities and costs (€; year 2011 values) of Markov states were obtained from the literature and Spanish sources. The analysis was performed from the perspective of the Spanish National Health System, for a life expectancy of 82 years in Spain. An annual discount rate of 3.5 % for costs and benefits was applied. For a Cardio inCode® price of €400, the cost per QALY gained compared with the standard method [incremental cost-effectiveness ratio (ICER)] would be €12,969 and €21,385 in REGICOR and Framingham cohorts, respectively. The threshold price of Cardio inCode® to reach the ICER threshold generally accepted in Spain (€30,000/QALY) would range between €668 and €836. The greatest benefit occurred in the subgroup of patients with moderate–high risk, with a high-risk reclassification of 22.8 % and 12 % of patients and an ICER of €1,652/QALY and €5,884/QALY in the REGICOR and Framingham cohorts, respectively. Sensitivity analyses confirmed the stability of the study results. Cardio inCode® is a cost-effective risk score option in CHD risk assessment compared with the standard method.

Cost-effectiveness Analysis of Stereotactic Radiosurgery Alone Versus Stereotactic Radiosurgery with Upfront Whole Brain Radiation Therapy for Brain Metastases.

PubMed

Kim, H; Rajagopalan, M S; Beriwal, S; Smith, K J

2017-10-01

Stereotactic radiosurgery (SRS) alone or upfront whole brain radiation therapy (WBRT) plus SRS are the most commonly used treatment options for one to three brain oligometastases. The most recent randomised clinical trial result comparing SRS alone with upfront WBRT plus SRS (NCCTG N0574) has favoured SRS alone for neurocognitive function, whereas treatment options remain controversial in terms of cognitive decline and local control. The aim of this study was to conduct a cost-effectiveness analysis of these two competing treatments. A Markov model was constructed for patients treated with SRS alone or SRS plus upfront WBRT based on largely randomised clinical trials. Costs were based on 2016 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER) and effectiveness was measured in quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were carried out. Strategies were evaluated from the healthcare payer's perspective with a willingness-to-pay threshold of $100 000 per QALY gained. In the base case analysis, the median survival was 9 months for both arms. SRS alone resulted in an ICER of $9917 per QALY gained. In one-way sensitivity analyses, results were most sensitive to variation in cognitive decline rates for both groups and median survival rates, but the SRS alone remained cost-effective for most parameter ranges. Based on the current available evidence, SRS alone was found to be cost-effective for patients with one to three brain metastases compared with upfront WBRT plus SRS. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Trade-space Analysis for Constellations

NASA Astrophysics Data System (ADS)

Le Moigne, J.; Dabney, P.; de Weck, O. L.; Foreman, V.; Grogan, P.; Holland, M. P.; Hughes, S. P.; Nag, S.

2016-12-01

Traditionally, space missions have relied on relatively large and monolithic satellites, but in the past few years, under a changing technological and economic environment, including instrument and spacecraft miniaturization, scalable launchers, secondary launches as well as hosted payloads, there is growing interest in implementing future NASA missions as Distributed Spacecraft Missions (DSM). The objective of our project is to provide a framework that facilitates DSM Pre-Phase A investigations and optimizes DSM designs with respect to a-priori Science goals. In this first version of our Trade-space Analysis Tool for Constellations (TAT-C), we are investigating questions such as: "How many spacecraft should be included in the constellation? Which design has the best cost/risk value?" The main goals of TAT-C are to: Handle multiple spacecraft sharing a mission objective, from SmallSats up through flagships, Explore the variables trade space for pre-defined science, cost and risk goals, and pre-defined metrics Optimize cost and performance across multiple instruments and platforms vs. one at a time. This paper describes the overall architecture of TAT-C including: a User Interface (UI) interacting with multiple users - scientists, missions designers or program managers; an Executive Driver gathering requirements from UI, then formulating Trade-space Search Requests for the Trade-space Search Iterator first with inputs from the Knowledge Base, then, in collaboration with the Orbit & Coverage, Reduction & Metrics, and Cost& Risk modules, generating multiple potential architectures and their associated characteristics. TAT-C leverages the use of the Goddard Mission Analysis Tool (GMAT) to compute coverage and ancillary data, streamlining the computations by modeling orbits in a way that balances accuracy and performance. TAT-C current version includes uniform Walker constellations as well as Ad-Hoc constellations, and its cost model represents an aggregate model consisting of Cost Estimating Relationships (CERs) from widely accepted models. The Knowledge Base supports both analysis and exploration, and the current GUI prototype automatically generates graphics representing metrics such as average revisit time or coverage as a function of cost.

Satellite services system analysis study. Volume 1, part 2: Executive summary

NASA Technical Reports Server (NTRS)

1981-01-01

The early mission model was developed through a survey of the potential user market. Service functions were defined and a group of design reference missions were selected which represented needs for each of the service functions. Servicing concepts were developed through mission analysis and STS timeline constraint analysis. The hardware needs for accomplishing the service functions were identified with emphasis being placed on applying equipment in the current NASA inventory and that in advanced stages of planning. A more comprehensive service model was developed based on the NASA and DoD mission models segregated by mission class. The number of service events of each class were estimated based on average revisit and service assumptions. Service Kits were defined as collections of equipment applicable to performing one or more service functions. Preliminary design was carrid out on a selected set of hardware needed for early service missions. The organization and costing of the satellie service systems were addressed.

The economic burden of schizophrenia in Canada in 2004.

PubMed

Goeree, R; Farahati, F; Burke, N; Blackhouse, G; O'Reilly, D; Pyne, J; Tarride, J-E

2005-12-01

To estimate the financial burden of schizophrenia in Canada in 2004. A prevalence-based cost-of-illness (COI) approach was used. The primary sources of information for the study included a review of the published literature, a review of published reports and documents, secondary analysis of administrative datasets, and information collected directly from various federal and provincial government programs and services. The literature review included publications up to April 2005 reported in MedLine, EMBASE and PsychINFO. Where specific information from a province was not available, the method of mean substitution from other provinces was used. Costs incurred by various levels/departments of government were separated into healthcare and non-healthcare costs. Also included in the analysis was the value of lost productivity for premature mortality and morbidity associated with schizophrenia. Sensitivity analysis was used to test major cost assumptions used in the analysis. Where possible, all resource utilization estimates for the financial burden of schizophrenia were obtained for 2004 and are expressed in 2004 Canadian dollars (CAN dollars). The estimated number of persons with schizophrenia in Canada in 2004 was 234 305 (95% CI, 136 201-333 402). The direct healthcare and non-healthcare costs were estimated to be 2.02 billion CAN dollars in 2004. There were 374 deaths attributed to schizophrenia. This combined with the high unemployment rate due to schizophrenia resulted in an additional productivity morbidity and mortality loss estimate of 4.83 billion CAN dollars, for a total cost estimate in 2004 of 6.85 billion CAN dollars. By far the largest component of the total cost estimate was for productivity losses associated with morbidity in schizophrenia (70% of total costs) and the results showed that total cost estimates were most sensitive to alternative assumptions regarding the additional unemployment due to schizophrenia in Canada. Despite significant improvements in the past decade in pharmacotherapy, programs and services available for patients with schizophrenia, the economic burden of schizophrenia in Canada remains high. The most significant factor affecting the cost of schizophrenia in Canada is lost productivity due to morbidity. Programs targeted at improving patient symptoms and functioning to increase workforce participation has the potential to make a significant contribution in reducing the cost of this severe mental illness in Canada.

Space shuttle low cost/risk avionics study

NASA Technical Reports Server (NTRS)

1971-01-01

All work breakdown structure elements containing any avionics related effort were examined for pricing the life cycle costs. The analytical, testing, and integration efforts are included for the basic onboard avionics and electrical power systems. The design and procurement of special test equipment and maintenance and repair equipment are considered. Program management associated with these efforts is described. Flight test spares and labor and materials associated with the operations and maintenance of the avionics systems throughout the horizontal flight test are examined. It was determined that cost savings can be achieved by using existing hardware, maximizing orbiter-booster commonality, specifying new equipments to MIL quality standards, basing redundancy on cost effective analysis, minimizing software complexity and reducing cross strapping and computer-managed functions, utilizing compilers and floating point computers, and evolving the design as dictated by the horizontal flight test schedules.

Comparative analysis for various redox flow batteries chemistries using a cost performance model

NASA Astrophysics Data System (ADS)

Crawford, Alasdair; Viswanathan, Vilayanur; Stephenson, David; Wang, Wei; Thomsen, Edwin; Reed, David; Li, Bin; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent

2015-10-01

The total energy storage system cost is determined by means of a robust performance-based cost model for multiple flow battery chemistries. Systems aspects such as shunt current losses, pumping losses and various flow patterns through electrodes are accounted for. The system cost minimizing objective function determines stack design by optimizing the state of charge operating range, along with current density and current-normalized flow. The model cost estimates are validated using 2-kW stack performance data for the same size electrodes and operating conditions. Using our validated tool, it has been demonstrated that an optimized all-vanadium system has an estimated system cost of < 350 kWh-1 for 4-h application. With an anticipated decrease in component costs facilitated by economies of scale from larger production volumes, coupled with performance improvements enabled by technology development, the system cost is expected to decrease to 160 kWh-1 for a 4-h application, and to 100 kWh-1 for a 10-h application. This tool has been shared with the redox flow battery community to enable cost estimation using their stack data and guide future direction.

A facility location model for municipal solid waste management system under uncertain environment.

PubMed

Yadav, Vinay; Bhurjee, A K; Karmakar, Subhankar; Dikshit, A K

2017-12-15

In municipal solid waste management system, decision makers have to develop an insight into the processes namely, waste generation, collection, transportation, processing, and disposal methods. Many parameters (e.g., waste generation rate, functioning costs of facilities, transportation cost, and revenues) in this system are associated with uncertainties. Often, these uncertainties of parameters need to be modeled under a situation of data scarcity for generating probability distribution function or membership function for stochastic mathematical programming or fuzzy mathematical programming respectively, with only information of extreme variations. Moreover, if uncertainties are ignored, then the problems like insufficient capacities of waste management facilities or improper utilization of available funds may be raised. To tackle uncertainties of these parameters in a more efficient manner an algorithm, based on interval analysis, has been developed. This algorithm is applied to find optimal solutions for a facility location model, which is formulated to select economically best locations of transfer stations in a hypothetical urban center. Transfer stations are an integral part of contemporary municipal solid waste management systems, and economic siting of transfer stations ensures financial sustainability of this system. The model is written in a mathematical programming language AMPL with KNITRO as a solver. The developed model selects five economically best locations out of ten potential locations with an optimum overall cost of [394,836, 757,440] Rs. 1 /day ([5906, 11,331] USD/day) approximately. Further, the requirement of uncertainty modeling is explained based on the results of sensitivity analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

Upon accounting for the impact of isoenzyme loss, gene deletion costs anticorrelate with their evolutionary rates

DOE PAGES

Jacobs, Christopher; Lambourne, Luke; Xia, Yu; ...

2017-01-20

Here, system-level metabolic network models enable the computation of growth and metabolic phenotypes from an organism's genome. In particular, flux balance approaches have been used to estimate the contribution of individual metabolic genes to organismal fitness, offering the opportunity to test whether such contributions carry information about the evolutionary pressure on the corresponding genes. Previous failure to identify the expected negative correlation between such computed gene-loss cost and sequence-derived evolutionary rates in Saccharomyces cerevisiae has been ascribed to a real biological gap between a gene's fitness contribution to an organism "here and now"º and the same gene's historical importance asmore » evidenced by its accumulated mutations over millions of years of evolution. Here we show that this negative correlation does exist, and can be exposed by revisiting a broadly employed assumption of flux balance models. In particular, we introduce a new metric that we call "function-loss cost", which estimates the cost of a gene loss event as the total potential functional impairment caused by that loss. This new metric displays significant negative correlation with evolutionary rate, across several thousand minimal environments. We demonstrate that the improvement gained using function-loss cost over gene-loss cost is explained by replacing the base assumption that isoenzymes provide unlimited capacity for backup with the assumption that isoenzymes are completely non-redundant. We further show that this change of the assumption regarding isoenzymes increases the recall of epistatic interactions predicted by the flux balance model at the cost of a reduction in the precision of the predictions. In addition to suggesting that the gene-to-reaction mapping in genome-scale flux balance models should be used with caution, our analysis provides new evidence that evolutionary gene importance captures much more than strict essentiality.« less

Upon accounting for the impact of isoenzyme loss, gene deletion costs anticorrelate with their evolutionary rates

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

Jacobs, Christopher; Lambourne, Luke; Xia, Yu

Here, system-level metabolic network models enable the computation of growth and metabolic phenotypes from an organism's genome. In particular, flux balance approaches have been used to estimate the contribution of individual metabolic genes to organismal fitness, offering the opportunity to test whether such contributions carry information about the evolutionary pressure on the corresponding genes. Previous failure to identify the expected negative correlation between such computed gene-loss cost and sequence-derived evolutionary rates in Saccharomyces cerevisiae has been ascribed to a real biological gap between a gene's fitness contribution to an organism "here and now"º and the same gene's historical importance asmore » evidenced by its accumulated mutations over millions of years of evolution. Here we show that this negative correlation does exist, and can be exposed by revisiting a broadly employed assumption of flux balance models. In particular, we introduce a new metric that we call "function-loss cost", which estimates the cost of a gene loss event as the total potential functional impairment caused by that loss. This new metric displays significant negative correlation with evolutionary rate, across several thousand minimal environments. We demonstrate that the improvement gained using function-loss cost over gene-loss cost is explained by replacing the base assumption that isoenzymes provide unlimited capacity for backup with the assumption that isoenzymes are completely non-redundant. We further show that this change of the assumption regarding isoenzymes increases the recall of epistatic interactions predicted by the flux balance model at the cost of a reduction in the precision of the predictions. In addition to suggesting that the gene-to-reaction mapping in genome-scale flux balance models should be used with caution, our analysis provides new evidence that evolutionary gene importance captures much more than strict essentiality.« less

Two weeks of additional standing balance circuit classes during inpatient rehabilitation are cost saving and effective: an economic evaluation.

PubMed

Treacy, Daniel; Howard, Kirsten; Hayes, Alison; Hassett, Leanne; Schurr, Karl; Sherrington, Catherine

2018-01-01

Among people admitted for inpatient rehabilitation, is usual care plus standing balance circuit classes more cost-effective than usual care alone? Cost-effectiveness study embedded within a randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. 162 rehabilitation inpatients from a metropolitan hospital in Sydney, Australia. The experimental group received a 1-hour standing balance circuit class, delivered three times a week for 2 weeks, in addition to usual therapy. The circuit classes were supervised by one physiotherapist and one physiotherapy assistant for up to eight patients. The control group received usual therapy alone. Costs were estimated from routinely collected hospital use data in the 3 months after randomisation. The functional outcome measure was mobility measured at 3 months using the Short Physical Performance Battery administered by a blinded assessor. An incremental analysis was conducted and the joint probability distribution of costs and outcomes was examined using bootstrapping. The median cost savings for the intervention group was AUD4,741 (95% CI 137 to 9,372) per participant; 94% of bootstraps showed that the intervention was both effective and cost saving. Two weeks of additional standing balance circuit classes delivered in addition to usual therapy resulted in decreased healthcare costs at 3 months in hospital inpatients admitted for rehabilitation. There is a high probability that this intervention is both cost saving and effective. ACTRN12611000412932. [Treacy D, Howard K, Hayes A, Hassett L, Schurr K, Sherrington C (2018) Two weeks of additional standing balance circuit classes during inpatient rehabilitation are cost saving and effective: an economic evaluation. Journal of Physiotherapy 64: 41-47]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Long-term Cost-Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies.

PubMed

Bertoldi, Eduardo G; Stella, Steffan F; Rohde, Luis E; Polanczyk, Carisi A

2016-05-01

Several tests exist for diagnosing coronary artery disease, with varying accuracy and cost. We sought to provide cost-effectiveness information to aid physicians and decision-makers in selecting the most appropriate testing strategy. We used the state-transitions (Markov) model from the Brazilian public health system perspective with a lifetime horizon. Diagnostic strategies were based on exercise electrocardiography (Ex-ECG), stress echocardiography (ECHO), single-photon emission computed tomography (SPECT), computed tomography coronary angiography (CTA), or stress cardiac magnetic resonance imaging (C-MRI) as the initial test. Systematic review provided input data for test accuracy and long-term prognosis. Cost data were derived from the Brazilian public health system. Diagnostic test strategy had a small but measurable impact in quality-adjusted life-years gained. Switching from Ex-ECG to CTA-based strategies improved outcomes at an incremental cost-effectiveness ratio of 3100 international dollars per quality-adjusted life-year. ECHO-based strategies resulted in cost and effectiveness almost identical to CTA, and SPECT-based strategies were dominated because of their much higher cost. Strategies based on stress C-MRI were most effective, but the incremental cost-effectiveness ratio vs CTA was higher than the proposed willingness-to-pay threshold. Invasive strategies were dominant in the high pretest probability setting. Sensitivity analysis showed that results were sensitive to costs of CTA, ECHO, and C-MRI. Coronary CT is cost-effective for the diagnosis of coronary artery disease and should be included in the Brazilian public health system. Stress ECHO has a similar performance and is an acceptable alternative for most patients, but invasive strategies should be reserved for patients at high risk. © 2016 Wiley Periodicals, Inc.

Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.

PubMed

Sanclemente-Ansó, Carmen; Bosch, Xavier; Salazar, Albert; Moreno, Ramón; Capdevila, Cristina; Rosón, Beatriz; Corbella, Xavier

2016-05-01

Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere. Copyright © 2015. Published by Elsevier B.V.

Cost-effectiveness analysis and formulary decision making in England: findings from research.

PubMed

Williams, Iestyn P; Bryan, Stirling

2007-11-01

In a context of rapid technological advances in health care and increasing demand for expensive treatments, local formulary committees are key players in the management of scarce resources. However, little is known about the information and processes used when making decisions on the inclusion of new treatments. This paper reports research on the use of economic evaluations in technology coverage decisions in England, although the findings have a relevance to other health care systems with devolved responsibility for resource allocation. It reports a study of four local formulary committees in which both qualitative and quantitative data were collected. Our main research finding is that it is an exception for cost-effectiveness analysis to inform technology coverage decisions. Barriers to use include access and expertise levels, concerns relating to the independence of analyses and problems with implementation of study recommendations. Further barriers derive from the constraints on decision makers, a lack of clarity over functions and aims of local committees, and the challenge of disinvestment in medical technologies. The relative weakness of the research-practice dynamics in this context suggests the need for a rethinking of the role of both analysts and decision makers. Our research supports the view that in order to be useful, analysis needs to better reflect the constraints of the local decision-making environment. We also recommend that local decision-making committees and bodies in the National Health Service more clearly identify the 'problems' which they are charged with solving and how their outputs contribute to broader finance and commissioning functions. This would help to establish the ways in which the routine use of cost-effectiveness analysis might become a reality.

Cost-effectiveness analysis of treatments for vertebral compression fractures.

PubMed

Edidin, Avram A; Ong, Kevin L; Lau, Edmund; Schmier, Jordana K; Kemner, Jason E; Kurtz, Steven M

2012-07-01

Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population. Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005-2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67 018 VCF patients in the 5% Medicare dataset (2005-2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses. After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and vertebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763. Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.

Incremental cost of postacute care in nursing homes.

PubMed

Spector, William D; Limcangco, Maria Rhona; Ladd, Heather; Mukamel, Dana

2011-02-01

To determine whether the case mix index (CMI) based on the 53-Resource Utilization Groups (RUGs) captures all the cross-sectional variation in nursing home (NH) costs or whether NHs that have a higher percent of Medicare skilled care days (%SKILLED) have additional costs. DATA AND SAMPLE: Nine hundred and eighty-eight NHs in California in 2005. Data are from Medicaid cost reports, the Minimum Data Set, and the Economic Census. We estimate hybrid cost functions, which include in addition to outputs, case mix, ownership, wages, and %SKILLED. Two-stage least-square (2SLS) analysis was used to deal with the potential endogeneity of %SKILLED and CMI. On average 11 percent of NHs days were due to skilled care. Based on the 2SLS model, %SKILLED is associated with costs even when controlling for CMI. The marginal cost of a one percentage point increase in %SKILLED is estimated at U.S.$70,474 or about 1.2 percent of annual costs for the average cost facility. Subanalyses show that the increase in costs is mainly due to additional expenses for nontherapy ancillaries and rehabilitation. The 53-RUGs case mix does not account completely for all the variation in actual costs of care for postacute patients in NHs. © Health Research and Educational Trust.

Controlling for endogeneity in attributable costs of vancomycin-resistant enterococci from a Canadian hospital.

PubMed

Lloyd-Smith, Patrick

2017-12-01

Decisions regarding the optimal provision of infection prevention and control resources depend on accurate estimates of the attributable costs of health care-associated infections. This is challenging given the skewed nature of health care cost data and the endogeneity of health care-associated infections. The objective of this study is to determine the hospital costs attributable to vancomycin-resistant enterococci (VRE) while accounting for endogeneity. This study builds on an attributable cost model conducted by a retrospective cohort study including 1,292 patients admitted to an urban hospital in Vancouver, Canada. Attributable hospital costs were estimated with multivariate generalized linear models (GLMs). To account for endogeneity, a control function approach was used. The analysis sample included 217 patients with health care-associated VRE. In the standard GLM, the costs attributable to VRE are $17,949 (SEM, $2,993). However, accounting for endogeneity, the attributable costs were estimated to range from $14,706 (SEM, $7,612) to $42,101 (SEM, $15,533). Across all model specifications, attributable costs are 76% higher on average when controlling for endogeneity. VRE was independently associated with increased hospital costs, and controlling for endogeneity lead to higher attributable cost estimates. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Incremental Cost of Postacute Care in Nursing Homes

PubMed Central

Spector, William D; Limcangco, Maria Rhona; Ladd, Heather; Mukamel, Dana A

2011-01-01

Objectives To determine whether the case mix index (CMI) based on the 53-Resource Utilization Groups (RUGs) captures all the cross-sectional variation in nursing home (NH) costs or whether NHs that have a higher percent of Medicare skilled care days (%SKILLED) have additional costs. Data and Sample Nine hundred and eighty-eight NHs in California in 2005. Data are from Medicaid cost reports, the Minimum Data Set, and the Economic Census. Research Design We estimate hybrid cost functions, which include in addition to outputs, case mix, ownership, wages, and %SKILLED. Two-stage least-square (2SLS) analysis was used to deal with the potential endogeneity of %SKILLED and CMI. Results On average 11 percent of NHs days were due to skilled care. Based on the 2SLS model, %SKILLED is associated with costs even when controlling for CMI. The marginal cost of a one percentage point increase in %SKILLED is estimated at U.S.$70,474 or about 1.2 percent of annual costs for the average cost facility. Subanalyses show that the increase in costs is mainly due to additional expenses for nontherapy ancillaries and rehabilitation. Conclusion The 53-RUGs case mix does not account completely for all the variation in actual costs of care for postacute patients in NHs. PMID:21029085

Sensitivity analysis of navy aviation readiness based sparing model

DTIC Science & Technology

2017-09-01

variability. (See Figure 4.) Figure 4. Research design flowchart 18 Figure 4 lays out the four steps of the methodology , starting in the upper left-hand...as a function of changes in key inputs. We develop NAVARM Experimental Designs (NED), a computational tool created by applying a state-of-the-art...experimental design to the NAVARM model. Statistical analysis of the resulting data identifies the most influential cost factors. Those are, in order of

Space station data system analysis/architecture study. Task 4: System definition report

NASA Technical Reports Server (NTRS)

1985-01-01

Functional/performance requirements for the Space Station Data System (SSDS) are analyzed and architectural design concepts are derived and evaluated in terms of their performance and growth potential, technical feasibility and risk, and cost effectiveness. The design concepts discussed are grouped under five major areas: SSDS top-level architecture overview, end-to-end SSDS design and operations perspective, communications assumptions and traffic analysis, onboard SSDS definition, and ground SSDS definition.

Valuation of opportunity costs by rats working for rewarding electrical brain stimulation.

PubMed

Solomon, Rebecca Brana; Conover, Kent; Shizgal, Peter

2017-01-01

Pursuit of one goal typically precludes simultaneous pursuit of another. Thus, each exclusive activity entails an "opportunity cost:" the forgone benefits from the next-best activity eschewed. The present experiment estimates, in laboratory rats, the function that maps objective opportunity costs into subjective ones. In an operant chamber, rewarding electrical brain stimulation was delivered when the cumulative time a lever had been depressed reached a criterion duration. The value of the activities forgone during this duration is the opportunity cost of the electrical reward. We determined which of four functions best describes how objective opportunity costs, expressed as the required duration of lever depression, are translated into their subjective equivalents. The simplest account is the identity function, which equates subjective and objective opportunity costs. A variant of this function called the "sigmoidal-slope function," converges on the identity function at longer durations but deviates from it at shorter durations. The sigmoidal-slope function has the form of a hockey stick. The flat "blade" denotes a range over which opportunity costs are subjectively equivalent; these durations are too short to allow substitution of more beneficial activities. The blade extends into an upward-curving portion over which costs become discriminable and finally into the straight "handle," over which objective and subjective costs match. The two remaining functions are based on hyperbolic and exponential temporal discounting, respectively. The results are best described by the sigmoidal-slope function. That this is so suggests that different principles of intertemporal choice are involved in the evaluation of time spent working for a reward or waiting for its delivery. The subjective opportunity-cost function plays a key role in the evaluation and selection of goals. An accurate description of its form and parameters is essential to successful modeling and prediction of instrumental performance and reward-related decision making.

Analysis of multigrid methods on massively parallel computers: Architectural implications

NASA Technical Reports Server (NTRS)

Matheson, Lesley R.; Tarjan, Robert E.

1993-01-01

We study the potential performance of multigrid algorithms running on massively parallel computers with the intent of discovering whether presently envisioned machines will provide an efficient platform for such algorithms. We consider the domain parallel version of the standard V cycle algorithm on model problems, discretized using finite difference techniques in two and three dimensions on block structured grids of size 10(exp 6) and 10(exp 9), respectively. Our models of parallel computation were developed to reflect the computing characteristics of the current generation of massively parallel multicomputers. These models are based on an interconnection network of 256 to 16,384 message passing, 'workstation size' processors executing in an SPMD mode. The first model accomplishes interprocessor communications through a multistage permutation network. The communication cost is a logarithmic function which is similar to the costs in a variety of different topologies. The second model allows single stage communication costs only. Both models were designed with information provided by machine developers and utilize implementation derived parameters. With the medium grain parallelism of the current generation and the high fixed cost of an interprocessor communication, our analysis suggests an efficient implementation requires the machine to support the efficient transmission of long messages, (up to 1000 words) or the high initiation cost of a communication must be significantly reduced through an alternative optimization technique. Furthermore, with variable length message capability, our analysis suggests the low diameter multistage networks provide little or no advantage over a simple single stage communications network.

A method for accounting for maintenance costs in flux balance analysis improves the prediction of plant cell metabolic phenotypes under stress conditions.

PubMed

Cheung, C Y Maurice; Williams, Thomas C R; Poolman, Mark G; Fell, David A; Ratcliffe, R George; Sweetlove, Lee J

2013-09-01

Flux balance models of metabolism generally utilize synthesis of biomass as the main determinant of intracellular fluxes. However, the biomass constraint alone is not sufficient to predict realistic fluxes in central heterotrophic metabolism of plant cells because of the major demand on the energy budget due to transport costs and cell maintenance. This major limitation can be addressed by incorporating transport steps into the metabolic model and by implementing a procedure that uses Pareto optimality analysis to explore the trade-off between ATP and NADPH production for maintenance. This leads to a method for predicting cell maintenance costs on the basis of the measured flux ratio between the oxidative steps of the oxidative pentose phosphate pathway and glycolysis. We show that accounting for transport and maintenance costs substantially improves the accuracy of fluxes predicted from a flux balance model of heterotrophic Arabidopsis cells in culture, irrespective of the objective function used in the analysis. Moreover, when the new method was applied to cells under control, elevated temperature and hyper-osmotic conditions, only elevated temperature led to a substantial increase in cell maintenance costs. It is concluded that the hyper-osmotic conditions tested did not impose a metabolic stress, in as much as the metabolic network is not forced to devote more resources to cell maintenance. © 2013 The Authors The Plant Journal © 2013 John Wiley & Sons Ltd.

Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment

PubMed Central

Wang, Myra; Xie, Xuanqian; Wells, David; Higgins, Caroline

2017-01-01

Background Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the prostate gland and surrounding tissues. In recent years, surgeons have begun to use robot-assisted radical prostatectomy more frequently. We aimed to determine the clinical benefits and harms of the robotic surgical system for radical prostatectomy (robot-assisted radical prostatectomy) compared with the open and laparoscopic surgical methods. We also assessed the cost-effectiveness of robot-assisted versus open radical prostatectomy in patients with clinically localized prostate cancer in Ontario. Methods We performed a literature search and included prospective comparative studies that examined robot-assisted versus open or laparoscopic radical prostatectomy for prostate cancer. The outcomes of interest were perioperative, functional, and oncological. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also conducted a cost–utility analysis with a 1-year time horizon. The potential long-term benefits of robot-assisted radical prostatectomy for functional and oncological outcomes were also evaluated in a 10-year Markov model in scenario analyses. In addition, we conducted a budget impact analysis to estimate the additional costs to the provincial budget if the adoption of robot-assisted radical prostatectomy were to increase in the next 5 years. A needs assessment determined that the published literature on patient perspectives was relatively well developed, and that direct patient engagement would add relatively little new information. Results Compared with the open approach, we found robot-assisted radical prostatectomy reduced length of stay and blood loss (moderate quality evidence) but had no difference or inconclusive results for functional and oncological outcomes (low to moderate quality evidence). Compared with laparoscopic radical prostatectomy, robot-assisted radical prostatectomy had no difference in perioperative, functional, and oncological outcomes (low to moderate quality evidence). Compared with open radical prostatectomy, our best estimates suggested that robot-assisted prostatectomy was associated with higher costs ($6,234) and a small gain in quality-adjusted life-years (QALYs) (0.0012). The best estimate of the incremental cost-effectiveness ratio (ICER) was $5.2 million per QALY gained. However, if robot-assisted radical prostatectomy were assumed to have substantially better long-term functional and oncological outcomes, the ICER might be as low as $83,921 per QALY gained. We estimated the annual budget impact to be $0.8 million to $3.4 million over the next 5 years. Conclusions There is no high-quality evidence that robot-assisted radical prostatectomy improves functional and oncological outcomes compared with open and laparoscopic approaches. However, compared with open radical prostatectomy, the costs of using the robotic system are relatively large while the health benefits are relatively small. PMID:28744334

Composite Tissue Transplant of Hand or Arm: A Health Technology Assessment.

PubMed

2016-01-01

Injuries to arms and legs following severe trauma can result in the loss of large regions of tissue, disrupting healing and function and sometimes leading to amputation of the damaged limb. People experiencing amputations of the hand or arm could potentially benefit from composite tissue transplant, which is being performed in some countries. Currently, there are no composite tissue transplant programs in Canada. We conducted a systematic review of the literature, with no restriction on study design, examining the effectiveness and cost-effectiveness of hand and arm transplant. We assessed the overall quality of the clinical evidence with GRADE. We developed a Markov decision analytic model to determine the cost-effectiveness of transplant versus standard care for a healthy adult with a hand amputation. Incremental cost-effectiveness ratios (ICERs) were calculated using a 30-year time horizon. We also estimated the impact on provincial health care costs if these transplants were publicly funded in Ontario. Compared to pre-transplant function, patients' post-transplant function was significantly better. For various reasons, 17% of transplanted limbs were amputated, 6.4% of patients died within the first year after the transplant, and 10.6% of patients experienced chronic rejections. GRADE quality of evidence for all outcomes was very low. In the cost-effectiveness analysis, single-hand transplant was dominated by standard care, with increased costs ($735,647 CAD vs. $61,429) and reduced quality-adjusted life-years (QALYs) (10.96 vs. 11.82). Double-hand transplant also had higher costs compared with standard care ($633,780), but it had an increased effectiveness of 0.17 QALYs, translating to an ICER of $3.8 million per QALY gained. In most sensitivity analyses, ICERs for bilateral hand transplant were greater than $1 million per QALY gained. A hand transplant program would lead to an estimated annual budget impact of $0.9 million to $1.2 million in the next 3 years, 2016 to 2018, to treat 3 adults per year. Composite tissue transplant of the hand or arm may improve a patient's ability to function, but because the overall quality of evidence is of very low quality, there is considerable uncertainty as to whether benefits outweigh harms. Compared with standard care, both single- and double-hand transplants are not cost-effective.

Composite Tissue Transplant of Hand or Arm: A Health Technology Assessment

PubMed Central

Lambrinos, Anna; Xie, Xuanqian; Higgins, Caroline; Holubowich, Corinne

2016-01-01

Background Injuries to arms and legs following severe trauma can result in the loss of large regions of tissue, disrupting healing and function and sometimes leading to amputation of the damaged limb. People experiencing amputations of the hand or arm could potentially benefit from composite tissue transplant, which is being performed in some countries. Currently, there are no composite tissue transplant programs in Canada. Methods We conducted a systematic review of the literature, with no restriction on study design, examining the effectiveness and cost-effectiveness of hand and arm transplant. We assessed the overall quality of the clinical evidence with GRADE. We developed a Markov decision analytic model to determine the cost-effectiveness of transplant versus standard care for a healthy adult with a hand amputation. Incremental cost-effectiveness ratios (ICERs) were calculated using a 30-year time horizon. We also estimated the impact on provincial health care costs if these transplants were publicly funded in Ontario. Results Compared to pre-transplant function, patients’ post-transplant function was significantly better. For various reasons, 17% of transplanted limbs were amputated, 6.4% of patients died within the first year after the transplant, and 10.6% of patients experienced chronic rejections. GRADE quality of evidence for all outcomes was very low. In the cost-effectiveness analysis, single-hand transplant was dominated by standard care, with increased costs ($735,647 CAD vs. $61,429) and reduced quality-adjusted life-years (QALYs) (10.96 vs. 11.82). Double-hand transplant also had higher costs compared with standard care ($633,780), but it had an increased effectiveness of 0.17 QALYs, translating to an ICER of $3.8 million per QALY gained. In most sensitivity analyses, ICERs for bilateral hand transplant were greater than $1 million per QALY gained. A hand transplant program would lead to an estimated annual budget impact of $0.9 million to $1.2 million in the next 3 years, 2016 to 2018, to treat 3 adults per year. Conclusions Composite tissue transplant of the hand or arm may improve a patient's ability to function, but because the overall quality of evidence is of very low quality, there is considerable uncertainty as to whether benefits outweigh harms. Compared with standard care, both single- and double-hand transplants are not cost-effective. PMID:27468324

Cost analysis of living donor liver transplantation: the first Italian economical data.

PubMed

Passarani, S; De Carlis, L; Maione, G; Alberti, A B; Bevilacqua, L; Baraldi, S

2007-10-01

Over a period of 30 months, the Niguarda Ca'Granda Hospital performed 12 living donor liver transplants (LDLT) on adult subjects using the split-liver technique and transplant of the right lobe. The purpose of this work is to evaluate the financial obligation that this technique will bring, the ethical and cultural aspects, and the mortality related to surgery on a healthy donor whose only reward is in the knowledge of having done everything possible for a loved family member. The analysis of the costs of the surgical process takes into account the simultaneous consideration of both types of patients: the donor and the recipient. The diagnostic course is subdivided into seven functional phases of the cost centers, and the transitory sequences of the foreseeable events of the entire process. The method used consists in the appraisal of all the clinical activities in chronological order several the centers of cost. The direct expenses are evaluated according to an analytical method, and the indirect costs has been carried out on the criterion of the activities of support to the process (management of the orders, recording and programming of the activities) and support to the organization (maintenance, management supplying and contests of contract, programming of the business production, management warehouses, supplyings, marketing and relations with the public). The cost of all the patients evaluated that were not able to donate has been added to the direct expenses of 12 donor and 12 recipient patients, in all 30 patients, so as to shift the added expenses only to the donor patient, since these costs are not included in the typical costs of transplantation from a cadaver. The indirect cost calculated for each patient has been added to the direct costs of the donor and recipient patients. The total calculated cost of LDLT is 175, 210.78 Euros. The analysis of the economical obligation that this practice brings is the starting point for an accurate evaluation of all the new technology that, in conjunction with the results of clinical efficacy and efficiency trials, is part of program of a larger scope to fulfil the general social principles of equity and justice.

Concepts of Cost and Cost Analysis for Higher Education.

ERIC Educational Resources Information Center

Brinkman, Paul T.; Allen, Richard H.

1986-01-01

Concepts of costs and cost analysis in higher education are examined, along with how to prepare for a cost study. Specific cost analysis techniques are identified, along with types of data generated and potential problems. In preparing for cost studies, it is important to consider: purpose, types of cost analysis, types of cost, common…