Assessment of physiological demand in kitesurfing.

PubMed

Vercruyssen, F; Blin, N; L'huillier, D; Brisswalter, J

2009-01-01

To evaluate the physiological demands of kitesurfing, ten elite subjects performed an incremental running test on a 400-m track and a 30-min on-water crossing trial during a light crosswind (LW, 12-15 knots). Oxygen uptake (V(O)(2)) was estimated from the heart rate (HR) recorded during the crossing trial using the individual HR-V(O)(2) relationship determined during the incremental test. Blood lactate concentration [La(b)] was measured at rest and 3 min after the exercise completion. Mean HR and estimated V(O)(2) values represented, respectively 80.6 +/- 7.5% of maximal heart rate and 69.8 +/- 11.7% of maximal oxygen uptake for board speeds ranging from 15 to 17 knots. Low values for [La(b)] were observed at the end of crossing trial (2.1 +/- 1.2 mmol l(-1). This first analysis of kitesurfing suggests that the energy demand is mainly sustained by aerobic metabolism during a LW condition.

39 CFR 3050.23 - Documentation supporting incremental cost estimates in the Postal Service's section 3652 report.

Code of Federal Regulations, 2010 CFR

2010-07-01

... incremental cost model shall be reported. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Documentation supporting incremental cost... REGULATORY COMMISSION PERSONNEL PERIODIC REPORTING § 3050.23 Documentation supporting incremental cost...

Long-term implications of sustained wind power growth in the United States: Direct electric system impacts and costs

DOE PAGES

Lantz, Eric; Mai, Trieu; Wiser, Ryan H.; ...

2016-07-22

This paper evaluates potential changes in the power system associated with sustained growth in wind generation in the United States to 35% of end-use demand by 2050; Wiser et al. (forthcoming) evaluates societal benefits and other impacts for this same scenario. Under reference or central conditions, the analysis finds cumulative wind capacity of 404 GW would be required to reach this level and drive 2050 incremental electricity rate and cumulative electric sector savings of 2% and 3%, respectively, relative to a scenario with no new wind capacity additions. Greater savings are estimated under higher fossil fuel costs or with greatermore » advancements in wind technologies. Conversely, incremental costs are found when fossil fuel costs are lower than central assumptions or wind technology improvements are more-limited. Through 2030 the primary generation sources displaced by new wind capacity include natural gas and coal-fired generation. By 2050 wind could displace other renewables. Incremental new transmission infrastructure totaling 29 million MW-miles is estimated to be needed by 2050. In conjunction with related societal benefits, this work demonstrates that 35% wind energy by 2050 is plausible, could support enduring benefits, and could result in long-term consumer savings, if nearer-term (pre-2030) cost barriers are overcome; at the same time, these opportunities are not anticipated to be realized in their full form under “business-as-usual” conditions.« less

The Incremental Cost-Effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia

PubMed Central

Mahendradhata, Yodi; Probandari, Ari; Ahmad, Riris A.; Utarini, Adi; Trisnantoro, Laksono; Lindholm, Lars; van der Werf, Marieke J.; Kimerling, Michael; Boelaert, Marleen; Johns, Benjamin; Van der Stuyft, Patrick

2010-01-01

We aimed to evaluate the incremental cost-effectiveness of engaging private practitioners (PPs) to refer tuberculosis (TB) suspects to public health centers in Jogjakarta, Indonesia. Effectiveness was assessed for TB suspects notified between May 2004 and April 2005. Private practitioners referred 1,064 TB suspects, of which 57.5% failed to reach a health center. The smear-positive rate among patients reaching a health center was 61.8%. Two hundred eighty (280) out of a total of 1,306 (21.4%) new smear-positive cases were enrolled through the PPs strategy. The incremental cost-effectiveness ratio per smear-positive case successfully treated for the PPs strategy was US$351.66 (95% CI 322.84–601.33). On the basis of an acceptability curve using the National TB control program's willingness-to-pay threshold (US$448.61), we estimate the probability that the PPs strategy is cost-effective at 66.8%. The strategy of engaging PPs was incrementally cost-effective, although under specific conditions, most importantly a well-functioning public directly observed treatment, short-course (DOTS) program. PMID:20519613

Per tree estimates with n-tree distance sampling: an application to increment core data

Treesearch

Thomas B. Lynch; Robert F. Wittwer

2002-01-01

Per tree estimates using the n trees nearest a point can be obtained by using a ratio of per unit area estimates from n-tree distance sampling. This ratio was used to estimate average age by d.b.h. classes for cottonwood trees (Populus deltoides Bartr. ex Marsh.) on the Cimarron National Grassland. Increment...

Incremental inverse kinematics based vision servo for autonomous robotic capture of non-cooperative space debris

NASA Astrophysics Data System (ADS)

Dong, Gangqi; Zhu, Z. H.

2016-04-01

This paper proposed a new incremental inverse kinematics based vision servo approach for robotic manipulators to capture a non-cooperative target autonomously. The target's pose and motion are estimated by a vision system using integrated photogrammetry and EKF algorithm. Based on the estimated pose and motion of the target, the instantaneous desired position of the end-effector is predicted by inverse kinematics and the robotic manipulator is moved incrementally from its current configuration subject to the joint speed limits. This approach effectively eliminates the multiple solutions in the inverse kinematics and increases the robustness of the control algorithm. The proposed approach is validated by a hardware-in-the-loop simulation, where the pose and motion of the non-cooperative target is estimated by a real vision system. The simulation results demonstrate the effectiveness and robustness of the proposed estimation approach for the target and the incremental control strategy for the robotic manipulator.

Competition in Weapon Systems Acquisition: Cost Analyses of Some Issues

DTIC Science & Technology

1990-09-01

10% increments , also known as the step-ladder bids) submitted by the contractor in the first year of dual source procurement. The triangles represent...savings by subtracting annual incremental government costs, stated in constant dollars, from (3). (5) Estimate nonrecurring start-up costs, stated in...constant dollars, by fiscal year. (6) Estimate incremental logistic support costs, stated in constant dollars. by fiscal year. (7) Calculate a net

On the validity of the incremental approach to estimate the impact of cities on air quality

NASA Astrophysics Data System (ADS)

Thunis, Philippe

2018-01-01

The question of how much cities are the sources of their own air pollution is not only theoretical as it is critical to the design of effective strategies for urban air quality planning. In this work, we assess the validity of the commonly used incremental approach to estimate the likely impact of cities on their air pollution. With the incremental approach, the city impact (i.e. the concentration change generated by the city emissions) is estimated as the concentration difference between a rural background and an urban background location, also known as the urban increment. We show that the city impact is in reality made up of the urban increment and two additional components and consequently two assumptions need to be fulfilled for the urban increment to be representative of the urban impact. The first assumption is that the rural background location is not influenced by emissions from within the city whereas the second requires that background concentration levels, obtained with zero city emissions, are equal at both locations. Because the urban impact is not measurable, the SHERPA modelling approach, based on a full air quality modelling system, is used in this work to assess the validity of these assumptions for some European cities. Results indicate that for PM2.5, these two assumptions are far from being fulfilled for many large or medium city sizes. For this type of cities, urban increments are largely underestimating city impacts. Although results are in better agreement for NO2, similar issues are met. In many situations the incremental approach is therefore not an adequate estimate of the urban impact on air pollution. This poses issues in terms of interpretation when these increments are used to define strategic options in terms of air quality planning. We finally illustrate the interest of comparing modelled and measured increments to improve our confidence in the model results.

Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States.

PubMed

Bhattacharyya, Neil

2011-07-01

I determined incremental increases in health care expenditures and utilization associated with chronic rhinosinusitis (CRS). Patients with a reported diagnosis of CRS were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. The patients with CRS were then compared to patients without CRS to determine differences in health care utilization (office visits,emergency facility visits, and prescriptions filled), as well as differences in health care expenditures (total health care costs, office visit costs, prescription medication costs, and self-expenditures) by use of demographically adjusted and comorbidity-adjusted multivariate models. An estimated 11.1+/-0.48 million adult patients reported having CRS in 2007 (4.9%+/-0.2% of the US population). The additional incremental health care utilizations associated with CRS relative to patients without CRS for office visits, emergency facility visits, and number of prescriptions filled were 3.45+/-0.42, 0.09+/-0.03, and 5.5+/-0.8, respectively (all p

Observers for a class of systems with nonlinearities satisfying an incremental quadratic inequality

NASA Technical Reports Server (NTRS)

Acikmese, Ahmet Behcet; Martin, Corless

2004-01-01

We consider the problem of state estimation from nonlinear time-varying system whose nonlinearities satisfy an incremental quadratic inequality. Observers are presented which guarantee that the state estimation error exponentially converges to zero.

Simulation of fatigue crack growth under large scale yielding conditions

NASA Astrophysics Data System (ADS)

Schweizer, Christoph; Seifert, Thomas; Riedel, Hermann

2010-07-01

A simple mechanism based model for fatigue crack growth assumes a linear correlation between the cyclic crack-tip opening displacement (ΔCTOD) and the crack growth increment (da/dN). The objective of this work is to compare analytical estimates of ΔCTOD with results of numerical calculations under large scale yielding conditions and to verify the physical basis of the model by comparing the predicted and the measured evolution of the crack length in a 10%-chromium-steel. The material is described by a rate independent cyclic plasticity model with power-law hardening and Masing behavior. During the tension-going part of the cycle, nodes at the crack-tip are released such that the crack growth increment corresponds approximately to the crack-tip opening. The finite element analysis performed in ABAQUS is continued for so many cycles until a stabilized value of ΔCTOD is reached. The analytical model contains an interpolation formula for the J-integral, which is generalized to account for cyclic loading and crack closure. Both simulated and estimated ΔCTOD are reasonably consistent. The predicted crack length evolution is found to be in good agreement with the behavior of microcracks observed in a 10%-chromium steel.

Phonological priming in young children who stutter: holistic versus incremental processing.

PubMed

Byrd, Courtney T; Conture, Edward G; Ohde, Ralph N

2007-02-01

To investigate the holistic versus incremental phonological encoding processes of young children who stutter (CWS; N = 26) and age- and gender-matched children who do not stutter (CWNS; N = 26) via a picture-naming auditory priming paradigm. Children named pictures during 3 auditory priming conditions: neutral, holistic, and incremental. Speech reaction time (SRT) was measured from the onset of picture presentation to the onset of participant response. CWNS shifted from being significantly faster in the holistic priming condition to being significantly faster in the incremental priming condition from 3 to 5 years of age. In contrast, the majority of 3- and 5-year-old CWS continued to exhibit faster SRT in the holistic than the incremental condition. CWS are delayed in making the developmental shift in phonological encoding from holistic to incremental processing, a delay that may contribute to their difficulties establishing fluent speech.

The erosion of carbonate stone by acid rain: Laboratory and field investigations

USGS Publications Warehouse

Baedecker, P.A.; Reddy, M.M.

1993-01-01

One of the goals of research on the effects of acidic deposition on carbonate stone surfaces is to define the incremental impact of acidic deposition relative to natural weathering processes on the rate of carbonate stone erosion. If rain that impacts carbonate stone surfaces is resident on the surface long enough to approach chemical equilibrium, the incremental effect of hydrogen ion is expected to be small (i.e., 6% for a rain of pH 4.0). Under nonequilibrium (i.e., high flow rate) conditions, kinetic considerations suggest that the incremental effect of hydrogen ion deposition could be quite significant. Field run-off experiments involving the chemical analysis of rain collected from inclined stone slabs have been used to evaluate stone dissolution processes under ambient conditions of wet and dry deposition of acidic species. The stoichiometry of the reaction of stone with hydrogen ion is difficult to define from the field data due to scatter in the data attributed to hydrodynamic effects. Laboratory run-off experiments show that the stoichiometry is best defined by a reaction with H+ in which CO2 is released from the system. The baseline effect caused by water in equilibrium with atmospheric CO2 is identical in the field and in laboratory simulation. The experiments show that the solutions are close enough to equilibrium for the incremental effect of hydrogen ion to be minor (i.e., 24% for marble for a rain of pH 4.0) relative to dissolution due to water and carbonic acid reactions. Stone erosion rates based on physical measurement are approximately double the recession rates that are due to dissolution (estimated from the observed calcium content of the run-off solutions). The difference may reflect the loss of granular material not included in recession estimates based on the run-off data. Neither the field nor the laboratory run-off experiments indicate a pH dependence for the grain-removal process.

Modeling individual tree growth by fusing diameter tape and increment core data

Treesearch

Erin M. Schliep; Tracy Qi Dong; Alan E. Gelfand; Fan. Li

2014-01-01

Tree growth estimation is a challenging task as difficulties associated with data collection and inference often result in inaccurate estimates. Two main methods for tree growth estimation are diameter tape measurements and increment cores. The former involves repeatedly measuring tree diameters with a cloth or metal tape whose scale has been adjusted to give diameter...

Essays in financial economics and econometrics

NASA Astrophysics Data System (ADS)

La Spada, Gabriele

Chapter 1 (my job market paper) asks the following question: Do asset managers reach for yield because of competitive pressures in a low rate environment? I propose a tournament model of money market funds (MMFs) to study this issue. I show that funds with different costs of default respond differently to changes in interest rates, and that it is important to distinguish the role of risk-free rates from that of risk premia. An increase in the risk premium leads funds with lower default costs to increase risk-taking, while funds with higher default costs reduce risk-taking. Without changes in the premium, low risk-free rates reduce risk-taking. My empirical analysis shows that these predictions are consistent with the risk-taking of MMFs during the 2006--2008 period. Chapter 2, co-authored with Fabrizio Lillo and published in Studies in Nonlinear Dynamics and Econometrics (2014), studies the effect of round-off error (or discretization) on stationary Gaussian long-memory process. For large lags, the autocovariance is rescaled by a factor smaller than one, and we compute this factor exactly. Hence, the discretized process has the same Hurst exponent as the underlying one. We show that in presence of round-off error, two common estimators of the Hurst exponent, the local Whittle (LW) estimator and the detrended fluctuation analysis (DFA), are severely negatively biased in finite samples. We derive conditions for consistency and asymptotic normality of the LW estimator applied to discretized processes and compute the asymptotic properties of the DFA for generic long-memory processes that encompass discretized processes. Chapter 3, co-authored with Fabrizio Lillo, studies the effect of round-off error on integrated Gaussian processes with possibly correlated increments. We derive the variance and kurtosis of the realized increment process in the limit of both "small" and "large" round-off errors, and its autocovariance for large lags. We propose novel estimators for the variance and lag-one autocorrelation of the underlying, unobserved increment process. We also show that for fractionally integrated processes, the realized increments have the same Hurst exponent as the underlying ones, but the LW estimator applied to the realized series is severely negatively biased in medium-sized samples.

A cost-effectiveness analysis of in-vitro fertilization by maternal age and number of treatment attempts.

PubMed

Griffiths, Alison; Dyer, Suzanne M; Lord, Sarah J; Pardy, Chris; Fraser, Ian S; Eckermann, Simon

2010-04-01

The increase in use and costs of assisted reproductive therapies including in-vitro fertilization (IVF) has led to debate over public funding. A decision analytic model was designed to estimate the incremental cost-effectiveness of IVF by additional treatment programmes and maternal age. Data from the Australian and New Zealand Assisted Reproductive Database were used to estimate incremental effects (live birth and other pregnancy outcomes) and costs for cohorts of women attempting up to three treatment programmes. A treatment programme included one fresh cycle and a variable number of frozen cycles dependent on maternal age. The incremental cost per live birth ranged from AU dollars 27 373 and AU dollars 31 986 for women aged 30-33 on their first and third programmes to AU dollars 130 951 and AU dollars 187 515 for 42-45-year-old women on their first and second attempts. Overall, these trends were not affected by inclusions of costs associated with ovarian hyperstimulation syndrome or multiple births. This study suggests that cost per live birth from IVF increases with maternal age and treatment programme number and indicates that maternal age has the much greater effect. This evidence may help decisionmakers target the use of IVF services conditional on societal willingness to pay for live births and equity considerations.

Variation in heart rate and blood lactate concentration in freestyle kytesurfing.

PubMed

Camps, A; Vercruyssen, F; Brisswalter, J

2011-06-01

The aim of this paper was to evaluate the physiological demands of freestyle kitesurfing. Ten elite subjects performed an incremental running test on a treadmill and a three 7 min simulated freestyle heats of kitesurfing in MW (Midwind) condition ranging from 15 to 22 knots. Oxygen uptake (VO(2)) was estimated from the heart rate (HR) recorded during the freestyle trial using the individual HR-VO(2) relationship determined during the incremental test. Blood lactate concentration [Lab] was measured at rest and 3 min after the exercise completion. 3 experienced kitesurfers acted as judges to better simulate competition conditions. Linear relationship was demonstrated between scores and % HR(max) on water (r=-0.764, P<0.05), HR(max) on water (r=-0.684, P<0.05) estimated VO(2) on water (r=-0.724, P<0.05), HR on water (r=0.709, P<0.05), % VO(2) on water (r=0.740, P<0.05), final [Lab] (r=-0.884, P<0.05), anaerobic threshold (AT) (r=0.836, P<0.05), HR in AT (r=0.748, P<0.05) and ranking (r=-0,924, P<0.05), mean HR and estimated VO(2) values represented, respectively 85.4±3.0% of maximal heart rate and 80.0±4.5% of maximal oxygen uptake. Mid values for [Lab] were observed at the end of crossing trial (5.2±0.8 mmol L(-1)). This first analysis of freestyle kitesurfing suggests that the energy demand is sustained by both aerobic and anaerobic metabolism during a MW condition and freestyle event of kitesurfing.

Using Top‐down and Bottom‐up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale

PubMed Central

Sinanovic, Edina; Ramma, Lebogang; Foster, Nicola; Berrie, Leigh; Stevens, Wendy; Molapo, Sebaka; Marokane, Puleng; McCarthy, Kerrigan; Churchyard, Gavin; Vassall, Anna

2016-01-01

Abstract Purpose Estimating the incremental costs of scaling‐up novel technologies in low‐income and middle‐income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low‐income and middle‐income countries, using the example of costing the scale‐up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. Materials and methods We estimate costs, by applying two distinct approaches of bottom‐up and top‐down costing, together with an assessment of processes and capacity. Results The unit costs measured using the different methods of bottom‐up and top‐down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. Conclusion Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource‐use data collected from a bottom‐up or top‐down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce. PMID:26763594

Using Top-down and Bottom-up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale.

PubMed

Cunnama, Lucy; Sinanovic, Edina; Ramma, Lebogang; Foster, Nicola; Berrie, Leigh; Stevens, Wendy; Molapo, Sebaka; Marokane, Puleng; McCarthy, Kerrigan; Churchyard, Gavin; Vassall, Anna

2016-02-01

Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

An economic analysis comparison of stationary and dual-axis tracking grid-connected photovoltaic systems in the US Upper Midwest

NASA Astrophysics Data System (ADS)

Choi, Wongyu; Pate, Michael B.; Warren, Ryan D.; Nelson, Ron M.

2018-05-01

This paper presents an economic analysis of stationary and dual-axis tracking photovoltaic (PV) systems installed in the US Upper Midwest in terms of life-cycle costs, payback period, internal rate of return, and the incremental cost of solar energy. The first-year performance and energy savings were experimentally found along with documented initial cost. Future PV performance, savings, and operating and maintenance costs were estimated over 25-year assumed life. Under the given assumptions and discount rates, the life-cycle savings were found to be negative. Neither system was found to have payback periods less than the assumed system life. The lifetime average incremental costs of energy generated by the stationary and dual-axis tracking systems were estimated to be 0.31 and 0.37 per kWh generated, respectively. Economic analyses of different scenarios, each having a unique set of assumptions for costs and metering, showed a potential for economic feasibility under certain conditions when compared to alternative investments with assumed yields.

Health care resource use, health care expenditures and absenteeism costs associated with osteoarthritis in US healthcare system.

PubMed

Menon, J; Mishra, P

2018-04-01

We determined incremental health care resource utilization, incremental health care expenditures, incremental absenteeism, and incremental absenteeism costs associated with osteoarthritis. Medical Expenditure Panel Survey (MEPS) for 2011 was used as data source. Individuals 18 years or older and employed during 2011 were eligible for inclusion in the sample for analyses. Individuals with osteoarthritis were identified based on ICD-9-CM codes. Incremental health care resource utilization included annual hospitalization, hospital days, emergency room visits and outpatient visits. Incremental health expenditures included annual inpatient, outpatient, emergency room, medications, miscellaneous and annual total expenditures. Of the total sample, 1354 were diagnosed with osteoarthritis, and compared to non osteoarthritis individuals. Incremental resource utilization, expenditures, absenteeism and absenteeism costs were estimated using regression models, adjusting for age, gender, sex, region, marital status, insurance coverage, comorbidities, anxiety, asthma, hypertension and hyperlipidemia. Regression models revealed incremental mean annual resource use associated with osteoarthritis of 0.07 hospitalizations, equal to 70 additional hospitalizations per 100 osteoarthritic patients annually, and 3.63 outpatient visits, equal to 363 additional visits per 100 osteoarthritic patients annually. Mean annual incremental total expenditures associated with osteoarthritis were $2046. Annually, mean incremental expenditures were largest for inpatient expenditures at $826, followed by mean incremental outpatient expenditures of $659, and mean incremental medication expenditures of $325. Mean annual incremental absenteeism was 2.2 days and mean annual incremental absenteeism costs were $715.74. Total direct expenditures were estimated at $41.7 billion. Osteoarthritis was associated with significant incremental health care resource utilization, expenditures, absenteeism and absenteeism costs. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Estimation of Energy Expenditure Using a Patch-Type Sensor Module with an Incremental Radial Basis Function Neural Network

PubMed Central

Li, Meina; Kwak, Keun-Chang; Kim, Youn Tae

2016-01-01

Conventionally, indirect calorimetry has been used to estimate oxygen consumption in an effort to accurately measure human body energy expenditure. However, calorimetry requires the subject to wear a mask that is neither convenient nor comfortable. The purpose of our study is to develop a patch-type sensor module with an embedded incremental radial basis function neural network (RBFNN) for estimating the energy expenditure. The sensor module contains one ECG electrode and a three-axis accelerometer, and can perform real-time heart rate (HR) and movement index (MI) monitoring. The embedded incremental network includes linear regression (LR) and RBFNN based on context-based fuzzy c-means (CFCM) clustering. This incremental network is constructed by building a collection of information granules through CFCM clustering that is guided by the distribution of error of the linear part of the LR model. PMID:27669249

Approach for Estimating Exposures and Incremental Health Effects from Lead During Renovation, Repair, and Painting Activities in Public and Commercial Buildings

EPA Science Inventory

Approach for Estimating Exposures and Incremental Health Effects from Lead During Renovation, Repair, and Painting Activities in Public and Commercial Buildings” (Technical Approach Document). Also available for public review and comment are two supplementary documents: the detai...

Approach for Estimating Exposures and Incremental Health Effects from Lead Due to Renovation Repair and Painting Activities in Public and Commercial Buildings

EPA Pesticide Factsheets

Approach for Estimating Exposures and Incremental Health Effects from Lead Due to Renovation Repair and Painting Activities in Public and Commercial Buildings: links to documents at www.regulations.gov, links to PDFs related to Approach document

A Geostatistical Scaling Approach for the Generation of Non Gaussian Random Variables and Increments

NASA Astrophysics Data System (ADS)

Guadagnini, Alberto; Neuman, Shlomo P.; Riva, Monica; Panzeri, Marco

2016-04-01

We address manifestations of non-Gaussian statistical scaling displayed by many variables, Y, and their (spatial or temporal) increments. Evidence of such behavior includes symmetry of increment distributions at all separation distances (or lags) with sharp peaks and heavy tails which tend to decay asymptotically as lag increases. Variables reported to exhibit such distributions include quantities of direct relevance to hydrogeological sciences, e.g. porosity, log permeability, electrical resistivity, soil and sediment texture, sediment transport rate, rainfall, measured and simulated turbulent fluid velocity, and other. No model known to us captures all of the documented statistical scaling behaviors in a unique and consistent manner. We recently proposed a generalized sub-Gaussian model (GSG) which reconciles within a unique theoretical framework the probability distributions of a target variable and its increments. We presented an algorithm to generate unconditional random realizations of statistically isotropic or anisotropic GSG functions and illustrated it in two dimensions. In this context, we demonstrated the feasibility of estimating all key parameters of a GSG model underlying a single realization of Y by analyzing jointly spatial moments of Y data and corresponding increments. Here, we extend our GSG model to account for noisy measurements of Y at a discrete set of points in space (or time), present an algorithm to generate conditional realizations of corresponding isotropic or anisotropic random field, and explore them on one- and two-dimensional synthetic test cases.

Reproductive biology of Lutzomyia shannoni (Dyar) (Diptera: Psychodidae) under experimental conditions.

PubMed

Cárdenas, E; Ferro, C; Corredor, D; Martínez, O; Munstermann, L E

1999-12-01

Baseline biological growth data of Lutzomyia shannoni (Dyar) were compared under two experimental conditions within insulated styrofoam chests and in standard laboratory incubators. The developmental time from egg to adult was 67 and 52 days, respectively. Based on cohorts of 100 females in each experiment, horizontal life tables were constructed. The following predictive parameters were obtained under each of the two conditions: net rate of reproduction (23.5 and 18.0 females per cohort female), generation time (11.4 and 9.4 weeks), intrinsic rate of population increase (0.27 and 0.30), and finite rate of population increment (1.31 and 1.36). The reproductive value for each class age of the cohort females was calculated. The observed parameters were obtained under each experimental condition: net rate of reproduction (1.9 and 2.5 females per cohort female), generation time (11.7 and 9.6 weeks), intrinsic rate of population increase (0.05 and 0.09), and finite rate of population increment (1.06 and 1.10). Vertical life tables were elaborated and mortality was described for every generation in each cohort. In addition, for two successive generations, additive variance and heritability for fecundity were estimated.

Effects of Taxing Sugar-Sweetened Beverages on Caries and Treatment Costs.

PubMed

Schwendicke, F; Thomson, W M; Broadbent, J M; Stolpe, M

2016-11-01

Caries increment is affected by sugar-sweetened beverage (SSB) consumption. Taxing SSBs could reduce sugar consumption and caries increment. The authors aimed to estimate the impact of a 20% SSB sales tax on caries increment and associated treatment costs (as well as the resulting tax revenue) in the context of Germany. A model-based approach was taken, estimating the effects for the German population aged 14 to 79 y over a 10-y period. Taxation was assumed to affect beverage-associated sugar consumption via empirical demand elasticities. Altered consumption affected caries increments and treatment costs, with cost estimates being calculated under the perspective of the statutory health insurance. National representative consumption and price data were used to estimate tax revenue. Microsimulations were performed to estimate health outcomes, costs, and revenue impact in different age, sex, and income groups. Implementing a 20% SSB sales tax reduced sugar consumption in nearly all male groups but in fewer female groups. The reduction was larger among younger than older individuals and among those with low income. Taxation reduced caries increment and treatment costs especially in younger (rather than older) individuals and those with low income. Over 10 y, mean (SD) net caries increments at the population level were 82.27 (1.15) million and 83.02 (1.08) million teeth at 20% and 0% SSB tax, respectively. These generated treatment costs of 2.64 (0.39) billion and 2.72 (0.35) billion euro, respectively. Additional tax revenue was 37.99 (3.41) billion euro over the 10 y. In conclusion and within the limitations of this study's perspective, database, and underlying assumptions, implementing a 20% sales tax on SSBs is likely to reduce caries increment, especially in young low-income males, thereby also reducing inequalities in the distribution of caries experience. Taxation would also reduce treatment costs. However, these reductions might be limited in the total population.

Bigger is Better, but at What Cost? Estimating the Economic Value of Incremental Data Assets.

PubMed

Dalessandro, Brian; Perlich, Claudia; Raeder, Troy

2014-06-01

Many firms depend on third-party vendors to supply data for commercial predictive modeling applications. An issue that has received very little attention in the prior research literature is the estimation of a fair price for purchased data. In this work we present a methodology for estimating the economic value of adding incremental data to predictive modeling applications and present two cases studies. The methodology starts with estimating the effect that incremental data has on model performance in terms of common classification evaluation metrics. This effect is then translated into economic units, which gives an expected economic value that the firm might realize with the acquisition of a particular data asset. With this estimate a firm can then set a data acquisition price that targets a particular return on investment. This article presents the methodology in full detail and illustrates it in the context of two marketing case studies.

Can rising CO2 concentrations in the atmosphere mitigate the impact of drought years on tree growth?

NASA Astrophysics Data System (ADS)

Achim, Alexis; Plumpton, Heather; Auty, David; Ogee, Jerome; MacCarthy, Heather; Bert, Didier; Domec, Jean-Christophe; Oren, Ram; Wingate, Lisa

2015-04-01

Atmospheric CO2 concentrations and nitrogen deposition rates have increased substantially over the last century and are expected to continue unabated. As a result, terrestrial ecosystems will experience warmer temperatures and some may even experience droughts of a more intense and frequent nature that could lead to widespread forest mortality. Thus there is mounting pressure to understand and predict how forest growth will be affected by such environmental interactions in the future. In this study we used annual tree growth data from the Duke Free Air CO2 Enrichment (FACE) experiment to determine the effects of elevated atmospheric CO2 concentration (+200 ppm) and Nitrogen fertilisation (11.2 g of N m-2 yr-1) on the stem biomass increments of mature loblolly pine (Pinus taeda L.) trees from 1996 to 2010. A non-linear mixed-effects model was developed to provide estimates of annual ring specific gravity in all trees using cambial age and annual ring width as explanatory variables. Elevated CO2 did not have a significant effect on annual ring specific gravity, but N fertilisation caused a slight decrease of approximately 2% compared to the non-fertilised in both the ambient and CO2-elevated plots. When basal area increments were multiplied by wood specific gravity predictions to provide estimates of stem biomass, there was a 40% increase in the CO2-elevated plots compared to those in ambient conditions. This difference remained relatively stable until the application of the fertilisation treatment, which caused a further increase in biomass increments that peaked after three years. Unexpectedly the magnitude of this second response was similar in the CO2-elevated and ambient plots (about 25% in each after 3 years), suggesting that there was no interaction between the concentration of CO2 and the availability of soil N on biomass increments. Importantly, during drier years when annual precipitation was less than 1000 mm we observed a significant decrease in annual increments across all treatments. However, the relative difference in growth between CO2-elevated and ambient plots was greater during drought years, providing evidence that tree growth in the future might become less sensitive to water shortages under elevated CO2 conditions.

Estimating the total energy demand for supra-maximal exercise using the VO2-power regression from an incremental exercise test.

PubMed

Aisbett, B; Le Rossignol, P

2003-09-01

The VO2-power regression and estimated total energy demand for a 6-minute supra-maximal exercise test was predicted from a continuous incremental exercise test. Sub-maximal VO2-power co-ordinates were established from the last 40 seconds (s) of 150-second exercise stages. The precision of the estimated total energy demand was determined using the 95% confidence interval (95% CI) of the estimated total energy demand. The linearity of the individual VO2-power regression equations was determined using Pearson's correlation coefficient. The mean 95% CI of the estimated total energy demand was 5.9 +/- 2.5 mL O2 Eq x kg(-1) x min(-1), and the mean correlation coefficient was 0.9942 +/- 0.0042. The current study contends that the sub-maximal VO2-power co-ordinates from a continuous incremental exercise test can be used to estimate supra-maximal energy demand without compromising the precision of the accumulated oxygen deficit (AOD) method.

Estimation of Comfort/Disconfort Based on EEG in Massage by Use of Clustering according to Correration and Incremental Learning type NN

NASA Astrophysics Data System (ADS)

Teramae, Tatsuya; Kushida, Daisuke; Takemori, Fumiaki; Kitamura, Akira

Authors proposed the estimation method combining k-means algorithm and NN for evaluating massage. However, this estimation method has a problem that discrimination ratio is decreased to new user. There are two causes of this problem. One is that generalization of NN is bad. Another one is that clustering result by k-means algorithm has not high correlation coefficient in a class. Then, this research proposes k-means algorithm according to correlation coefficient and incremental learning for NN. The proposed k-means algorithm is method included evaluation function based on correlation coefficient. Incremental learning is method that NN is learned by new data and initialized weight based on the existing data. The effect of proposed methods are verified by estimation result using EEG data when testee is given massage.

14 CFR 1260.53 - Incremental funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Incremental funding. 1260.53 Section 1260.53 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.53 Incremental funding. Incremental Funding October 2000 (a...

14 CFR 1260.53 - Incremental funding.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Incremental funding. 1260.53 Section 1260.53 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.53 Incremental funding. Incremental Funding October 2000 (a...

14 CFR 1260.53 - Incremental funding.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Incremental funding. 1260.53 Section 1260.53 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.53 Incremental funding. Incremental Funding October 2000 (a...

Estimating the variance and integral scale of the transmissivity field using head residual increments

USGS Publications Warehouse

Zheng, Li; Silliman, Stephen E.

2000-01-01

A modification of previously published solutions regarding the spatial variation of hydraulic heads is discussed whereby the semivariogram of increments of head residuals (termed head residual increments HRIs) are related to the variance and integral scale of the transmissivity field. A first‐order solution is developed for the case of a transmissivity field which is isotropic and whose second‐order behavior can be characterized by an exponential covariance structure. The estimates of the variance σY2 and the integral scale λ of the log transmissivity field are then obtained via fitting a theoretical semivariogram for the HRI to its sample semivariogram. This approach is applied to head data sampled from a series of two‐dimensional, simulated aquifers with isotropic, exponential covariance structures and varying degrees of heterogeneity (σY2 = 0.25, 0.5, 1.0, 2.0, and 5.0). The results show that this method provided reliable estimates for both λ and σY2 in aquifers with the value of σY2 up to 2.0, but the errors in those estimates were higher for σY2 equal to 5.0. It is also demonstrated through numerical experiments and theoretical arguments that the head residual increments will provide a sample semivariogram with a lower variance than will the use of the head residuals without calculation of increments.

Department of the Navy Justification of Estimates for Fiscal Year 1983 Submitted to Congress February 1982. Procurement. Book 2. Shipbuilding and Conversion, Navy; Other Procurement, Navy; Procurement, Marine Corps

DTIC Science & Technology

1982-02-01

two increments . Increment 1 provides the austere essential ofticer in Tactical Conatana (Uu) co,.manac center organic data display and communications...and a large screen display group. Equipment in Increment 2 has been chosen trom inventory or tnavy stauu- aros and provides a stand alone austere...installation or increment I on 19 designated flagships (14 carriers and five cruisers) and installation or Increment 2 on six carriers auG and the

Online shaft encoder geometry compensation for arbitrary shaft speed profiles using Bayesian regression

NASA Astrophysics Data System (ADS)

Diamond, D. H.; Heyns, P. S.; Oberholster, A. J.

2016-12-01

The measurement of instantaneous angular speed is being increasingly investigated for its use in a wide range of condition monitoring and prognostic applications. Central to many measurement techniques are incremental shaft encoders recording the arrival times of shaft angular increments. The conventional approach to processing these signals assumes that the angular increments are equidistant. This assumption is generally incorrect when working with toothed wheels and especially zebra tape encoders and has been shown to introduce errors in the estimated shaft speed. There are some proposed methods in the literature that aim to compensate for this geometric irregularity. Some of the methods require the shaft speed to be perfectly constant for calibration, something rarely achieved in practice. Other methods assume the shaft speed to be nearly constant with minor deviations. Therefore existing methods cannot calibrate the entire shaft encoder geometry for arbitrary shaft speeds. The present article presents a method to calculate the shaft encoder geometry for arbitrary shaft speed profiles. The method uses Bayesian linear regression to calculate the encoder increment distances. The method is derived and then tested against simulated and laboratory experiments. The results indicate that the proposed method is capable of accurately determining the shaft encoder geometry for any shaft speed profile.

14 CFR 1260.53 - Incremental funding.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Incremental funding. 1260.53 Section 1260.53 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.53 Incremental funding. Incremental Funding October 2000 (a) Only $___ of the...

B-2 Extremely High Frequency SATCOM and Computer Increment 1 (B-2 EHF Inc 1)

DTIC Science & Technology

2015-12-01

Confidence Level Confidence Level of cost estimate for current APB: 55% This APB reflects cost and funding data based on the B-2 EHF Increment I SCP...This cost estimate was quantified at the Mean (~55%) confidence level . Total Quantity Quantity SAR Baseline Production Estimate Current APB...Production Estimate Econ Qty Sch Eng Est Oth Spt Total 33.624 -0.350 1.381 0.375 0.000 -6.075 0.000 -0.620 -5.289 28.335 Current SAR Baseline to Current

Aerodynamic Analyses and Database Development for Ares I Vehicle First Stage Separation

NASA Technical Reports Server (NTRS)

Pamadi, Bandu N.; Pei, Jing; Pinier, Jeremy T.; Holland, Scott D.; Covell, Peter F.; Klopfer, Goetz, H.

2012-01-01

This paper presents the aerodynamic analysis and database development for the first stage separation of the Ares I A106 Crew Launch Vehicle configuration. Separate databases were created for the first stage and upper stage. Each database consists of three components: isolated or free-stream coefficients, power-off proximity increments, and power-on proximity increments. The power-on database consists of three parts, all plumes firing at nominal conditions, the one booster deceleration motor out condition, and the one ullage settling motor out condition. The isolated and power-off incremental databases were developed using wind tunnel test data. The power-on proximity increments were developed using CFD solutions.

40 CFR 52.2219 - Conditional approval.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... EPA is conditionally approving TDEC's submittal with respect to the PSD requirements of CAA sections... enforceable provisions for PSD increments as detailed in TDEC's October 4, 2012, commitment letter. Tennessee... PSD increments as described in the State's letter of commitment. (d) Conditional Approval—Submittal...

Sucralose Affects Glycemic and Hormonal Responses to an Oral Glucose Load

PubMed Central

Pepino, M. Yanina; Tiemann, Courtney D.; Patterson, Bruce W.; Wice, Burton M.; Klein, Samuel

2013-01-01

OBJECTIVE Nonnutritive sweeteners (NNS), such as sucralose, have been reported to have metabolic effects in animal models. However, the relevance of these findings to human subjects is not clear. We evaluated the acute effects of sucralose ingestion on the metabolic response to an oral glucose load in obese subjects. RESEARCH DESIGN AND METHODS Seventeen obese subjects (BMI 42.3 ± 1.6 kg/m2) who did not use NNS and were insulin sensitive (based on a homeostasis model assessment of insulin resistance score ≤2.6) underwent a 5-h modified oral glucose tolerance test on two separate occasions preceded by consuming either sucralose (experimental condition) or water (control condition) 10 min before the glucose load in a randomized crossover design. Indices of β-cell function, insulin sensitivity (SI), and insulin clearance rates were estimated by using minimal models of glucose, insulin, and C-peptide kinetics. RESULTS Compared with the control condition, sucralose ingestion caused 1) a greater incremental increase in peak plasma glucose concentrations (4.2 ± 0.2 vs. 4.8 ± 0.3 mmol/L; P = 0.03), 2) a 20 ± 8% greater incremental increase in insulin area under the curve (AUC) (P < 0.03), 3) a 22 ± 7% greater peak insulin secretion rate (P < 0.02), 4) a 7 ± 4% decrease in insulin clearance (P = 0.04), and 5) a 23 ± 20% decrease in SI (P = 0.01). There were no significant differences between conditions in active glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, glucagon incremental AUC, or indices of the sensitivity of the β-cell response to glucose. CONCLUSIONS These data demonstrate that sucralose affects the glycemic and insulin responses to an oral glucose load in obese people who do not normally consume NNS. PMID:23633524

Theory and generation of conditional, scalable sub-Gaussian random fields

NASA Astrophysics Data System (ADS)

Panzeri, M.; Riva, M.; Guadagnini, A.; Neuman, S. P.

2016-03-01

Many earth and environmental (as well as a host of other) variables, Y, and their spatial (or temporal) increments, ΔY, exhibit non-Gaussian statistical scaling. Previously we were able to capture key aspects of such non-Gaussian scaling by treating Y and/or ΔY as sub-Gaussian random fields (or processes). This however left unaddressed the empirical finding that whereas sample frequency distributions of Y tend to display relatively mild non-Gaussian peaks and tails, those of ΔY often reveal peaks that grow sharper and tails that become heavier with decreasing separation distance or lag. Recently we proposed a generalized sub-Gaussian model (GSG) which resolves this apparent inconsistency between the statistical scaling behaviors of observed variables and their increments. We presented an algorithm to generate unconditional random realizations of statistically isotropic or anisotropic GSG functions and illustrated it in two dimensions. Most importantly, we demonstrated the feasibility of estimating all parameters of a GSG model underlying a single realization of Y by analyzing jointly spatial moments of Y data and corresponding increments, ΔY. Here, we extend our GSG model to account for noisy measurements of Y at a discrete set of points in space (or time), present an algorithm to generate conditional realizations of corresponding isotropic or anisotropic random fields, introduce two approximate versions of this algorithm to reduce CPU time, and explore them on one and two-dimensional synthetic test cases.

Prediction of height increment for models of forest growth

Treesearch

Albert R. Stage

1975-01-01

Functional forms of equations were derived for predicting 10-year periodic height increment of forest trees from height, diameter, diameter increment, and habitat type. Crown ratio was considered as an additional variable for prediction, but its contribution was negligible. Coefficients of the function were estimated for 10 species of trees growing in 10 habitat types...

Global Combat Support System - Joint Increment 8 (GCSS-J Inc 8)

DTIC Science & Technology

2016-03-01

Acquisition Executive DoD - Department of Defense DoDAF - DoD Architecture Framework FD - Full Deployment FDD - Full Deployment Decision FY - Fiscal...Estimate (Or Actual) Milestone B1 Mar 2014 Mar 2014 Milestone C1 Mar 2014 Mar 2014 Increment 8 FDD Dec 2018 Dec 2018 Increment 8 FD TBD TBD Memo 1

14 CFR 1274.918 - Incremental funding.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Incremental funding. 1274.918 Section 1274... COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.918 Incremental funding. Incremental Funding... Agreement, as required, until it is fully funded. Any work beyond the funding limit will be at the recipient...

14 CFR 1274.918 - Incremental funding.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Incremental funding. 1274.918 Section 1274... COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.918 Incremental funding. Incremental Funding... Agreement, as required, until it is fully funded. Any work beyond the funding limit will be at the recipient...

14 CFR 1274.918 - Incremental funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Incremental funding. 1274.918 Section 1274... COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.918 Incremental funding. Incremental Funding... Agreement, as required, until it is fully funded. Any work beyond the funding limit will be at the recipient...

14 CFR 1274.918 - Incremental funding.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Incremental funding. 1274.918 Section 1274... COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.918 Incremental funding. Incremental Funding... Agreement, as required, until it is fully funded. Any work beyond the funding limit will be at the recipient...

14 CFR § 1260.53 - Incremental funding.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Incremental funding. § 1260.53 Section § 1260.53 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.53 Incremental funding. Incremental Funding October 2000 (a...

An empiric estimate of the value of life: updating the renal dialysis cost-effectiveness standard.

PubMed

Lee, Chris P; Chertow, Glenn M; Zenios, Stefanos A

2009-01-01

Proposals to make decisions about coverage of new technology by comparing the technology's incremental cost-effectiveness with the traditional benchmark of dialysis imply that the incremental cost-effectiveness ratio of dialysis is seen a proxy for the value of a statistical year of life. The frequently used ratio for dialysis has, however, not been updated to reflect more recently available data on dialysis. We developed a computer simulation model for the end-stage renal disease population and compared cost, life expectancy, and quality adjusted life expectancy of current dialysis practice relative to three less costly alternatives and to no dialysis. We estimated incremental cost-effectiveness ratios for these alternatives relative to the next least costly alternative and no dialysis and analyzed the population distribution of the ratios. Model parameters and costs were estimated using data from the Medicare population and a large integrated health-care delivery system between 1996 and 2003. The sensitivity of results to model assumptions was tested using 38 scenarios of one-way sensitivity analysis, where parameters informing the cost, utility, mortality and morbidity, etc. components of the model were by perturbed +/-50%. The incremental cost-effectiveness ratio of dialysis of current practice relative to the next least costly alternative is on average $129,090 per quality-adjusted life-year (QALY) ($61,294 per year), but its distribution within the population is wide; the interquartile range is $71,890 per QALY, while the 1st and 99th percentiles are $65,496 and $488,360 per QALY, respectively. Higher incremental cost-effectiveness ratios were associated with older age and more comorbid conditions. Sensitivity to model parameters was comparatively small, with most of the scenarios leading to a change of less than 10% in the ratio. The value of a statistical year of life implied by dialysis practice currently averages $129,090 per QALY ($61,294 per year), but is distributed widely within the dialysis population. The spread suggests that coverage decisions using dialysis as the benchmark may need to incorporate percentile values (which are higher than the average) to be consistent with the Rawlsian principles of justice of preserving the rights and interests of society's most vulnerable patient groups.

[Volatile organic compounds (VOCs) emitted from furniture and electrical appliances].

PubMed

Tanaka-Kagawa, Toshiko; Jinno, Hideto; Furukawa, Yoko; Nishimura, Tetsuji

2010-01-01

Organic chemicals are widely used as ingredients in household products. Therefore, furniture and other household products as well as building products may influence the indoor air quality. This study was performed to estimate quantitatively influence of household products on indoor air quality. Volatile organic compound (VOC) emissions were investigated for 10 products including furniture (chest, desk, dining table, sofa, cupboard) and electrical appliances (refrigerator, electric heater, desktop personal computer, liquid crystal display television and audio) by the large chamber test method (JIS A 1912) under the standard conditions of 28 degrees C, 50% relative humidity and 0.5 times/h ventilation. Emission rate of total VOC (TVOC) from the sofa showed the highest; over 7900 microg toluene-equivalent/unit/h. Relatively high TVOC emissions were observed also from desk and chest. Based on the emission rates, the impacts on the indoor TVOC were estimated by the simple model with a volume of 17.4 m3 and ventilation frequency of 0.5 times/h. The estimated TVOC increment for the sofa was 911 microg/m3, accounting for almost 230% of the provisional target value, 400 microg/m3. The values of estimated increment of toluene emitted from cupboard and styrene emitted from refrigerator were 10% and 16% of guideline values, respectively. These results revealed that VOC emissions from household products may influence significantly indoor air quality.

Stochastic precision analysis of 2D cardiac strain estimation in vivo

NASA Astrophysics Data System (ADS)

Bunting, E. A.; Provost, J.; Konofagou, E. E.

2014-11-01

Ultrasonic strain imaging has been applied to echocardiography and carries great potential to be used as a tool in the clinical setting. Two-dimensional (2D) strain estimation may be useful when studying the heart due to the complex, 3D deformation of the cardiac tissue. Increasing the framerate used for motion estimation, i.e. motion estimation rate (MER), has been shown to improve the precision of the strain estimation, although maintaining the spatial resolution necessary to view the entire heart structure in a single heartbeat remains challenging at high MERs. Two previously developed methods, the temporally unequispaced acquisition sequence (TUAS) and the diverging beam sequence (DBS), have been used in the past to successfully estimate in vivo axial strain at high MERs without compromising spatial resolution. In this study, a stochastic assessment of 2D strain estimation precision is performed in vivo for both sequences at varying MERs (65, 272, 544, 815 Hz for TUAS; 250, 500, 1000, 2000 Hz for DBS). 2D incremental strains were estimated during left ventricular contraction in five healthy volunteers using a normalized cross-correlation function and a least-squares strain estimator. Both sequences were shown capable of estimating 2D incremental strains in vivo. The conditional expected value of the elastographic signal-to-noise ratio (E(SNRe|ɛ)) was used to compare strain estimation precision of both sequences at multiple MERs over a wide range of clinical strain values. The results here indicate that axial strain estimation precision is much more dependent on MER than lateral strain estimation, while lateral estimation is more affected by strain magnitude. MER should be increased at least above 544 Hz to avoid suboptimal axial strain estimation. Radial and circumferential strain estimations were influenced by the axial and lateral strain in different ways. Furthermore, the TUAS and DBS were found to be of comparable precision at similar MERs.

The importance of age-related decline in forest NPP for modeling regional carbon balances.

PubMed

Zaehle, Sönke; Sitch, Stephen; Prentice, I Colin; Liski, Jari; Cramer, Wolfgang; Erhard, Markus; Hickler, Thomas; Smith, Benjamin

2006-08-01

We show the implications of the commonly observed age-related decline in aboveground productivity of forests, and hence forest age structure, on the carbon dynamics of European forests in response to historical changes in environmental conditions. Size-dependent carbon allocation in trees to counteract increasing hydraulic resistance with tree height has been hypothesized to be responsible for this decline. Incorporated into a global terrestrial biosphere model (the Lund-Potsdam-Jena model, LPJ), this hypothesis improves the simulated increase in biomass with stand age. Application of the advanced model, including a generic representation of forest management in even-aged stands, for 77 European provinces shows that model-based estimates of biomass development with age compare favorably with inventory-based estimates for different tree species. Model estimates of biomass densities on province and country levels, and trends in growth increment along an annual mean temperature gradient are in broad agreement with inventory data. However, the level of agreement between modeled and inventory-based estimates varies markedly between countries and provinces. The model is able to reproduce the present-day age structure of forests and the ratio of biomass removals to increment on a European scale based on observed changes in climate, atmospheric CO2 concentration, forest area, and wood demand between 1948 and 2000. Vegetation in European forests is modeled to sequester carbon at a rate of 100 Tg C/yr, which corresponds well to forest inventory-based estimates.

Effect of high altitude exposure on the hemodynamics of the bidirectional Glenn physiology: modeling incremented pulmonary vascular resistance and heart rate.

PubMed

Vallecilla, Carolina; Khiabani, Reza H; Sandoval, Néstor; Fogel, Mark; Briceño, Juan Carlos; Yoganathan, Ajit P

2014-06-03

The considerable blood mixing in the bidirectional Glenn (BDG) physiology further limits the capacity of the single working ventricle to pump enough oxygenated blood to the circulatory system. This condition is exacerbated under severe conditions such as physical activity or high altitude. In this study, the effect of high altitude exposure on hemodynamics and ventricular function of the BDG physiology is investigated. For this purpose, a mathematical approach based on a lumped parameter model was developed to model the BDG circulation. Catheterization data from 39 BDG patients at stabilized oxygen conditions was used to determine baseline flows and pressures for the model. The effect of high altitude exposure was modeled by increasing the pulmonary vascular resistance (PVR) and heart rate (HR) in increments up to 80% and 40%, respectively. The resulting differences in vascular flows, pressures and ventricular function parameters were analyzed. By simultaneously increasing PVR and HR, significant changes (p <0.05) were observed in cardiac index (11% increase at an 80% PVR and 40% HR increase) and pulmonary flow (26% decrease at an 80% PVR and 40% HR increase). Significant increase in mean systemic pressure (9%) was observed at 80% PVR (40% HR) increase. The results show that the poor ventricular function fails to overcome the increased preload and implied low oxygenation in BDG patients at higher altitudes, especially for those with high baseline PVRs. The presented mathematical model provides a framework to estimate the hemodynamic performance of BDG patients at different PVR increments. Copyright © 2014 Elsevier Ltd. All rights reserved.

14 CFR § 1274.918 - Incremental funding.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Incremental funding. § 1274.918 Section Â... WITH COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.918 Incremental funding. Incremental Funding July 2002 (a) Of the award amount indicated on the cover page of this Agreement, only the...

Biometrics Enabling Capability Increment 1 (BEC Inc 1)

DTIC Science & Technology

2016-03-01

2016 Major Automated Information System Annual Report Biometrics Enabling Capability Increment 1 (BEC Inc 1) Defense Acquisition Management...Phone: 227-3119 DSN Fax: Date Assigned: July 15, 2015 Program Information Program Name Biometrics Enabling Capability Increment 1 (BEC Inc 1) DoD...therefore, no Original Estimate has been established. BEC Inc 1 2016 MAR UNCLASSIFIED 4 Program Description The Biometrics Enabling Capability (BEC

The power induced effects module: A FORTRAN code which estimates lift increments due to power induced effects for V/STOL flight

NASA Technical Reports Server (NTRS)

Sandlin, Doral R.; Howard, Kipp E.

1991-01-01

A user friendly FORTRAN code that can be used for preliminary design of V/STOL aircraft is described. The program estimates lift increments, due to power induced effects, encountered by aircraft in V/STOL flight. These lift increments are calculated using empirical relations developed from wind tunnel tests and are due to suckdown, fountain, ground vortex, jet wake, and the reaction control system. The code can be used as a preliminary design tool along with NASA Ames' Aircraft Synthesis design code or as a stand-alone program for V/STOL aircraft designers. The Power Induced Effects (PIE) module was validated using experimental data and data computed from lift increment routines. Results are presented for many flat plate models along with the McDonnell Aircraft Company's MFVT (mixed flow vectored thrust) V/STOL preliminary design and a 15 percent scale model of the YAV-8B Harrier V/STOL aircraft. Trends and magnitudes of lift increments versus aircraft height above the ground were predicted well by the PIE module. The code also provided good predictions of the magnitudes of lift increments versus aircraft forward velocity. More experimental results are needed to determine how well the code predicts lift increments as they vary with jet deflection angle and angle of attack. The FORTRAN code is provided in the appendix.

Estimating increment-decrement life tables with multiple covariates from panel data: the case of active life expectancy.

PubMed

Land, K C; Guralnik, J M; Blazer, D G

1994-05-01

A fundamental limitation of current multistate life table methodology-evident in recent estimates of active life expectancy for the elderly-is the inability to estimate tables from data on small longitudinal panels in the presence of multiple covariates (such as sex, race, and socioeconomic status). This paper presents an approach to such an estimation based on an isomorphism between the structure of the stochastic model underlying a conventional specification of the increment-decrement life table and that of Markov panel regression models for simple state spaces. We argue that Markov panel regression procedures can be used to provide smoothed or graduated group-specific estimates of transition probabilities that are more stable across short age intervals than those computed directly from sample data. We then join these estimates with increment-decrement life table methods to compute group-specific total, active, and dependent life expectancy estimates. To illustrate the methods, we describe an empirical application to the estimation of such life expectancies specific to sex, race, and education (years of school completed) for a longitudinal panel of elderly persons. We find that education extends both total life expectancy and active life expectancy. Education thus may serve as a powerful social protective mechanism delaying the onset of health problems at older ages.

Modelling and Prediction of Spark-ignition Engine Power Performance Using Incremental Least Squares Support Vector Machines

NASA Astrophysics Data System (ADS)

Wong, Pak-kin; Vong, Chi-man; Wong, Hang-cheong; Li, Ke

2010-05-01

Modern automotive spark-ignition (SI) power performance usually refers to output power and torque, and they are significantly affected by the setup of control parameters in the engine management system (EMS). EMS calibration is done empirically through tests on the dynamometer (dyno) because no exact mathematical engine model is yet available. With an emerging nonlinear function estimation technique of Least squares support vector machines (LS-SVM), the approximate power performance model of a SI engine can be determined by training the sample data acquired from the dyno. A novel incremental algorithm based on typical LS-SVM is also proposed in this paper, so the power performance models built from the incremental LS-SVM can be updated whenever new training data arrives. With updating the models, the model accuracies can be continuously increased. The predicted results using the estimated models from the incremental LS-SVM are good agreement with the actual test results and with the almost same average accuracy of retraining the models from scratch, but the incremental algorithm can significantly shorten the model construction time when new training data arrives.

Incremental cost of nosocomial bacteremia according to the focus of infection and antibiotic sensitivity of the causative microorganism in a university hospital.

PubMed

Riu, Marta; Chiarello, Pietro; Terradas, Roser; Sala, Maria; Garcia-Alzorriz, Enric; Castells, Xavier; Grau, Santiago; Cots, Francesc

2017-04-01

To estimate the incremental cost of nosocomial bacteremia according to the causative focus and classified by the antibiotic sensitivity of the microorganism.Patients admitted to Hospital del Mar in Barcelona from 2005 to 2012 were included. We analyzed the total hospital costs of patients with nosocomial bacteremia caused by microorganisms with a high prevalence and, often, with multidrug-resistance. A control group was defined by selecting patients without bacteremia in the same diagnosis-related group.Our hospital has a cost accounting system (full-costing) that uses activity-based criteria to estimate per-patient costs. A logistic regression was fitted to estimate the probability of developing bacteremia (propensity score) and was used for propensity-score matching adjustment. This propensity score was included in an econometric model to adjust the incremental cost of patients with bacteremia with differentiation of the causative focus and antibiotic sensitivity.The mean incremental cost was estimated at &OV0556;15,526. The lowest incremental cost corresponded to bacteremia caused by multidrug-sensitive urinary infection (&OV0556;6786) and the highest to primary or unknown sources of bacteremia caused by multidrug-resistant microorganisms (&OV0556;29,186).This is one of the first analyses to include all episodes of bacteremia produced during hospital stays in a single study. The study included accurate information about the focus and antibiotic sensitivity of the causative organism and actual hospital costs. It provides information that could be useful to improve, establish, and prioritize prevention strategies for nosocomial infections.

Cost-effectiveness of dapagliflozin versus DPP-4 inhibitors as an add-on to Metformin in the Treatment of Type 2 Diabetes Mellitus from a UK Healthcare System Perspective.

PubMed

Charokopou, M; McEwan, P; Lister, S; Callan, L; Bergenheim, K; Tolley, K; Postema, R; Townsend, R; Roudaut, M

2015-11-05

Type 2 diabetes mellitus (T2DM) is a chronic, progressive condition where the primary treatment goal is to maintain control of glycated haemoglobin (HbA1c). In order for healthcare decision makers to ensure patients receive the highest standard of care within the available budget, the clinical benefits of each treatment option must be balanced against the economic consequences. The aim of this study was to assess the cost-effectiveness of dapagliflozin, the first-in-class sodium-glucose co-transporter 2 (SGLT2) inhibitor, compared with a dipeptidyl peptidase-4 inhibitor (DPP-4i), when added to metformin for the treatment of patients with T2DM inadequately controlled on metformin alone. The previously published and validated Cardiff diabetes model was used as the basis for this economic evaluation, with treatment effect parameters sourced from a systematic review and network meta-analysis. Costs, derived from a UK healthcare system perspective, and quality-adjusted life years (QALYs), were used to present the final outcome as an incremental cost-effectiveness ratio (ICER) over a lifetime horizon. Univariate and probabilistic sensitivity analyses (PSA) were carried out to assess uncertainty in the model results. Compared with DPP-4i, dapagliflozin was associated with a mean incremental benefit of 0.032 QALYs (95% confidence interval [CI]: -0.022, 0.140) and with an incremental cost of £216 (95% CI: £-258, £795). This resulted in an ICER point estimate of £6,761 per QALY gained. Sensitivity analysis determined incremental costs to be insensitive to variation in most parameters, with only the treatment effect on weight having a notable impact on the incremental QALYs; however, there were no scenarios which raised the ICER above £15,000 per QALY. The PSA estimated that dapagliflozin had an 85% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained. Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option from a UK healthcare system perspective for patients with T2DM who are inadequately controlled on metformin alone.

Hurst Estimation of Scale Invariant Processes with Stationary Increments and Piecewise Linear Drift

NASA Astrophysics Data System (ADS)

Modarresi, N.; Rezakhah, S.

The characteristic feature of the discrete scale invariant (DSI) processes is the invariance of their finite dimensional distributions by dilation for certain scaling factor. DSI process with piecewise linear drift and stationary increments inside prescribed scale intervals is introduced and studied. To identify the structure of the process, first, we determine the scale intervals, their linear drifts and eliminate them. Then, a new method for the estimation of the Hurst parameter of such DSI processes is presented and applied to some period of the Dow Jones indices. This method is based on fixed number equally spaced samples inside successive scale intervals. We also present some efficient method for estimating Hurst parameter of self-similar processes with stationary increments. We compare the performance of this method with the celebrated FA, DFA and DMA on the simulated data of fractional Brownian motion (fBm).

Estimating evaporative vapor generation from automobiles based on parking activities.

PubMed

Dong, Xinyi; Tschantz, Michael; Fu, Joshua S

2015-07-01

A new approach is proposed to quantify the evaporative vapor generation based on real parking activity data. As compared to the existing methods, two improvements are applied in this new approach to reduce the uncertainties: First, evaporative vapor generation from diurnal parking events is usually calculated based on estimated average parking duration for the whole fleet, while in this study, vapor generation rate is calculated based on parking activities distribution. Second, rather than using the daily temperature gradient, this study uses hourly temperature observations to derive the hourly incremental vapor generation rates. The parking distribution and hourly incremental vapor generation rates are then adopted with Wade-Reddy's equation to estimate the weighted average evaporative generation. We find that hourly incremental rates can better describe the temporal variations of vapor generation, and the weighted vapor generation rate is 5-8% less than calculation without considering parking activity. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cost-effectiveness analysis of entecavir versus lamivudine in the first-line treatment of Australian patients with chronic hepatitis B.

PubMed

Arnold, Elizabeth; Yuan, Yong; Iloeje, Uchenna; Cook, Greg

2008-01-01

Chronic hepatitis B (CHB) virus infection is a major global healthcare problem. The recent introduction of entecavir in Australia for the treatment of CHB patients in the naive treatment setting has triggered significant optimism with regards to improved clinical outcomes for CHB patients. To estimate, from an Australian healthcare perspective, the cost effectiveness of entecavir 0.5 mg/day versus lamivudine 100 mg/day in the treatment of CHB patients naive to nucleos(t)ide therapy. A cost-utility analysis to project the clinical and economic outcomes associated with CHB disease and treatment was conducted by developing two decision-tree models specific to hepatitis B e antigen-positive (HBeAg+ve) and HBeAg-ve CHB patient subsets. This analysis was constructed using the Australian payer perspective of direct costs and outcomes, with indirect medical costs and lost productivity not being included. The study population comprised a hypothetical cohort of 1000 antiviral treatment-naive CHB patients who received either entecavir 0.5 mg/day or lamivudine 100 mg/day at model entry. The population of patients used in this analysis was representative of those patients likely to receive initial antiviral therapy in clinical practice in Australia. The long-term cost effectiveness of entecavir compared with lamivudine in the first-line treatment of CHB patients was expressed as an incremental cost per life-year gained (LYG) or QALY gained. Results revealed that the availability of entecavir 0.5 mg/day as part of the Australian hepatologist's treatment armamentarium should result in significantly lower future rates of compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC) events (i.e. 54 fewer cases of CC, seven fewer cases of DC, and 20 fewer cases of HCC over the model's timeframe for HBeAg+ve CHB patients, and 69 fewer cases of CC, eight fewer cases of DC and 25 fewer cases of HCC over the model's timeframe for HBeAg-ve CHB patients). Compared with lamivudine 100 mg/day, entecavir 0.5 mg/day generated an estimated incremental cost per LYG of Australian dollars ($A, year 2006 values) 5046 and an estimated incremental cost per QALY of $A5952 in the HBeAg+ve CHB patient population, an estimated incremental cost per LYG of $A7063 and an estimated incremental cost per QALY of $A8003 in the HBeAg-ve CHB patient population, and an overall estimated incremental cost per LYG of $A5853 and an estimated incremental cost per QALY of $A6772 in the general CHB population. The availability of entecavir in Australian clinical practice should make long-term suppression of hepatitis B virus replication increasingly attainable, resulting in fewer CHB sequelae, at an acceptable financial cost.

Acceleration of incremental-pressure-correction incompressible flow computations using a coarse-grid projection method

NASA Astrophysics Data System (ADS)

Kashefi, Ali; Staples, Anne

2016-11-01

Coarse grid projection (CGP) methodology is a novel multigrid method for systems involving decoupled nonlinear evolution equations and linear elliptic equations. The nonlinear equations are solved on a fine grid and the linear equations are solved on a corresponding coarsened grid. Mapping functions transfer data between the two grids. Here we propose a version of CGP for incompressible flow computations using incremental pressure correction methods, called IFEi-CGP (implicit-time-integration, finite-element, incremental coarse grid projection). Incremental pressure correction schemes solve Poisson's equation for an intermediate variable and not the pressure itself. This fact contributes to IFEi-CGP's efficiency in two ways. First, IFEi-CGP preserves the velocity field accuracy even for a high level of pressure field grid coarsening and thus significant speedup is achieved. Second, because incremental schemes reduce the errors that arise from boundaries with artificial homogenous Neumann conditions, CGP generates undamped flows for simulations with velocity Dirichlet boundary conditions. Comparisons of the data accuracy and CPU times for the incremental-CGP versus non-incremental-CGP computations are presented.

Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany.

PubMed

Westerhout, K Y; Verheggen, B G; Schreder, C H; Augustin, M

2012-01-01

An economic evaluation was conducted to assess the outcomes and costs as well as cost-effectiveness of the following grass-pollen immunotherapies: OA (Oralair; Stallergenes S.A., Antony, France) vs GRZ (Grazax; ALK-Abelló, Hørsholm, Denmark), and ALD (Alk Depot SQ; ALK-Abelló) (immunotherapy agents alongside symptomatic medication) and symptomatic treatment alone for grass pollen allergic rhinoconjunctivitis. The costs and outcomes of 3-year treatment were assessed for a period of 9 years using a Markov model. Treatment efficacy was estimated using an indirect comparison of available clinical trials with placebo as a common comparator. Estimates for immunotherapy discontinuation, occurrence of asthma, health state utilities, drug costs, resource use, and healthcare costs were derived from published sources. The analysis was conducted from the insurant's perspective including public and private health insurance payments and co-payments by insurants. Outcomes were reported as quality-adjusted life years (QALYs) and symptom-free days. The uncertainty around incremental model results was tested by means of extensive deterministic univariate and probabilistic multivariate sensitivity analyses. In the base case analysis the model predicted a cost-utility ratio of OA vs symptomatic treatment of €14,728 per QALY; incremental costs were €1356 (95%CI: €1230; €1484) and incremental QALYs 0.092 (95%CI: 0.052; 0.140). OA was the dominant strategy compared to GRZ and ALD, with estimated incremental costs of -€1142 (95%CI: -€1255; -€1038) and -€54 (95%CI: -€188; €85) and incremental QALYs of 0.015 (95%CI: -0.025; 0.056) and 0.027 (95%CI: -0.022; 0.075), respectively. At a willingness-to-pay threshold of €20,000, the probability of OA being the most cost-effective treatment was predicted to be 79%. Univariate sensitivity analyses show that incremental outcomes were moderately sensitive to changes in efficacy estimates. The main study limitation was the requirement of an indirect comparison involving several steps to assess relative treatment effects. The analysis suggests OA to be cost-effective compared to GRZ and ALD, and a symptomatic treatment. Sensitivity analyses showed that uncertainty surrounding treatment efficacy estimates affected the model outcomes.

Keeping a Spacecraft on the Sun-Earth Line

NASA Technical Reports Server (NTRS)

Roithmayr, Carlos M.; Kay-Bunnell, Linda

2005-01-01

Measurements of Earth's atmosphere as it occults sunlight can be obtained advantageously from a spacecraft placed in the proximity of the Sun-Earth Lagrange point L2. Maintaining the condition of continuous solar occultation by all parts of the atmospheric disk requires that the displacement of the spacecraft perpendicular to the Sun-Earth line remains less than 200 km. However, the gravitational force exerted by the Earth s moon must be negated by propulsion in order to meet this rather tight constraint. We provide an estimate of propulsive force needed to keep the spacecraft coincident with L2, as well as estimates of velocity increments needed to maintain various trajectories in the close vicinity of L2.

Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India.

PubMed

Vassall, Anna; Pickles, Michael; Chandrashekar, Sudhashree; Boily, Marie-Claude; Shetty, Govindraj; Guinness, Lorna; Lowndes, Catherine M; Bradley, Janet; Moses, Stephen; Alary, Michel; Vickerman, Peter

2014-09-01

Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached. Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study). This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all that can benefit from it. Policy makers should consider funding and sustaining large-scale targeted HIV prevention programmes in India and beyond. Bill & Melinda Gates Foundation. Copyright © 2014 Vassall et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.

Observers for Systems with Nonlinearities Satisfying an Incremental Quadratic Inequality

NASA Technical Reports Server (NTRS)

Acikmese, Ahmet Behcet; Corless, Martin

2004-01-01

We consider the problem of state estimation for nonlinear time-varying systems whose nonlinearities satisfy an incremental quadratic inequality. These observer results unifies earlier results in the literature; and extend it to some additional classes of nonlinearities. Observers are presented which guarantee that the state estimation error exponentially converges to zero. Observer design involves solving linear matrix inequalities for the observer gain matrices. Results are illustrated by application to a simple model of an underwater.

Cost-effectiveness analysis of once-yearly injection of zoledronic acid for the treatment of osteoporosis in Japan.

PubMed

Moriwaki, K; Mouri, M; Hagino, H

2017-06-01

Model-based economic evaluation was performed to assess the cost-effectiveness of zoledronic acid. Although zoledronic acid was dominated by alendronate, the incremental quality-adjusted life year (QALY) was quite small in extent. Considering the advantage of once-yearly injection of zoledronic acid in persistence, zoledronic acid might be a cost-effective treatment option compared to once-weekly oral alendronate. The purpose of this study was to estimate the cost-effectiveness of once-yearly injection of zoledronic acid for the treatment of osteoporosis in Japan. A patient-level state-transition model was developed to predict the outcome of patients with osteoporosis who have experienced a previous vertebral fracture. The efficacy of zoledronic acid was derived from a published network meta-analysis. Lifetime cost and QALYs were estimated for patients who had received zoledronic acid, alendronate, or basic treatment alone. The incremental cost-effectiveness ratio (ICER) of zoledronic acid was estimated. For patients 70 years of age, zoledronic acid was dominated by alendronate with incremental QALY of -0.004 to -0.000 and incremental cost of 430 USD to 493 USD. Deterministic sensitivity analysis indicated that the relative risk of hip fracture and drug cost strongly affected the cost-effectiveness of zoledronic acid compared to alendronate. Scenario analysis considering treatment persistence showed that the ICER of zoledronic acid compared to alendronate was estimated to be 47,435 USD, 27,018 USD, and 10,749 USD per QALY gained for patients with a T-score of -2.0, -2.5, or -3.0, respectively. Although zoledronic acid is dominated by alendronate, the incremental QALY is quite small in extent. Considering the advantage of annual zoledronic acid treatment in compliance and persistence, zoledronic acid may be a cost-effective treatment option compared to alendronate.

Cost-effectiveness analysis of low-molecular-weight heparin versus aspirin thromboprophylaxis in patients newly diagnosed with multiple myeloma.

PubMed

Chalayer, Emilie; Bourmaud, Aurélie; Tinquaut, Fabien; Chauvin, Franck; Tardy, Bernard

2016-09-01

The aim of this study was to assess the cost-effectiveness of low molecular weight heparin versus aspirin as primary thromboprophylaxis throughout chemotherapy for newly diagnosed multiple myeloma patients treated with protocols including thalidomide from the perspective of French health care providers. We used a modeling approach combining data from the only randomized trial evaluating the efficacy of the two treatments and secondary sources for costs, and utility values. We performed a decision-tree analysis and our base case was a hypothetical cohort of 10,000 patients. A bootstrap resampling technique was used. The incremental cost-effectiveness ratio was calculated using estimated quality-adjusted life years as the efficacy outcome. Incremental costs and effectiveness were estimated for each strategy and the incremental cost-effectiveness ratio was calculated. One-way sensitivity analyses were performed. The number of quality-adjusted life years was estimated to be 0.300 with aspirin and 0.299 with heparin. The estimated gain with aspirin was therefore approximately one day. Over 6months, the mean total cost was € 1518 (SD=601) per patient in the heparin arm and € 273 (SD=1019) in the aspirin arm. This resulted in an incremental cost of € 1245 per patient treated with heparin. The incremental cost-effectiveness ratio for the aspirin versus heparin strategy was calculated to be - 687,398 € (95% CI, -13,457,369 to -225,385). Aspirin rather than heparin thromboprophylaxis, during the first six months of chemotherapy for myeloma, is associated with significant cost savings per patient and also with an unexpected slight increase in quality of life. Copyright © 2016 Elsevier Ltd. All rights reserved.

BMI and BMI SDS in childhood: annual increments and conditional change.

PubMed

Brannsether, Bente; Eide, Geir Egil; Roelants, Mathieu; Bjerknes, Robert; Júlíusson, Pétur Benedikt

2017-02-01

Background Early detection of abnormal weight gain in childhood may be important for preventive purposes. It is still debated which annual changes in BMI should warrant attention. Aim To analyse 1-year increments of Body Mass Index (BMI) and standardised BMI (BMI SDS) in childhood and explore conditional change in BMI SDS as an alternative method to evaluate 1-year changes in BMI. Subjects and methods The distributions of 1-year increments of BMI (kg/m 2 ) and BMI SDS are summarised by percentiles. Differences according to sex, age, height, weight, initial BMI and weight status on the BMI and BMI SDS increments were assessed with multiple linear regression. Conditional change in BMI SDS was based on the correlation between annual BMI measurements converted to SDS. Results BMI increments depended significantly on sex, height, weight and initial BMI. Changes in BMI SDS depended significantly only on the initial BMI SDS. The distribution of conditional change in BMI SDS using a two-correlation model was close to normal (mean = 0.11, SD = 1.02, n = 1167), with 3.2% (2.3-4.4%) of the observations below -2 SD and 2.8% (2.0-4.0%) above +2 SD. Conclusion Conditional change in BMI SDS can be used to detect unexpected large changes in BMI SDS. Although this method requires the use of a computer, it may be clinically useful to detect aberrant weight development.

Local short-term variability in solar irradiance

NASA Astrophysics Data System (ADS)

Lohmann, Gerald M.; Monahan, Adam H.; Heinemann, Detlev

2016-05-01

Characterizing spatiotemporal irradiance variability is important for the successful grid integration of increasing numbers of photovoltaic (PV) power systems. Using 1 Hz data recorded by as many as 99 pyranometers during the HD(CP)2 Observational Prototype Experiment (HOPE), we analyze field variability of clear-sky index k* (i.e., irradiance normalized to clear-sky conditions) and sub-minute k* increments (i.e., changes over specified intervals of time) for distances between tens of meters and about 10 km. By means of a simple classification scheme based on k* statistics, we identify overcast, clear, and mixed sky conditions, and demonstrate that the last of these is the most potentially problematic in terms of short-term PV power fluctuations. Under mixed conditions, the probability of relatively strong k* increments of ±0.5 is approximately twice as high compared to increment statistics computed without conditioning by sky type. Additionally, spatial autocorrelation structures of k* increment fields differ considerably between sky types. While the profiles for overcast and clear skies mostly resemble the predictions of a simple model published by , this is not the case for mixed conditions. As a proxy for the smoothing effects of distributed PV, we finally show that spatial averaging mitigates variability in k* less effectively than variability in k* increments, for a spatial sensor density of 2 km-2.

[Economic impact of nosocomial bacteraemia. A comparison of three calculation methods].

PubMed

Riu, Marta; Chiarello, Pietro; Terradas, Roser; Sala, Maria; Castells, Xavier; Knobel, Hernando; Cots, Francesc

2016-12-01

The excess cost associated with nosocomial bacteraemia (NB) is used as a measurement of the impact of these infections. However, some authors have suggested that traditional methods overestimate the incremental cost due to the presence of various types of bias. The aim of this study was to compare three assessment methods of NB incremental cost to correct biases in previous analyses. Patients who experienced an episode of NB between 2005 and 2007 were compared with patients grouped within the same All Patient Refined-Diagnosis-Related Group (APR-DRG) without NB. The causative organisms were grouped according to the Gram stain, and whether bacteraemia was caused by a single or multiple microorganisms, or by a fungus. Three assessment methods are compared: stratification by disease; econometric multivariate adjustment using a generalised linear model (GLM); and propensity score matching (PSM) was performed to control for biases in the econometric model. The analysis included 640 admissions with NB and 28,459 without NB. The observed mean cost was €24,515 for admissions with NB and €4,851.6 for controls (without NB). Mean incremental cost was estimated at €14,735 in stratified analysis. Gram positive microorganism had the lowest mean incremental cost, €10,051. In the GLM, mean incremental cost was estimated as €20,922, and adjusting with PSM, the mean incremental cost was €11,916. The three estimates showed important differences between groups of microorganisms. Using enhanced methodologies improves the adjustment in this type of study and increases the value of the results. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

The Dark Side of Malleability: Incremental Theory Promotes Immoral Behaviors

PubMed Central

Huang, Niwen; Zuo, Shijiang; Wang, Fang; Cai, Pan; Wang, Fengxiang

2017-01-01

Implicit theories drastically affect an individual’s processing of social information, decision making, and action. The present research focuses on whether individuals who hold the implicit belief that people’s moral character is fixed (entity theorists) and individuals who hold the implicit belief that people’s moral character is malleable (incremental theorists) make different choices when facing a moral decision. Incremental theorists are less likely to make the fundamental attribution error (FAE), rarely make moral judgment based on traits and show more tolerance to immorality, relative to entity theorists, which might decrease the possibility of undermining the self-image when they engage in immoral behaviors, and thus we posit that incremental beliefs facilitate immorality. Four studies were conducted to explore the effect of these two types of implicit theories on immoral intention or practice. The association between implicit theories and immoral behavior was preliminarily examined from the observer perspective in Study 1, and the results showed that people tended to associate immoral behaviors (including everyday immoral intention and environmental destruction) with an incremental theorist rather than an entity theorist. Then, the relationship was further replicated from the actor perspective in Studies 2–4. In Study 2, implicit theories, which were measured, positively predicted the degree of discrimination against carriers of the hepatitis B virus. In Study 3, implicit theories were primed through reading articles, and the participants in the incremental condition showed more cheating than those in the entity condition. In Study 4, implicit theories were primed through a new manipulation, and the participants in the unstable condition (primed incremental theory) showed more discrimination than those in the other three conditions. Taken together, the results of our four studies were consistent with our hypotheses. PMID:28824517

The Dark Side of Malleability: Incremental Theory Promotes Immoral Behaviors.

PubMed

Huang, Niwen; Zuo, Shijiang; Wang, Fang; Cai, Pan; Wang, Fengxiang

2017-01-01

Implicit theories drastically affect an individual's processing of social information, decision making, and action. The present research focuses on whether individuals who hold the implicit belief that people's moral character is fixed (entity theorists) and individuals who hold the implicit belief that people's moral character is malleable (incremental theorists) make different choices when facing a moral decision. Incremental theorists are less likely to make the fundamental attribution error (FAE), rarely make moral judgment based on traits and show more tolerance to immorality, relative to entity theorists, which might decrease the possibility of undermining the self-image when they engage in immoral behaviors, and thus we posit that incremental beliefs facilitate immorality. Four studies were conducted to explore the effect of these two types of implicit theories on immoral intention or practice. The association between implicit theories and immoral behavior was preliminarily examined from the observer perspective in Study 1, and the results showed that people tended to associate immoral behaviors (including everyday immoral intention and environmental destruction) with an incremental theorist rather than an entity theorist. Then, the relationship was further replicated from the actor perspective in Studies 2-4. In Study 2, implicit theories, which were measured, positively predicted the degree of discrimination against carriers of the hepatitis B virus. In Study 3, implicit theories were primed through reading articles, and the participants in the incremental condition showed more cheating than those in the entity condition. In Study 4, implicit theories were primed through a new manipulation, and the participants in the unstable condition (primed incremental theory) showed more discrimination than those in the other three conditions. Taken together, the results of our four studies were consistent with our hypotheses.

The cost effectiveness of intracyctoplasmic sperm injection (ICSI).

PubMed

Hollingsworth, Bruce; Harris, Anthony; Mortimer, Duncan

2007-12-01

To estimate the incremental cost effectiveness of ICSI, and total costs for the population of Australia. Treatment effects for three patient groups were drawn from a published systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI. Incremental costs derived from resource-based costing of ICSI and existing practice comparators for each patient group. Incremental cost per live birth for patients unsuited to IVF is estimated between A$8,500 and 13,400. For the subnormal semen indication, cost per live birth could be as low as A$3,600, but in the worst case scenario, there would just be additional incremental costs of A$600 per procedure. Multiplying out the additional costs of ICSI over the relevant target populations in Australia gives potential total financial implications of over A$31 million per annum. While there are additional benefits from ICSI procedure, particularly for those with subnormal sperm, the additional cost for the health care system is substantial.

Comparison of lifetime incremental cost:utility ratios of surgery relative to failed medical management for the treatment of hip, knee and spine osteoarthritis modelled using 2-year postsurgical values

PubMed Central

Tso, Peggy; Walker, Kevin; Mahomed, Nizar; Coyte, Peter C.; Rampersaud, Y. Raja

2012-01-01

Background Demand for surgery to treat osteoarthritis (OA) of the hip, knee and spine has risen dramatically. Whereas total hip (THA) and total knee arthroplasty (TKA) have been widely accepted as cost-effective, spine surgeries (decompression, decompression with fusion) to treat degenerative conditions remain underfunded compared with other surgeries. Methods An incremental cost–utility analysis comparing decompression and decompression with fusion to THA and TKA, from the perspective of the provincial health insurance system, was based on an observational matched-cohort study of prospectively collected outcomes and retrospectively collected costs. Patient outcomes were measured using short-form (SF)-36 surveys over a 2-year follow-up period. Utility was modelled over the lifetime, and quality-adjusted life years (QALYs) were determined. We calculated the incremental cost per QALY gained by estimating mean incremental lifetime costs and QALYs of surgery compared with medical management of each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses were also conducted. Results The lifetime incremental cost:utility ratios (ICURs) discounted at 3% were $5321 per QALY for THA, $11 275 per QALY for TKA, $2307 per QALY for spinal decompression and $7153 per QALY for spinal decompression with fusion. The sensitivity analyses did not alter the ranking of the lifetime ICURs. Conclusion In appropriately selected patients with leg-dominant symptoms secondary to focal lumbar spinal stenosis who have failed medical management, the lifetime ICUR for surgical treatment of lumbar spinal stenosis is similar to those of THA and TKA for the treatment of OA. PMID:22630061

Incremental and comparative health care expenditures for head and neck cancer in the United States.

PubMed

Dwojak, Sunshine M; Bhattacharyya, Neil

2014-10-01

Determine the incremental costs associated with head and neck cancer (HNCa) and compare the costs with other common cancers. Cross-sectional analysis of a healthcare expenditure database. The Medical Expenditure Panel Survey is a national survey of US households. All cases of HNCa were extracted for 2006, 2008, and 2010. The incremental expenditures associated with HNCa were determined by comparing the healthcare expenditures of individuals with HNCa to the population without cancer, controlling for age, sex, education, insurance status, marital status, geographic region, and comorbidities. Healthcare expenditures for HNCa were then compared to individuals with lung cancer and colon cancer to determine relative healthcare expenditures. An estimated 264,713 patients (annualized) with HNCa were identified. The mean annual healthcare expenditures per individual for HNCa were $23,408 ± $3,397 versus $3,860 ± $52 for those without cancer. The mean adjusted incremental cost associated with HNCa was $15,852 ± $3,297 per individual (P < .001). Within this incremental cost, there was an increased incremental outpatient services cost of $3,495 ± $1,044 (P = .001) and an increased incremental hospital inpatient cost of $6,783 ± $2,894 (P = .020) associated with HNCa. The annual healthcare expenditures per individual fell in between those for lung cancer ($25,267 ± $2,375, P = .607) and colon cancer ($16,975 ± $1,291, P = .055). Despite its lower relative incidence, HNCa is associated with a significant incremental increase in annual healthcare expenditures per individual, which is comparable to or higher than other common cancers. In aggregate, the estimated annual costs associated with HNCa are $4.20 billion. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

More DoD Oversight Needed for Purchases Made Through the Department of Energy

DTIC Science & Technology

2010-12-03

the selected servicing agency?  Will significant elements of the work be contracted out or be done in-house?  Is there a service fee /charge...the estimated cost and any fee of a cost- reimbursement contract. If the contract is incrementally funded, funds are obligated to cover the amount...allotted and any corresponding increment of fee . However, the FAR does not provide enough guidance on when contracts should be incrementally or fully

Joint Precision Approach and Landing System Increment 1A (JPALS Inc 1A)

DTIC Science & Technology

2015-12-01

Selected Acquisition Report (SAR) RCS: DD-A&T(Q&A)823-238 Joint Precision Approach and Landing System Increment 1A (JPALS Inc 1A) As of FY 2017...President’s Budget Defense Acquisition Management Information Retrieval (DAMIR) March 10, 2016 11:30:56 UNCLASSIFIED JPALS Inc 1A December 2015 SAR...Fiscal Year FYDP - Future Years Defense Program ICE - Independent Cost Estimate IOC - Initial Operational Capability Inc - Increment JROC - Joint

Illumination estimation via thin-plate spline interpolation.

PubMed

Shi, Lilong; Xiong, Weihua; Funt, Brian

2011-05-01

Thin-plate spline interpolation is used to interpolate the chromaticity of the color of the incident scene illumination across a training set of images. Given the image of a scene under unknown illumination, the chromaticity of the scene illumination can be found from the interpolated function. The resulting illumination-estimation method can be used to provide color constancy under changing illumination conditions and automatic white balancing for digital cameras. A thin-plate spline interpolates over a nonuniformly sampled input space, which in this case is a training set of image thumbnails and associated illumination chromaticities. To reduce the size of the training set, incremental k medians are applied. Tests on real images demonstrate that the thin-plate spline method can estimate the color of the incident illumination quite accurately, and the proposed training set pruning significantly decreases the computation.

A 6-year trend of the healthcare costs of arthritis in a population-based cohort of older women.

PubMed

Lo, Tkt; Parkinson, Lynne; Cunich, Michelle; Byles, Julie

2016-06-01

To provide an accurate representation of the economic burden of arthritis by estimating the adjusted incremental healthcare cost of arthritis at multiple percentiles and reporting the cost trends across time. A healthcare cost study based on health survey and linked administrative data, where costs were estimated from the government's perspective in dollars per person per year. Quantile regression was used to estimate the adjusted incremental cost at the 25th, 50th, 75th, 90th, and 95th percentiles. Data from 4287 older Australian women were included. The median incremental healthcare cost of arthritis was, in 2012 Australian dollars, $480 (95% CI: $498-759) in 2009; however, 5% of individuals had 5-times higher costs than the 'average individual' with arthritis. Healthcare cost of arthritis did not increase significantly from 2003 to 2009. Healthcare cost of arthritis represents a substantial burden for the governments. Future research should continue to monitor the economic burden of arthritis.

Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse.

PubMed

Shepard, Donald S; Lwin, Aung K; Barnett, Nancy P; Mastroleo, Nadine; Colby, Suzanne M; Gwaltney, Chad; Monti, Peter M

2016-05-01

To estimate the incremental cost, cost-effectiveness and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. The underlying trial took place at a major urban hospital in the United States. The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited. We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 US$, incorporated quality and mortality effects from a closely related trial and derived the cost per quality-adjusted life-year (QALY) gained. From a health system perspective, the incremental cost per patient of adding an SO was $341.09 [95% confidence interval (CI) = $244.44-437.74]. The incremental cost per year per hazardous drinker averted was $3623 (CI = $1777-22,709), the cost per QALY gained $32,200 (CI = $15,800-201,700), and the benefit-cost ratio was 4.73 (95% CI = 0.7-9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in a trauma unit, it would become even more cost-beneficial. Using criteria established by the World Health Organization (cost-effectiveness below the country's gross domestic product per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost-effective. © 2015 Society for the Study of Addiction.

Projecting the impact of a nationwide school plain water access intervention on childhood obesity: a cost-benefit analysis.

PubMed

An, R; Xue, H; Wang, L; Wang, Y

2017-09-22

This study aimed to project the societal cost and benefit of an expansion of a water access intervention that promotes lunchtime plain water consumption by placing water dispensers in New York school cafeterias to all schools nationwide. A decision model was constructed to simulate two events under Markov chain processes - placing water dispensers at lunchtimes in school cafeterias nationwide vs. no action. The incremental cost pertained to water dispenser purchase and maintenance, whereas the incremental benefit was resulted from cases of childhood overweight/obesity prevented and corresponding lifetime direct (medical) and indirect costs saved. Based on the decision model, the estimated incremental cost of the school-based water access intervention is $18 per student, and the corresponding incremental benefit is $192, resulting in a net benefit of $174 per student. Subgroup analysis estimates the net benefit per student to be $199 and $149 among boys and girls, respectively. Nationwide adoption of the intervention would prevent 0.57 million cases of childhood overweight, resulting in a lifetime cost saving totalling $13.1 billion. The estimated total cost saved per dollar spent was $14.5. The New York school-based water access intervention, if adopted nationwide, may have a considerably favourable benefit-cost portfolio. © 2017 World Obesity Federation.

Cost-effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial).

PubMed

Edwards, Rhiannon Tudor; Yeo, Seow Tien; Russell, Daphne; Thomson, Colin E; Beggs, Ian; Gibson, J N Alastair; McMillan, Diane; Martin, Denis J; Russell, Ian T

2015-01-01

Morton's neuroma is a common foot condition affecting health-related quality of life. Though its management frequently includes steroid injections, evidence of cost-effectiveness is sparse. So, we aimed to evaluate whether steroid injection is cost-effective in treating Morton's neuroma compared with anaesthetic injection alone. We undertook incremental cost-effectiveness and cost-utility analyses from the perspective of the National Health Service, alongside a patient-blinded pragmatic randomised trial in hospital-based orthopaedic outpatient clinics in Edinburgh, UK. Of the original randomised sample of 131 participants with Morton's neuroma (including 67 controls), economic analysis focused on 109 (including 55 controls). Both groups received injections guided by ultrasound. We estimated the incremental cost per point improvement in the area under the curve of the Foot Health Thermometer (FHT-AUC) until three months after injection. We also conducted cost-utility analyses using European Quality of life-5 Dimensions-3 Levels (EQ-5D-3L), enhanced by the Foot Health Thermometer (FHT), to estimate utility and thus quality-adjusted life years (QALYs). The unit cost of an ultrasound-guided steroid injection was £149. Over the three months of follow-up, the mean cost of National Health Service resources was £280 for intervention participants and £202 for control participants - a difference of £79 [bootstrapped 95% confidence interval (CI): £18 to £152]. The corresponding estimated incremental cost-effectiveness ratio was £32 per point improvement in the FHT-AUC (bootstrapped 95% CI: £7 to £100). If decision makers value improvement of one point at £100 (the upper limit of this CI), there is 97.5% probability that steroid injection is cost-effective. As EQ-5D-3L seems unresponsive to changes in foot health, we based secondary cost-utility analysis on the FHT-enhanced EQ-5D. This estimated the corresponding incremental cost-effectiveness ratio as £6,400 per QALY. Over the recommended UK threshold, ranging from £20,000 to £30,000 per QALY, there is 80%-85% probability that steroid injection is cost-effective. Steroid injections are effective and cost-effective in relieving foot pain measured by the FHT for three months. However, cost-utility analysis was initially inconclusive because the EQ-5D-3L is less responsive than the FHT to changes in foot health. By using the FHT to enhance the EQ-5D, we inferred that injections yield good value in cost per QALY. Current Controlled Trials ISRCTN13668166.

Predicting Robust Vocabulary Growth from Measures of Incremental Learning

ERIC Educational Resources Information Center

Frishkoff, Gwen A.; Perfetti, Charles A.; Collins-Thompson, Kevyn

2011-01-01

We report a study of incremental learning of new word meanings over multiple episodes. A new method called MESA (Markov Estimation of Semantic Association) tracked this learning through the automated assessment of learner-generated definitions. The multiple word learning episodes varied in the strength of contextual constraint provided by…

[Estimation of average traffic emission factor based on synchronized incremental traffic flow and air pollutant concentration].

PubMed

Li, Run-Kui; Zhao, Tong; Li, Zhi-Peng; Ding, Wen-Jun; Cui, Xiao-Yong; Xu, Qun; Song, Xian-Feng

2014-04-01

On-road vehicle emissions have become the main source of urban air pollution and attracted broad attentions. Vehicle emission factor is a basic parameter to reflect the status of vehicle emissions, but the measured emission factor is difficult to obtain, and the simulated emission factor is not localized in China. Based on the synchronized increments of traffic flow and concentration of air pollutants in the morning rush hour period, while meteorological condition and background air pollution concentration retain relatively stable, the relationship between the increase of traffic and the increase of air pollution concentration close to a road is established. Infinite line source Gaussian dispersion model was transformed for the inversion of average vehicle emission factors. A case study was conducted on a main road in Beijing. Traffic flow, meteorological data and carbon monoxide (CO) concentration were collected to estimate average vehicle emission factors of CO. The results were compared with simulated emission factors of COPERT4 model. Results showed that the average emission factors estimated by the proposed approach and COPERT4 in August were 2.0 g x km(-1) and 1.2 g x km(-1), respectively, and in December were 5.5 g x km(-1) and 5.2 g x km(-1), respectively. The emission factors from the proposed approach and COPERT4 showed close values and similar seasonal trends. The proposed method for average emission factor estimation eliminates the disturbance of background concentrations and potentially provides real-time access to vehicle fleet emission factors.

Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar.

PubMed

Bishai, David; Sachathep, Karampreet; LeFevre, Amnesty; Thant, Hnin New Nwe; Zaw, Min; Aung, Tin; McFarland, Willi; Montagu, Dominic

2015-01-01

This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL. The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices. Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods. Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted. Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.

A Magnetic Plethysmograph Probe for Local Pulse Wave Velocity Measurement.

PubMed

P M, Nabeel; Joseph, Jayaraj; Sivaprakasam, Mohanasankar

2017-10-01

We present the design and experimental validation of an arterial compliance probe with dual magnetic plethysmograph (MPG) transducers for local pulse wave velocity (PWV) measurement. The MPG transducers (positioned at 23 mm distance apart) utilizes Hall-effect sensors and permanent magnets for arterial blood pulse detection. The MPG probe was initially validated on an arterial flow phantom using a reference method. Further, 20 normotensive subjects (14 males, age = 24 ± 3.5 years) were studied under two different physical conditions: 1) Physically relaxed condition, 2) Postexercise condition. Local PWV was measured from the left carotid artery using the MPG probe. Brachial blood pressure (BP) was measured to investigate the correlation of BP with local PWV. The proposed MPG arterial compliance probe was capable of detecting high-fidelity blood pulse waveforms. Reliable local pulse transit time estimates were assessed by the developed measurement system. Beat-by-beat local PWV was measured from multiple subjects under different physical conditions. A profound increment was observed in the carotid local PWV for all subjects after exercise (average increment = 0.42 ± 0.22 m/s). Local PWV values and brachial BP parameters were significantly correlated (r ≥ 0.72), except for pulse pressure (r = 0.42). MPG arterial compliance probe for local PWV measurement was validated. Carotid local PWV measurement, its variations due to physical exercise and correlation with BP levels were examined during the in vivo study. A novel dual MPG probe for local PWV measurement and potential use in cuffless BP measurement.

Economic Burden of Chronic Conditions Among Survivors of Cancer in the United States.

PubMed

Guy, Gery P; Yabroff, K Robin; Ekwueme, Donatus U; Rim, Sun Hee; Li, Rui; Richardson, Lisa C

2017-06-20

Purpose The prevalence of cancer survivorship and chronic health conditions is increasing. Limited information exists on the economic burden of chronic conditions among survivors of cancer. This study examines the prevalence and economic effect of chronic conditions among survivors of cancer. Methods Using the 2008 to 2013 Medical Expenditure Panel Survey, we present nationally representative estimates of the prevalence of chronic conditions (heart disease, high blood pressure, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma) and multiple chronic conditions (MCCs) and the incremental annual health care use, medical expenditures, and lost productivity for survivors of cancer attributed to individual chronic conditions and MCCs. Incremental use, expenditures, and lost productivity were evaluated with multivariable regression. Results Survivors of cancer were more likely to have chronic conditions and MCCs compared with adults without a history of cancer. The presence of chronic conditions among survivors of cancer was associated with substantially higher annual medical expenditures, especially for heart disease ($4,595; 95% CI, $3,262 to $5,927) and stroke ($3,843; 95% CI, $1,983 to $5,704). The presence of four or more chronic conditions was associated with increased annual expenditures of $10,280 (95% CI, $7,435 to $13,125) per survivor of cancer. Annual lost productivity was higher among survivors of cancer with other chronic conditions, especially stroke ($4,325; 95% CI, $2,687 to $5,964), and arthritis ($3,534; 95% CI, $2,475 to $4,593). Having four or more chronic conditions was associated with increased annual lost productivity of $9,099 (95% CI, $7,224 to $10,973) per survivor of cancer. The economic impact of chronic conditions was similar among survivors of cancer and individuals without a history of cancer. Conclusion These results highlight the importance of ensuring access to lifelong personalized screening, surveillance, and chronic disease management to help manage chronic conditions, reduce disruptions in employment, and reduce medical expenditures among survivors of cancer.

Sensitivity of the acid-base properties of clays to the methods of preparation and measurement. 2. Evidence from continuous potentiometric titrations.

PubMed

Duc, Myriam; Gaboriaud, Fabien; Thomas, Fabien

2005-09-01

The effects of experimental procedures on the acid-base consumption titration curves of montmorillonite suspension were studied using continuous potentiometric titration. For that purpose, the hysteresis amplitudes between the acid and base branches were found to be useful to systematically evaluate the impacts of storage conditions (wet or dried), the atmosphere in titration reactor, the solid-liquid ratio, the time interval between successive increments, and the ionic strength. In the case of storage conditions, the increase of the hysteresis was significantly higher for longer storage of clay in suspension and drying procedures compared to "fresh" clay suspension. The titration carried out under air demonstrated carbonate contamination that could only be cancelled by performing experiments under inert gas. Interestingly, the increase of the time intervals between successive increments of titrant strongly emphasized the amplitude of hysteresis, which could be correlated with the slow kinetic process specifically observed for acid addition in acid media. Thus, such kinetic behavior is probably associated with dissolution processes of clay particles. However, the resulting curves recorded at different ionic strengths under optimized conditions did not show the common intersection point required to define point of zero charge. Nevertheless, the ionic strength dependence of the point of zero net proton charge suggested that the point of zero charge of sodic montmorillonite could be estimated as lower than 5.

Effects of acute hypoxia on the determination of anaerobic threshold using the heart rate-work rate relationships during incremental exercise tests.

PubMed

Ozcelik, O; Kelestimur, H

2004-01-01

Anaerobic threshold which describes the onset of systematic increase in blood lactate concentration is a widely used concept in clinical and sports medicine. A deflection point between heart rate-work rate has been introduced to determine the anaerobic threshold non-invasively. However, some researchers have consistently reported a heart rate deflection at higher work rates, while others have not. The present study was designed to investigate whether the heart rate deflection point accurately predicts the anaerobic threshold under the condition of acute hypoxia. Eight untrained males performed two incremental exercise tests using an electromagnetically braked cycle ergometer: one breathing room air and one breathing 12 % O2. The anaerobic threshold was estimated using the V-slope method and determined from the increase in blood lactate and the decrease in standard bicarbonate concentration. This threshold was also estimated by in the heart rate-work rate relationship. Not all subjects exhibited a heart rate deflection. Only two subjects in the control and four subjects in the hypoxia groups showed a heart rate deflection. Additionally, the heart rate deflection point overestimated the anaerobic threshold. In conclusion, the heart rate deflection point was not an accurate predictor of anaerobic threshold and acute hypoxia did not systematically affect the heart rate-work rate relationships.

Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial.

PubMed

Briffa, Tom G; Eckermann, Simon D; Griffiths, Alison D; Harris, Phillip J; Heath, M Rose; Freedman, Saul B; Donaldson, Lana T; Briffa, N Kathryn; Keech, Anthony C

2005-11-07

To estimate the incremental effects on cost and quality of life of cardiac rehabilitation after an acute coronary syndrome. Open randomised controlled trial with 1 year's follow-up. Analysis was on an intention-to-treat basis. Two tertiary hospitals in Sydney. 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor. 113 patients aged 41-75 years who were self-caring and literate in English. Patients with uncompensated heart failure, uncontrolled arrhythmias, severe and symptomatic aortic stenosis or physical impairment were excluded. Costs (hospitalisations, medication use, outpatient visits, investigations, and personal expenses); and measures of quality of life. Incremental cost per quality-adjusted life year (QALY) saved at 1 year (this estimate combines within-study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality). Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival, 3 years of treatment effect on survival and variations in utility. The estimated incremental cost per QALY saved for rehabilitation relative to standard care was 42,535 US dollars when modelling included the reported treatment effect on survival. This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included. The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective. The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee.

The burden of hepatitis C to the United States Medicare system in 2009: Descriptive and economic characteristics.

PubMed

Rein, David B; Borton, Joshua; Liffmann, Danielle K; Wittenborn, John S

2016-04-01

The aim of this work was to estimate and describe the Medicare beneficiaries diagnosed with hepatitis C virus (HCV) in 2009, incremental annual costs by disease stage, incremental total Medicare HCV payments in 2009 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data covering the years 2002 to 2009. We weighted the 2009 SEER-Medicare data to create estimates of the number of patients with an HCV diagnosis, used an inverse probability-weighted two-part, probit, and generalized linear model to estimate incremental per patient per month costs, and used simulation to estimate annual 2009 Medicare burden, presented in 2014 dollars. We summarized patient characteristics, diagnoses, and costs from SEER-Medicare files into a person-year panel data set. We estimated there were 407,786 patients with diagnosed HCV in 2009, of whom 61.4% had one or more comorbidities defined by the study. In 2009, 68% of patients were diagnosed with chronic HCV only, 9% with cirrhosis, 12% with decompensated cirrhosis (DCC), 2% with liver cancer, 2% with a history of transplant, and 8% who died. Annual costs for patients with chronic infection only and DCC were higher than the values used in many previous cost-effectiveness studies, and treatment of DCC accounted for 63.9% of total Medicare's HCV expenditures. Medicare paid $2.7 billion (credible interval: $0.7-$4.6 billion) in incremental costs for HCV in 2009. The costs of HCV to Medicare in 2009 were substantial and expected to increase over the next decade. Annual costs for patients with chronic infection only and DCC were higher than values used in many cost-effectiveness analyses. © 2015 by the American Association for the Study of Liver Diseases.

Online and unsupervised face recognition for continuous video stream

NASA Astrophysics Data System (ADS)

Huo, Hongwen; Feng, Jufu

2009-10-01

We present a novel online face recognition approach for video stream in this paper. Our method includes two stages: pre-training and online training. In the pre-training phase, our method observes interactions, collects batches of input data, and attempts to estimate their distributions (Box-Cox transformation is adopted here to normalize rough estimates). In the online training phase, our method incrementally improves classifiers' knowledge of the face space and updates it continuously with incremental eigenspace analysis. The performance achieved by our method shows its great potential in video stream processing.

75 FR 1568 - Endangered and Threatened Wildlife and Plants; Proposed Designation of Critical Habitat for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... designation. The majority of the total future baseline impacts are associated with development projects ($6.4... development projects. The DEA estimates that total potential incremental economic impacts in areas proposed as..., the range in total incremental impacts is due to the range in development forecasts. The lack of...

Maize flour fortification in Africa: markets, feasibility, coverage, and costs.

PubMed

Fiedler, John L; Afidra, Ronald; Mugambi, Gladys; Tehinse, John; Kabaghe, Gladys; Zulu, Rodah; Lividini, Keith; Smitz, Marc-Francois; Jallier, Vincent; Guyondet, Christophe; Bermudez, Odilia

2014-04-01

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries. © 2013 New York Academy of Sciences.

Asymmetry in power-law magnitude correlations.

PubMed

Podobnik, Boris; Horvatić, Davor; Tenenbaum, Joel N; Stanley, H Eugene

2009-07-01

Time series of increments can be created in a number of different ways from a variety of physical phenomena. For example, in the phenomenon of volatility clustering-well-known in finance-magnitudes of adjacent increments are correlated. Moreover, in some time series, magnitude correlations display asymmetry with respect to an increment's sign: the magnitude of |x_{i}| depends on the sign of the previous increment x_{i-1} . Here we define a model-independent test to measure the statistical significance of any observed asymmetry. We propose a simple stochastic process characterized by a an asymmetry parameter lambda and a method for estimating lambda . We illustrate both the test and process by analyzing physiological data.

Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)

PubMed Central

Gray, Alastair; Raikou, Maria; McGuire, Alistair; Fenn, Paul; Stevens, Richard; Cull, Carole; Stratton, Irene; Adler, Amanda; Holman, Rury; Turner, Robert

2000-01-01

Objective To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Design Incremental cost effectiveness analysis alongside randomised controlled trial. Setting 23 UK hospital clinic based study centres. Participants 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Interventions Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Main outcome measures Incremental cost per event-free year gained within the trial period. Results Intensive glucose control increased trial treatment costs by £695 (95% confidence interval £555 to £836) per patient but reduced the cost of complications by £957 (£233 to £1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was £478 (−£275 to £1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was £1166 (costs and effects discounted at 6% a year) and £563 (costs discounted at 6% a year and effects not discounted). Conclusions Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications. PMID:10818026

40 CFR 69.32 - Title V conditional exemption.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (PSD) increments. (2) CNMI may conduct air emissions modeling, using EPA guidelines, for power plants... determine whether existing power plants cause or contribute to violation of the NAAQS and PSD increments in...

40 CFR 69.32 - Title V conditional exemption.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (PSD) increments. (2) CNMI may conduct air emissions modeling, using EPA guidelines, for power plants... determine whether existing power plants cause or contribute to violation of the NAAQS and PSD increments in...

40 CFR 69.32 - Title V conditional exemption.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (PSD) increments. (2) CNMI may conduct air emissions modeling, using EPA guidelines, for power plants... determine whether existing power plants cause or contribute to violation of the NAAQS and PSD increments in...

40 CFR 69.32 - Title V conditional exemption.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (PSD) increments. (2) CNMI may conduct air emissions modeling, using EPA guidelines, for power plants... determine whether existing power plants cause or contribute to violation of the NAAQS and PSD increments in...

A Comparison of Increment Core Sampling for Estimating Tree Specific Gravity

Treesearch

Michael A. Taras; Harold E. Wadlgren

1963-01-01

Increment cores have been used to evaluate such tree characteristics as age, rate of growth, percentage of various types of tissue, chemical composition, and density. Of the wood characteristics listed, density has come to be of considerable interest to numerous researchers, since it is highly correlated with the strength properties, workability, and weight of wood....

Defense Agencies Initiative Increment 2 (DAI Inc 2)

DTIC Science & Technology

2016-03-01

2016 Major Automated Information System Annual Report Defense Agencies Initiative Increment 2 (DAI Inc 2) Defense Acquisition Management...Automated Information System MAIS OE - MAIS Original Estimate MAR – MAIS Annual Report MDA - Milestone Decision Authority MDD - Materiel Development...management systems supporting diverse operational functions and the warfighter in decision making and financial reporting . These disparate, non

Antihypertensive drugs: a perspective on pharmaceutical price erosion and its impact on cost-effectiveness.

PubMed

Refoios Camejo, Rodrigo; McGrath, Clare; Herings, Ron; Meerding, Willem-Jan; Rutten, Frans

2012-01-01

When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension. Cost-effectiveness at launch was estimated for all antihypertensive drugs launched between 1998 and 2008 in the United Kingdom using hypothetical degrees of incremental clinical effectiveness within the methodologic framework applied by the UK National Institute for Health and Clinical Excellence. Incremental cost-effectiveness ratios were computed and compared with funding thresholds. In addition, the levels of incremental clinical effectiveness required to achieve specific cost-effectiveness thresholds at given prices were estimated. Significant price decreases were observed for existing drugs. This was shown to markedly affect cost-effectiveness of technologies entering the market. The required incremental clinical effectiveness was in many cases greater than physiologically possible so, as a consequence, a number of products might not be available today if current methods of economic appraisal had been applied. We conclude that the definition of cost-effectiveness thresholds is fundamental in promoting efficient innovation. Our findings demonstrate that comparator price attrition has the potential to put pressure in the pharmaceutical research model and presents a challenge to new therapies being accepted for funding. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Enhanced waterflooding design with dilute surfactant concentrations for North Sea conditions

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

Michels, A.M.; Djojosoeparto, R.S.; Haas, H.

1996-08-01

Efficient selection procedures for surfactants have been applied to design a low-concentration surfactant-flooding process for North Sea oilfield application. Anionic surfactants of the propoxy ethoxy glyceryl sulfonate type can be used at 0.1 wt% concentrations together with sacrificial agents and without a polymer drive. Currently estimated unit technical costs (UTC`s)--at 8%--for application in the North Sea oil fields range frommore » $81 to $$94/incremental m{sup 3}, without taking uncertainty factors into account. Including such factors would likely add another $$31/m{sup 3} to the costs.« less

Health care expenditures associated with pediatric pain-related conditions in the United States.

PubMed

Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M

2015-05-01

The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.

Selected Flight Test Results for Online Learning Neural Network-Based Flight Control System

NASA Technical Reports Server (NTRS)

Williams-Hayes, Peggy S.

2004-01-01

The NASA F-15 Intelligent Flight Control System project team developed a series of flight control concepts designed to demonstrate neural network-based adaptive controller benefits, with the objective to develop and flight-test control systems using neural network technology to optimize aircraft performance under nominal conditions and stabilize the aircraft under failure conditions. This report presents flight-test results for an adaptive controller using stability and control derivative values from an online learning neural network. A dynamic cell structure neural network is used in conjunction with a real-time parameter identification algorithm to estimate aerodynamic stability and control derivative increments to baseline aerodynamic derivatives in flight. This open-loop flight test set was performed in preparation for a future phase in which the learning neural network and parameter identification algorithm output would provide the flight controller with aerodynamic stability and control derivative updates in near real time. Two flight maneuvers are analyzed - pitch frequency sweep and automated flight-test maneuver designed to optimally excite the parameter identification algorithm in all axes. Frequency responses generated from flight data are compared to those obtained from nonlinear simulation runs. Flight data examination shows that addition of flight-identified aerodynamic derivative increments into the simulation improved aircraft pitch handling qualities.

Incremental Costs and Cost Effectiveness of Intensive Treatment in Individuals with Type 2 Diabetes Detected by Screening in the ADDITION-UK Trial: An Update with Empirical Trial-Based Cost Data.

PubMed

Laxy, Michael; Wilson, Edward C F; Boothby, Clare E; Griffin, Simon J

2017-12-01

There is uncertainty about the cost effectiveness of early intensive treatment versus routine care in individuals with type 2 diabetes detected by screening. To derive a trial-informed estimate of the incremental costs of intensive treatment as delivered in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Europe (ADDITION) trial and to revisit the long-term cost-effectiveness analysis from the perspective of the UK National Health Service. We analyzed the electronic primary care records of a subsample of the ADDITION-Cambridge trial cohort (n = 173). Unit costs of used primary care services were taken from the published literature. Incremental annual costs of intensive treatment versus routine care in years 1 to 5 after diagnosis were calculated using multilevel generalized linear models. We revisited the long-term cost-utility analyses for the ADDITION-UK trial cohort and reported results for ADDITION-Cambridge using the UK Prospective Diabetes Study Outcomes Model and the trial-informed cost estimates according to a previously developed evaluation framework. Incremental annual costs of intensive treatment over years 1 to 5 averaged £29.10 (standard error = £33.00) for consultations with general practitioners and nurses and £54.60 (standard error = £28.50) for metabolic and cardioprotective medication. For ADDITION-UK, over the 10-, 20-, and 30-year time horizon, adjusted incremental quality-adjusted life-years (QALYs) were 0.014, 0.043, and 0.048, and adjusted incremental costs were £1,021, £1,217, and £1,311, resulting in incremental cost-effectiveness ratios of £71,232/QALY, £28,444/QALY, and £27,549/QALY, respectively. Respective incremental cost-effectiveness ratios for ADDITION-Cambridge were slightly higher. The incremental costs of intensive treatment as delivered in the ADDITION-Cambridge trial were lower than expected. Given UK willingness-to-pay thresholds in patients with screen-detected diabetes, intensive treatment is of borderline cost effectiveness over a time horizon of 20 years and more. Copyright © 2017. Published by Elsevier Inc.

Dendroclimatic estimates of a drought index for northern Virginia

USGS Publications Warehouse

Puckett, Larry J.

1981-01-01

A 230-year record of the Palmer drought-severity index (PDSI) was estimated for northern Virginia from variations in widths of tree rings. Increment cores were extracted from eastern hemlock, Tsuga canadensis (L.) Carr., at three locations in northern Virginia. Measurements of annual growth increments were made and converted to standardized indices of growth. A response function was derived for hemlock to determine the growth-climate relationship. Growth was positively correlated with precipitation and negatively correlated with temperature during the May-July growing season. Combined standardized indices of growth were calibrated with the July PDSI. Growth accounted for 20-30 percent of the PDSI variance. Further regressions using factor scores of combined tree growth indices resulted in a small but significant improvement. Greatest improvement was made by using factor scores of growth indices of individual trees, thereby accounting for 64 percent of the July PDSI variance in the regression. Comparison of the results with a 241-year reconstruction from New York showed good agreement between low-frequency climatic trends. Analysis of the estimated Central Mountain climatic division of Virginia PDSI record indicated that, relative to the long-term record (1746-1975), dry years have occurred in disproportionally larger numbers during the last half of the 19th century and the mid-20th century. This trend appears reversed for the last half of the 18th century and the first half of the 19th century. Although these results are considered first-generation products, they are encouraging, suggesting that once additional tree-ring chronologies are constructed and techniques are refined, it will be possible to obtain more accurate estimates of prior climatic conditions in the mid-Atlantic region.

Age diagnosis based on incremental lines in dental cementum: a critical reflection.

PubMed

Grosskopf, Birgit; McGlynn, George

2011-01-01

Age estimation based on the counting of incremental lines in dental cementum is a method frequently used for the estimation of the age at death for humans in bioarchaeology, and increasingly, forensic anthropology. Assessment of applicability, precision, and method reproducibility continue to be the focus of research in this area, and are occasionally accompanied by significant controversy. Differences in methodological techniques for data collection (e.g. number of sections, factor of magnification for counting or interpreting "outliers") are presented. Potential influences on method reliability are discussed, especially for their applicability in forensic contexts.

Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence.

PubMed

Wetzelaer, Pim; Lokkerbo, Joran; Arntz, Arnoud; van Aselt, Thea; Smit, Filip; Evers, Silvia

2017-12-01

Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use. The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of 2.367 million (95% C.I.: 1,717,000 - 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the comparator condition and the assumption of high intervention costs. We present a method for the synthesis of evidence from different types of studies in a way that respects the uncertainty surrounding those findings. Limitations of the study pertain to the inclusion of findings from studies with suboptimal designs, the transferability of research findings, and uncertainty regarding the time horizon considered. More research is needed on the sensitivity of our findings to the choice of included studies based on the comparator condition. THE results suggest that the provision of specialized outpatient psychotherapy for BPD leads to a reduction in other health care resource use. Overall, the results are promising and encourage future studies on aspects that are currently still uncertain. The results may support policy makers in deciding whether or not to allocate health care budget for the provision of specialized outpatient psychotherapy for patients with BPD in the Netherlands. The results provide important directions for future research. This includes the need for future studies to make a comparison between specialized outpatient psychotherapy and treatment as usual and to have longer follow-up time.

Basal area growth, carbon isotope discrimination, and intrinsic ...

EPA Pesticide Factsheets

Many hectares of intensively managed Douglas-fir (Pseudotsuga menziesii Mirb. Franco) stands in western North America are fertilized with nitrogen to increase growth rates. Understanding the mechanisms of response facilitates prioritization of stands for treatment. The objective of this study was to test the hypothesis that the short-term basal area growth response to a single application of 224 kg N ha-1 as urea was associated with reduced stable carbon isotope discrimination (∆13C) and increased intrinsic water use efficiency (iWUE) in a 20-yr-old plantation of Douglas-fir in the Oregon Coast Range, USA. Increment cores were measured to estimate earlywood, latewood, and total basal area increment over a time series from 1997 to 2015. Stable carbon isotope discrimination and iWUE were estimated using earlywood and latewood stable carbon isotope concentrations in tree-ring holocellulose starting seven years before fertilization in early 2009 and ending seven years after treatment. A highly significant interaction effect between fertilization treatment and year was found for total basal area growth and earlywood basal area increment. Fertilized trees showed significant total basal area growth and earlywood basal area increment in the first (2009) and second (2010) growing seasons after fertilization in 2009. A marginally significant fertilization effect was found for latewood basal area increment only in the first growing season after treatment. A significant i

A comparative study of velocity increment generation between the rigid body and flexible models of MMET

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

Ismail, Norilmi Amilia, E-mail: aenorilmi@usm.my

The motorized momentum exchange tether (MMET) is capable of generating useful velocity increments through spin–orbit coupling. This study presents a comparative study of the velocity increments between the rigid body and flexible models of MMET. The equations of motions of both models in the time domain are transformed into a function of true anomaly. The equations of motion are integrated, and the responses in terms of the velocity increment of the rigid body and flexible models are compared and analysed. Results show that the initial conditions, eccentricity, and flexibility of the tether have significant effects on the velocity increments ofmore » the tether.« less

Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: part 2--estimated lifetime incremental cost-utility ratios.

PubMed

Rampersaud, Y Raja; Tso, Peggy; Walker, Kevin R; Lewis, Stephen J; Davey, J Roderick; Mahomed, Nizar N; Coyte, Peter C

2014-02-01

Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been widely accepted as highly cost-effective procedures, spine surgery for the treatment of degenerative conditions does not share the same perception among stakeholders. In particular, the sustainability of the outcome and cost-effectiveness following lumbar spinal stenosis (LSS) surgery compared with THA/TKA remain uncertain. The purpose of the study was to estimate the lifetime incremental cost-utility ratios for decompression and decompression with fusion for focal LSS versus THA and TKA for osteoarthritis (OA) from the perspective of the provincial health insurance system (predominantly from the hospital perspective) based on long-term health status data at a median of 5 years after surgical intervention. An incremental cost-utility analysis from a hospital perspective was based on a single-center, retrospective longitudinal matched cohort study of prospectively collected outcomes and retrospectively collected costs. Patients who had undergone primary one- to two-level spinal decompression with or without fusion for focal LSS were compared with a matched cohort of patients who had undergone elective THA or TKA for primary OA. Outcome measures included incremental cost-utility ratio (ICUR) ($/quality adjusted life year [QALY]) determined using perioperative costs (direct and indirect) and Short Form-6D (SF-6D) utility scores converted from the SF-36. Patient outcomes were collected using the SF-36 survey preoperatively and annually for a minimum of 5 years. Utility was modeled over the lifetime and QALYs were determined using the median 5-year health status data. The primary outcome measure, cost per QALY gained, was calculated by estimating the mean incremental lifetime costs and QALYs for each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses adjusting for +25% primary and revision surgery cost, +25% revision rate, upper and lower confidence interval utility score, variable inpatient rehabilitation rate for THA/TKA, and discounting at 5% were conducted to determine factors affecting the value of each type of surgery. At a median of 5 years (4-7 years), follow-up and revision surgery data was attained for 85%-FLSS, 80%-THA, and 75%-THA of the cohorts. The 5-year ICURs were $21,702/QALY for THA; $28,595/QALY for TKA; $12,271/QALY for spinal decompression; and $35,897/QALY for spinal decompression with fusion. The estimated lifetime ICURs using the median 5-year follow-up data were $5,682/QALY for THA; $6,489/QALY for TKA; $2,994/QALY for spinal decompression; and $10,806/QALY for spinal decompression with fusion. The overall spine (decompression alone and decompression and fusion) ICUR was $5,617/QALY. The estimated best- and worst-case lifetime ICURs varied from $1,126/QALY for the best-case (spinal decompression) to $39,323/QALY for the worst case (spinal decompression with fusion). Surgical management of primary OA of the spine, hip, and knee results in durable cost-utility ratios that are well below accepted thresholds for cost-effectiveness. Despite a significantly higher revision rate, the overall surgical management of FLSS for those who have failed medical management results in similar median 5-year and lifetime cost-utility compared with those of THA and TKA for the treatment of OA from the limited perspective of a public health insurance system. Copyright © 2014 Elsevier Inc. All rights reserved.

Approach for Estimating Exposures and Incremental Health ...

EPA Pesticide Factsheets

Approach for Estimating Exposures and Incremental Health Effects from Lead During Renovation, Repair, and Painting Activities in Public and Commercial Buildings” (Technical Approach Document). Also available for public review and comment are two supplementary documents: the detailed appendices for the Technical Approach Document and a supplementary report entitled “Developing a Concentration-Response Function for Pb Exposure and Cardiovascular Disease-Related Mortality.” Together, these documents describes an analysis for estimating exposures and incremental health effects created by renovations of public and commercial buildings (P&CBs). This analysis could be used to identify and evaluate hazards from renovation, repair, and painting activities in P&CBs. A general overview of how this analysis can be used to inform EPA’s hazard finding is described in the Framework document that was previously made available for public comment (79 FR 31072; FRL9910-44). The analysis can be used in any proposed rulemaking to estimate the reduction in deleterious health effects that would result from any proposed regulatory requirements to mitigate exposure from P&CB renovation activities. The Technical Approach Document describes in detail how the analyses under this approach have been performed and presents the results – expected changes in blood lead levels and health effects due to lead exposure from renovation activities.

High-resolution sclerochronological analysis of the bivalve mollusk Saxidomus gigantea from Alaska and British Columbia: techniques for revealing environmental archives and archaeological seasonality

USGS Publications Warehouse

Hallman, Nadine; Burchell, Meghan; Schone, Bernd R.; Irvine, Gail V.; Maxwell, David

2009-01-01

The butter clam, Saxidomus gigantea, is one of the most commonly recovered bivalves from archaeological shell middens on the Pacific Coast of North America. This study presents the results of the sclerochronology of modern specimens of S. gigantea, collected monthly from Pender Island (British Columbia), and additional modern specimens from the Dundas Islands (BC) and Mink and Little Takli Islands (Alaska). The methods presented can be used as a template to interpret local environmental conditions and increase the precision of seasonality estimates in shellfish using sclerochronology and oxygen isotope analysis. This method can also identify, with a high degree of accuracy, the date of shell collection to the nearest fortnightly cycle, the time of day the shell was collected and the approximate tidal elevation (i.e., approx. water depth and distance from the shoreline) from which the shell was collected. Life-history traits of S. gigantea were analyzed to understand the timing of growth line formation, the duration of the growing season, the growth rate, and the reliability of annual increments. We also examine the influence of the tidal regime and freshwater mixing in estuarine locations and how these variables can affect both incremental structures and oxygen isotope values. The results of the sclerochronological analysis show that there is a latitudinal trend in shell growth that needs to be considered when using shells for seasonality studies. Oxygen isotope analysis reveals clear annual cycles with the most positive values corresponding to the annual winter growth lines, and the most negative values corresponding to high temperatures during the summer. Intra-annual increment widths demonstrate clear seasonal oscillations with broadest increments in summer and very narrow increments or no growth during the winter months. This study provides new insights into the biology, geochemistry and seasonal growth of S. gigantea, which are crucial for paleoclimate reconstructions and interpreting seasonality patterns of past human collection.

Evaluating direct medical expenditures estimation methods of adults using the medical expenditure panel survey: an example focusing on head and neck cancer.

PubMed

Coughlan, Diarmuid; Yeh, Susan T; O'Neill, Ciaran; Frick, Kevin D

2014-01-01

To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

Spatial variability in growth-increment chronologies of long-lived freshwater mussels: Implications for climate impacts and reconstructions

USGS Publications Warehouse

Black, Bryan A.; Dunham, Jason B.; Blundon, Brett W.; Raggon, Mark F.; Zima, Daniela

2010-01-01

Estimates of historical variability in river ecosystems are often lacking, but long-lived freshwater mussels could provide unique opportunities to understand past conditions in these environments. We applied dendrochronology techniques to quantify historical variability in growth-increment widths in valves (shells) of western pearlshell freshwater mussels (Margaritifera falcata). A total of 3 growth-increment chronologies, spanning 19 to 26 y in length, were developed. Growth was highly synchronous among individuals within each site, and to a lesser extent, chronologies were synchronous among sites. All 3 chronologies negatively related to instrumental records of stream discharge, while correlations with measures of water temperature were consistently positive but weaker. A reconstruction of stream discharge was performed using linear regressions based on a mussel growth chronology and the regional Palmer Drought Severity Index (PDSI). Models based on mussel growth and PDSI yielded similar coefficients of prediction (R2Pred) of 0.73 and 0.77, respectively, for predicting out-ofsample observations. From an ecological perspective, we found that mussel chronologies provided a rich source of information for understanding climate impacts. Responses of mussels to changes in climate and stream ecosystems can be very site- and process-specific, underscoring the complex nature of biotic responses to climate change and the need to understand both regional and local processes in projecting climate impacts on freshwater species.

Economic evaluation of tocilizumab monotherapy compared to adalimumab monotherapy in the treatment of severe active rheumatoid arthritis.

PubMed

Carlson, Josh J; Ogale, Sarika; Dejonckheere, Fred; Sullivan, Sean D

2015-03-01

To estimate the cost-effectiveness of tocilizumab (TCZ) monotherapy (Mono) versus adalimumab (ADA) Mono from the US payer perspective in patients with rheumatoid arthritis for whom methotrexate is inappropriate. We compared TCZ Mono (8 mg/kg monthly) with ADA Mono (40 mg every other week), using efficacy results from a head-to-head study, ADalimumab ACTemrA (ADACTA). We calculated the incremental cost per responder (achievement of American College of Rheumatology [ACR] 20% improvement criteria, ACR 50% improvement criteria, ACR 70% improvement criteria, or low disease activity score) for TCZ versus ADA at 6 months. A patient-level simulation was used to estimate the lifetime incremental cost per quality-adjusted life-year (QALY) of initiating treatment with TCZ Mono versus ADA Mono. Both drugs are followed by an etanercept-certolizumab-palliative care sequence. Nonresponders discontinue at 6 months; responders experience a constant probability of discontinuation. Discontinuers move to the next treatment. ACR responses produce changes in the Health Assessment Questionnaire (HAQ) score. We mapped the HAQ score to utility to estimate QALYs. Costs include those related to hospitalization and those related to treatment (drug acquisition, administration, and monitoring). Probabilistic and one-way sensitivity analyses were conducted, along with several scenario analyses. Compared with ADA, TCZ was more effective, with an estimated 6-month incremental cost ranging from $6,570 per additional low disease activity score achiever to $14,265 per additional ACR 70% improvement criteria responder. The lifetime incremental cost-effectiveness ratio was $36,944/QALY. TCZ Mono is projected to be cost-effective compared with ADA Mono in patients with severe rheumatoid arthritis for whom methotrexate is not appropriate, from a US payer perspective. Copyright © 2015. Published by Elsevier Inc.

Senior high-cost healthcare users’ resource utilization and outcomes: a protocol of a retrospective matched cohort study in Canada

PubMed Central

Muratov, Sergei; Lee, Justin; Holbrook, Anne; Paterson, J Michael; Guertin, Jason Robert; Mbuagbaw, Lawrence; Gomes, Tara; Khuu, Wayne; Pequeno, Priscila; Costa, Andrew P; Tarride, Jean-Eric

2017-01-01

Introduction Senior high-cost users (HCUs) are estimated to represent 60% of all HCUs in Ontario, Canada’s most populous province. To improve our understanding of individual and health system characteristics related to senior HCUs, we will examine incident senior HCUs to determine their incremental healthcare utilisation and costs, characteristics of index hospitalisation episodes, mortality and their regional variation across Ontario. Methods and analysis A retrospective, population-based cohort study using administrative healthcare records will be used. Incident senior HCUs will be defined as Ontarians aged ≥66 years who were in the top 5% of healthcare cost users during fiscal year 2013 but not during fiscal year 2012. Each HCU will be matched to three non-HCUs by age, sex and health planning region. Incremental healthcare use and costs will be determined using the method of recycled predictions. We will apply multivariable logistic regression to determine patient and health service factors associated with index hospitalisation and inhospital mortality during the incident year. The most common causes of admission will be identified and contrasted with the most expensive hospitalised conditions. We will also calculate the ratio of inpatient costs incurred through admissions of ambulatory care sensitive conditions to the total inpatient expenditures. The magnitude of variation in costs and health service utilisation will be established by calculating the extremal quotient, the coefficient of variation and the Gini mean difference for estimates obtained through multilevel regression analyses. Ethics and dissemination This study has been approved by Hamilton Integrated Research Ethics Board (ID#1715-C). The results of the study will be distributed through peer-reviewed journals. They also will be disseminated at research events in academic settings, national and international conferences as well as with presentations to provincial health authorities. PMID:29282266

Can children with Type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks?

PubMed

Smart, C E; Ross, K; Edge, J A; King, B R; McElduff, P; Collins, C E

2010-03-01

Carbohydrate (CHO) counting allows children with Type 1 diabetes to adjust mealtime insulin dose to carbohydrate intake. Little is known about the ability of children to count CHO and whether a particular method for assessing CHO quantity is better than others. We investigated how accurately children and their caregivers estimate carbohydrate, and whether counting in gram increments improves accuracy compared with CHO portions or exchanges. One hundred and two children and adolescents (age range 8.3-18.1 years) on intensive insulin therapy and 110 caregivers independently estimated the CHO content of 17 standardized meals (containing 8-90 g CHO), using whichever method of carbohydrate quantification they had been taught (gram increments, 10-g portions or 15-g exchanges). Seventy-three per cent (n = 2530) of all estimates were within 10-15 g of actual CHO content. There was no relationship between the mean percentage error and method of carbohydrate counting or glycated haemoglobin (HbA(1c)) (P > 0.05). Mean gram error and meal size were negatively correlated (r = -0.70, P < 0.0001). The longer children had been CHO counting the greater the mean percentage error (r = 0.173, P = 0.014). Core foods in non-standard quantities were most frequently inaccurately estimated, while individually labelled foods were most often accurately estimated. Children with Type 1 diabetes and their caregivers can estimate the carbohydrate content of meals with reasonable accuracy. Teaching CHO counting in gram increments did not improve accuracy compared with CHO portions or exchanges. Large meals tended to be underestimated and snacks overestimated. Repeated age-appropriate education appears necessary to maintain accuracy in carbohydrate estimations.

[Medical and economic evaluation of donated blood screening for hepatitis C and non-A, non-B, non-C hepatitis].

PubMed

Vergnon, P; Colin, C; Jullien, A M; Bory, E; Excoffier, S; Matillon, Y; Trepo, C

1996-01-01

The aim of this study was to evaluate the cost of hepatitis C and non-A non-B non-C screening strategy in donated blood, currently used in French transfusion centres and to assess the effect in the blood transfusion centres according to the prevalence of the disease and the intrinsec values of tests. This screening strategy was based on alanine aminotransferase assay, and HBc and HCV antibodies detection. In 1993, a survey was conducted in 26 French transfusion centers to estimate the costs of the screening strategy currently used. Average expenditure on diagnostic sets, equipment, staff and administration charges for hepatitis C and non-A non-B non-C screening were calculated. From these results, we estimated the cost of the previous strategy which did not involve HCV antibody testing, so as to determine the incremental cost between the two strategies. We used clinical decision analysis and sensitivity analysis to estimate the incremental cost-effectiveness ratio with data gathered from the literature and examine the impact on blood transfusion centre. Implemented for 100,000 volunteer blood donations, the incremental cost of the new strategy was FF 2,566,111 (1992) and the marginal effectiveness was 180 additional infected donations detected. The sensitivity analysis showed the major influence of infection prevalence in donated blood on the incremental cost-effectiveness ratio: the lower the prevalence, the higher the cost-effectiveness ratio per contaminated blood product avoided.

Out-of-pocket medical costs and third-party healthcare costs for children with Down syndrome.

PubMed

Kageleiry, Andrew; Samuelson, David; Duh, Mei Sheng; Lefebvre, Patrick; Campbell, John; Skotko, Brian G

2017-03-01

Prior analyses have estimated the lifetime total societal costs of a person with Down syndrome (DS); however, no studies capture the expected medical costs that patients with DS can expect to incur during childhood. The study utilized the OptumHealth Reporting and Insights administrative claims database from 1999 to 2013. Children with a diagnosis of DS were identified, and their time was divided into clinically relevant age categories. Patients with DS in each age category were matched to controls without chromosomal conditions. Out-of-pocket medical costs and third-party expenditures were compared between the patient-age cohorts with DS and matched controls. Patients with DS had significantly higher mean annual out-of-pocket costs than their matched controls within each age and cost category. Total annual incremental out-of-pocket costs associated with DS were highest among individuals from birth to age 1 ($1,907, P < 0.001). The main drivers of the incremental out-of-pocket costs associated with DS were inpatient costs in the 1st year of life ($925, P < 0.001) and outpatient costs in later years (ranging $183-$623, all P < 0.001). Overall, patients with DS incurred incremental out-of-pocket medical costs of $18,248 between birth and age 18 years; third-party payers incurred incremental costs of $230,043 during the same period. Across all age categories, mean total out-of-pocket annual costs were greater for individuals with DS than those of matched controls. On average, parents of children with DS pay an additional $84 per month for out-of-pocket medical expenses when costs are amortized over 18 years. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Defensiveness versus remediation: self-theories and modes of self-esteem maintenance.

PubMed

Nussbaum, A David; Dweck, Carol S

2008-05-01

How people maintain and repair their self-esteem has been a topic of widespread interest. In this article, the authors ask, What determines whether people will use direct, remedial actions, or defensive actions? In three studies, they tested the hypothesis that a belief in fixed intelligence (entity theory) would produce defensiveness, whereas a belief in improvable intelligence (incremental theory) would foster remediation. In each study, participants assigned to the entity condition opted for defensive self-esteem repair (downward comparison in Studies 1 and 3; a tutorial on already mastered material in Study 2), but those in the incremental condition opted for self-improvement (upward comparison in Studies 1 and 3; a tutorial on unmastered material in Study 2). Experiment 3 also linked these strategies to self-esteem repair; remedial strategies were the most effective in recovering lost self-esteem for those in the incremental condition, whereas defensive strategies were most effective for those in the entity condition.

Multilevel models for estimating incremental net benefits in multinational studies.

PubMed

Grieve, Richard; Nixon, Richard; Thompson, Simon G; Cairns, John

2007-08-01

Multilevel models (MLMs) have been recommended for estimating incremental net benefits (INBs) in multicentre cost-effectiveness analysis (CEA). However, these models have assumed that the INBs are exchangeable and that there is a common variance across all centres. This paper examines the plausibility of these assumptions by comparing various MLMs for estimating the mean INB in a multinational CEA. The results showed that the MLMs that assumed the INBs were exchangeable and had a common variance led to incorrect inferences. The MLMs that included covariates to allow for systematic differences across the centres, and estimated different variances in each centre, made more plausible assumptions, fitted the data better and led to more appropriate inferences. We conclude that the validity of assumptions underlying MLMs used in CEA need to be critically evaluated before reliable conclusions can be drawn. Copyright 2006 John Wiley & Sons, Ltd.

Cost-Effectiveness Analysis of the Introduction of HPV Vaccination of 9-Year-Old-Girls in Iran.

PubMed

Yaghoubi, Mohsen; Nojomi, Marzieh; Vaezi, Atefeh; Erfani, Vida; Mahmoudi, Susan; Ezoji, Khadijeh; Zahraei, Seyed Mohsen; Chaudhri, Irtaza; Moradi-Lakeh, Maziar

2018-04-23

To estimate the cost effectiveness of introducing the quadrivalent human papillomavirus (HPV) vaccine into the national immunization program of Iran. The CERVIVAC cost-effectiveness model was used to calculate incremental cost per averted disability-adjusted life-year by vaccination compared with no vaccination from both governmental and societal perspectives. Calculations were based on epidemiologic parameters from the Iran National Cancer Registry and other national data sources as well as from literature review. We estimated all direct and indirect costs of cervical cancer treatment and vaccination program. All future costs and benefits were discounted at 3% per year and deterministic sensitivity analysis was used. During a 10-year period, HPV vaccination was estimated to avert 182 cervical cancer cases and 20 deaths at a total vaccination cost of US $23,459,897; total health service cost prevented because of HPV vaccination was estimated to be US $378,646 and US $691,741 from the governmental and societal perspective, respectively. Incremental cost per disability-adjusted life-year averted within 10 years was estimated to be US $15,205 and US $14,999 from the governmental and societal perspective, respectively, and both are higher than 3 times the gross domestic product per capita of Iran (US $14,289). Sensitivity analysis showed variation in vaccine price, and the number of doses has the greatest volatility on the incremental cost-effectiveness ratio. Using a two-dose vaccination program could be cost-effective from the societal perspective (incremental cost-effectiveness ratio = US $11,849). Introducing a three-dose HPV vaccination program is currently not cost-effective in Iran. Because vaccine supplies cost is the most important parameter in this evaluation, considering a two-dose schedule or reducing vaccine prices has an impact on final conclusions. Copyright © 2018. Published by Elsevier Inc.

The effects of rater bias and assessment method used to estimate disease severity on hypothesis testing

USDA-ARS?s Scientific Manuscript database

The effects of bias (over and underestimates) in estimates of disease severity on hypothesis testing using different assessment methods was explored. Nearest percent estimates (NPE), the Horsfall-Barratt (H-B) scale, and two different linear category scales (10% increments, with and without addition...

Improving tree age estimates derived from increment cores: a case study of red pine

Treesearch

Shawn Fraver; John B. Bradford; Brian J. Palik

2011-01-01

Accurate tree ages are critical to a range of forestry and ecological studies. However, ring counts from increment cores, if not corrected for the years between the root collar and coring height, can produce sizeable age errors. The magnitude of errors is influenced by both the height at which the core is extracted and the growth rate. We destructively sampled saplings...

Predicting height increment of young-growth red fir in California and southern Oregon

Treesearch

K. Leroy Dolph

1992-01-01

An equation is given to estimate 10-year height increment for young-growth red fir trees in California and southern Oregon. The independent variables are the individual tree, stand, and site characteristics significantly related to a tree's height growth. Data used to develop the equation came from stem analysis of 492 trees sampled from 56 stands in the study...

Evaluating growth assumptions using diameter or radial increments in natural even-aged longleaf pine

Treesearch

John C. Gilbert; Ralph S. Meldahl; Jyoti N. Rayamajhi; John S. Kush

2010-01-01

When using increment cores to predict future growth, one often assumes future growth is identical to past growth for individual trees. Once this assumption is accepted, a decision has to be made between which growth estimate should be used, constant diameter growth or constant basal area growth. Often, the assumption of constant diameter growth is used due to the ease...

Some simulation estimates of mean annual increment of Douglas-fir: results, limitations, and implications for management.

Treesearch

Robert O. Curtis

1994-01-01

Patterns of development of mean annual increment in relation to age predicted by the widely used DFSIM, SPS, TASS, and ORGANON simulators were examined. Although predictions differ considerably among simulators for portions of the range of sites, ages, and treatments, comparisons indicated that (1) culmination is relatively late, (2) the curve is relatively flat in the...

An efficient incremental learning mechanism for tracking concept drift in spam filtering

PubMed Central

Sheu, Jyh-Jian; Chu, Ko-Tsung; Li, Nien-Feng; Lee, Cheng-Chi

2017-01-01

This research manages in-depth analysis on the knowledge about spams and expects to propose an efficient spam filtering method with the ability of adapting to the dynamic environment. We focus on the analysis of email’s header and apply decision tree data mining technique to look for the association rules about spams. Then, we propose an efficient systematic filtering method based on these association rules. Our systematic method has the following major advantages: (1) Checking only the header sections of emails, which is different from those spam filtering methods at present that have to analyze fully the email’s content. Meanwhile, the email filtering accuracy is expected to be enhanced. (2) Regarding the solution to the problem of concept drift, we propose a window-based technique to estimate for the condition of concept drift for each unknown email, which will help our filtering method in recognizing the occurrence of spam. (3) We propose an incremental learning mechanism for our filtering method to strengthen the ability of adapting to the dynamic environment. PMID:28182691

Reassessment of spiny dogfish Squalus acanthias age and growth using vertebrae and dorsal-fin spines.

PubMed

Bubley, W J; Kneebone, J; Sulikowski, J A; Tsang, P C W

2012-04-01

Male and female spiny dogfish Squalus acanthias were collected in the western North Atlantic Ocean in the Gulf of Maine between July 2006 and June 2009. Squalus acanthias ranged from 25 to 102 cm stretch total length and were caught during all months of the year except January. Age estimates derived from banding patterns visible in both the vertebrae and second dorsal-fin spines were compared. Vertebral growth increments were visualized using a modified histological staining technique, which was verified as appropriate for obtaining age estimates. Marginal increment analysis of vertebrae verified the increment periodicity, suggesting annual band deposition. Based on increased precision and accuracy of age estimates, as well as more biologically realistic parameters generated in growth models, the current study found that vertebrae provided a more reliable and accurate means of estimating age in S. acanthias than the second dorsal-fin spine. Age estimates obtained from vertebrae ranged from <1 year-old to 17 years for male and 24 years for female S. acanthias. The two-parameter von Bertalanffy growth model fit to vertebrae-derived age estimates produced parameters of L∞ = 94·23 cm and k = 0·11 for males and L∞ = 100·76 cm and k = 0·12 for females. While these growth parameters differed from those previously reported for S. acanthias in the western North Atlantic Ocean, the causes of such differences were beyond the scope of the current study and remain to be determined. © 2011 The Authors. Journal of Fish Biology © 2011 The Fisheries Society of the British Isles.

Nonparametric Density Estimation Based on Self-Organizing Incremental Neural Network for Large Noisy Data.

PubMed

Nakamura, Yoshihiro; Hasegawa, Osamu

2017-01-01

With the ongoing development and expansion of communication networks and sensors, massive amounts of data are continuously generated in real time from real environments. Beforehand, prediction of a distribution underlying such data is difficult; furthermore, the data include substantial amounts of noise. These factors make it difficult to estimate probability densities. To handle these issues and massive amounts of data, we propose a nonparametric density estimator that rapidly learns data online and has high robustness. Our approach is an extension of both kernel density estimation (KDE) and a self-organizing incremental neural network (SOINN); therefore, we call our approach KDESOINN. An SOINN provides a clustering method that learns about the given data as networks of prototype of data; more specifically, an SOINN can learn the distribution underlying the given data. Using this information, KDESOINN estimates the probability density function. The results of our experiments show that KDESOINN outperforms or achieves performance comparable to the current state-of-the-art approaches in terms of robustness, learning time, and accuracy.

Endogenous-cue prospective memory involving incremental updating of working memory: an fMRI study.

PubMed

Halahalli, Harsha N; John, John P; Lukose, Ammu; Jain, Sanjeev; Kutty, Bindu M

2015-11-01

Prospective memory paradigms are conventionally classified on the basis of event-, time-, or activity-based intention retrieval. In the vast majority of such paradigms, intention retrieval is provoked by some kind of external event. However, prospective memory retrieval cues that prompt intention retrieval in everyday life are commonly endogenous, i.e., linked to a specific imagined retrieval context. We describe herein a novel prospective memory paradigm wherein the endogenous cue is generated by incremental updating of working memory, and investigated the hemodynamic correlates of this task. Eighteen healthy adult volunteers underwent functional magnetic resonance imaging while they performed a prospective memory task where the delayed intention was triggered by an endogenous cue generated by incremental updating of working memory. Working memory and ongoing task control conditions were also administered. The 'endogenous-cue prospective memory condition' with incremental working memory updating was associated with maximum activations in the right rostral prefrontal cortex, and additional activations in the brain regions that constitute the bilateral fronto-parietal network, central and dorsal salience networks as well as cerebellum. In the working memory control condition, maximal activations were noted in the left dorsal anterior insula. Activation of the bilateral dorsal anterior insula, a component of the central salience network, was found to be unique to this 'endogenous-cue prospective memory task' in comparison to previously reported exogenous- and endogenous-cue prospective memory tasks without incremental working memory updating. Thus, the findings of the present study highlight the important role played by the dorsal anterior insula in incremental working memory updating that is integral to our endogenous-cue prospective memory task.

Temporal Surface Reconstruction

DTIC Science & Technology

1991-05-03

and the convergence cannot be guaranteed. Maybank [68] investigated alternative incremental schemes for the estimation of feature locations from a...depth from image sequences. International Journal of Computer Vision, 3, 1989. [68] S. J. Maybank . Filter based estimates of depth. In Proceedings of the

New geothermal site identification and qualification. Final report

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

Not Available

2004-04-01

This study identifies remaining undeveloped geothermal resources in California and western Nevada, and it estimates the development costs of each. It has relied on public-domain information and such additional data as geothermal developers have chosen to make available. Reserve estimation has been performed by volumetric analysis with a probabilistic approach to uncertain input parameters. Incremental geothermal reserves in the California/Nevada study area have a minimum value of 2,800 grosss MW and a most-likely value of 4,300 gross MW. For the state of California alone, these values are 2,000 and 3,000 gross MW, respectively. These estimates may be conservative to themore » extent that they do not take into account resources about which little or no public-domain information is available. The average capital cost of incremental generation capacity is estimated to average $3,100/kW for the California/Nevada study area, and $2,950/kW for the state of California alone. These cost estimates include exploration, confirmation drilling, development drilling, plant construction, and transmission-line costs. For the purposes of this study, a capital cost of $2,400/kW is considered competitive with other renewable resources. The amount of incremental geothermal capacity available at or below $2,400/kW is about 1,700 gross MW for the California/Nevada study area, and the same amount (within 50-MW rounding) for the state of California alone. The capital cost estimates are only approximate, because each developer would bring its own experience, bias, and opportunities to the development process. Nonetheless, the overall costs per project estimated in this study are believed to be reasonable.« less

Numerical simulation of pseudoelastic shape memory alloys using the large time increment method

NASA Astrophysics Data System (ADS)

Gu, Xiaojun; Zhang, Weihong; Zaki, Wael; Moumni, Ziad

2017-04-01

The paper presents a numerical implementation of the large time increment (LATIN) method for the simulation of shape memory alloys (SMAs) in the pseudoelastic range. The method was initially proposed as an alternative to the conventional incremental approach for the integration of nonlinear constitutive models. It is adapted here for the simulation of pseudoelastic SMA behavior using the Zaki-Moumni model and is shown to be especially useful in situations where the phase transformation process presents little or lack of hardening. In these situations, a slight stress variation in a load increment can result in large variations of strain and local state variables, which may lead to difficulties in numerical convergence. In contrast to the conventional incremental method, the LATIN method solve the global equilibrium and local consistency conditions sequentially for the entire loading path. The achieved solution must satisfy the conditions of static and kinematic admissibility and consistency simultaneously after several iterations. 3D numerical implementation is accomplished using an implicit algorithm and is then used for finite element simulation using the software Abaqus. Computational tests demonstrate the ability of this approach to simulate SMAs presenting flat phase transformation plateaus and subjected to complex loading cases, such as the quasi-static behavior of a stent structure. Some numerical results are contrasted to those obtained using step-by-step incremental integration.

The National Institute of Education and Incremental Budgeting.

ERIC Educational Resources Information Center

Hastings, Anne H.

1979-01-01

The National Institute of Education's (NIE) history demonstrates that the relevant criteria for characterizing budgeting as incremental are not the predictability and stability of appropriations but the conditions of complexity, limited information, multiple factors, and imperfect agreement on ends; NIE's appropriations were dominated by political…

Volatilities, Traded Volumes, and Price Increments in Derivative Securities

NASA Astrophysics Data System (ADS)

Kim, Kyungsik; Lim, Gyuchang; Kim, Soo Yong; Scalas, Enrico

2007-03-01

We apply the detrended fluctuation analysis (DFA) to the statistics of the Korean treasury bond (KTB) futures from which the logarithmic increments, volatilities, and traded volumes are estimated over a specific time lag. For our case, the logarithmic increment of futures prices has no long-memory property, while the volatility and the traded volume exhibit the existence of long-memory property. To analyze and calculate whether the volatility clustering is due to the inherent higher-order correlation not detected by applying directly the DFA to logarithmic increments of the KTB futures, it is of importance to shuffle the original tick data of futures prices and to generate the geometric Brownian random walk with the same mean and standard deviation. It is really shown from comparing the three tick data that the higher-order correlation inherent in logarithmic increments makes the volatility clustering. Particularly, the result of the DFA on volatilities and traded volumes may be supported the hypothesis of price changes.

Volatilities, traded volumes, and the hypothesis of price increments in derivative securities

NASA Astrophysics Data System (ADS)

Lim, Gyuchang; Kim, SooYong; Scalas, Enrico; Kim, Kyungsik

2007-08-01

A detrended fluctuation analysis (DFA) is applied to the statistics of Korean treasury bond (KTB) futures from which the logarithmic increments, volatilities, and traded volumes are estimated over a specific time lag. In this study, the logarithmic increment of futures prices has no long-memory property, while the volatility and the traded volume exhibit the existence of the long-memory property. To analyze and calculate whether the volatility clustering is due to a inherent higher-order correlation not detected by with the direct application of the DFA to logarithmic increments of KTB futures, it is of importance to shuffle the original tick data of future prices and to generate a geometric Brownian random walk with the same mean and standard deviation. It was found from a comparison of the three tick data that the higher-order correlation inherent in logarithmic increments leads to volatility clustering. Particularly, the result of the DFA on volatilities and traded volumes can be supported by the hypothesis of price changes.

Joint Space Operations Center (JSpOC) Mission System Increment 3 (JMS Inc 3)

DTIC Science & Technology

2016-03-01

2016 Major Automated Information System Annual Report Joint Space Operations Center (JSpOC) Mission System Increment 3 (JMS Inc 3) Defense...1725 DSN Phone: DSN Fax: Date Assigned: May 16, 2014 Program Information Program Name Joint Space Operations Center (JSpOC) Mission System...approved program baseline; therefore, no Original Estimate has been established. JMS Inc 3 2016 MAR UNCLASSIFIED 4 Program Description The Joint Space

Anaerobic Threshold and Salivary α-amylase during Incremental Exercise.

PubMed

Akizuki, Kazunori; Yazaki, Syouichirou; Echizenya, Yuki; Ohashi, Yukari

2014-07-01

[Purpose] The purpose of this study was to clarify the validity of salivary α-amylase as a method of quickly estimating anaerobic threshold and to establish the relationship between salivary α-amylase and double-product breakpoint in order to create a way to adjust exercise intensity to a safe and effective range. [Subjects and Methods] Eleven healthy young adults performed an incremental exercise test using a cycle ergometer. During the incremental exercise test, oxygen consumption, carbon dioxide production, and ventilatory equivalent were measured using a breath-by-breath gas analyzer. Systolic blood pressure and heart rate were measured to calculate the double product, from which double-product breakpoint was determined. Salivary α-amylase was measured to calculate the salivary threshold. [Results] One-way ANOVA revealed no significant differences among workloads at the anaerobic threshold, double-product breakpoint, and salivary threshold. Significant correlations were found between anaerobic threshold and salivary threshold and between anaerobic threshold and double-product breakpoint. [Conclusion] As a method for estimating anaerobic threshold, salivary threshold was as good as or better than determination of double-product breakpoint because the correlation between anaerobic threshold and salivary threshold was higher than the correlation between anaerobic threshold and double-product breakpoint. Therefore, salivary threshold is a useful index of anaerobic threshold during an incremental workload.

Cost-effectiveness of enzyme replacement therapy with alglucosidase alfa in classic-infantile patients with Pompe disease

PubMed Central

2014-01-01

Background Infantile Pompe disease is a rare metabolic disease. Patients generally do not survive the first year of life. Enzyme replacement therapy (ERT) has proven to have substantial effects on survival in infantile Pompe disease. However, the costs of therapy are very high. In this paper, we assess the cost-effectiveness of enzyme replacement therapy in infantile Pompe disease. Methods A patient simulation model was used to compare costs and effects of ERT with costs of effects of supportive therapy (ST). The model was filled with data on survival, quality of life and costs. For both arms of the model, data on survival were obtained from international literature. In addition, survival as observed among 20 classic-infantile Dutch patients, who all received ERT, was used. Quality of life was measured using the EQ-5D and assumed to be the same in both treatment groups. Costs included the costs of ERT (which depend on a child’s weight), infusions, costs of other health care utilization, and informal care. A lifetime time horizon was used, with 6-month time cycles. Results Life expectancy was significantly longer in the ERT group than in the ST group. On average, ST receiving patients were modelled not to survive the first half year of life; whereas the life expectancy in the ERT patients was modelled to be almost 14 years. Lifetime incremental QALYs were 6.8. Incremental costs were estimated to be € 7.0 million, which primarily consisted of treatment costs (95%). The incremental costs per QALY were estimated to be € 1.0 million (range sensitivity analyses: € 0.3 million - € 1.3 million). The incremental cost per life year gained was estimated to be € 0.5 million. Conclusions The incremental costs per QALY ratio is far above the conventional threshold values. Results from univariate and probabilistic sensitivity analyses showed the robustness of the results. PMID:24884717

Economic healthcare costs of Clostridium difficile infection: a systematic review.

PubMed

Ghantoji, S S; Sail, K; Lairson, D R; DuPont, H L; Garey, K W

2010-04-01

Clostridium difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients. CDI increases patient healthcare costs due to extended hospitalisation, re-hospitalisation, laboratory tests and medications. However, the economic costs of CDI on healthcare systems remain uncertain. The purpose of this study was to perform a systematic review to summarise available studies aimed at defining the economic healthcare costs of CDI. We conducted a literature search for peer-reviewed studies that investigated costs associated with CDI (1980 to present). Thirteen studies met inclusion and exclusion criteria. CDI costs in 2008 US dollars were calculated using the consumer price index. The total and incremental costs for primary and recurrent CDI were estimated. Of the 13, 10 were from the USA and one each from Canada, UK, and Ireland. In US-based studies incremental cost estimates ranged from $2,871 to $4,846 per case for primary CDI and from $13,655 to $18,067 per case for recurrent CDI. US-based studies in special populations (subjects with irritable bowel disease, surgical inpatients, and patients treated in the intensive care unit) showed an incremental cost range from $6,242 to $90,664. Non-US-based studies showed an estimated incremental cost of $5,243 to $8,570 per case for primary CDI and $13,655 per case for recurrent CDI. Economic healthcare costs of CDI were high for primary and recurrent cases. The high cost associated with CDI justifies the use of additional resources for CDI prevention and control. Copyright (c) 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Productivity losses in chronic obstructive pulmonary disease: a population-based survey.

PubMed

Erdal, Marta; Johannessen, Ane; Askildsen, Jan Erik; Eagan, Tomas; Gulsvik, Amund; Grønseth, Rune

2014-01-01

We aimed to estimate incremental productivity losses (sick leave and disability) of spirometry-defined chronic obstructive pulmonary disease (COPD) in a population-based sample and in hospital-recruited patients with COPD. Furthermore, we examined predictors of productivity losses by multivariate analyses. We performed four quarterly telephone interviews of 53 and 107 population-based patients with COPD and controls, as well as 102 hospital-recruited patients with COPD below retirement age. Information was gathered regarding annual productivity loss, exacerbations of respiratory symptoms and comorbidities. Incremental productivity losses were estimated by multivariate quantile median regression according to the human capital approach, adjusting for sex, age, smoking habits, education and lung function. Main effect variables were COPD/control status, number of comorbidities and exacerbations of respiratory symptoms. Altogether 55%, 87% and 31% of population-based COPD cases, controls and hospital patients, respectively, had a paid job at baseline. The annual incremental productivity losses were 5.8 (95% CI 1.4 to 10.1) and 330.6 (95% CI 327.8 to 333.3) days, comparing population-recruited and hospital-recruited patients with COPD to controls, respectively. There were significantly higher productivity losses associated with female sex and less education. Additional adjustments for comorbidities, exacerbations and FEV1% predicted explained all productivity losses in the population-based sample, as well as nearly 40% of the productivity losses in hospital-recruited patients. Annual incremental productivity losses were more than 50 times higher in hospital-recruited patients with COPD than that of population-recruited patients with COPD. To ensure a precise estimation of societal burden, studies on patients with COPD should be population-based.

Evaluation of incremental reactivity and its uncertainty in Southern California.

PubMed

Martien, Philip T; Harley, Robert A; Milford, Jana B; Russell, Armistead G

2003-04-15

The incremental reactivity (IR) and relative incremental reactivity (RIR) of carbon monoxide and 30 individual volatile organic compounds (VOC) were estimated for the South Coast Air Basin using two photochemical air quality models: a 3-D, grid-based model and a vertically resolved trajectory model. Both models include an extended version of the SAPRC99 chemical mechanism. For the 3-D modeling, the decoupled direct method (DDM-3D) was used to assess reactivities. The trajectory model was applied to estimate uncertainties in reactivities due to uncertainties in chemical rate parameters, deposition parameters, and emission rates using Monte Carlo analysis with Latin hypercube sampling. For most VOC, RIRs were found to be consistent in rankings with those produced by Carter using a box model. However, 3-D simulations show that coastal regions, upwind of most of the emissions, have comparatively low IR but higher RIR than predicted by box models for C4-C5 alkenes and carbonyls that initiate the production of HOx radicals. Biogenic VOC emissions were found to have a lower RIR than predicted by box model estimates, because emissions of these VOC were mostly downwind of the areas of primary ozone production. Uncertainties in RIR of individual VOC were found to be dominated by uncertainties in the rate parameters of their primary oxidation reactions. The coefficient of variation (COV) of most RIR values ranged from 20% to 30%, whereas the COV of absolute incremental reactivity ranged from about 30% to 40%. In general, uncertainty and variability both decreased when relative rather than absolute reactivity metrics were used.

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011.

PubMed

Echouffo-Tcheugui, Justin B; Bishu, Kinfe G; Fonarow, Gregg C; Egede, Leonard E

2017-04-01

Population-based national data on the trends in expenditures related to heart failure (HF) are scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Using 10-year data (2002-2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194US adults aged ≥18years) and a 2-part model (adjusting for demographics, comorbidities, and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency department, inpatient hospital, pharmacy, home health care, and other medical expenditures). Compared with expenditures for individuals without HF ($5511 [95% CI 5405-5617]), individuals with HF had a 4-fold higher mean expenditures of ($23,854 [95% CI 21,733-25,975]). Individuals with HF had $3446 (95% CI 2592-4299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95% CI 18,359-24,272) in 2002/2003 to $27,152 (95% CI 20,066-34,237) in 2010/2011, and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/y and the adjusted total incremental expenditure was $5.8 billion/y. Heart failure is costly and over a recent 10-year period, and direct expenditure related to HF increased markedly, mainly driven by inpatient costs. Copyright © 2017 Elsevier Inc. All rights reserved.

Trends in Health Care Expenditure among U.S. Adults with Heart Failure - The Medical Expenditure Panel Survey 2002–2011

PubMed Central

Echouffo-Tcheugui, Justin B.; Bishu, Kinfe G.; Fonarow, Gregg C; Egede, Leonard E.

2017-01-01

Background Population-based national data on the trends in expenditures related to heart failure (HF) is scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Methods Using 10-year data (2002–2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194 U.S adults aged ≥18 years) and a two-part model (adjusting for demographics, comorbidities and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures). Results Compared to expenditures for individuals without HF ($5,511 [95% confidence interval (CI): 5,405–5,617]), individuals with HF had a four-fold higher mean expenditures of ($23,854 [95%CI: 21,733–25,975]). Individuals with HF had $3,446 (95%CI: 2,592–4,299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95%CI: 18,359–24,272) in 2002/2003 to $27,152 (95%CI: 20,066–34,237) in 2010/2011; and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/year and the adjusted total incremental expenditure $5.8 billion/year. Conclusions Heart failure is costly and over a recent 10-year period, direct expenditure related to HF increased markedly, mainly driven by inpatient costs. PMID:28454834

Integrating Incremental Learning and Episodic Memory Models of the Hippocampal Region

ERIC Educational Resources Information Center

Meeter, M.; Myers, C. E.; Gluck, M. A.

2005-01-01

By integrating previous computational models of corticohippocampal function, the authors develop and test a unified theory of the neural substrates of familiarity, recollection, and classical conditioning. This approach integrates models from 2 traditions of hippocampal modeling, those of episodic memory and incremental learning, by drawing on an…

Cost-effectiveness of everolimus for second-line treatment of metastatic renal cell carcinoma in Serbia.

PubMed

Mihajlović, Jovan; Pechlivanoglou, Petros; Sabo, Ana; Tomić, Zdenko; Postma, Maarten J

2013-12-01

New targeted therapeutics for metastatic renal cell carcinoma (mRCC) enable an increment in progression-free survival (PFS) ranging from 2 to 6 months. Compared with best supportive care, everolimus demonstrated an additional PFS of 3 months in patients with mRCC whose disease had progressed on sunitinib and/or sorafenib. The only targeted therapy for mRCC currently reimbursed in Serbia is sunitinib. The aim of this study was to estimate the cost-effectiveness and the budget impact of the introduction of everolimus in Serbia in comparison to best supportive care, for mRCC patients refractory to sunitinib. A Markov model was designed corresponding with Serbian treatment protocols. A health care payer perspective was taken, including direct costs only. Treated and untreated cohorts were followed up over 18 cycles, each cycle lasting 8 weeks, which covered the lifetime horizon of mRCC patients refractory to the first-line treatment. Annual discounted rates of 1.5% for effectiveness and 3% for costs were applied. Transitions between health states were modeled by time-dependent probabilities extracted from published Kaplan-Meier curves of PFS and overall survival (OS). Utility values were obtained from the appraisals of other mRCC treatments. One-way and probabilistic sensitivity analyses were done to test the robustness and uncertainty of the base-case estimate. Lastly, the potential impacts of everolimus on the overall health care expenditures on annual and 4-year bases were estimated in the budget-impact analysis. The incremental cost-effectiveness ratio for everolimus was estimated at €86,978 per quality-adjusted life-year. Sensitivity analysis identified the hazard multiplier, a statistical approximator of OS gain, as the main driver of everolimus cost-effectiveness. Furthermore, probabilistic sensitivity analyses revealed a wide 95% CI around the base-case incremental cost-effectiveness ratio estimate (€32,594-€425,258 per quality-adjusted life-year). Finally, an average annual budgetary impact of everolimus in first 4 years after its potential reimbursement would be around €270,000, contributing to <1% of the total budget in Serbian oncology. Everolimus as a second-line treatment of mRCC is not likely to be a cost-effective option under the present conditions in Serbia, with a relatively limited impact on its budget in oncology. A major constraint on the estimation of the cost-effectiveness of everolimus relates to the uncertainty around the everolimus effect on extending OS. However, prior to a final decision on the acceptance/rejection of everolimus, reassessment of the whole therapeutic group might be needed to construct an economically rational treatment strategy within the mRCC field. © 2013 Elsevier HS Journals, Inc. All rights reserved.

The Decremental Protocol as an Alternative Protocol to Measure Maximal Oxygen Consumption in Athletes.

PubMed

Taylor, Katrina; Seegmiller, Jeffrey; Vella, Chantal A

2016-11-01

To determine whether a decremental protocol could elicit a higher maximal oxygen consumption (VO 2 max) than an incremental protocol in trained participants. A secondary aim was to examine whether cardiac-output (Q) and stroke-volume (SV) responses differed between decremental and incremental protocols in this sample. Nineteen runners/triathletes were randomized to either the decremental or incremental group. All participants completed an initial incremental VO 2 max test on a treadmill, followed by a verification phase. The incremental group completed 2 further incremental tests. The decremental group completed a second VO 2 max test using the decremental protocol, based on their verification phase. The decremental group then completed a final incremental test. During each test, VO 2 , ventilation, and heart rate were measured, and cardiac variables were estimated with thoracic bioimpedance. Repeated-measures analysis of variance was conducted with an alpha level set at .05. There were no significant main effects for group (P = .37) or interaction (P = .10) over time (P = .45). VO 2 max was similar between the incremental (57.29 ± 8.94 mL · kg -1 · min -1 ) and decremental (60.82 ± 8.49 mL · kg -1 · min -1 ) groups over time. Furthermore, Q and SV were similar between the incremental (Q 22.72 ± 5.85 L/min, SV 119.64 ± 33.02 mL/beat) and decremental groups (Q 20.36 ± 4.59 L/min, SV 109.03 ± 24.27 mL/beat) across all 3 trials. The findings suggest that the decremental protocol does not elicit higher VO 2 max than an incremental protocol but may be used as an alternative protocol to measure VO 2 max in runners and triathletes.

Evaluation of an emergency department-based enrollment program for uninsured children.

PubMed

Mahajan, Prashant; Stanley, Rachel; Ross, Kevin W; Clark, Linda; Sandberg, Keisha; Lichtenstein, Richard

2005-03-01

We evaluate the effectiveness of an emergency department (ED)-based outreach program in increasing the enrollment of uninsured children. The study involved placing a full-time worker trained to enroll uninsured children into Medicaid or the State Children's Health Insurance Program in an inner-city academic children's hospital ED. Analysis was carried out for outpatient ED visits by insurance status, average revenue per patient from uninsured and insured children, proportion of patients enrolled in Medicaid and State Children's Health Insurance Program through this program, estimated incremental revenue from new enrollees, and program-specific incremental costs. A cost-benefit analysis and breakeven analysis was conducted to determine the impact of this intervention on ED revenues. Five thousand ninety-four uninsured children were treated during the 10 consecutive months assessed, and 4,667 were treated during program hours. One thousand eight hundred and three applications were filed, giving a program penetration rate of 39%. Eighty-four percent of applications filed were resolved (67% of these were Medicaid). Average revenue from each outpatient ED visit for Medicaid was US135.68 dollars, other insurance was US210.43 dollars, and uninsured was US15.03 dollars. Estimated incremental revenue for each uninsured patient converted to Medicaid was US120.65 dollars. Total annualized incremental revenue was US224,474 dollars, and the net incremental revenue, after accounting for program costs, was US157,414 dollars per year. A program enrolling uninsured children at an inner-city pediatric ED into government insurance was effective and generated revenue that paid for program costs.

Selected Flight Test Results for Online Learning Neural Network-Based Flight Control System

NASA Technical Reports Server (NTRS)

Williams, Peggy S.

2004-01-01

The NASA F-15 Intelligent Flight Control System project team has developed a series of flight control concepts designed to demonstrate the benefits of a neural network-based adaptive controller. The objective of the team is to develop and flight-test control systems that use neural network technology to optimize the performance of the aircraft under nominal conditions as well as stabilize the aircraft under failure conditions. Failure conditions include locked or failed control surfaces as well as unforeseen damage that might occur to the aircraft in flight. This report presents flight-test results for an adaptive controller using stability and control derivative values from an online learning neural network. A dynamic cell structure neural network is used in conjunction with a real-time parameter identification algorithm to estimate aerodynamic stability and control derivative increments to the baseline aerodynamic derivatives in flight. This set of open-loop flight tests was performed in preparation for a future phase of flights in which the learning neural network and parameter identification algorithm output would provide the flight controller with aerodynamic stability and control derivative updates in near real time. Two flight maneuvers are analyzed a pitch frequency sweep and an automated flight-test maneuver designed to optimally excite the parameter identification algorithm in all axes. Frequency responses generated from flight data are compared to those obtained from nonlinear simulation runs. An examination of flight data shows that addition of the flight-identified aerodynamic derivative increments into the simulation improved the pitch handling qualities of the aircraft.

Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010.

PubMed

Wisløff, Torbjørn; Hagen, Gunhild; Hamidi, Vida; Movik, Espen; Klemp, Marianne; Olsen, Jan Abel

2014-04-01

Reimbursement agencies in several countries now require health outcomes to be measured in terms of quality-adjusted life-years (QALYs), leading to an immense increase in publications reporting QALY gains. However, there is a growing concern that the various 'multi-attribute utility' (MAU) instruments designed to measure the Q in the QALY yield disparate values, implying that results from different instruments are incommensurable. By reviewing cost-utility analyses published in 2010, we aim to contribute to improved knowledge on how QALYs are currently calculated in applied analyses; how transparently QALY measurement is presented; and how large the expected incremental QALY gains are. We searched Embase, MEDLINE and NHS EED for all cost-utility analyses published in 2010. All analyses that had estimated QALYs gained from health interventions were included. Of the 370 studies included in this review, 48% were pharmacoeconomic evaluations. Active comparators were used in 71% of studies. The median incremental QALY gain was 0.06, which translates to 3 weeks in best imaginable health. The EQ-5D-3L is the dominant instrument used. However, reporting of how QALY gains are estimated is generally inadequate. In 55% of the studies there was no reference to which MAU instrument or direct valuation method QALY data came from. The methods used for estimating expected QALY gains are not transparently reported in published papers. Given the wide variation in utility scores that different methodologies may assign to an identical health state, it is important for journal editors to require a more transparent way of reporting the estimation of incremental QALY gains.

On convergence of the unscented Kalman-Bucy filter using contraction theory

NASA Astrophysics Data System (ADS)

Maree, J. P.; Imsland, L.; Jouffroy, J.

2016-06-01

Contraction theory entails a theoretical framework in which convergence of a nonlinear system can be analysed differentially in an appropriate contraction metric. This paper is concerned with utilising stochastic contraction theory to conclude on exponential convergence of the unscented Kalman-Bucy filter. The underlying process and measurement models of interest are Itô-type stochastic differential equations. In particular, statistical linearisation techniques are employed in a virtual-actual systems framework to establish deterministic contraction of the estimated expected mean of process values. Under mild conditions of bounded process noise, we extend the results on deterministic contraction to stochastic contraction of the estimated expected mean of the process state. It follows that for the regions of contraction, a result on convergence, and thereby incremental stability, is concluded for the unscented Kalman-Bucy filter. The theoretical concepts are illustrated in two case studies.

Assessing Zambia's industrial fortification options: getting beyond changes in prevalence and cost-effectiveness.

PubMed

Fiedler, John L; Lividini, Keith; Kabaghe, Gladys; Zulu, Rodah; Tehinse, John; Bermudez, Odilia I; Jallier, Vincent; Guyondet, Christophe

2013-12-01

Background. Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates ofmicronutrient deficiencies. Objective. To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program. Methods. Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternativefoodfortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures. Results. Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed. Conclusions. Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose-response-based approach to estimating the number ofDALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status.

Cost-effectiveness of atorvastatin in the prevention of cardiovascular events in diabetic patients: a French adaptation of CARDS.

PubMed

Lafuma, Antoine; Colin, Xavier; Solesse, Anne

2008-05-01

We estimated the cost-effectiveness of atorvastatin in the primary prevention of cardiovascular events in patients with type 2 diabetes using data from the Collaborative AtoRvastatin Diabetes Study (CARDS). A total of 2838 patients aged 40-75 years with type 2 diabetes and no documented history of cardiovascular disease and without elevated low-density-lipoprotein cholesterol were recruited in the UK and in Ireland. Patients were randomly allocated to atorvastatin 10mg daily (n=1428) or placebo (n=1410) and were followed up for a median of 3.9 years. Direct treatment costs and effectiveness were analysed to provide estimates of cost per event avoided and cost per life-year gained over the trial period and over a patient's lifetime. The incremental cost-effectiveness ratio over the trial period was estimated to be Euro 3862 per clinical event avoided. Over the patient's lifetime, the incremental cost per life-year gained was Euro 2506 when considering cardiovascular deaths, and Euro 1418 per year when considering all-cause death. Primary prevention of cardiovascular disease with atorvastatin is cost-effective in patients with type 2 diabetes, with the incremental cost-effectiveness ratio for this intervention falling within the current acceptance threshold.

Longitudinal Aerodynamic Modeling of the Adaptive Compliant Trailing Edge Flaps on a GIII Airplane and Comparisons to Flight Data

NASA Technical Reports Server (NTRS)

Smith, Mark S.; Bui, Trong T.; Garcia, Christian A.; Cumming, Stephen B.

2016-01-01

A pair of compliant trailing edge flaps was flown on a modified GIII airplane. Prior to flight test, multiple analysis tools of various levels of complexity were used to predict the aerodynamic effects of the flaps. Vortex lattice, full potential flow, and full Navier-Stokes aerodynamic analysis software programs were used for prediction, in addition to another program that used empirical data. After the flight-test series, lift and pitching moment coefficient increments due to the flaps were estimated from flight data and compared to the results of the predictive tools. The predicted lift increments matched flight data well for all predictive tools for small flap deflections. All tools over-predicted lift increments for large flap deflections. The potential flow and Navier-Stokes programs predicted pitching moment coefficient increments better than the other tools.

Effect of discounting on estimation of benefits determined by hepatitis C treatment.

PubMed

Messori, Andrea; Fadda, Valeria; Maratea, Dario; Trippoli, Sabrina

2012-06-21

The combination of either boceprevir or telaprevir with ribavirin and interferon (triple therapy) has been shown to be more effective than ribavirin+interferon (dual therapy) for the treatment of genotype 1 hepatitis C. Since the benefit of these treatments takes place after years, simulation models are needed to predict long-term outcomes. In simulation models, the choice of different values of yearly discount rates (e.g., 6%, 3.5%, 2%, 1.5% or 0%) influences the results, but no studies have specifically addressed this issue. We examined this point by determining the long-term benefits under different conditions on the basis of standard modelling and using quality-adjusted life years (QALYs) to quantify the benefits. In our base case scenario, we compared the long-term benefit between patients given a treatment with a 40% sustained virologic response (SVR) (dual therapy) and patients given a treatment with a 70% SVR (triple therapy), and we then examined how these specific yearly discount rates influenced the incremental benefit. The gain between a 70% SVR and a 40% SVR decreased from 0.45 QALYs with a 0% discount rate to 0.22 QALYs with a 6% discount rate (ratio between the two values = 2.04). Testing the other discounting assumptions confirmed that the discount rate has a marked impact on the magnitude of the model-estimated incremental benefit. In conclusion, the results of our analysis can be helpful to better interpret cost-effectiveness studies evaluating new treatment for hepatitis C.

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence.

PubMed

Rafia, Rachid; Dodd, Peter J; Brennan, Alan; Meier, Petra S; Hope, Vivian D; Ncube, Fortune; Byford, Sarah; Tie, Hiong; Metrebian, Nicola; Hellier, Jennifer; Weaver, Tim; Strang, John

2016-09-01

To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources. A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. Data on attendance to vaccination from a UK cluster randomized trial. Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%. © 2016 Society for the Study of Addiction.

77 FR 13632 - Receipt of Complaint; Solicitation of Comments Relating to the Public Interest

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-07

... Certain Digital Models, Digital Data, and Treatment Plans for Use in Making Incremental Dental Positioning... importation of certain digital models, digital data, and treatment plans for use in making incremental dental... health and welfare in the United States, competitive conditions in the United States economy, the...

40 CFR 52.1773 - Conditional approval.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Deterioration (PSD) infrastructure requirements for the 1997 annual and 2006 24-hour fine particulate matter... to the PM2.5 standard for their PSD program and committing to providing the necessary SIP revision to... PM2.5 Rule (including PM2.5 PSD Increment-SILs-SMC, as it relates to PM2.5 increments to meet the...

40 CFR 52.1773 - Conditional approval.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Deterioration (PSD) infrastructure requirements for the 1997 annual and 2006 24-hour fine particulate matter... to the PM2.5 standard for their PSD program and committing to providing the necessary SIP revision to... PM2.5 Rule (including PM2.5 PSD Increment-SILs-SMC, as it relates to PM2.5 increments to meet the...

Delineating Area of Review in a System with Pre-injection Relative Overpressure

DOE PAGES

Oldenburg, Curtis M.; Cihan, Abdullah; Zhou, Quanlin; ...

2014-12-31

The Class VI permit application for geologic carbon sequestration (GCS) requires delineation of an area of review (AoR), defined as the region surrounding the (GCS) project where underground sources of drinking water (USDWs) may be endangered. The methods for estimating AoR under the Class VI regulation were developed assuming that GCS reservoirs would be in hydrostatic equilibrium with overlying aquifers. Here we develop and apply an approach to estimating AoR for sites with preinjection relative overpressure for which standard AoR estimation methods produces an infinite AoR. The approach we take is to compare brine leakage through a hypothetical open flowmore » path in the base-case scenario (no-injection) to the incrementally larger leakage that would occur in the CO 2-injection case. To estimate AoR by this method, we used semi-analytical solutions to single-phase flow equations to model reservoir pressurization and flow up (single) leaky wells located at progressively greater distances from the injection well. We found that the incrementally larger flow rates for hypothetical leaky wells located 6 km and 4 km from the injection well are ~20% and 30% greater, respectively, than hypothetical baseline leakage rates. If total brine leakage is considered, the results depend strongly on how the incremental increase in total leakage is calculated, varying from a few percent to up to 40% greater (at most at early time) than base-case total leakage.« less

Numerical modeling of axi-symmetrical cold forging process by ``Pseudo Inverse Approach''

NASA Astrophysics Data System (ADS)

Halouani, A.; Li, Y. M.; Abbes, B.; Guo, Y. Q.

2011-05-01

The incremental approach is widely used for the forging process modeling, it gives good strain and stress estimation, but it is time consuming. A fast Inverse Approach (IA) has been developed for the axi-symmetric cold forging modeling [1-2]. This approach exploits maximum the knowledge of the final part's shape and the assumptions of proportional loading and simplified tool actions make the IA simulation very fast. The IA is proved very useful for the tool design and optimization because of its rapidity and good strain estimation. However, the assumptions mentioned above cannot provide good stress estimation because of neglecting the loading history. A new approach called "Pseudo Inverse Approach" (PIA) was proposed by Batoz, Guo et al.. [3] for the sheet forming modeling, which keeps the IA's advantages but gives good stress estimation by taking into consideration the loading history. Our aim is to adapt the PIA for the cold forging modeling in this paper. The main developments in PIA are resumed as follows: A few intermediate configurations are generated for the given tools' positions to consider the deformation history; the strain increment is calculated by the inverse method between the previous and actual configurations. An incremental algorithm of the plastic integration is used in PIA instead of the total constitutive law used in the IA. An example is used to show the effectiveness and limitations of the PIA for the cold forging process modeling.

Heat increment of feeding in Steller sea lions, Eumetopias jubatus.

PubMed

Rosen, D A; Trites, A W

1997-11-01

The heat increment of feeding (HIF) was measured in six captive, juvenile Steller sea lions (Eumetopias jubatus), fed meals of either 2 or 4 kg of herring. HIF was calculated as the post-prandial increase in metabolism above baseline levels, and was measured using open-circuit (gas) respirometry. It averaged 12.4 +/- 0.9% (SE) of ingested energy intake for the 4-kg meal trials, and 9.9 +/- 0.9% for the 2-kg meal size. The effect lasted 8-10 hr for the larger meal size. Metabolism peaked 3.7 hr after feeding, and was 2.13 times higher than baseline levels. For the 2-kg meal size, the effect lasted 6-8 hr, with metabolism peaking 2.8 hr after ingestion at 1.76 times baseline levels. Our estimates of HIF for Steller sea lions are at the lower end of estimates for terrestrial mammals, and are consistent with estimates for other marine mammals.

Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania

PubMed Central

2012-01-01

Background Cervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV) offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900), Tanzania and to model incremental scaled-up costs of a regional vaccination program. Methods We first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998) and class-based (class 6) vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI). Results Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose). Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose. Conclusions Project costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention. Potentially, integrating HPV vaccine delivery with cost-effective school-based health interventions and a reduction of vaccine price below US$5 per dose would further reduce the costs per fully HPV-immunized girl. PMID:23148516

Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania.

PubMed

Quentin, Wilm; Terris-Prestholt, Fern; Changalucha, John; Soteli, Selephina; Edmunds, W John; Hutubessy, Raymond; Ross, David A; Kapiga, Saidi; Hayes, Richard; Watson-Jones, Deborah

2012-11-13

Cervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV) offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900), Tanzania and to model incremental scaled-up costs of a regional vaccination program. We first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998) and class-based (class 6) vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI). Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose). Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose. Project costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention. Potentially, integrating HPV vaccine delivery with cost-effective school-based health interventions and a reduction of vaccine price below US$5 per dose would further reduce the costs per fully HPV-immunized girl.

Economic Burden of Attention-Deficit/Hyperactivity Disorder among Pediatric Patients in the United States.

PubMed

Gupte-Singh, Komal; Singh, Rakesh R; Lawson, Kenneth A

2017-04-01

To determine the adjusted incremental total costs (direct and indirect) for patients (aged 3-17 years) with attention-deficit/hyperactivity disorder (ADHD) and the differences in the adjusted incremental direct expenditures with respect to age groups (preschoolers, 0-5 years; children, 6-11 years; and adolescents, 12-17 years). The 2011 Medical Expenditure Panel Survey was used as the data source. The ADHD cohort consisted of patients aged 0 to 17 years with a diagnosis of ADHD, whereas the non-ADHD cohort consisted of subjects in the same age range without a diagnosis of ADHD. The annual incremental total cost of ADHD is composed of the incremental direct expenditures and indirect costs. A two-part model with a logistic regression (first part) and a generalized linear model (second part) was used to estimate the incremental costs of ADHD while controlling for patient characteristics and access-to-care variables. The 2011 Medical Expenditure Panel Survey database included 9108 individuals aged 0 to 17 years, with 458 (5.0%) having an ADHD diagnosis. The ADHD cohort was 4.90 times more likely (95% confidence interval [CI] 2.97-8.08; P < 0.001) than the non-ADHD cohort to have an expenditure of at least $1, and among those with positive expenditures, the ADHD cohort had 58.4% higher expenditures than the non-ADHD cohort (P < 0.001). The estimated adjusted annual total incremental cost of ADHD was $949.24 (95% CI $593.30-$1305.18; P < 0.001). The adjusted annual incremental total direct expenditure for ADHD was higher among preschoolers ($989.34; 95% CI $402.70-$1575.98; P = 0.001) than among adolescents ($894.94; 95% CI $428.16-$1361.71; P < 0.001) or children ($682.71; 95% CI $347.94-$1017.48; P < 0.001). Early diagnosis and use of evidence-based treatments may address the substantial burden of ADHD. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-Effectiveness of Endovascular Stroke Therapy: A Patient Subgroup Analysis From a US Healthcare Perspective.

PubMed

Kunz, Wolfgang G; Hunink, M G Myriam; Sommer, Wieland H; Beyer, Sebastian E; Meinel, Felix G; Dorn, Franziska; Wirth, Stefan; Reiser, Maximilian F; Ertl-Wagner, Birgit; Thierfelder, Kolja M

2016-11-01

Endovascular therapy in addition to standard care (EVT+SC) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke. Our aim was to determine the cost-effectiveness of EVT+SC depending on patients' initial National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion location. A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with both strategies applied in a US setting. Model input parameters were obtained from the literature, including recently pooled outcome data of 5 randomized controlled trials (ESCAPE [Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke], EXTEND-IA [Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial], MR CLEAN [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], REVASCAT [Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within 8 Hours of Symptom Onset], and SWIFT PRIME [Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment]). Probabilistic sensitivity analysis was performed to estimate uncertainty of the model results. Net monetary benefits, incremental costs, incremental effectiveness, and incremental cost-effectiveness ratios were derived from the probabilistic sensitivity analysis. The willingness-to-pay was set to $50 000/QALY. Overall, EVT+SC was cost-effective compared with SC (incremental cost: $4938, incremental effectiveness: 1.59 QALYs, and incremental cost-effectiveness ratio: $3110/QALY) in 100% of simulations. In all patient subgroups, EVT+SC led to gained QALYs (range: 0.47-2.12), and mean incremental cost-effectiveness ratios were considered cost-effective. However, subgroups with ASPECTS ≤5 or with M2 occlusions showed considerably higher incremental cost-effectiveness ratios ($14 273/QALY and $28 812/QALY, respectively) and only reached suboptimal acceptability in the probabilistic sensitivity analysis (75.5% and 59.4%, respectively). All other subgroups had acceptability rates of 90% to 100%. EVT+SC is cost-effective in most subgroups. In patients with ASPECTS ≤5 or with M2 occlusions, cost-effectiveness remains uncertain based on current data. © 2016 American Heart Association, Inc.

Net primary productivity, allocation pattern and carbon use efficiency in an apple orchard assessed by integrating eddy-covariance, biometric and continuous soil chamber measurements

NASA Astrophysics Data System (ADS)

Zanotelli, D.; Montagnani, L.; Manca, G.; Tagliavini, M.

2012-10-01

Carbon use efficiency (CUE) is a functional parameter that could possibly link the current increasingly accurate global estimates of gross primary production with those of net ecosystem exchange, for which global predictors are still unavailable. Nevertheless, CUE estimates are actually available for only a few ecosystem types, while information regarding agro-ecosystems is scarce, in spite of the simplified spatial structure of these ecosystems that facilitates studies on allocation patterns and temporal growth dynamics. We combined three largely deployed methods, eddy covariance, soil respiration and biometric measurements, to assess monthly values of CUE, net primary production (NPP) and allocation patterns in different plant organs in an apple orchard during a complete year (2010). We applied a~measurement protocol optimized for quantifying monthly values of carbon fluxes in this ecosystem type, which allows for a cross-check between estimates obtained from different methods. We also attributed NPP components to standing biomass increments, detritus cycle feeding and lateral exports. We found that in the apple orchard both net ecosystem production and gross primary production on yearly basis, 380 ± 30 g C m-2 and 1263 ± 189 g C m-2 respectively, were of a magnitude comparable to those of natural forests growing in similar climate conditions. The largest differences with respect to forests are in the allocation pattern and in the fate of produced biomass. The carbon sequestered from the atmosphere was largely allocated to production of fruits: 49% of annual NPP was taken away from the ecosystem through apple production. Organic material (leaves, fine root litter, pruned wood and early fruit falls) contributing to the detritus cycle was 46% of the NPP. Only 5% was attributable to standing biomass increment, while this NPP component is generally the largest in forests. The CUE, with an annual average of 0.71 ± 0.09, was higher than the previously suggested constant values of 0.47-0.50. Low nitrogen investment in fruits, the limited root-apparatus, and the optimal growth temperature and nutritional condition observed at the site are suggested to be explanatory variables for the high CUE observed.

A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department.

PubMed

Hohl, Corinne Michèle; Nosyk, Bohdan; Sadatsafavi, Mohsen; Anis, Aslam Hayat

2008-01-01

To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED). The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared to midazolam. A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated. The authors derived estimates of clinical effectiveness and risk of adverse events (AEs) from a systematic review. The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit, the cost of the drug, the cost of labor of physicians and nurses, the cost and probability of an AE, and the cost and probability of a PS failure. A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation. Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed. This resulted in an incremental cost-effectiveness ratio of -$597.03 (95% credibility interval -$6,434.03 to $6,113.57) indicating savings of $597.03 per additional successful sedation performed with propofol. This result was driven by shorter recovery times and was robust to all sensitivity analyses performed. These results indicate that using propofol for PS in the ED is a cost-saving strategy.

A close examination of healthcare expenditures related to fractures.

PubMed

Kilgore, Meredith L; Curtis, Jeffrey R; Delzell, Elizabeth; Becker, David J; Arora, Tarun; Saag, Kenneth G; Morrisey, Michael A

2013-04-01

This study evaluated reasons for healthcare expenditures both before and after the occurrence of fractures among Medicare beneficiaries. In a previous study we examined healthcare expenditures in the 6 months before and after fractures. The difference-"incremental" expenditures-provides one estimate of the potentially avoidable costs associated with fractures. We constructed a second estimate of the cost burden-"attributable" expenditures-using only those costs recorded in claims with fracture diagnosis codes. Attributable expenditures accounted for only 24% to 60% of incremental expenditures, depending on the fracture site. We examined health care expenditures between 1999 and 2005 among Medicare beneficiaries who experienced fractures (cases) and among beneficiaries who did not experience fractures (controls), matched to cases on age, race, and sex. We also examined healthcare expenditures for cases and controls for 24 months prior to the fracture index date. When expenditures associated with diagnoses for aftercare, joint pain, and osteoporosis, other musculoskeletal diagnoses, pneumonia, and pressure ulcers were included, the proportion of incremental costs directly attributable to fracture care rose to 72% to 88%. Expenditures prior to fracture were higher for cases than controls, and the rate of increase accelerated over the 12 months prior to the hip fracture. Our findings confirm that the original incremental cost analysis constituted a satisfactory method for estimating avoidable costs associated with fractures. We also conclude that those with fractures had much higher and growing healthcare expenditures in the 12 months prior to the event, compared with age-, race-, and sex-matched controls. This suggests that patterns of healthcare services utilization may provide a means to improve fracture prediction rules. Copyright © 2013 American Society for Bone and Mineral Research.

Incremental cost effectiveness of proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug ulcers: a pharmacoeconomic analysis linked to a case-control study.

PubMed

Vonkeman, Harald E; Braakman-Jansen, Louise M A; Klok, Rogier M; Postma, Maarten J; Brouwers, Jacobus R B J; van de Laar, Mart A F J

2008-01-01

We estimated the cost effectiveness of concomitant proton pump inhibitors (PPIs) in relation to the occurrence of non-steroidal anti-inflammatory drug (NSAID) ulcer complications. This study was linked to a nested case-control study. Patients with NSAID ulcer complications were compared with matched controls. Only direct medical costs were reported. For the calculation of the incremental cost effectiveness ratio we extrapolated the data to 1,000 patients using concomitant PPIs and 1,000 patients not using PPIs for 1 year. Sensitivity analysis was performed by 'worst case' and 'best case' scenarios in which the 95% confidence interval (CI) of the odds ratio (OR) and the 95% CI of the cost estimate of a NSAID ulcer complication were varied. Costs of PPIs was varied separately. In all, 104 incident cases and 284 matched controls were identified from a cohort of 51,903 NSAID users with 10,402 NSAID exposition years. Use of PPIs was associated with an adjusted OR of 0.33 (95% CI 0.17 to 0.67; p = 0.002) for NSAID ulcer complications. In the extrapolation the estimated number of NSAID ulcer complications was 13.8 for non-PPI users and 3.6 for PPI users. The incremental total costs were euro 50,094 higher for concomitant PPIs use. The incremental cost effectiveness ratio was euro 4,907 per NSAID ulcer complication prevented when using the least costly PPIs. Concomitant use of PPIs for the prevention of NSAID ulcer complications costs euro 4,907 per NSAID ulcer complication prevented when using the least costly PPIs. The price of PPIs highly influenced the robustness of the results.

Cost-Effectiveness of a Home Based Intervention for Secondary Prevention of Readmission with Chronic Heart Disease

PubMed Central

Byrnes, Joshua; Carrington, Melinda; Chan, Yih-Kai; Pollicino, Christine; Dubrowin, Natalie; Stewart, Simon; Scuffham, Paul A.

2015-01-01

The aim of this study is to consider the cost-effectiveness of a nurse-led, home-based intervention (HBI) in cardiac patients with private health insurance compared to usual post-discharge care. A within trial analysis of the Young @ Heart multicentre, randomized controlled trial along with a micro-simulation decision analytical model was conducted to estimate the incremental costs and quality adjusted life years associated with the home based intervention compared to usual care. For the micro-simulation model, future costs, from the perspective of the funder, and effects are estimated over a twenty-year time horizon. An Incremental Cost-Effectiveness Ratio, along with Incremental Net Monetary Benefit, is evaluated using a willingness to pay threshold of $50,000 per quality adjusted life year. Sub-group analyses are conducted for men and women across three age groups separately. Costs and benefits that arise in the future are discounted at five percent per annum. Overall, home based intervention for secondary prevention in patients with chronic heart disease identified in the Australian private health care sector is not cost-effective. The estimated within trial incremental net monetary benefit is -$3,116 [95%CI: -11,145, $4,914]; indicating that the costs outweigh the benefits. However, for males and in particular males aged 75 years and above, home based intervention indicated a potential to reduce health care costs when compared to usual care (within trial: -$10,416 [95%CI: -$26,745, $5,913]; modelled analysis: -$1,980 [95%CI: -$22,843, $14,863]). This work provides a crucial impetus for future research to understand for whom disease management programs are likely to benefit most. PMID:26657844

Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis

PubMed Central

Sander, Beate; Kwong, Jeffrey C.; Bauch, Chris T.; Maetzel, Andreas; McGeer, Allison; Raboud, Janet M.; Krahn, Murray

2010-01-01

Background In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP). Methods and Findings A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted. Conclusions Universal immunization against seasonal influenza was estimated to be an economically attractive intervention. Please see later in the article for the Editors' Summary PMID:20386727

Potential stocks and increments of woody biomass in the European Union under different management and climate scenarios.

PubMed

Kindermann, Georg E; Schörghuber, Stefan; Linkosalo, Tapio; Sanchez, Anabel; Rammer, Werner; Seidl, Rupert; Lexer, Manfred J

2013-02-01

Forests play an important role in the global carbon flow. They can store carbon and can also provide wood which can substitute other materials. In EU27 the standing biomass is steadily increasing. Increments and harvests seem to have reached a plateau between 2005 and 2010. One reason for reaching this plateau will be the circumstance that the forests are getting older. High ages have the advantage that they typical show high carbon concentration and the disadvantage that the increment rates are decreasing. It should be investigated how biomass stock, harvests and increments will develop under different climate scenarios and two management scenarios where one is forcing to store high biomass amounts in forests and the other tries to have high increment rates and much harvested wood. A management which is maximising standing biomass will raise the stem wood carbon stocks from 30 tC/ha to 50 tC/ha until 2100. A management which is maximising increments will lower the stock to 20 tC/ha until 2100. The estimates for the climate scenarios A1b, B1 and E1 are different but there is much more effect by the management target than by the climate scenario. By maximising increments the harvests are 0.4 tC/ha/year higher than in the management which maximises the standing biomass. The increments until 2040 are close together but around 2100 the increments when maximising standing biomass are approximately 50 % lower than those when maximising increments. Cold regions will benefit from the climate changes in the climate scenarios by showing higher increments. The results of this study suggest that forest management should maximise increments, not stocks to be more efficient in sense of climate change mitigation. This is true especially for regions which have already high carbon stocks in forests, what is the case in many regions in Europe. During the time span 2010-2100 the forests of EU27 will absorb additional 1750 million tC if they are managed to maximise increments compared if they are managed to maximise standing biomass. Incentives which will increase the standing biomass beyond the increment optimal biomass should therefore be avoided. Mechanisms which will maximise increments and sustainable harvests need to be developed to have substantial amounts of wood which can be used as substitution of non sustainable materials.

Detecting Statistically Significant Communities of Triangle Motifs in Undirected Networks

DTIC Science & Technology

2015-03-16

moderately-sized networks. As a consequence, throughout this effort, a simulated annealing (SA) algorithm will be employed to effectively search the...then increment k by 1 and repeat the search to find z∗3. Once can continue to increment k until W < zδ, at which point the algorithm will stop and...collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources

Investigation of Drag and Pressure Distribution of Windshields at High Speeds

DTIC Science & Technology

1942-01-01

sharp nega~ive pressure .peaks.and by 10V positivs preqsuro gradisnts-o?er the tail. Of the windshields rppresonted In-figure 11, the -“ &&rne ~nea...extension of the field with Mach number. In the quantitative discus~.on of Interference, it Is convenient to consider the velocity-increment coeffl- , 19...Before the effect of Interference due to the wing and fuselage can be quantitatively estimated, the veloci- ty increments due to these bodies must be

Association between progression-free survival and health-related quality of life in oncology: a systematic review protocol

PubMed Central

Kovic, Bruno; Guyatt, Gordon; Brundage, Michael; Thabane, Lehana; Bhatnagar, Neera; Xie, Feng

2016-01-01

Introduction There is an increasing number of new oncology drugs being studied, approved and put into clinical practice based on improvement in progression-free survival, when no overall survival benefits exist. In oncology, the association between progression-free survival and health-related quality of life is currently unknown, despite its importance for patients with cancer, and the unverified assumption that longer progression-free survival indicates improved health-related quality of life. Thus far, only 1 study has investigated this association, providing insufficient evidence and inconclusive results. The objective of this study protocol is to provide increased transparency in supporting a systematic summary of the evidence bearing on this association in oncology. Methods and analysis Using the OVID platform in MEDLINE, Embase and Cochrane databases, we will conduct a systematic review of randomised controlled human trials addressing oncology issues published starting in 2000. A team of reviewers will, in pairs, independently screen and abstract data using standardised, pilot-tested forms. We will employ numerical integration to calculate mean incremental area under the curve between treatment groups in studies for health-related quality of life, along with total related error estimates, and a 95% CI around incremental area. To describe the progression-free survival to health-related quality of life association, we will construct a scatterplot for incremental health-related quality of life versus incremental progression-free survival. To estimate the association, we will use a weighted simple regression approach, comparing mean incremental health-related quality of life with either median incremental progression-free survival time or the progression-free survival HR, in the absence of overall survival benefit. Discussion Identifying direction and magnitude of association between progression-free survival and health-related quality of life is critically important in interpreting results of oncology trials. Systematic evidence produced from our study will contribute to improvement of patient care and practice of evidence-based medicine in oncology. PMID:27591026

Weapon System Requirements: Detailed Systems Engineering Prior to Product Development Positions Programs for Success

DTIC Science & Technology

2016-11-01

systems engineering had better outcomes. For example, the Small Diameter Bomb Increment I program, which delivered within cost and schedule estimates ...its current portfolio. This portfolio has experienced cost growth of 48 percent since first full estimates and average delays in delivering initial...stable design, building and testing of prototypes, and demonstration of mature production processes. • Realistic cost estimate : Sound cost estimates

An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.

PubMed

Walker, Damian; McDermott, Jeanne M; Fox-Rushby, Julia; Tanjung, Marwan; Nadjib, Mardiati; Widiatmoko, Dono; Achadi, Endang

2002-01-01

In order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US$ 764.6 and US$ 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US$ 1225.5 and US$ 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US$ 898.1 per intern if replicated elsewhere, and at a cost of US$ 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison.

Quantifying energy intake in Pacific bluefin tuna (Thunnus orientalis) using the heat increment of feeding.

PubMed

Whitlock, R E; Walli, A; Cermeño, P; Rodriguez, L E; Farwell, C; Block, B A

2013-11-01

Using implanted archival tags, we examined the effects of meal caloric value, food type (sardine or squid) and ambient temperature on the magnitude and duration of the heat increment of feeding in three captive juvenile Pacific bluefin tuna. The objective of our study was to develop a model that can be used to estimate energy intake in wild fish of similar body mass. Both the magnitude and duration of the heat increment of feeding (measured by visceral warming) showed a strong positive correlation with the caloric value of the ingested meal. Controlling for meal caloric value, the extent of visceral warming was significantly greater at lower ambient temperature. The extent of visceral warming was also significantly higher for squid meals compared with sardine meals. By using a hierarchical Bayesian model to analyze our data and treating individuals as random effects, we demonstrate how increases in visceral temperature can be used to estimate the energy intake of wild Pacific bluefin tuna of similar body mass to the individuals used in our study.

Validation of Growth Layer Group (GLG) depositional rate using daily incremental growth lines in the dentin of beluga (Delphinapterus leucas (Pallas, 1776)) teeth

PubMed Central

Suydam, Robert S.; Ortiz, Joseph D.; Thewissen, J. G. M.

2018-01-01

Counts of Growth Layer Groups (GLGs) in the dentin of marine mammal teeth are widely used as indicators of age. In most marine mammals, observations document that GLGs are deposited yearly, but in beluga whales, some studies have supported the view that two GLGs are deposited each year. Our understanding of beluga life-history differs substantially depending on assumptions regarding the timing of GLG deposition; therefore, resolving this issue has important considerations for population assessments. In this study, we used incremental lines that represent daily pulses of dentin mineralization to test the hypothesis that GLGs in beluga dentin are deposited on a yearly basis. Our estimate of the number of daily growth lines within one GLG is remarkably close to 365 days within error, supporting the hypothesis that GLGs are deposited annually in beluga. We show that measurement of daily growth increments can be used to validate the time represented by GLGs in beluga. Furthermore, we believe this methodology may have broader applications to age estimation in other taxa. PMID:29338011

Validation of Growth Layer Group (GLG) depositional rate using daily incremental growth lines in the dentin of beluga (Delphinapterus leucas (Pallas, 1776)) teeth.

PubMed

Waugh, David A; Suydam, Robert S; Ortiz, Joseph D; Thewissen, J G M

2018-01-01

Counts of Growth Layer Groups (GLGs) in the dentin of marine mammal teeth are widely used as indicators of age. In most marine mammals, observations document that GLGs are deposited yearly, but in beluga whales, some studies have supported the view that two GLGs are deposited each year. Our understanding of beluga life-history differs substantially depending on assumptions regarding the timing of GLG deposition; therefore, resolving this issue has important considerations for population assessments. In this study, we used incremental lines that represent daily pulses of dentin mineralization to test the hypothesis that GLGs in beluga dentin are deposited on a yearly basis. Our estimate of the number of daily growth lines within one GLG is remarkably close to 365 days within error, supporting the hypothesis that GLGs are deposited annually in beluga. We show that measurement of daily growth increments can be used to validate the time represented by GLGs in beluga. Furthermore, we believe this methodology may have broader applications to age estimation in other taxa.

Comparative cost-effectiveness of two interventions to promote work functioning by targeting mental health complaints among nurses: pragmatic cluster randomised trial.

PubMed

Noben, Cindy; Smit, Filip; Nieuwenhuijsen, Karen; Ketelaar, Sarah; Gärtner, Fania; Boon, Brigitte; Sluiter, Judith; Evers, Silvia

2014-10-01

The specific job demands of working in a hospital may place nurses at elevated risk for developing distress, anxiety and depression. Screening followed by referral to early interventions may reduce the incidence of these health problems and promote work functioning. To evaluate the comparative cost-effectiveness of two strategies to promote work functioning among nurses by reducing symptoms of mental health complaints. Three conditions were compared: the control condition consisted of online screening for mental health problems without feedback about the screening results. The occupational physician condition consisted of screening, feedback and referral to the occupational physician for screen-positive nurses. The third condition included screening, feedback, and referral to e-mental health. The study was designed as an economic evaluation alongside a pragmatic cluster randomised controlled trial with randomisation at hospital-ward level. The study included 617 nurses in one academic medical centre in the Netherlands. Treatment response was defined as an improvement on the Nurses Work Functioning Questionnaire of at least 40% between baseline and follow-up. Total per-participant costs encompassed intervention costs, direct medical and non-medical costs, and indirect costs stemming from lost productivity due to absenteeism and presenteeism. All costs were indexed for the year 2011. At 6 months follow-up, significant improvement in work functioning occurred in 20%, 24% and 16% of the participating nurses in the control condition, the occupational physician condition and the e-mental health condition, respectively. In these conditions the total average annualised costs were €1752, €1266 and €1375 per nurse. The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant, suggesting cost savings of €5049 per treatment responder. The incremental cost-effectiveness ratio for the e-mental health condition versus the control condition was estimated at €4054 (added costs) per treatment responder. Sensitivity analyses attested to the robustness of these findings. The occupational physician condition resulted in greater treatment responses for less costs relative to the control condition and can therefore be recommended. The e-mental health condition produced less treatment response than the control condition and cannot be recommended as an intervention to improve work functioning among nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Study on Mutil-Scale Background Error Covariances in 3D-Var Data Assimilation

NASA Astrophysics Data System (ADS)

Zhang, Xubin; Tan, Zhe-Min

2017-04-01

The construction of background error covariances is a key component of three-dimensional variational data assimilation. There are different scale background errors and interactions among them in the numerical weather Prediction. However, the influence of these errors and their interactions cannot be represented in the background error covariances statistics when estimated by the leading methods. So, it is necessary to construct background error covariances influenced by multi-scale interactions among errors. With the NMC method, this article firstly estimates the background error covariances at given model-resolution scales. And then the information of errors whose scales are larger and smaller than the given ones is introduced respectively, using different nesting techniques, to estimate the corresponding covariances. The comparisons of three background error covariances statistics influenced by information of errors at different scales reveal that, the background error variances enhance particularly at large scales and higher levels when introducing the information of larger-scale errors by the lateral boundary condition provided by a lower-resolution model. On the other hand, the variances reduce at medium scales at the higher levels, while those show slight improvement at lower levels in the nested domain, especially at medium and small scales, when introducing the information of smaller-scale errors by nesting a higher-resolution model. In addition, the introduction of information of larger- (smaller-) scale errors leads to larger (smaller) horizontal and vertical correlation scales of background errors. Considering the multivariate correlations, the Ekman coupling increases (decreases) with the information of larger- (smaller-) scale errors included, whereas the geostrophic coupling in free atmosphere weakens in both situations. The three covariances obtained in above work are used in a data assimilation and model forecast system respectively, and then the analysis-forecast cycles for a period of 1 month are conducted. Through the comparison of both analyses and forecasts from this system, it is found that the trends for variation in analysis increments with information of different scale errors introduced are consistent with those for variation in variances and correlations of background errors. In particular, introduction of smaller-scale errors leads to larger amplitude of analysis increments for winds at medium scales at the height of both high- and low- level jet. And analysis increments for both temperature and humidity are greater at the corresponding scales at middle and upper levels under this circumstance. These analysis increments improve the intensity of jet-convection system which includes jets at different levels and coupling between them associated with latent heat release, and these changes in analyses contribute to the better forecasts for winds and temperature in the corresponding areas. When smaller-scale errors are included, analysis increments for humidity enhance significantly at large scales at lower levels to moisten southern analyses. This humidification devotes to correcting dry bias there and eventually improves forecast skill of humidity. Moreover, inclusion of larger- (smaller-) scale errors is beneficial for forecast quality of heavy (light) precipitation at large (small) scales due to the amplification (diminution) of intensity and area in precipitation forecasts but tends to overestimate (underestimate) light (heavy) precipitation .

Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier

PubMed Central

Berger, Ariel; Inglese, Gary; Skountrianos, George; Karlsmark, Tonny; Oguz, Mustafa

2018-01-01

PURPOSE: To assess the cost-effectiveness of a ceramide-infused skin barrier (CIB) versus other skin barriers (standard of care) among patients who have undergone ostomy creation. DESIGN: Cost-effectiveness analysis, based on a decision-analytic model that was estimated using data from the ADVOCATE (A Study Determining Variances in Ostomy Skin Conditions And The Economic Impact) trial, which investigated stoma-related healthcare costs over 12 weeks among patients who recently underwent fecal ostomy, and from other sources. SUBJECTS AND SETTING: Analysis was based on a hypothetical cohort of 1000 patients who recently underwent fecal ostomy; over a 1-year period, 500 patients were assumed to use CIB and 500 were assumed to use standard of care. METHODS: We adapted a previous economic model to estimate expected 1-year costs and outcomes among persons with a new ostomy assumed to use CIB versus standard of care. Outcomes of interest included peristomal skin complications (PSCs) (up to 2 during the 1-year period of interest) and quality-adjusted life days (QALDs); QALDs vary from 1, indicating a day of perfect health to 0, indicating a day with the lowest possible health (deceased). Subjects were assigned QALDs on a daily basis, with the value of the QALD on any given day based on whether the patient was experiencing a PSC. Costs included those related to skin barriers, ostomy accessories, and care of PSCs. The incremental cost-effectiveness of CIB versus standard of care was estimated as the incremental cost per PSC averted and QALD gained, respectively; net monetary benefit of CIB was also estimated. All analyses were run using the perspective of an Australian payer. RESULTS: On a per-patient basis, use of CIB was expected over a 1-year period to result in 0.16 fewer PSCs, an additional 0.35 QALDs, and a savings of A$180 (Australian dollars, US $137) in healthcare costs all versus standard of care. Management with CIB provided a net monetary benefit (calculated as the product of maximum willingness to pay for 1 QALD times additional QALDs with CIB less the incremental cost of CIB) of A$228 (US $174). Probabilistic sensitivity analysis was also completed; it revealed that 97% of model runs resulted in fewer expected PSCs with CIB; 92% of these runs resulted in lower expected costs with CIB. CONCLUSIONS: Findings suggest that the CIB is a cost-effective skin barrier for persons living with an ostomy. PMID:29438140

Lift hysteresis at stall as an unsteady boundary-layer phenomenon

NASA Technical Reports Server (NTRS)

Moore, Franklin K

1956-01-01

Analysis of rotating stall of compressor blade rows requires specification of a dynamic lift curve for the airfoil section at or near stall, presumably including the effect of lift hysteresis. Consideration of the magnus lift of a rotating cylinder suggests performing an unsteady boundary-layer calculation to find the movement of the separation points of an airfoil fixed in a stream of variable incidence. The consideration of the shedding of vorticity into the wake should yield an estimate of lift increment proportional to time rate of change of angle of attack. This increment is the amplitude of the hysteresis loop. An approximate analysis is carried out according to the foregoing ideas for a 6:1 elliptic airfoil at the angle of attack for maximum lift. The assumptions of small perturbations from maximum lift are made, permitting neglect of distributed vorticity in the wake. The calculated hysteresis loop is counterclockwise. Finally, a discussion of the forms of hysteresis loops is presented; and, for small reduced frequency of oscillation, it is concluded that the concept of a viscous "time lag" is appropriate only for harmonic variations of angle of attack with time at mean conditions other than maximum lift.

Adaptive and predictive control of a simulated robot arm.

PubMed

Tolu, Silvia; Vanegas, Mauricio; Garrido, Jesús A; Luque, Niceto R; Ros, Eduardo

2013-06-01

In this work, a basic cerebellar neural layer and a machine learning engine are embedded in a recurrent loop which avoids dealing with the motor error or distal error problem. The presented approach learns the motor control based on available sensor error estimates (position, velocity, and acceleration) without explicitly knowing the motor errors. The paper focuses on how to decompose the input into different components in order to facilitate the learning process using an automatic incremental learning model (locally weighted projection regression (LWPR) algorithm). LWPR incrementally learns the forward model of the robot arm and provides the cerebellar module with optimal pre-processed signals. We present a recurrent adaptive control architecture in which an adaptive feedback (AF) controller guarantees a precise, compliant, and stable control during the manipulation of objects. Therefore, this approach efficiently integrates a bio-inspired module (cerebellar circuitry) with a machine learning component (LWPR). The cerebellar-LWPR synergy makes the robot adaptable to changing conditions. We evaluate how this scheme scales for robot-arms of a high number of degrees of freedom (DOFs) using a simulated model of a robot arm of the new generation of light weight robots (LWRs).

Spatial and temporal variation in recruitment and growth of Channel Catfish Alabama bass and Tallapoosa Bass in the Tallapoosa River and associated tributaries

USGS Publications Warehouse

Irwin, Elise R.; Goar, Taconya

2015-01-01

Effects of hydrology on growth and hatching success of age-0 black basses and Channel Catfish were examined in regulated and unregulated reaches of the Tallapoosa River, Alabama. Species of the family Centrarchidae, Ictalurus punctatus Channel Catfish and Pylodictis olivaris Flathead Catfish were also collected from multiple tributaries in the basin. Fish were collected from 2010-2014 and were assigned daily ages using otoliths. Hatch dates of individuals of three species (Micropterus henshalli Alabama Bass, M. tallapoosae Tallapoosa Bass and Channel Catfish) were back calculated, and growth histories were estimated every 5 d post hatch from otolith sections using incremental growth analysis. Hatch dates and incremental growth were related to hydrologic and temperature metrics from environmental data collected during the same time periods. Hatch dates at the regulated sites were related to and typically occurred during periods with low and stable flow conditions; however no clear relations between hatch and thermal or flow metrics were evident for the unregulated sites. Some fish hatched during unsuitable thermal conditions at the regulated site suggesting that some fish may recruit from unregulated tributaries. Ages and growth rates of age-0 black basses ranged from 105 to 131 d and 0.53 to 1.33 mm/day at the regulated sites and 44 to 128 d and 0.44 to 0.96 mm/d at the unregulated sites. In general, growth was highest among age-0 fish from the regulated sites, consistent with findings of other studies. Mortality of age-0 to age-1 fish was also variable among years and between sites and with the exception of one year, was lower at regulated sites. Multiple and single regression models of incremental growth versus age, discharge, and temperature metrics were evaluated with Akaike’s Information Criterion (AICc) to assess models that best described growth parameters. Of the models evaluated, the best overall models predicted that daily incremental growth was positively related to low flow parameters and negatively related to the number of times the hydrograph changed direction (e.g., reversals). These results suggest that specific flow and temperature criteria provided from the dam could potentially enhance growth and hatch success of these important sport fish species.

Life tables and reproductive parameters of Lutzomyia spinicrassa (Diptera: Psychodidae) under laboratory conditions.

PubMed

Escovar, Jesús; Bello, Felio J; Morales, Alberto; Moncada, Ligia; Cárdenas, Estrella

2004-10-01

Lutzomyia spinicrassa is a vector of Leishmania braziliensis in Colombia. This sand fly has a broad geographical distribution in Colombia and Venezuela and it is found mainly in coffee plantations. Baseline biological growth data of L. spinicrassa were obtained under experimental laboratory conditions. The development time from egg to adult ranged from 59 to 121 days, with 12.74 weeks in average. Based on cohorts of 100 females, horizontal life table was constructed. The following predictive parameters were obtained: net rate of reproduction (8.4 females per cohort female), generation time (12.74 weeks), intrinsic rate of population increase (0.17), and finite rate of population increment (1.18). The reproductive value for each class age of the cohort females was calculated. Vertical life tables were elaborated and mortality was described for the generation obtained of the field cohort. In addition, for two successive generations, additive variance and heritability for fecundity were estimated.

Generation of stimulated noncoherent radiation in light-scattering media exhibiting chemical reactions

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

Izmailov, I.A.; Kochelap, V.A.; Mel'nikov, L.Y.

1982-05-01

It is proposed that a feedback resulting from scattering be used to achieve lasing in a disperse reactive medium. The example of a simple two-level system shows that under advanced lasing conditions the quantum efficiency of the radiation emission approaches the quantum efficiency of the excitation of the upper level, and the emission spectrum becomes much narrower. Feasibility of chemical pumping of such a laser is estimated on the basis of calculations of heterophase burning of a drop of a fuel in an oxidizing atmosphere. The growth increment of light is calculated and the threshold conditions for the excitation ofmore » lasing are found. Examples are given to illustrate the feasibility of purely chemical pumping of a laser with a nonresonant feedback. It is shown that dense reactive media can be used in such lasers.« less

Cost-utility analysis of screening for diabetic retinopathy in Japan: a probabilistic Markov modeling study.

PubMed

Kawasaki, Ryo; Akune, Yoko; Hiratsuka, Yoshimune; Fukuhara, Shunichi; Yamada, Masakazu

2015-02-01

To evaluate the cost-effectiveness for a screening interval longer than 1 year detecting diabetic retinopathy (DR) through the estimation of incremental costs per quality-adjusted life year (QALY) based on the best available clinical data in Japan. A Markov model with a probabilistic cohort analysis was framed to calculate incremental costs per QALY gained by implementing a screening program detecting DR in Japan. A 1-year cycle length and population size of 50,000 with a 50-year time horizon (age 40-90 years) was used. Best available clinical data from publications and national surveillance data was used, and a model was designed including current diagnosis and management of DR with corresponding visual outcomes. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters. In the base-case analysis, the strategy with a screening program resulted in an incremental cost of 5,147 Japanese yen (¥; US$64.6) and incremental effectiveness of 0.0054 QALYs per person screened. The incremental cost-effectiveness ratio was ¥944,981 (US$11,857) per QALY. The simulation suggested that screening would result in a significant reduction in blindness in people aged 40 years or over (-16%). Sensitivity analyses suggested that in order to achieve both reductions in blindness and cost-effectiveness in Japan, the screening program should screen those aged 53-84 years, at intervals of 3 years or less. An eye screening program in Japan would be cost-effective in detecting DR and preventing blindness from DR, even allowing for the uncertainties in estimates of costs, utility, and current management of DR.

Increasing Growth of Established Teak

Treesearch

C. B. Briscoe; Raul Ybarra-Cornado

1971-01-01

Teak plantations, 3 to 16 years old, were thinned and fertilized in an effort to increase productivity. The best single method for increasing rate of tree increment was removal of competitors. Larger trees had a faster basal area increment but slower height growth than smaller trees on the same site conditions. Height growth was greater in the areas with higher...

Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014.

PubMed

Kirkland, Elizabeth B; Heincelman, Marc; Bishu, Kinfe G; Schumann, Samuel O; Schreiner, Andrew; Axon, R Neal; Mauldin, Patrick D; Moran, William P

2018-05-30

One in 3 US adults has high blood pressure, or hypertension. As prior projections suggest hypertension is the costliest of all cardiovascular diseases, it is important to define the current state of healthcare expenditures related to hypertension. We used a nationally representative database, the Medical Expenditure Panel Survey, to calculate the estimated annual healthcare expenditure for patients with hypertension and to measure trends in expenditure longitudinally over a 12-year period. A 2-part model was used to estimate adjusted incremental expenditures for individuals with hypertension versus those without hypertension. Sex, race/ethnicity, education, insurance status, census region, income, marital status, Charlson Comorbidity Index, and year category were included as covariates. The 2003-2014 pooled data include a total sample of 224 920 adults, of whom 36.9% had hypertension. Unadjusted mean annual medical expenditure attributable to patients with hypertension was $9089. Relative to individuals without hypertension, individuals with hypertension had $1920 higher annual adjusted incremental expenditure, 2.5 times the inpatient cost, almost double the outpatient cost, and nearly triple the prescription medication expenditure. Based on the prevalence of hypertension in the United States, the estimated adjusted annual incremental cost is $131 billion per year higher for the hypertensive adult population compared with the nonhypertensive population. Individuals with hypertension are estimated to face nearly $2000 higher annual healthcare expenditure compared with their nonhypertensive peers. This trend has been relatively stable over 12 years. Healthcare costs associated with hypertension account for about $131 billion. This warrants intense effort toward hypertension prevention and management. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Support vector machine incremental learning triggered by wrongly predicted samples

NASA Astrophysics Data System (ADS)

Tang, Ting-long; Guan, Qiu; Wu, Yi-rong

2018-05-01

According to the classic Karush-Kuhn-Tucker (KKT) theorem, at every step of incremental support vector machine (SVM) learning, the newly adding sample which violates the KKT conditions will be a new support vector (SV) and migrate the old samples between SV set and non-support vector (NSV) set, and at the same time the learning model should be updated based on the SVs. However, it is not exactly clear at this moment that which of the old samples would change between SVs and NSVs. Additionally, the learning model will be unnecessarily updated, which will not greatly increase its accuracy but decrease the training speed. Therefore, how to choose the new SVs from old sets during the incremental stages and when to process incremental steps will greatly influence the accuracy and efficiency of incremental SVM learning. In this work, a new algorithm is proposed to select candidate SVs and use the wrongly predicted sample to trigger the incremental processing simultaneously. Experimental results show that the proposed algorithm can achieve good performance with high efficiency, high speed and good accuracy.

Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale.

PubMed

Thind, Munveer; Ahmed, Mustafa I; Gok, Gulay; Joson, Marisa; Elsayed, Mahmoud; Tuck, Benjamin C; Townsley, Matthew M; Klas, Berthold; McGiffin, David C; Nanda, Navin C

2015-05-01

We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden. © 2015, Wiley Periodicals, Inc.

integrated Electronic Health Record Increment 1 (iEHR Inc 1)

DTIC Science & Technology

2016-03-01

Executive DoD - Department of Defense DoDAF - DoD Architecture Framework FD - Full Deployment FDD - Full Deployment Decision FY - Fiscal Year IA...Acronyms and Abbreviations ADM - Acquisition Decision Memorandum FD - Full Deployment FDD - Full Deployment Decision iEHR Inc 1 2016 MAR UNCLASSIFIED...iEHR Increment 1 APB for FDD achieved in November 2014 was signed by the MDA March 2, 2015. Current estimate is consistent with the FDD APB. iEHR Inc 1 2016 MAR UNCLASSIFIED 11

Public Key Infrastructure (PKI) Increment 2 Root Cause Analysis (RCA) for Performance Assessments and Root Cause Analyses (PARCA)

DTIC Science & Technology

2015-05-01

for issuing this critical change:  Inability to achieve PKI Increment 2 Full Deployment Decision ( FDD ) within five years of program initiation...March 1, 2014 deadline), and  Delay of over one year in the original FDD estimate provided to the Congress (1 March 2014 deadline). The proximate...to support a 1 March 2014 FDD .” The Director, Performance Assessments and Root Cause Analyses (PARCA), asked the Institute for Defense Analyses

Square Deal: Lower Bounds and Improved Relaxations for Tensor Recovery

DTIC Science & Technology

2013-08-16

problem size n from 10 to 30 with increment 1, and the observation ratio ρ from 0.01 to 0.2 with increment 0.01. For each (ρ, n)-pair, we simulate 5 test ...Foundations of Computational Mathematics, 12(6):805–849, 2012. [CRT] Emmanuel J. Candès, Justin K. Romberg , and Terence Tao. Stable signal recov- ery...2012. [SDS10] Marco Signoretto, Lieven De Lathauwer, and Johan AK Suykens. Nuclear norms for tensors and their use for convex multilinear estimation

Impact of hospital-acquired conditions on financial liabilities for Medicare patients.

PubMed

Coomer, Nicole M; Kandilov, Amy M G

2016-11-01

Hospital-acquired conditions (HACs) can increase the financial liabilities faced by patients when the HACs require additional treatment both in the hospital and in subsequent health care encounters. This article estimates incremental effects of 6 HACs on Medicare beneficiary financial liabilities. Descriptive and multivariate analyses were used to examine the differences in beneficiary liability between care episodes with and without HACs. Episodes included the index hospitalization in which the HAC occurred and all inpatient, outpatient, and physician claims within 90 days of index hospital discharge. Medicare fee-for-service patients discharged from a hospital in fiscal year (FY) 2009 or FY 2010 with severe pressure ulcer, fracture, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection, or deep vein thrombosis or pulmonary embolism after certain orthopedic procedures were matched by diagnosis, sex, race, and age to with patients without HACs. Medicare patients were liable for an additional $20.5 million per year across the HAC episodes compared with what they would have owed without the HACs. Beneficiaries with HACs were also more likely to exhaust their Part A days in the index hospitalization. HACs create significant financial burden for Medicare beneficiaries. The incremental financial liabilities are concentrated in the episode of care after the index hospitalization with the HAC. Policies and programs that reduce HAC incidence will improve Medicare beneficiaries' physical and financial health. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Retrieving water productivity parameters by using Landsat images in the Nilo Coelho irrigation scheme, Brazil

NASA Astrophysics Data System (ADS)

de C. Teixeira, Antônio H.; Lopes, Hélio L.; Hernandez, Fernando B. T.; Scherer-Warren, Morris; Andrade, Ricardo G.; Neale, Christopher M. U.

2013-10-01

The Nilo Coelho irrigation scheme, located in the semi-arid region of Brazil, is highlighted as an important agricultural irrigated perimeter. Considering the scenario of this fast land use change, the development and application of suitable tools to quantify the trends of the water productivity parameters on a large scale is important. To analyse the effects of land use change within this perimeter, the large-scale values of biomass production (BIO) and actual evapotranspiration (ET) were quantified from 1992 to 2011, under the naturally driest conditions along the year. Monteith's radiation model was applied for estimating the absorbed photosynthetically active radiation (APAR), while the SAFER (Simple Algorithm For Evapotranspiration Retrieving) algorithm was used to retrieve ET. The highest incremental BIO values happened during the years of 1999 and 2005, as a result of the increased agricultural area under production inside the perimeter, when the average differences between irrigated crops and natural vegetation were more than 70 kg ha-1 d-1. Comparing the average ET rates of 1992 (1.6 mm d-1) with those for 2011 (3.1 mm d-1), it was verified that the extra water consumption doubled because of the increments of irrigated areas along the years. More uniformity along the years on both water productivity parameters occurred for natural vegetation, evidenced by the lower values of standard deviation when comparing to irrigated crops. The heterogeneity of ET values under irrigation conditions are due to the different species, crop stages, cultural and water managements.

Cost-Effectiveness of Haemorrhoidal Artery Ligation versus Rubber Band Ligation for the Treatment of Grade II-III Haemorrhoids: Analysis Using Evidence from the HubBLe Trial.

PubMed

Alshreef, Abualbishr; Wailoo, Allan J; Brown, Steven R; Tiernan, James P; Watson, Angus J M; Biggs, Katie; Bradburn, Mike; Hind, Daniel

2017-09-01

Haemorrhoids are a common condition, with nearly 30,000 procedures carried out in England in 2014/15, and result in a significant quality-of-life burden to patients and a financial burden to the healthcare system. This study examined the cost effectiveness of haemorrhoidal artery ligation (HAL) compared with rubber band ligation (RBL) in the treatment of grade II-III haemorrhoids. This analyses used data from the HubBLe study, a multicentre, open-label, parallel group, randomised controlled trial conducted in 17 acute UK hospitals between September 2012 and August 2015. A full economic evaluation, including long-term cost effectiveness, was conducted from the UK National Health Service (NHS) perspective. Main outcomes included healthcare costs, quality-adjusted life-years (QALYs) and recurrence. Cost-effectiveness results were presented in terms of incremental cost per QALY gained and cost per recurrence avoided. Extrapolation analysis for 3 years beyond the trial follow-up, two subgroup analyses (by grade of haemorrhoids and recurrence following RBL at baseline), and various sensitivity analyses were undertaken. In the primary base-case within-trial analysis, the incremental total mean cost per patient for HAL compared with RBL was £1027 (95% confidence interval [CI] £782-£1272, p < 0.001). The incremental QALYs were 0.01 QALYs (95% CI -0.02 to 0.04, p = 0.49). This generated an incremental cost-effectiveness ratio (ICER) of £104,427 per QALY. In the extrapolation analysis, the estimated probabilistic ICER was £21,798 per QALY. Results from all subgroup and sensitivity analyses did not materially change the base-case result. Under all assessed scenarios, the HAL procedure was not cost effective compared with RBL for the treatment of grade II-III haemorrhoids at a cost-effectiveness threshold of £20,000 per QALY; therefore, economically, its use in the NHS should be questioned.

The value of atorvastatin over the product life cycle in the United States.

PubMed

Grabner, Michael; Johnson, Wallace; Abdulhalim, Abdulla M; Kuznik, Andreas; Mullins, C Daniel

2011-10-01

US health care reform mandates the reduction of wasteful health care spending while maintaining quality of care. Introducing new drugs into crowded therapeutic classes may be viewed as offering "me-too" (new drugs with a similar mechanism of action compared to existing drugs) drugs without incremental benefit. This article presents an analysis of the incremental costs and benefits of atorvastatin, a lipid-lowering agent. This analysis models the cost-effectiveness of atorvastatin over the product life cycle. The yearly cost-effectiveness of atorvastatin compared to simvastatin was modeled from 1997 to 2030 from the point of view of a US third-party payer. Estimates for incremental costs (in US $) and effects (in quality-adjusted life-years [QALYs]) for the primary and secondary prevention of cardiovascular events were taken from previously published literature and adjusted for changes in drug prices over time. Estimates of total statin use were derived using the National Health and Nutrition Examination Survey. Sensitivity analyses were conducted to examine variations in study parameters, including drug prices, indications, and discount rates. Assuming increasing statin use over time (with a mean of 1.07 million new users per year) and a 3% discount rate, the cumulative incremental cost-effectiveness ratio (ICER) of atorvastatin versus simvastatin ranged from cost-savings at release to a maximum of $45,066/QALY after 6 years of generic simvastatin use in 2012. Over the full modeled life cycle (1997-2030), the cumulative ICER of atorvastatin was $20,331/QALY. The incremental value of atorvastatin to US payers (after subtracting costs) was estimated at $44.57 to $194.78 billion, depending on willingness to pay. Findings from the sensitivity analyses were similar. A hypothetical situation in which atorvastatin did not exist was associated with a reduction in total expenditures but also a loss of QALYs gained. The cumulative ICER of atorvastatin varied across the product life cycle, increasing during the period between generic simvastatin entry and generic atorvastatin entry, and decreasing thereafter. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

Objectivity and validity of EMG method in estimating anaerobic threshold.

PubMed

Kang, S-K; Kim, J; Kwon, M; Eom, H

2014-08-01

The purposes of this study were to verify and compare the performances of anaerobic threshold (AT) point estimates among different filtering intervals (9, 15, 20, 25, 30 s) and to investigate the interrelationships of AT point estimates obtained by ventilatory threshold (VT) and muscle fatigue thresholds using electromyographic (EMG) activity during incremental exercise on a cycle ergometer. 69 untrained male university students, yet pursuing regular exercise voluntarily participated in this study. The incremental exercise protocol was applied with a consistent stepwise increase in power output of 20 watts per minute until exhaustion. AT point was also estimated in the same manner using V-slope program with gas exchange parameters. In general, the estimated values of AT point-time computed by EMG method were more consistent across 5 filtering intervals and demonstrated higher correlations among themselves when compared with those values obtained by VT method. The results found in the present study suggest that the EMG signals could be used as an alternative or a new option in estimating AT point. Also the proposed computing procedure implemented in Matlab for the analysis of EMG signals appeared to be valid and reliable as it produced nearly identical values and high correlations with VT estimates. © Georg Thieme Verlag KG Stuttgart · New York.

Senior high-cost healthcare users' resource utilization and outcomes: a protocol of a retrospective matched cohort study in Canada.

PubMed

Muratov, Sergei; Lee, Justin; Holbrook, Anne; Paterson, J Michael; Guertin, Jason Robert; Mbuagbaw, Lawrence; Gomes, Tara; Khuu, Wayne; Pequeno, Priscila; Costa, Andrew P; Tarride, Jean-Eric

2017-12-26

Senior high-cost users (HCUs) are estimated to represent 60% of all HCUs in Ontario, Canada's most populous province. To improve our understanding of individual and health system characteristics related to senior HCUs, we will examine incident senior HCUs to determine their incremental healthcare utilisation and costs, characteristics of index hospitalisation episodes, mortality and their regional variation across Ontario. A retrospective, population-based cohort study using administrative healthcare records will be used. Incident senior HCUs will be defined as Ontarians aged ≥66 years who were in the top 5% of healthcare cost users during fiscal year 2013 but not during fiscal year 2012. Each HCU will be matched to three non-HCUs by age, sex and health planning region. Incremental healthcare use and costs will be determined using the method of recycled predictions. We will apply multivariable logistic regression to determine patient and health service factors associated with index hospitalisation and inhospital mortality during the incident year. The most common causes of admission will be identified and contrasted with the most expensive hospitalised conditions. We will also calculate the ratio of inpatient costs incurred through admissions of ambulatory care sensitive conditions to the total inpatient expenditures. The magnitude of variation in costs and health service utilisation will be established by calculating the extremal quotient, the coefficient of variation and the Gini mean difference for estimates obtained through multilevel regression analyses. This study has been approved by Hamilton Integrated Research Ethics Board (ID#1715-C). The results of the study will be distributed through peer-reviewed journals. They also will be disseminated at research events in academic settings, national and international conferences as well as with presentations to provincial health authorities. © 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.

Space-time quantitative source apportionment of soil heavy metal concentration increments.

PubMed

Yang, Yong; Christakos, George; Guo, Mingwu; Xiao, Lu; Huang, Wei

2017-04-01

Assessing the space-time trends and detecting the sources of heavy metal accumulation in soils have important consequences in the prevention and treatment of soil heavy metal pollution. In this study, we collected soil samples in the eastern part of the Qingshan district, Wuhan city, Hubei Province, China, during the period 2010-2014. The Cd, Cu, Pb and Zn concentrations in soils exhibited a significant accumulation during 2010-2014. The spatiotemporal Kriging technique, based on a quantitative characterization of soil heavy metal concentration variations in terms of non-separable variogram models, was employed to estimate the spatiotemporal soil heavy metal distribution in the study region. Our findings showed that the Cd, Cu, and Zn concentrations have an obvious incremental tendency from the southwestern to the central part of the study region. However, the Pb concentrations exhibited an obvious tendency from the northern part to the central part of the region. Then, spatial overlay analysis was used to obtain absolute and relative concentration increments of adjacent 1- or 5-year periods during 2010-2014. The spatial distribution of soil heavy metal concentration increments showed that the larger increments occurred in the center of the study region. Lastly, the principal component analysis combined with the multiple linear regression method were employed to quantify the source apportionment of the soil heavy metal concentration increments in the region. Our results led to the conclusion that the sources of soil heavy metal concentration increments should be ascribed to industry, agriculture and traffic. In particular, 82.5% of soil heavy metal concentration increment during 2010-2014 was ascribed to industrial/agricultural activities sources. Using STK and SOA to obtain the spatial distribution of heavy metal concentration increments in soils. Using PCA-MLR to quantify the source apportionment of soil heavy metal concentration increments. Copyright © 2017 Elsevier Ltd. All rights reserved.

CROSS-DISCIPLINARY PHYSICS AND RELATED AREAS OF SCIENCE AND TECHNOLOGY: Note on Two-Phase Phenomena in Financial Markets

NASA Astrophysics Data System (ADS)

Jiang, Shi-Mei; Cai, Shi-Min; Zhou, Tao; Zhou, Pei-Ling

2008-06-01

The two-phase behaviour in financial markets actually means the bifurcation phenomenon, which represents the change of the conditional probability from an unimodal to a bimodal distribution. We investigate the bifurcation phenomenon in Hang-Seng index. It is observed that the bifurcation phenomenon in financial index is not universal, but specific under certain conditions. For Hang-Seng index and randomly generated time series, the phenomenon just emerges when the power-law exponent of absolute increment distribution is between 1 and 2 with appropriate period. Simulations on a randomly generated time series suggest the bifurcation phenomenon itself is subject to the statistics of absolute increment, thus it may not be able to reflect essential financial behaviours. However, even under the same distribution of absolute increment, the range where bifurcation phenomenon occurs is far different from real market to artificial data, which may reflect certain market information.

Matching achievement contexts with implicit theories to maximize motivation after failure: a congruence model.

PubMed

El-Alayli, Amani

2006-12-01

Previous research has shown that matching person variables with achievement contexts can produce the best motivational outcomes. The current study examines whether this is also true when matching entity and incremental beliefs with the appropriate motivational climate. Participants were led to believe that a personal attribute was fixed (entity belief) or malleable (incremental belief). After thinking that they failed a test that assessed the attribute, participants performed a second (related) task in a context that facilitated the pursuit of either performance or learning goals. Participants were expected to exhibit greater effort on the second task in the congruent conditions (entity belief plus performance goal climate and incremental belief plus learning goal climate) than in the incongruent conditions. These results were obtained, but only for participants who either valued competence on the attribute or had high achievement motivation. Results are discussed in terms of developing strategies for optimizing motivation in achievement settings.

Bevacizumab in Treatment of High-Risk Ovarian Cancer—A Cost-Effectiveness Analysis

PubMed Central

Herzog, Thomas J.; Hu, Lilian; Monk, Bradley J.; Kiet, Tuyen; Blansit, Kevin; Kapp, Daniel S.; Yu, Xinhua

2014-01-01

Objective. The objective of this study was to evaluate a cost-effectiveness strategy of bevacizumab in a subset of high-risk advanced ovarian cancer patients with survival benefit. Methods. A subset analysis of the International Collaboration on Ovarian Neoplasms 7 trial showed that additions of bevacizumab (B) and maintenance bevacizumab (mB) to paclitaxel (P) and carboplatin (C) improved the overall survival (OS) of high-risk advanced cancer patients. Actual and estimated costs of treatment were determined from Medicare payment. Incremental cost-effectiveness ratio per life-year saved was established. Results. The estimated cost of PC is $535 per cycle; PCB + mB (7.5 mg/kg) is $3,760 per cycle for the first 6 cycles and then $3,225 per cycle for 12 mB cycles. Of 465 high-risk stage IIIC (>1 cm residual) or stage IV patients, the previously reported OS after PC was 28.8 months versus 36.6 months in those who underwent PCB + mB. With an estimated 8-month improvement in OS, the incremental cost-effectiveness ratio of B was $167,771 per life-year saved. Conclusion. In this clinically relevant subset of women with high-risk advanced ovarian cancer with overall survival benefit after bevacizumab, our economic model suggests that the incremental cost of bevacizumab was approximately $170,000. PMID:24721817

Coffee and the risk of hepatocellular carcinoma and chronic liver disease: a systematic review and meta-analysis of prospective studies.

PubMed

Bravi, Francesca; Tavani, Alessandra; Bosetti, Cristina; Boffetta, Paolo; La Vecchia, Carlo

2017-09-01

An inverse association has been reported between coffee drinking and the risk of hepatocellular carcinoma (HCC) and chronic liver disease (CLD), but its magnitude is still unclear. Thus, we carried out a systematic review and meta-analysis of prospective cohort studies that investigated the association between coffee consumption and the risk of HCC or CLD. We separately estimated the relative risk (RR) of the two conditions, for regular, low, and high consumption compared with no or occasional coffee consumption; we also calculated the summary RR for an increment of one cup of coffee per day. Twelve studies on HCC (3414 cases) and six studies on CLD (1463 cases) were identified. The summary RRs for HCC were 0.66 [95% confidence interval (CI): 0.55-0.78] for regular, 0.78 (95% CI: 0.66-0.91) for low, and 0.50 (95% CI: 0.43-0.58) for high coffee consumption, respectively. The summary RR for an increment of one cup per day was 0.85 (95% CI: 0.81-0.90). The summary RRs for CLD were 0.62 (95% CI: 0.47-0.82) for regular, 0.72 (95% CI: 0.59-0.88) for low, 0.35 (95% CI: 0.22-0.56) for high, and 0.74 (95% CI: 0.65-0.83) for an increment of one cup per day. The present meta-analysis provides a precise quantification of the inverse relation between coffee consumption and the risk of HCC, and adds evidence to the presence of an even stronger negative association with CLD.

Cost-effectiveness of the 21-gene recurrence score assay in the context of multifactorial decision making to guide chemotherapy for early-stage breast cancer.

PubMed

Reed, Shelby D; Dinan, Michaela A; Schulman, Kevin A; Lyman, Gary H

2013-03-01

New evidence is available regarding the utility of the 21-gene recurrence score assay in guiding chemotherapy use for node-negative, estrogen receptor-positive breast cancer. We applied this evidence in a decision-analytic model to re-evaluate the cost-effectiveness of the assay. We cross-classified patients by clinicopathologic characteristics from the Adjuvant! risk index and by recurrence score risk group. For non-recurrence score-guided treatment, we assumed patients receiving hormonal therapy alone had low-risk characteristics and patients receiving chemotherapy and hormonal therapy had higher-risk characteristics. For recurrence score-guided treatment, we assigned chemotherapy probabilities conditional on recurrence score risk group and clinicopathologic characteristics. An estimated 40.4% of patients in the recurrence score-guided strategy and 47.3% in the non-recurrence score-guided strategy were expected to receive chemotherapy. The incremental gain in quality-adjusted life-years was 0.16 (95% confidence interval, 0.08-0.28) with the recurrence score-guided strategy. Lifetime medical costs to the health system were $2,692 ($1,546-$3,821) higher with the recurrence score-guided strategy, for an incremental cost-effectiveness ratio of $16,677/quality-adjusted life-year ($7,613-$37,219). From a societal perspective, the incremental cost-effectiveness was $10,788/quality-adjusted life-year ($6,840-$30,265). The findings provide supportive evidence for the economic value of the 21-gene recurrence score assay in node-negative, estrogen receptor-positive breast cancer.

Simulation and experimental design of a new advanced variable step size Incremental Conductance MPPT algorithm for PV systems.

PubMed

Loukriz, Abdelhamid; Haddadi, Mourad; Messalti, Sabir

2016-05-01

Improvement of the efficiency of photovoltaic system based on new maximum power point tracking (MPPT) algorithms is the most promising solution due to its low cost and its easy implementation without equipment updating. Many MPPT methods with fixed step size have been developed. However, when atmospheric conditions change rapidly , the performance of conventional algorithms is reduced. In this paper, a new variable step size Incremental Conductance IC MPPT algorithm has been proposed. Modeling and simulation of different operational conditions of conventional Incremental Conductance IC and proposed methods are presented. The proposed method was developed and tested successfully on a photovoltaic system based on Flyback converter and control circuit using dsPIC30F4011. Both, simulation and experimental design are provided in several aspects. A comparative study between the proposed variable step size and fixed step size IC MPPT method under similar operating conditions is presented. The obtained results demonstrate the efficiency of the proposed MPPT algorithm in terms of speed in MPP tracking and accuracy. Copyright © 2015 ISA. Published by Elsevier Ltd. All rights reserved.

Computing rank-revealing QR factorizations of dense matrices.

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

Bischof, C. H.; Quintana-Orti, G.; Mathematics and Computer Science

1998-06-01

We develop algorithms and implementations for computing rank-revealing QR (RRQR) factorizations of dense matrices. First, we develop an efficient block algorithm for approximating an RRQR factorization, employing a windowed version of the commonly used Golub pivoting strategy, aided by incremental condition estimation. Second, we develop efficiently implementable variants of guaranteed reliable RRQR algorithms for triangular matrices originally suggested by Chandrasekaran and Ipsen and by Pan and Tang. We suggest algorithmic improvements with respect to condition estimation, termination criteria, and Givens updating. By combining the block algorithm with one of the triangular postprocessing steps, we arrive at an efficient and reliablemore » algorithm for computing an RRQR factorization of a dense matrix. Experimental results on IBM RS/6000 SGI R8000 platforms show that this approach performs up to three times faster that the less reliable QR factorization with column pivoting as it is currently implemented in LAPACK, and comes within 15% of the performance of the LAPACK block algorithm for computing a QR factorization without any column exchanges. Thus, we expect this routine to be useful in may circumstances where numerical rank deficiency cannot be ruled out, but currently has been ignored because of the computational cost of dealing with it.« less

Battery Capacity Fading Estimation Using a Force-Based Incremental Capacity Analysis

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

Samad, Nassim A.; Kim, Youngki; Siegel, Jason B.

Traditionally health monitoring techniques in lithium-ion batteries rely on voltage and current measurements. A novel method of using a mechanical rather than electrical signal in the incremental capacity analysis (ICA) method is introduced in this paper. This method derives the incremental capacity curves based onmeasured force (ICF) instead of voltage (ICV). The force ismeasured on the surface of a cell under compression in a fixture that replicates a battery pack assembly and preloading. The analysis is performed on data collected from cycling encased prismatic Lithium-ion Nickel-Manganese-Cobalt Oxide (NMC) cells. For the NMC chemistry, the ICF method can complement or replacemore » the ICV method for the following reasons. The identified ICV peaks are centered around 40% of state of charge (SOC) while the peaks of the ICF method are centered around 70% of SOC indicating that the ICF can be used more often because it is more likely that an electric vehicle (EV) or a plug-in hybrid electric vehicle (PHEV) will traverse the 70% SOC range than the 40% SOC. In addition the Signal to Noise ratio (SNR) of the force signal is four times larger than the voltage signal using laboratory grade sensors. The proposed ICF method is shown to achieve 0.42% accuracy in capacity estimation during a low C-rate constant current discharge. Future work will investigate the application of the capacity estimation technique under charging and operation under high C-rates by addressing the transient behavior of force so that an online methodology for capacity estimation is developed.« less

Battery Capacity Fading Estimation Using a Force-Based Incremental Capacity Analysis

DOE PAGES

Samad, Nassim A.; Kim, Youngki; Siegel, Jason B.; ...

2016-05-27

Traditionally health monitoring techniques in lithium-ion batteries rely on voltage and current measurements. A novel method of using a mechanical rather than electrical signal in the incremental capacity analysis (ICA) method is introduced in this paper. This method derives the incremental capacity curves based onmeasured force (ICF) instead of voltage (ICV). The force ismeasured on the surface of a cell under compression in a fixture that replicates a battery pack assembly and preloading. The analysis is performed on data collected from cycling encased prismatic Lithium-ion Nickel-Manganese-Cobalt Oxide (NMC) cells. For the NMC chemistry, the ICF method can complement or replacemore » the ICV method for the following reasons. The identified ICV peaks are centered around 40% of state of charge (SOC) while the peaks of the ICF method are centered around 70% of SOC indicating that the ICF can be used more often because it is more likely that an electric vehicle (EV) or a plug-in hybrid electric vehicle (PHEV) will traverse the 70% SOC range than the 40% SOC. In addition the Signal to Noise ratio (SNR) of the force signal is four times larger than the voltage signal using laboratory grade sensors. The proposed ICF method is shown to achieve 0.42% accuracy in capacity estimation during a low C-rate constant current discharge. Future work will investigate the application of the capacity estimation technique under charging and operation under high C-rates by addressing the transient behavior of force so that an online methodology for capacity estimation is developed.« less

Modeling Nonlinear Site Response Uncertainty in Broadband Ground Motion Simulations for the Los Angeles Basin

NASA Astrophysics Data System (ADS)

Assimaki, D.; Li, W.; Steidl, J. M.; Schmedes, J.

2007-12-01

The assessment of strong motion site response is of great significance, both for mitigating seismic hazard and for performing detailed analyses of earthquake source characteristics. There currently exists, however, large degree of uncertainty concerning the mathematical model to be employed for the computationally efficient evaluation of local site effects, and the site investigation program necessary to evaluate the nonlinear input model parameters and ensure cost-effective predictions; and while site response observations may provide critical constraints on interpretation methods, the lack of a statistically significant number of in-situ strong motion records prohibits statistical analyses to be conducted and uncertainties to be quantified based entirely on field data. In this paper, we combine downhole observations and broadband ground motion synthetics for characteristic site conditions the Los Angeles Basin, and investigate the variability in ground motion estimation introduced by the site response assessment methodology. In particular, site-specific regional velocity and attenuation structures are initially compiled using near-surface geotechnical data collected at downhole geotechnical arrays, inverse low-strain velocity and attenuation profiles at these sites obtained by inversion of weak motion records and the crustal velocity structure at the corresponding locations obtained from the Southern California Earthquake Centre Community Velocity Model. Successively, broadband ground motions are simulated by means of a hybrid low/high-frequency finite source model with correlated random parameters for rupture scenaria of weak, medium and large magnitude events (M =3.5-7.5). Observed estimates of site response at the stations of interest are first compared to the ensemble of approximate and incremental nonlinear site response models. Parametric studies are next conducted for each fixed magnitude (fault geometry) scenario by varying the source-to-site distance and source parameters for the ensemble of site conditions. Elastic, equivalent linear and nonlinear simulations are implemented for the deterministic description of the base-model velocity and attenuation structures and nonlinear soil properties, to examine the variability in ground motion predictions as a function of ground motion amplitude and frequency content, and nonlinear site response methodology. The modeling site response uncertainty introduced in the broadband ground motion predictions is reported by means of the COV of site amplification, defined as the ratio of the predicted peak ground acceleration (PGA) and spectral acceleration (SA) at short and long periods to the corresponding intensity measure on the ground surface of a typical NEHRP BC boundary profile (Vs30=760m/s), for the ensemble of approximate and incremental nonlinear models implemented. A frequency index is developed to describe the frequency content of incident ground motion. In conjunction with the rock-outcrop acceleration level, this index is used to identify the site and ground motion conditions where incremental nonlinear analyses should be employed in lieu of approximate methodologies. Finally, the effects of modeling uncertainty in ground response analysis is evaluated in the estimation of site amplification factors, which are successively compared to recently published factors of the New Generation Attenuation Relations (NGA) and the currently employed Seismic Code Provisions (NEHRP).

Modeling the temporal periodicity of growth increments based on harmonic functions

PubMed Central

Morales-Bojórquez, Enrique; González-Peláez, Sergio Scarry; Bautista-Romero, J. Jesús; Lluch-Cota, Daniel Bernardo

2018-01-01

Age estimation methods based on hard structures require a process of validation to confirm the periodical pattern of growth marks. Among such processes, one of the most used is the marginal increment ratio (MIR), which was stated to follow a sinusoidal cycle in a population. Despite its utility, in most cases, its implementation has lacked robust statistical analysis. Accordingly, we propose a modeling approach for the temporal periodicity of growth increments based on single and second order harmonic functions. For illustrative purposes, the MIR periodicities for two geoduck species (Panopea generosa and Panopea globosa) were modeled to identify the periodical pattern of growth increments in the shell. This model identified an annual periodicity for both species but described different temporal patterns. The proposed procedure can be broadly used to objectively define the timing of the peak, the degree of symmetry, and therefore, the synchrony of band deposition of different species on the basis of MIR data. PMID:29694381

Age effects on discrimination of timing in auditory sequences

NASA Astrophysics Data System (ADS)

Fitzgibbons, Peter J.; Gordon-Salant, Sandra

2004-08-01

The experiments examined age-related changes in temporal sensitivity to increments in the interonset intervals (IOI) of components in tonal sequences. Discrimination was examined using reference sequences consisting of five 50-ms tones separated by silent intervals; tone frequencies were either fixed at 4 kHz or varied within a 2-4-kHz range to produce spectrally complex patterns. The tonal IOIs within the reference sequences were either equal (200 or 600 ms) or varied individually with an average value of 200 or 600 ms to produce temporally complex patterns. The difference limen (DL) for increments of IOI was measured. Comparison sequences featured either equal increments in all tonal IOIs or increments in a single target IOI, with the sequential location of the target changing randomly across trials. Four groups of younger and older adults with and without sensorineural hearing loss participated. Results indicated that DLs for uniform changes of sequence rate were smaller than DLs for single target intervals, with the largest DLs observed for single targets embedded within temporally complex sequences. Older listeners performed more poorly than younger listeners in all conditions, but the largest age-related differences were observed for temporally complex stimulus conditions. No systematic effects of hearing loss were observed.

Incremental Net Effects in Multiple Regression

ERIC Educational Resources Information Center

Lipovetsky, Stan; Conklin, Michael

2005-01-01

A regular problem in regression analysis is estimating the comparative importance of the predictors in the model. This work considers the 'net effects', or shares of the predictors in the coefficient of the multiple determination, which is a widely used characteristic of the quality of a regression model. Estimation of the net effects can be a…

Accounting for estimated IQ in neuropsychological test performance with regression-based techniques.

PubMed

Testa, S Marc; Winicki, Jessica M; Pearlson, Godfrey D; Gordon, Barry; Schretlen, David J

2009-11-01

Regression-based normative techniques account for variability in test performance associated with multiple predictor variables and generate expected scores based on algebraic equations. Using this approach, we show that estimated IQ, based on oral word reading, accounts for 1-9% of the variability beyond that explained by individual differences in age, sex, race, and years of education for most cognitive measures. These results confirm that adding estimated "premorbid" IQ to demographic predictors in multiple regression models can incrementally improve the accuracy with which regression-based norms (RBNs) benchmark expected neuropsychological test performance in healthy adults. It remains to be seen whether the incremental variance in test performance explained by estimated "premorbid" IQ translates to improved diagnostic accuracy in patient samples. We describe these methods, and illustrate the step-by-step application of RBNs with two cases. We also discuss the rationale, assumptions, and caveats of this approach. More broadly, we note that adjusting test scores for age and other characteristics might actually decrease the accuracy with which test performance predicts absolute criteria, such as the ability to drive or live independently.

Method and system for controlling a permanent magnet machine

DOEpatents

Walters, James E.

2003-05-20

Method and system for controlling the start of a permanent magnet machine are provided. The method allows to assign a parameter value indicative of an estimated initial rotor position of the machine. The method further allows to energize the machine with a level of current being sufficiently high to start rotor motion in a desired direction in the event the initial rotor position estimate is sufficiently close to the actual rotor position of the machine. A sensing action allows to sense whether any incremental changes in rotor position occur in response to the energizing action. In the event no changes in rotor position are sensed, the method allows to incrementally adjust the estimated rotor position by a first set of angular values until changes in rotor position are sensed. In the event changes in rotor position are sensed, the method allows to provide a rotor alignment signal as rotor motion continues. The alignment signal allows to align the estimated rotor position relative to the actual rotor position. This alignment action allows for operating the machine over a wide speed range.

Distribution of physical properties and timing of relative uplift in upper plate off Costa Rica: IODP Expedition 344

NASA Astrophysics Data System (ADS)

Saiki, A.; Hashimoto, Y.

2015-12-01

Evolution of physical properties in subduction zone is a key to understand lithification processes, location of decollement, and stress distribution. In this study, we examined the physical properties of sediments using on-board data and laboratory experimental data on sediments obtained off Costa Rica margin. Target sites are in the Integrate Ocean Drilling Program (IODP) Expedition 344 off Costa Rica, including reference sites (U1381 and U1414), mid-slope site (U1378, U1380) and upper-slope site (U1413). Seven samples from reference sites were analyzed. Laboratory experiments for velocity and porosity measurements were conducted with variation of effective pressure. Velocity-porosity relationships from on-board data and from laboratory experiments are comparable. The porosity-effective pressure curves under isotropic condition were converted to the curves under uniaxial condition (Teeuw, 1971). Using the normal consolidation curves under uniaxial stress conditions, we converted onboard porosity to effective pressure and fluid pressure. In reference sites, hydrostatic fluid pressure was estimated as expected as a reference sites, suggesting that porosity-effective pressure relationship was obtained correctly by experiments and it can be adapted to estimation of fluid pressure for the wedge sites. The porosity-effective pressure relationship under isotropic conditions were used for the estimation in wedge sites. In wedge sites, estimated pore pressures show lower than hydrostatic pressure, suggesting that onboard porosity was lower than that under normal compaction. The lower porosity can be caused by relative uplift from deeper portion. The amount of relative uplift can be estimated by differences in porosity-depth relationships between onboard data and experimental data. The amount of relative uplift for each site shows more than ~1000m up to ~5000m. The small error in porosity depth curve from experimental data makes relative uplift larger or smaller exponentially in the deeper portion. The increment of relative uplift, however, starts from about 1Ma in each site, suggesting some events were occurred at the timing. Laboratory experiments under differential stress should be conducted in the near future because smaller porosity is expected under differential stress conditions.

A quick on-line state of health estimation method for Li-ion battery with incremental capacity curves processed by Gaussian filter

NASA Astrophysics Data System (ADS)

Li, Yi; Abdel-Monem, Mohamed; Gopalakrishnan, Rahul; Berecibar, Maitane; Nanini-Maury, Elise; Omar, Noshin; van den Bossche, Peter; Van Mierlo, Joeri

2018-01-01

This paper proposes an advanced state of health (SoH) estimation method for high energy NMC lithium-ion batteries based on the incremental capacity (IC) analysis. IC curves are used due to their ability of detect and quantify battery degradation mechanism. A simple and robust smoothing method is proposed based on Gaussian filter to reduce the noise on IC curves, the signatures associated with battery ageing can therefore be accurately identified. A linear regression relationship is found between the battery capacity with the positions of features of interest (FOIs) on IC curves. Results show that the developed SoH estimation function from one single battery cell is able to evaluate the SoH of other batteries cycled under different cycling depth with less than 2.5% maximum errors, which proves the robustness of the proposed method on SoH estimation. With this technique, partial charging voltage curves can be used for SoH estimation and the testing time can be therefore largely reduced. This method shows great potential to be applied in reality, as it only requires static charging curves and can be easily implemented in battery management system (BMS).

Validity of the alcohol purchase task: a meta-analysis.

PubMed

Kiselica, Andrew M; Webber, Troy A; Bornovalova, Marina A

2016-05-01

Behavioral economists assess alcohol consumption as a function of unit price. This method allows construction of demand curves and demand indices, which are thought to provide precise numerical estimates of risk for alcohol problems. One of the more commonly used behavioral economic measures is the Alcohol Purchase Task (APT). Although the APT has shown promise as a measure of risk for alcohol problems, the construct validity and incremental utility of the APT remain unclear. This paper presents a meta-analysis of the APT literature. Sixteen studies were included in the meta-analysis. Studies were gathered via searches of the PsycInfo, PubMed, Web of Science and EconLit research databases. Random-effects meta-analyses with inverse variance weighting were used to calculate summary effect sizes for each demand index-drinking outcome relationship. Moderation of these effects by drinking status (regular versus heavy drinkers) was examined. Additionally, tests of the incremental utility of the APT indices in predicting drinking problems above and beyond measuring alcohol consumption were performed. The APT indices were correlated in the expected directions with drinking outcomes, although many effects were small in size. These effects were typically not moderated by the drinking status of the samples. Additionally, the intensity metric demonstrated incremental utility in predicting alcohol use disorder symptoms beyond measuring drinking. The Alcohol Purchase Task appears to have good construct validity, but limited incremental utility in estimating risk for alcohol problems. © 2015 Society for the Study of Addiction.

Non-metallic coating thickness prediction using artificial neural network and support vector machine with time resolved thermography

NASA Astrophysics Data System (ADS)

Wang, Hongjin; Hsieh, Sheng-Jen; Peng, Bo; Zhou, Xunfei

2016-07-01

A method without requirements on knowledge about thermal properties of coatings or those of substrates will be interested in the industrial application. Supervised machine learning regressions may provide possible solution to the problem. This paper compares the performances of two regression models (artificial neural networks (ANN) and support vector machines for regression (SVM)) with respect to coating thickness estimations made based on surface temperature increments collected via time resolved thermography. We describe SVM roles in coating thickness prediction. Non-dimensional analyses are conducted to illustrate the effects of coating thicknesses and various factors on surface temperature increments. It's theoretically possible to correlate coating thickness with surface increment. Based on the analyses, the laser power is selected in such a way: during the heating, the temperature increment is high enough to determine the coating thickness variance but low enough to avoid surface melting. Sixty-one pain-coated samples with coating thicknesses varying from 63.5 μm to 571 μm are used to train models. Hyper-parameters of the models are optimized by 10-folder cross validation. Another 28 sets of data are then collected to test the performance of the three methods. The study shows that SVM can provide reliable predictions of unknown data, due to its deterministic characteristics, and it works well when used for a small input data group. The SVM model generates more accurate coating thickness estimates than the ANN model.

Number needed to treat and costs per responder among biologic treatments for moderate-to-severe psoriasis: a network meta-analysis.

PubMed

Armstrong, April W; Betts, Keith A; Signorovitch, James E; Sundaram, Murali; Li, Junlong; Ganguli, Arijit X; Wu, Eric Q

2018-04-23

The clinical benefits of biologic therapies for moderate-to-severe psoriasis are well established, but wide variations exist in patient response. To determine the number needed to treat (NNT) to achieve a 75% and 90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) with FDA-approved agents and evaluate the incremental cost per PASI-75 or PASI-90 responder. The relative probabilities of achieving PASI-75 and PASI-90, as well as NNTs, were estimated using a network meta-analysis. Costs (2017 USD) included drug acquisition and administration. The incremental cost per PASI-75 or PASI-90 responder for each treatment was estimated for the clinical trial period, and annually. Compared with supportive care, the NNT to achieve PASI-75 was 1.18 for ixekizumab, 1.29 for secukinumab 300 mg, 1.37 for infliximab, 1.48 for adalimumab, 1.53 for secukinumab 150 mg, 1.58 for ustekinumab, 2.25 for etanercept, and 3.71 for apremilast. The one-year incremental cost per PASI-75 responder relative to supportive care was $59,830 for infliximab, $88,775 for secukinumab 300 mg, $91,837 for adalimumab, $95,898 for ixekizumab, $97,363 for ustekinumab, $105,131 for secukinumab 150 mg, $129,665 for apremilast, and $159,328 for etanercept. Results were similar for PASI-90. The NNT and incremental cost per responder are meaningful ways to assess comparative effectiveness and cost effectiveness among psoriasis treatments.

Economic Evaluation of Complete Revascularization for Patients with Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention.

PubMed

Barton, Garry R; Irvine, Lisa; Flather, Marcus; McCann, Gerry P; Curzen, Nick; Gershlick, Anthony H

2017-06-01

To determine the cost-effectiveness of complete revascularization at index admission compared with infarct-related artery (IRA) treatment only, in patients with multivessel disease undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction. An economic evaluation of a multicenter randomized trial was conducted, comparing complete revascularization at index admission to IRA-only P-PCI in patients with multivessel disease (12-month follow-up). Overall hospital costs (costs for P-PCI procedure(s), hospital length of stay, and any subsequent re-admissions) were estimated. Outcomes were major adverse cardiac events (MACEs, a composite of all-cause death, recurrent myocardial infarction, heart failure, and ischemia-driven revascularization) and quality-adjusted life-years (QALYs) derived from the three-level EuroQol five-dimensional questionnaire. Multiple imputation was undertaken. The mean incremental cost and effect, with associated 95% confidence intervals, the incremental cost-effectiveness ratio, and the cost-effectiveness acceptability curve were estimated. On the basis of 296 patients, the mean incremental overall hospital cost for complete revascularization was estimated to be -£215.96 (-£1390.20 to £958.29), compared with IRA-only, with a per-patient mean reduction in MACEs of 0.170 (0.044 to 0.296) and a QALY gain of 0.011 (-0.019 to 0.041). According to the cost-effectiveness acceptability curve, the probability of complete revascularization being cost-effective was estimated to be 72.0% at a willingness-to-pay threshold value of £20,000 per QALY. Complete revascularization at index admission was estimated to be more effective (in terms of MACEs and QALYs) and cost-effective (overall costs were estimated to be lower and complete revascularization thereby dominated IRA-only). There was, however, some uncertainty associated with this decision. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Measurement of stress-strain behaviour of human hair fibres using optical techniques.

PubMed

Lee, J; Kwon, H J

2013-06-01

Many studies have presented stress-strain relationship of human hair, but most of them have been based on an engineering stress-strain curve, which is not a true representation of stress-strain behaviour. In this study, a more accurate 'true' stress-strain curve of human hair was determined by applying optical techniques to the images of the hair deformed under tension. This was achieved by applying digital image cross-correlation (DIC) to 10× magnified images of hair fibres taken under increasing tension to estimate the strain increments. True strain was calculated by summation of the strain increments according to the theoretical definition of 'true' strain. The variation in diameter with the increase in longitudinal elongation was also measured from the 40× magnified images to estimate the Poisson's ratio and true stress. By combining the true strain and the true stress, a true stress-strain curve could be determined, which demonstrated much higher stress values than the conventional engineering stress-strain curve at the same degree of deformation. Four regions were identified in the true stress-strain relationship and empirical constitutive equations were proposed for each region. Theoretical analysis on the necking condition using the constitutive equations provided the insight into the failure mechanism of human hair. This analysis indicated that local thinning caused by necking does not occur in the hair fibres, but, rather, relatively uniform deformation takes place until final failure (fracture) eventually occurs. © 2012 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Influence of tropospheric ozone control on exposure to ultraviolet radiation at the surface.

PubMed

Madronich, Sasha; Wagner, Mark; Groth, Philip

2011-08-15

Improving air quality by reducing ambient ozone (O(3)) will likely lower O(3) concentrations throughout the troposphere and increase the transmission of solar ultraviolet (UV) radiation to the surface. The changes in surface UV radiation between two control scenarios (nominally 84 and 70 ppb O(3) for summer 2020) in the Eastern two-thirds of the contiguous U.S. are estimated, using tropospheric O(3) profiles calculated with a chemistry-transport model (Community Multi-Scale Air Quality, CMAQ) as inputs to a detailed model of the transfer of solar radiation through the atmosphere (tropospheric ultraviolet-visible, TUV) for clear skies, weighed for the wavelengths known to induce sunburn and skin cancer. Because the incremental emission controls differ according to region, strong spatial variability in O(3) reductions and in corresponding UV radiation increments is seen. The geographically averaged UV increase is 0.11 ± 0.03%, whereas the population-weighted increase is larger, 0.19 ± 0.06%, because O(3) reductions are greater in more densely populated regions. These relative increments in exposure are non-negligible given the already high incidence of UV-related health effects, but are lower by an order of magnitude or more than previous estimates.

Cost effectiveness of recombinant activated factor VII for the control of bleeding in patients with severe blunt trauma injuries in the United Kingdom.

PubMed

Morris, S; Ridley, S; Munro, V; Christensen, M C

2007-01-01

The aim of this study was to assess the lifetime cost effectiveness of recombinant activated factor VII vs placebo as adjunctive therapy for control of bleeding in patients with severe blunt trauma in the UK. We developed a cost-effectiveness model based on patient level data from a 30-day international, randomised, placebo-controlled Phase II trial. The data were supplemented with secondary data from UK sources to estimate lifetime costs and benefits. The model produced a baseline estimate of the incremental cost per life year gained with recombinant activated factor VII relative to placebo of 12 613 UK pounds. The incremental cost per quality adjusted life year gained was 18 825 UK pounds. These estimates are sensitive to the choice of discount rate and health state utility values used. Preliminary results suggest that relative to placebo, recombinant activated factor VII may be a cost-effective therapy to the UK National Health Service.

Economic Evaluation of Telemedicine for Patients in ICUs.

PubMed

Yoo, Byung-Kwang; Kim, Minchul; Sasaki, Tomoko; Melnikow, Joy; Marcin, James P

2016-02-01

Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. Simulation analyses performed by standard decision models. Hypothetical ICU defined by the U.S. literature. Hypothetical adult patients in ICU defined by the U.S. literature. The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on break-even analyses. Our analyses suggest that telemedicine in the ICU is cost-effective in most cases and cost saving in some cases. The thresholds of cost and effectiveness, estimated by break-even analyses, help hospitals determine the impact of telemedicine in the ICU and potential cost saving.

Impact of air temperature on physically-based maximum precipitation estimation through change in moisture holding capacity of air

NASA Astrophysics Data System (ADS)

Ishida, K.; Ohara, N.; Kavvas, M. L.; Chen, Z. Q.; Anderson, M. L.

2018-01-01

Impact of air temperature on the Maximum Precipitation (MP) estimation through change in moisture holding capacity of air was investigated. A series of previous studies have estimated the MP of 72-h basin-average precipitation over the American River watershed (ARW) in Northern California by means of the Maximum Precipitation (MP) estimation approach, which utilizes a physically-based regional atmospheric model. For the MP estimation, they have selected 61 severe storm events for the ARW, and have maximized them by means of the atmospheric boundary condition shifting (ABCS) and relative humidity maximization (RHM) methods. This study conducted two types of numerical experiments in addition to the MP estimation by the previous studies. First, the air temperature on the entire lateral boundaries of the outer model domain was increased uniformly by 0.0-8.0 °C with 0.5 °C increments for the two severest maximized historical storm events in addition to application of the ABCS + RHM method to investigate the sensitivity of the basin-average precipitation over the ARW to air temperature rise. In this investigation, a monotonous increase was found in the maximum 72-h basin-average precipitation over the ARW with air temperature rise for both of the storm events. The second numerical experiment used specific amounts of air temperature rise that is assumed to happen under future climate change conditions. Air temperature was increased by those specified amounts uniformly on the entire lateral boundaries in addition to application of the ABCS + RHM method to investigate the impact of air temperature on the MP estimate over the ARW under changing climate. The results in the second numerical experiment show that temperature increases in the future climate may amplify the MP estimate over the ARW. The MP estimate may increase by 14.6% in the middle of the 21st century and by 27.3% in the end of the 21st century compared to the historical period.

Martingales, nonstationary increments, and the efficient market hypothesis

NASA Astrophysics Data System (ADS)

McCauley, Joseph L.; Bassler, Kevin E.; Gunaratne, Gemunu H.

2008-06-01

We discuss the deep connection between nonstationary increments, martingales, and the efficient market hypothesis for stochastic processes x(t) with arbitrary diffusion coefficients D(x,t). We explain why a test for a martingale is generally a test for uncorrelated increments. We explain why martingales look Markovian at the level of both simple averages and 2-point correlations. But while a Markovian market has no memory to exploit and cannot be beaten systematically, a martingale admits memory that might be exploitable in higher order correlations. We also use the analysis of this paper to correct a misstatement of the ‘fair game’ condition in terms of serial correlations in Fama’s paper on the EMH. We emphasize that the use of the log increment as a variable in data analysis generates spurious fat tails and spurious Hurst exponents.

Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States.

PubMed

Li, Qian; Blume, Steven W; Huang, Joanna C; Hammer, Mette; Ganz, Michael L

2015-01-01

This study estimated the economic burden of obesity-related comorbidities (ORCs) in the US, at both the person and population levels. The Geisinger Health System provided electronic medical records and claims between January 2004 and May 2013 for a sample of 153,561 adults (50% males and 97% white). Adults with < 2 years of data, who were underweight (body mass index (BMI) < 18.5 kg/m(2)), or had diseases causing major weight change (e.g., malignancy) during the study period (i.e., continuous enrollment in health plans) were excluded. A total of 21 chronic conditions, with established association with obesity in the literature, were identified by diagnosis codes and/or lab test results. The total healthcare costs were measured in each year. The association between annual costs and ORCs was assessed by a regression, which jointly considered all the ORCs. The per-person incremental costs of a single comorbidity, without any of the other ORCs, were calculated. The population-level economic burden was the product of each ORC's incremental costs and the annual prevalence of the ORC among 100,000 individuals. The prevalence of ORCs was stratified by obesity status to estimate the economic burden among 100,000 individuals with obesity and among those without. This study identified 56,895 adults (mean age = 47 years; mean BMI = 29.6 kg/m(2)). The annual prevalence of ORCs ranged from 0.5% for pulmonary embolism (PE) to 41.8% for dyslipidemia. The per-person annual incremental costs of a single ORC ranged from $120 for angina to $1665 for PE. Hypertensive diseases (HTND), dyslipidemia, and osteoarthritis were the three most expensive ORCs at the population level; each responsible for ≥$18 million annually among 100,000 individuals. HTND and osteoarthritis were much more costly among individuals with obesity than those without obesity. Data were from a small geographic region. ORCs are associated with substantial economic burden, especially for those requiring continuous treatments.

[Individual tree diameter increment model for natural Betula platyphylla forests based on meteorological factors].

PubMed

Zhang, Hai Ping; Li, Feng Ri; Dong, Li Hu; Liu, Qiang

2017-06-18

Based on the 212 re-measured permanent plots for natural Betula platyphylla fore-sts in Daxing'an Mountains and Xiaoxing'an Mountains and 30 meteorological stations data, an individual tree growth model based on meteorological factors was constructed. The differences of stand and meteorological factors between Daxing'an Mountains and Xiaoxing'an Mountains were analyzed and the diameter increment model including the regional effects was developed by dummy variable approach. The results showed that the minimum temperature (T g min ) and mean precipitation (P g m ) in growing season were the main meteorological factors which affected the diameter increment in the two study areas. T g min and P g m were positively correlated with the diameter increment, but the influence strength of T g min was obviously different between the two research areas. The adjusted coefficient of determination (R a 2 ) of the diameter increment model with meteorological factors was 0.56 and had an 11% increase compared to the one without meteorological factors. It was concluded that meteorological factors could well explain the diameter increment of B. platyphylla. R a 2 of the model with regional effects was 0.59, and increased by 18% compared to the one without regional effects, and effectively solved the incompatible problem of parameters between the two research areas. The validation results showed that the individual tree diameter growth model with regional effect had the best prediction accuracy in estimating the diameter increment of B. platyphylla. The mean error, mean absolute error, mean error percent and mean prediction error percent were 0.0086, 0.4476, 5.8% and 20.0%, respectively. Overall, dummy variable model of individual tree diameter increment based on meteorological factors could well describe the diameter increment process of natural B. platyphylla in Daxing'an Mountains and Xiaoxing'an Mountains.

Determining site index accurately in even-aged stands

Treesearch

Gayne G. Erdmann; Ralph M., Jr. Peterson

1992-01-01

Good site index estimates are necessary for intensive forest management. To get tree age used in determining site index, increment cores are commonly used. The diffuse-porous rings of northern hardwoods, though, are difficult to count in cores, so many site index estimates are imprecise. Also, measuring the height of standing trees is more difficult and less accurate...

Association between progression-free survival and health-related quality of life in oncology: a systematic review protocol.

PubMed

Kovic, Bruno; Guyatt, Gordon; Brundage, Michael; Thabane, Lehana; Bhatnagar, Neera; Xie, Feng

2016-09-02

There is an increasing number of new oncology drugs being studied, approved and put into clinical practice based on improvement in progression-free survival, when no overall survival benefits exist. In oncology, the association between progression-free survival and health-related quality of life is currently unknown, despite its importance for patients with cancer, and the unverified assumption that longer progression-free survival indicates improved health-related quality of life. Thus far, only 1 study has investigated this association, providing insufficient evidence and inconclusive results. The objective of this study protocol is to provide increased transparency in supporting a systematic summary of the evidence bearing on this association in oncology. Using the OVID platform in MEDLINE, Embase and Cochrane databases, we will conduct a systematic review of randomised controlled human trials addressing oncology issues published starting in 2000. A team of reviewers will, in pairs, independently screen and abstract data using standardised, pilot-tested forms. We will employ numerical integration to calculate mean incremental area under the curve between treatment groups in studies for health-related quality of life, along with total related error estimates, and a 95% CI around incremental area. To describe the progression-free survival to health-related quality of life association, we will construct a scatterplot for incremental health-related quality of life versus incremental progression-free survival. To estimate the association, we will use a weighted simple regression approach, comparing mean incremental health-related quality of life with either median incremental progression-free survival time or the progression-free survival HR, in the absence of overall survival benefit. Identifying direction and magnitude of association between progression-free survival and health-related quality of life is critically important in interpreting results of oncology trials. Systematic evidence produced from our study will contribute to improvement of patient care and practice of evidence-based medicine in oncology. 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/

Estimating the costs of human space exploration

NASA Technical Reports Server (NTRS)

Mandell, Humboldt C., Jr.

1994-01-01

The plan for NASA's new exploration initiative has the following strategic themes: (1) incremental, logical evolutionary development; (2) economic viability; and (3) excellence in management. The cost estimation process is involved with all of these themes and they are completely dependent upon the engineering cost estimator for success. The purpose is to articulate the issues associated with beginning this major new government initiative, to show how NASA intends to resolve them, and finally to demonstrate the vital importance of a leadership role by the cost estimation community.

Warfighter Information Network-Tactical Increment 2 (WIN-T Inc 2)

DTIC Science & Technology

2015-12-01

Company- level . Using equipment mounted on combat platforms, WIN-T Inc 2 delivers a mobile capability that reduces reliance on fixed infrastructure...Cost Estimate Reference Army Cost Position (ACP) dated April 28, 2015 Confidence Level Confidence Level of cost estimate for current APB: 50% The...Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total 2.064 -0.055 -0.063 0.016 0.000 0.093 0.000 0.200 0.191 2.255

Acute effects of caffeine on several operant behaviors in rhesus monkeys.

PubMed

Buffalo, E A; Gillam, M P; Allen, R R; Paule, M G

1993-11-01

The acute effects of 1,3-trimethylxanthine (caffeine) were assessed using an operant test battery (OTB) of complex food-reinforced tasks that are thought to depend upon relatively specific brain functions, such as motivation to work for food (progressive ratio, PR), learning (incremental repeated acquisition, IRA), color and position discrimination (conditioned position responding, CPR), time estimation (temporal response differentiation, TRD), and short-term memory and attention (delayed matching-to-sample, DMTS). Endpoints included response rates (RR), accuracies (ACC), and percent task completed (PTC). Caffeine sulfate (0.175-20.0 mg/kg, IV), given 15 min pretesting, produced significant dose-dependent decreases in TRD percent task completed and accuracy at doses > or = 5.6 mg/kg. Caffeine produced no systematic effects on either DMTS or PR responding, but low doses tended to enhance performance in both IRA and CPR tasks. Thus, in monkeys, performance of an operant task designed to model time estimation is more sensitive to the disruptive effects of caffeine than is performance of the other tasks in the OTB.

The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation.

PubMed

Pavey, T G; Anokye, N; Taylor, A H; Trueman, P; Moxham, T; Fox, K R; Hillsdon, M; Green, C; Campbell, J L; Foster, C; Mutrie, N; Searle, J; Taylor, R S

2011-12-01

Exercise referral schemes (ERS) aim to identify inactive adults in the primary-care setting. The GP or health-care professional then refers the patient to a third-party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the individual. To assess the clinical effectiveness and cost-effectiveness of ERS for people with a diagnosed medical condition known to benefit from physical activity (PA). The scope of this report was broadened to consider individuals without a diagnosed condition who are sedentary. MEDLINE; EMBASE; PsycINFO; The Cochrane Library, ISI Web of Science; SPORTDiscus and ongoing trial registries were searched (from 1990 to October 2009) and included study references were checked. Systematic reviews: the effectiveness of ERS, predictors of ERS uptake and adherence, and the cost-effectiveness of ERS; and the development of a decision-analytic economic model to assess cost-effectiveness of ERS. Seven randomised controlled trials (UK, n = 5; non-UK, n = 2) met the effectiveness inclusion criteria, five comparing ERS with usual care, two compared ERS with an alternative PA intervention, and one to an ERS plus a self-determination theory (SDT) intervention. In intention-to-treat analysis, compared with usual care, there was weak evidence of an increase in the number of ERS participants who achieved a self-reported 90-150 minutes of at least moderate-intensity PA per week at 6-12 months' follow-up [pooled relative risk (RR) 1.11, 95% confidence interval 0.99 to 1.25]. There was no consistent evidence of a difference between ERS and usual care in the duration of moderate/vigorous intensity and total PA or other outcomes, for example physical fitness, serum lipids, health-related quality of life (HRQoL). There was no between-group difference in outcomes between ERS and alternative PA interventions or ERS plus a SDT intervention. None of the included trials separately reported outcomes in individuals with medical diagnoses. Fourteen observational studies and five randomised controlled trials provided a numerical assessment of ERS uptake and adherence (UK, n = 16; non-UK, n = 3). Women and older people were more likely to take up ERS but women, when compared with men, were less likely to adhere. The four previous economic evaluations identified suggest ERS to be a cost-effective intervention. Indicative incremental cost per quality-adjusted life-year (QALY) estimates for ERS for various scenarios were based on a de novo model-based economic evaluation. Compared with usual care, the mean incremental cost for ERS was £169 and the mean incremental QALY was 0.008, with the base-case incremental cost-effectiveness ratio at £20,876 per QALY in sedentary people without a medical condition and a cost per QALY of £14,618 in sedentary obese individuals, £12,834 in sedentary hypertensive patients, and £8414 for sedentary individuals with depression. Estimates of cost-effectiveness were highly sensitive to plausible variations in the RR for change in PA and cost of ERS. We found very limited evidence of the effectiveness of ERS. The estimates of the cost-effectiveness of ERS are based on a simple analytical framework. The economic evaluation reports small differences in costs and effects, and findings highlight the wide range of uncertainty associated with the estimates of effectiveness and the impact of effectiveness on HRQoL. No data were identified as part of the effectiveness review to allow for adjustment of the effect of ERS in different populations. There remains considerable uncertainty as to the effectiveness of ERS for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. We failed to identify any trial-based evidence of the effectiveness of ERS in those with a medical diagnosis. Future work should include randomised controlled trials assessing the cinical effectiveness and cost-effectivenesss of ERS in disease groups that may benefit from PA. The National Institute for Health Research Health Technology Assessment programme.

International Space Station Increment Operations Services

NASA Astrophysics Data System (ADS)

Michaelis, Horst; Sielaff, Christian

2002-01-01

The Industrial Operator (IO) has defined End-to-End services to perform efficiently all required operations tasks for the Manned Space Program (MSP) as agreed during the Ministerial Council in Edinburgh in November 2001. Those services are the result of a detailed task analysis based on the operations processes as derived from the Space Station Program Implementation Plans (SPIP) and defined in the Operations Processes Documents (OPD). These services are related to ISS Increment Operations and ATV Mission Operations. Each of these End-to-End services is typically characterised by the following properties: It has a clearly defined starting point, where all requirements on the end-product are fixed and associated performance metrics of the customer are well defined. It has a clearly defined ending point, when the product or service is delivered to the customer and accepted by him, according to the performance metrics defined at the start point. The implementation of the process might be restricted by external boundary conditions and constraints mutually agreed with the customer. As far as those are respected the IO has the free choice to select methods and means of implementation. The ISS Increment Operations Service (IOS) activities required for the MSP Exploitation program cover the complete increment specific cycle starting with the support to strategic planning and ending with the post increment evaluation. These activities are divided into sub-services including the following tasks: - ISS Planning Support covering the support to strategic and tactical planning up to the generation - Development &Payload Integration Support - ISS Increment Preparation - ISS Increment Execution These processes are tight together by the Increment Integration Management, which provides the planning and scheduling of all activities as well as the technical management of the overall process . The paper describes the entire End-to-End ISS Increment Operations service and the implementation to support the Columbus Flight 1E related increment and subsequent ISS increments. Special attention is paid to the implications caused by long term operations on hardware, software and operations personnel.

Air pollution and health risks due to vehicle traffic.

PubMed

Zhang, Kai; Batterman, Stuart

2013-04-15

Traffic congestion increases vehicle emissions and degrades ambient air quality, and recent studies have shown excess morbidity and mortality for drivers, commuters and individuals living near major roadways. Presently, our understanding of the air pollution impacts from congestion on roads is very limited. This study demonstrates an approach to characterize risks of traffic for on- and near-road populations. Simulation modeling was used to estimate on- and near-road NO2 concentrations and health risks for freeway and arterial scenarios attributable to traffic for different traffic volumes during rush hour periods. The modeling used emission factors from two different models (Comprehensive Modal Emissions Model and Motor Vehicle Emissions Factor Model version 6.2), an empirical traffic speed-volume relationship, the California Line Source Dispersion Model, an empirical NO2-NOx relationship, estimated travel time changes during congestion, and concentration-response relationships from the literature, which give emergency doctor visits, hospital admissions and mortality attributed to NO2 exposure. An incremental analysis, which expresses the change in health risks for small increases in traffic volume, showed non-linear effects. For a freeway, "U" shaped trends of incremental risks were predicted for on-road populations, and incremental risks are flat at low traffic volumes for near-road populations. For an arterial road, incremental risks increased sharply for both on- and near-road populations as traffic increased. These patterns result from changes in emission factors, the NO2-NOx relationship, the travel delay for the on-road population, and the extended duration of rush hour for the near-road population. This study suggests that health risks from congestion are potentially significant, and that additional traffic can significantly increase risks, depending on the type of road and other factors. Further, evaluations of risk associated with congestion must consider travel time, the duration of rush-hour, congestion-specific emission estimates, and uncertainties. Copyright © 2013 Elsevier B.V. All rights reserved.

Air pollution and health risks due to vehicle traffic

PubMed Central

Zhang, Kai; Batterman, Stuart

2014-01-01

Traffic congestion increases vehicle emissions and degrades ambient air quality, and recent studies have shown excess morbidity and mortality for drivers, commuters and individuals living near major roadways. Presently, our understanding of the air pollution impacts from congestion on roads is very limited. This study demonstrates an approach to characterize risks of traffic for on- and near-road populations. Simulation modeling was used to estimate on- and near-road NO2 concentrations and health risks for freeway and arterial scenarios attributable to traffic for different traffic volumes during rush hour periods. The modeling used emission factors from two different models (Comprehensive Modal Emissions Model and Motor Vehicle Emissions Factor Model version 6.2), an empirical traffic speed–volume relationship, the California Line Source Dispersion Model, an empirical NO2–NOx relationship, estimated travel time changes during congestion, and concentration–response relationships from the literature, which give emergency doctor visits, hospital admissions and mortality attributed to NO2 exposure. An incremental analysis, which expresses the change in health risks for small increases in traffic volume, showed non-linear effects. For a freeway, “U” shaped trends of incremental risks were predicted for on-road populations, and incremental risks are flat at low traffic volumes for near-road populations. For an arterial road, incremental risks increased sharply for both on- and near-road populations as traffic increased. These patterns result from changes in emission factors, the NO2–NOx relationship, the travel delay for the on-road population, and the extended duration of rush hour for the near-road population. This study suggests that health risks from congestion are potentially significant, and that additional traffic can significantly increase risks, depending on the type of road and other factors. Further, evaluations of risk associated with congestion must consider travel time, the duration of rush-hour, congestion-specific emission estimates, and uncertainties. PMID:23500830

Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis.

PubMed

Lewis, James D; Brown, Alphonso; Localio, A Russell; Schwartz, J Sanford

2002-01-15

Evaluation of rectal bleeding in young patients is a frequent diagnostic challenge. To determine the relative cost-effectiveness of alternative diagnostic strategies for young patients with rectal bleeding. Cost-effectiveness analysis using a Markov model. Probability estimates were based on published medical literature. Cost estimates were based on Medicare reimbursement rates and published medical literature. Persons 25 to 45 years of age with otherwise asymptomatic rectal bleeding. The patient's lifetime. Modified societal perspective. Diagnostic strategies included no evaluation, colonoscopy, flexible sigmoidoscopy, barium enema, anoscopy, or any feasible combination of these procedures. Life expectancy and costs. For 35-year-old patients, the no-evaluation strategy yielded the least life expectancy. The incremental cost-effectiveness of flexible sigmoidoscopy compared with no evaluation or with any strategy incorporating anoscopy (followed by further evaluation if no anal disease was found on anoscopy) was less than $5300 per year of life gained. A strategy of flexible sigmoidoscopy plus barium enema yielded the greatest life expectancy, with an incremental cost of $23 918 per additional life-year gained compared with flexible sigmoidoscopy alone. As patient age at presentation of rectal bleeding increased, evaluation of the entire colon became more cost-effective. The incremental cost-effectiveness of flexible sigmoidoscopy plus barium enema compared with colonoscopy was sensitive to estimates of the sensitivity of the tests. In a probabilistic sensitivity analysis comparing flexible sigmoidoscopy with anoscopy followed by flexible sigmoidoscopy if needed, the middle 95th percentile of the distribution of the incremental cost-effectiveness ratios ranged from flexible sigmoidoscopy yielding an increased life expectancy at reduced cost to $52 158 per year of life gained (mean, $11 461 per year of life saved). Evaluation of the colon of persons 25 to 45 years of age with otherwise asymptomatic rectal bleeding increases the life expectancy at a cost comparable to that of colon cancer screening.

Accurate prediction of cardiorespiratory fitness using cycle ergometry in minimally disabled persons with relapsing-remitting multiple sclerosis.

PubMed

Motl, Robert W; Fernhall, Bo

2012-03-01

To examine the accuracy of predicting peak oxygen consumption (VO(2peak)) primarily from peak work rate (WR(peak)) recorded during a maximal, incremental exercise test on a cycle ergometer among persons with relapsing-remitting multiple sclerosis (RRMS) who had minimal disability. Cross-sectional study. Clinical research laboratory. Women with RRMS (n=32) and sex-, age-, height-, and weight-matched healthy controls (n=16) completed an incremental exercise test on a cycle ergometer to volitional termination. Not applicable. Measured and predicted VO(2peak) and WR(peak). There were strong, statistically significant associations between measured and predicted VO(2peak) in the overall sample (R(2)=.89, standard error of the estimate=127.4 mL/min) and subsamples with (R(2)=.89, standard error of the estimate=131.3 mL/min) and without (R(2)=.85, standard error of the estimate=126.8 mL/min) multiple sclerosis (MS) based on the linear regression analyses. Based on the 95% confidence limits for worst-case errors, the equation predicted VO(2peak) within 10% of its true value in 95 of every 100 subjects with MS. Peak VO(2) can be accurately predicted in persons with RRMS who have minimal disability as it is in controls by using established equations and WR(peak) recorded from a maximal, incremental exercise test on a cycle ergometer. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.

PubMed

Shao, Hui; Brown, Lisanne; Diana, Mark L; Schmidt, Laura A; Mason, Karen; Oronce, Carlos Irwin; Shi, Lizheng

2016-09-01

There is a need to understand the costs associated with supporting, implementing, and maintaining the system redesign of small and medium-sized safety-net clinics. The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation.The sample was 74 clinics in Greater New Orleans that received funds from the Primary Care Access and Stabilization Grant program between 2007 and 2010 to support their transformation. The study period was divided into baseline (September 21, 2007-March 21, 2008), transformation (March 22, 2008-March 21, 2009), and maintenance (March 22, 2009-September 20, 2010) periods, and data were collected at 6-month intervals. Baseline characteristics for the clinics that transformed were compared to those that did not. Fixed-effect models were conducted for cost estimation, controlling for baseline differences, using propensity score weights.Half of the 74 primary care clinics achieved transformation by the end of the study period. The clinics that transformed had higher total cost, more clinic visits, and a larger female patient proportion at baseline. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation.Larger-sized clinics and those with a higher female proportion were more likely to transform. The Primary Care Access and Stabilization Grant program provided approximately $24.86 per visit over the 2 and 1/2 years. This estimated incremental cost could be used to guide policy recommendations to support primary care transformation in the United States.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

2016-03-01

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Density variations and their influence on carbon stocks: case-study on two Biosphere Reserves in the Democratic Republic of Congo

NASA Astrophysics Data System (ADS)

De Ridder, Maaike; De Haulleville, Thalès; Kearsley, Elizabeth; Van den Bulcke, Jan; Van Acker, Joris; Beeckman, Hans

2014-05-01

It is commonly acknowledged that allometric equations for aboveground biomass and carbon stock estimates are improved significantly if density is included as a variable. However, not much attention is given to this variable in terms of exact, measured values and density profiles from pith to bark. Most published case-studies obtain density values from literature sources or databases, this way using large ranges of density values and possible causing significant errors in carbon stock estimates. The use of one single fixed value for density is also not recommended if carbon stock increments are estimated. Therefore, our objective is to measure and analyze a large number of tree species occurring in two Biosphere Reserves (Luki and Yangambi). Nevertheless, the diversity of tree species in these tropical forests is too high to perform this kind of detailed analysis on all tree species (> 200/ha). Therefore, we focus on the most frequently encountered tree species with high abundance (trees/ha) and dominance (basal area/ha) for this study. Increment cores were scanned with a helical X-ray protocol to obtain density profiles from pith to bark. This way, we aim at dividing the tree species with a distinct type of density profile into separate groups. If, e.g., slopes in density values from pith to bark remain stable over larger samples of one tree species, this slope could also be used to correct for errors in carbon (increment) estimates, caused by density values from simplified density measurements or density values from literature. In summary, this is most likely the first study in the Congo Basin that focuses on density patterns in order to check their influence on carbon stocks and differences in carbon stocking based on species composition (density profiles ~ temperament of tree species).

Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans

PubMed Central

Shao, Hui; Brown, Lisanne; Diana, Mark L.; Schmidt, Laura A.; Mason, Karen; Oronce, Carlos Irwin; Shi, Lizheng

2016-01-01

Abstract There is a need to understand the costs associated with supporting, implementing, and maintaining the system redesign of small and medium-sized safety-net clinics. The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation. The sample was 74 clinics in Greater New Orleans that received funds from the Primary Care Access and Stabilization Grant program between 2007 and 2010 to support their transformation. The study period was divided into baseline (September 21, 2007–March 21, 2008), transformation (March 22, 2008–March 21, 2009), and maintenance (March 22, 2009–September 20, 2010) periods, and data were collected at 6-month intervals. Baseline characteristics for the clinics that transformed were compared to those that did not. Fixed-effect models were conducted for cost estimation, controlling for baseline differences, using propensity score weights. Half of the 74 primary care clinics achieved transformation by the end of the study period. The clinics that transformed had higher total cost, more clinic visits, and a larger female patient proportion at baseline. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation. Larger-sized clinics and those with a higher female proportion were more likely to transform. The Primary Care Access and Stabilization Grant program provided approximately $24.86 per visit over the 2 and 1/2 years. This estimated incremental cost could be used to guide policy recommendations to support primary care transformation in the United States. PMID:27684855

Effects of implicit theories of ability and stereotype-inconsistent information on handgrip strength in older adults: A regulatory fit perspective.

PubMed

Emile, Mélanie; Chalabaev, Aina; Colson, Serge S; Vaulerin, Jerome; Falzon, Charlene; D'Arripe-Longueville, Fabienne

2017-03-01

This study examined whether stereotype-inconsistent information interacts with implicit theories of ability to affect handgrip strength in older adults. Eighty-two retired older adults (13 men and 69 women) from 61 to 89 years old (M age = 75.8 years; SD = 6.9) performed maximum voluntary contractions (MVC) during a handgrip task in a design manipulating implicit theories of ability and stereotype-inconsistent information related to physical decline with aging. Participants were randomly assigned to one of three groups: incremental condition, entity condition, or control group. The results showed that in the incremental condition the stereotype-inconsistent information improved the peak MVC, the average MVC, the peak rate of force development (RFD), and RFD in the initial 50 ms of the MVC. This study therefore demonstrated that individuals with an incremental mindset who are exposed to stereotype-inconsistent information can boost their physical performance. These findings are discussed from the perspective of regulatory fit (i.e., when task framing is congruent with the individual's goal). © 2016 The Authors. Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research.

Features of Scots pine radial growth in conditions of provenance trial.

NASA Astrophysics Data System (ADS)

Kuzmin, Sergey; Kuzmina, Nina

2013-04-01

Provenance trial of Scots pine in Boguchany forestry of Krasnoyarsk krai is conducted on two different soils - dark-grey loam forest soil and sod-podzol sandy soil. Complex of negative factors for plant growth and development appears in dry conditions of sandy soil. It could results in decrease of resistance to diseases. Sandy soils in different climatic zones have such common traits as low absorbing capacity, poorness of elemental nutrition, low microbiological activity and moisture capacity, very high water permeability. But Scots pine trees growing in such conditions could have certain advantages and perspectives of use. In the scope of climate change (global warming) the study of Scots pine growth on sandy soil become urgent because of more frequent appearance of dry seasons. Purpose of the work is revelation of radial growth features of Scots pine with different origin in dry conditions of sandy soil and assessment of external factors influence. The main feature of radial growth of majority of studied pine provenances in conditions of sandy soil is presence of significant variation of increment with distinct decline in 25-years old with loss of tree rings in a number of cases. The reason of it is complex of factors: deficit of June precipitation and next following outbreak of fungal disease. Found «frost rings» for all trees of studied clymatypes in 1992 are the consequence of temperature decline from May 21 to June 2 - from 23 down to 2 degree Celsius. Perspective climatypes with biggest radial increments and least sensitivity to fungal disease were revealed. Eniseysk and Vikhorevka (from Krasnoyarsk krai and Irkutsk oblast)provenances of pine have the biggest radial increments, the least sensitivity to Cenangium dieback and smallest increments decline. These climatypes are in the group of perspective provenances and in present time they are recommended for wide trial in the region for future use in plantation forest growing. Kandalaksha (Murmansk oblast) climatype from northern taiga with good resistance to pathogen have nonsignificant decline in radial increment during epiphytoty in comparison with local and southern climatypes. Southern Chemal provenance (Altai) after influence of Cenangium dieback has more than others losses of tree rings as the result of nonresistance to this fungal disease.

A new approach to impulsive rendezvous near circular orbit

NASA Astrophysics Data System (ADS)

Carter, Thomas; Humi, Mayer

2012-04-01

A new approach is presented for the problem of planar optimal impulsive rendezvous of a spacecraft in an inertial frame near a circular orbit in a Newtonian gravitational field. The total characteristic velocity to be minimized is replaced by a related characteristic-value function and this related optimization problem can be solved in closed form. The solution of this problem is shown to approach the solution of the original problem in the limit as the boundary conditions approach those of a circular orbit. Using a form of primer-vector theory the problem is formulated in a way that leads to relatively easy calculation of the optimal velocity increments. A certain vector that can easily be calculated from the boundary conditions determines the number of impulses required for solution of the optimization problem and also is useful in the computation of these velocity increments. Necessary and sufficient conditions for boundary conditions to require exactly three nonsingular non-degenerate impulses for solution of the related optimal rendezvous problem, and a means of calculating these velocity increments are presented. A simple example of a three-impulse rendezvous problem is solved and the resulting trajectory is depicted. Optimal non-degenerate nonsingular two-impulse rendezvous for the related problem is found to consist of four categories of solutions depending on the four ways the primer vector locus intersects the unit circle. Necessary and sufficient conditions for each category of solutions are presented. The region of the boundary values that admit each category of solutions of the related problem are found, and in each case a closed-form solution of the optimal velocity increments is presented. Similar results are presented for the simpler optimal rendezvous that require only one-impulse. For brevity degenerate and singular solutions are not discussed in detail, but should be presented in a following study. Although this approach is thought to provide simpler computations than existing methods, its main contribution may be in establishing a new approach to the more general problem.

Effects of climate variables on intra-annual stem radial increment in Pinus cembra (L.) along the alpine treeline ecotone

PubMed Central

GRUBER, Andreas; ZIMMERMANN, Jolanda; WIESER, Gerhard; OBERHUBER, Walter

2011-01-01

Within the alpine treeline ecotone tree growth is increasingly restricted by extreme climate conditions. Although intra-annual stem growth recorded by dendrometers can be linked to climate, stem diameter increments in slow-growing subalpine trees are masked by changes in tree water status. We tested the hypothesis that intra-annual radial stem growth in Pinus cembra is influenced by different climate variables along the treeline ecotone in the Austrian Alps. Dendrometer traces were compared with dynamics of xylem cell development to date onset of cambial activity and radial stem growth in spring. Daily fluctuations in stem radius reflected changes in tree water status throughout the treeline ecotone. Extracted daily radial increments were significantly correlated with air temperature at the timberline and treeline only, where budburst, cambial activity and enlargement of first tracheids also occurred quite similarly. A close relationship was detected between radial increment and number of enlarging tracheids throughout the treeline ecotone. We conclude that (i) the relationship between climate and radial stem growth within the treeline ecotone is dependent on a close coupling to atmospheric climate conditions and (ii) initiation of cambial activity and radial growth in spring can be distinguished from stem re-hydration by histological analysis. PMID:21423861

Effects of climate variables on intra-annual stem radial increment in Pinus cembra (L.) along the alpine treeline ecotone.

PubMed

Gruber, Andreas; Zimmermann, Jolanda; Wieser, Gerhard; Oberhuber, Walter

2009-08-01

Within the alpine treeline ecotone tree growth is increasingly restricted by extreme climate conditions. Although intra-annual stem growth recorded by dendrometers can be linked to climate, stem diameter increments in slow-growing subalpine trees are masked by changes in tree water status.We tested the hypothesis that intra-annual radial stem growth in Pinus cembra is influenced by different climate variables along the treeline ecotone in the Austrian Alps. Dendrometer traces were compared with dynamics of xylem cell development to date onset of cambial activity and radial stem growth in spring.Daily fluctuations in stem radius reflected changes in tree water status throughout the treeline ecotone. Extracted daily radial increments were significantly correlated with air temperature at the timberline and treeline only, where budburst, cambial activity and enlargement of first tracheids also occurred quite similarly. A close relationship was detected between radial increment and number of enlarging tracheids throughout the treeline ecotone.We conclude that (i) the relationship between climate and radial stem growth within the treeline ecotone is dependent on a close coupling to atmospheric climate conditions and (ii) initiation of cambial activity and radial growth in spring can be distinguished from stem re-hydration by histological analysis.

Modeling nonstructural carbohydrate reserve dynamics in forest trees

NASA Astrophysics Data System (ADS)

Richardson, Andrew; Keenan, Trevor; Carbone, Mariah; Pederson, Neil

2013-04-01

Understanding the factors influencing the availability of nonstructural carbohydrate (NSC) reserves is essential for predicting the resilience of forests to climate change and environmental stress. However, carbon allocation processes remain poorly understood and many models either ignore NSC reserves, or use simple and untested representations of NSC allocation and pool dynamics. Using model-data fusion techniques, we combined a parsimonious model of forest ecosystem carbon cycling with novel field sampling and laboratory analyses of NSCs. Simulations were conducted for an evergreen conifer forest and a deciduous broadleaf forest in New England. We used radiocarbon methods based on the 14C "bomb spike" to estimate the age of NSC reserves, and used this to constrain the mean residence time of modeled NSCs. We used additional data, including tower-measured fluxes of CO2, soil and biomass carbon stocks, woody biomass increment, and leaf area index and litterfall, to further constrain the model's parameters and initial conditions. Incorporation of fast- and slow-cycling NSC pools improved the ability of the model to reproduce the measured interannual variability in woody biomass increment. We show how model performance varies according to model structure and total pool size, and we use novel diagnostic criteria, based on autocorrelation statistics of annual biomass growth, to evaluate the model's ability to correctly represent lags and memory effects.

Dissolved Solids in Streams of the Conterminous United States

NASA Astrophysics Data System (ADS)

Anning, D. W.; Flynn, M.

2014-12-01

Studies have shown that excessive dissolved-solids concentrations in water can have adverse effects on the environment and on agricultural, municipal, and industrial water users. Such effects motivated the U.S. Geological Survey's National Water-Quality Assessment Program to develop a SPAtially-Referenced Regression on Watershed Attributes (SPARROW) model to improve the understanding of dissolved solids in streams of the United States. Using the SPARROW model, annual dissolved-solids loads from 2,560 water-quality monitoring stations were statistically related to several spatial datasets serving as surrogates for dissolved-solids sources and transport processes. Sources investigated in the model included geologic materials, road de-icers, urban lands, cultivated lands, and pasture lands. Factors affecting transport from these sources to streams in the model included climate, soil, vegetation, terrain, population, irrigation, and artificial-drainage characteristics. The SPARROW model was used to predict long-term mean annual conditions for dissolved-solids sources, loads, yields, and concentrations in about 66,000 stream reaches and corresponding incremental catchments nationwide. The estimated total amount of dissolved solids delivered to the Nation's streams is 272 million metric tons (Mt) annually, of which 194 million Mt (71%) are from geologic sources, 38 million Mt (14%) are from road de-icers, 18 million Mt (7%) are from pasture lands, 14 million Mt (5 %) are from urban lands, and 8 million Mt (3%) are from cultivated lands. The median incremental-catchment yield delivered to local streams is 26 metric tons per year per square kilometer [(Mt/yr)/km2]. Ten percent of the incremental catchments yield less than 4 (Mt/yr)/km2, and 10 percent yield more than 90 (Mt/yr)/km2. In 13% of the reaches, predicted flow-weighted concentrations exceed 500 mg/L—the U.S. Environmental Protection Agency secondary non-enforceable drinking-water standard.

Leaf area and light use efficiency patterns of Norway spruce under different thinning regimes and age classes

PubMed Central

Gspaltl, Martin; Bauerle, William; Binkley, Dan; Sterba, Hubert

2013-01-01

Silviculture focuses on establishing forest stand conditions that improve the stand increment. Knowledge about the efficiency of an individual tree is essential to be able to establish stand structures that increase tree resource use efficiency and stand level production. Efficiency is often expressed as stem growth per unit leaf area (leaf area efficiency), or per unit of light absorbed (light use efficiency). We tested the hypotheses that: (1) volume increment relates more closely with crown light absorption than leaf area, since one unit of leaf area can receive different amounts of light due to competition with neighboring trees and self-shading, (2) dominant trees use light more efficiently than suppressed trees and (3) thinning increases the efficiency of light use by residual trees, partially accounting for commonly observed increases in post-thinning growth. We investigated eight even-aged Norway spruce (Picea abies (L.) Karst.) stands at Bärnkopf, Austria, spanning three age classes (mature, immature and pole-stage) and two thinning regimes (thinned and unthinned). Individual leaf area was calculated with allometric equations and absorbed photosynthetically active radiation was estimated for each tree using the three-dimensional crown model Maestra. Absorbed photosynthetically active radiation was only a slightly better predictor of volume increment than leaf area. Light use efficiency increased with increasing tree size in all stands, supporting the second hypothesis. At a given tree size, trees from the unthinned plots were more efficient, however, due to generally larger tree sizes in the thinned stands, an average tree from the thinned treatment was superior (not congruent in all plots, thus only partly supporting the third hypothesis). PMID:25540477

A Cost-Effectiveness Analysis of Community Health Workers in Mozambique.

PubMed

Bowser, Diana; Okunogbe, Adeyemi; Oliveras, Elizabeth; Subramanian, Laura; Morrill, Tyler

2015-10-01

Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CHW programs, especially in developing countries. This study assessed the costs of a CHW program in Mozambique over the period 2010-2012. Incremental cost-effectiveness ratios, comparing the change in costs to the change in 3 output measures, as well as gains in efficiency were calculated over the periods 2010-2011 and 2010-2012. The results were reported both excluding and including salaries for CHWs. The results of the study showed total costs of the CHW program increased from US$1.34 million in 2010 to US$1.67 million in 2012. The highest incremental cost-effectiveness ratio was for the cost per beneficiary covered including CHW salaries, estimated at US$47.12 for 2010-2011. The smallest incremental cost-effectiveness ratio was for the cost per household visit not including CHW salaries, estimated at US$0.09 for 2010-2012. Adding CHW salaries would not only have increased total program costs by 362% in 2012 but also led to the largest efficiency gains in program implementation; a 56% gain in cost per output in the long run as compared with the short run after including CHW salaries. Our findings can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses. © The Author(s) 2015.

Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

PubMed

Derdeyn, C P; Powers, W J

1996-11-01

The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

Socio-economic costs of osteoarthritis: a systematic review of cost-of-illness studies.

PubMed

Puig-Junoy, Jaume; Ruiz Zamora, Alba

2015-04-01

The burden of illness that can be attributed to osteoarthritis is considerable and ever increasing. The aim of this systematic review is to analyze currently available data derived from cost-of-illness studies on the healthcare and non-healthcare costs of osteoarthritis. PubMed, Index Medicus Español (IME), and the Spanish Database of Health Sciences [Índice Bibliográfico Español en Ciencias de la Salud (IBECS)] were searched up to the end of April 2013. This study adhered to the PRISMA guidelines. Articles were reviewed and the study quality assessed by two independent investigators with consensus resolution of discrepancies. We identified 39 studies that investigated the socio-economic cost of osteoarthritis. Only nine studies took a social perspective. Rather than estimating the incremental cost of osteoarthritis, nine studies estimated the total cost of treating patients with osteoarthritis without a control for comorbidity. The other 30 studies determined the incremental cost with or without a control group. Only nine studies assessed a comprehensive list of healthcare resources. The annual incremental healthcare costs of generalized osteoarthritis ranged from €705 to €19,715. The annual incremental non-healthcare-related costs of generalized osteoarthritis ranged from €432 to €11,956. The study concludes that the social cost of osteoarthritis could be between 0.25% and 0.50% of a country׳s GDP. This should be considered in order to foster studies that take into account both healthcare and non-healthcare costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Cross-correlation of instantaneous phase increments in pressure-flow fluctuations: Applications to cerebral autoregulation

NASA Astrophysics Data System (ADS)

Chen, Zhi; Hu, Kun; Stanley, H. Eugene; Novak, Vera; Ivanov, Plamen Ch.

2006-03-01

We investigate the relationship between the blood flow velocities (BFV) in the middle cerebral arteries and beat-to-beat blood pressure (BP) recorded from a finger in healthy and post-stroke subjects during the quasisteady state after perturbation for four different physiologic conditions: supine rest, head-up tilt, hyperventilation, and CO2 rebreathing in upright position. To evaluate whether instantaneous BP changes in the steady state are coupled with instantaneous changes in the BFV, we compare dynamical patterns in the instantaneous phases of these signals, obtained from the Hilbert transform, as a function of time. We find that in post-stroke subjects the instantaneous phase increments of BP and BFV exhibit well-pronounced patterns that remain stable in time for all four physiologic conditions, while in healthy subjects these patterns are different, less pronounced, and more variable. We propose an approach based on the cross-correlation of the instantaneous phase increments to quantify the coupling between BP and BFV signals. We find that the maximum correlation strength is different for the two groups and for the different conditions. For healthy subjects the amplitude of the cross-correlation between the instantaneous phase increments of BP and BFV is small and attenuates within 3-5 heartbeats. In contrast, for post-stroke subjects, this amplitude is significantly larger and cross-correlations persist up to 20 heartbeats. Further, we show that the instantaneous phase increments of BP and BFV are cross-correlated even within a single heartbeat cycle. We compare the results of our approach with three complementary methods: direct BP-BFV cross-correlation, transfer function analysis, and phase synchronization analysis. Our findings provide insight into the mechanism of cerebral vascular control in healthy subjects, suggesting that this control mechanism may involve rapid adjustments (within a heartbeat) of the cerebral vessels, so that BFV remains steady in response to changes in peripheral BP.

Cross-correlation of instantaneous phase increments in pressure-flow fluctuations: applications to cerebral autoregulation.

PubMed

Chen, Zhi; Hu, Kun; Stanley, H Eugene; Novak, Vera; Ivanov, Plamen Ch

2006-03-01

We investigate the relationship between the blood flow velocities (BFV) in the middle cerebral arteries and beat-to-beat blood pressure (BP) recorded from a finger in healthy and post-stroke subjects during the quasisteady state after perturbation for four different physiologic conditions: supine rest, head-up tilt, hyperventilation, and CO2 rebreathing in upright position. To evaluate whether instantaneous BP changes in the steady state are coupled with instantaneous changes in the BFV, we compare dynamical patterns in the instantaneous phases of these signals, obtained from the Hilbert transform, as a function of time. We find that in post-stroke subjects the instantaneous phase increments of BP and BFV exhibit well-pronounced patterns that remain stable in time for all four physiologic conditions, while in healthy subjects these patterns are different, less pronounced, and more variable. We propose an approach based on the cross-correlation of the instantaneous phase increments to quantify the coupling between BP and BFV signals. We find that the maximum correlation strength is different for the two groups and for the different conditions. For healthy subjects the amplitude of the cross-correlation between the instantaneous phase increments of BP and BFV is small and attenuates within 3-5 heartbeats. In contrast, for post-stroke subjects, this amplitude is significantly larger and cross-correlations persist up to 20 heartbeats. Further, we show that the instantaneous phase increments of BP and BFV are cross-correlated even within a single heartbeat cycle. We compare the results of our approach with three complementary methods: direct BP-BFV cross-correlation, transfer function analysis, and phase synchronization analysis. Our findings provide insight into the mechanism of cerebral vascular control in healthy subjects, suggesting that this control mechanism may involve rapid adjustments (within a heartbeat) of the cerebral vessels, so that BFV remains steady in response to changes in peripheral BP.

Cost-effectiveness analysis of germ-line BRCA testing in women with breast cancer and cascade testing in family members of mutation carriers.

PubMed

Tuffaha, Haitham W; Mitchell, Andrew; Ward, Robyn L; Connelly, Luke; Butler, James R G; Norris, Sarah; Scuffham, Paul A

2018-01-04

PurposeTo evaluate the cost-effectiveness of BRCA testing in women with breast cancer, and cascade testing in family members of BRCA mutation carriers.MethodsA cost-effectiveness analysis was conducted using a cohort Markov model from a health-payer perspective. The model estimated the long-term benefits and costs of testing women with breast cancer who had at least a 10% pretest BRCA mutation probability, and the cascade testing of first- and second-degree relatives of women who test positive.ResultsCompared with no testing, BRCA testing of affected women resulted in an incremental cost per quality-adjusted life-year (QALY) gained of AU$18,900 (incremental cost AU$1,880; incremental QALY gain 0.10) with reductions of 0.04 breast and 0.01 ovarian cancer events. Testing affected women and cascade testing of family members resulted in an incremental cost per QALY gained of AU$9,500 compared with testing affected women only (incremental cost AU$665; incremental QALY gain 0.07) with additional reductions of 0.06 breast and 0.01 ovarian cancer events.ConclusionBRCA testing in women with breast cancer is cost-effective and is associated with reduced risk of cancer and improved survival. Extending testing to cover family members of affected women who test positive improves cost-effectiveness beyond restricting testing to affected women only.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.231.

Cost Attributable to Nosocomial Bacteremia. Analysis According to Microorganism and Antimicrobial Sensitivity in a University Hospital in Barcelona.

PubMed

Riu, Marta; Chiarello, Pietro; Terradas, Roser; Sala, Maria; Garcia-Alzorriz, Enric; Castells, Xavier; Grau, Santiago; Cots, Francesc

2016-01-01

To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who developed bacteremia, as well as differences in this cost, depending on whether the microorganism was multidrug-resistant or multidrug-sensitive. A total of 571 admissions with bacteremia matched the inclusion criteria and 82,022 were included in the control group. The mean cost was € 25,891 for admissions with bacteremia and € 6,750 for those without bacteremia. The mean incremental cost was estimated at € 15,151 (CI, € 11,570 to € 18,733). Multidrug-resistant P. aeruginosa bacteremia had the highest mean incremental cost, € 44,709 (CI, € 34,559 to € 54,859). Antimicrobial-susceptible E. coli nosocomial bacteremia had the lowest mean incremental cost, € 10,481 (CI, € 8,752 to € 12,210). Despite their lower cost, episodes of antimicrobial-susceptible E. coli nosocomial bacteremia had a major impact due to their high frequency. Adjustment of hospital cost according to the organism causing bacteremia and antibiotic sensitivity could improve prevention strategies and allow their prioritization according to their overall impact and costs. Infection reduction is a strategy to reduce resistance.

Cost Attributable to Nosocomial Bacteremia. Analysis According to Microorganism and Antimicrobial Sensitivity in a University Hospital in Barcelona

PubMed Central

Riu, Marta; Chiarello, Pietro; Terradas, Roser; Sala, Maria; Garcia-Alzorriz, Enric; Castells, Xavier; Grau, Santiago; Cots, Francesc

2016-01-01

Aim To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. Methods We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who developed bacteremia, as well as differences in this cost, depending on whether the microorganism was multidrug-resistant or multidrug-sensitive. Results A total of 571 admissions with bacteremia matched the inclusion criteria and 82,022 were included in the control group. The mean cost was € 25,891 for admissions with bacteremia and € 6,750 for those without bacteremia. The mean incremental cost was estimated at € 15,151 (CI, € 11,570 to € 18,733). Multidrug-resistant P. aeruginosa bacteremia had the highest mean incremental cost, € 44,709 (CI, € 34,559 to € 54,859). Antimicrobial-susceptible E. coli nosocomial bacteremia had the lowest mean incremental cost, € 10,481 (CI, € 8,752 to € 12,210). Despite their lower cost, episodes of antimicrobial-susceptible E. coli nosocomial bacteremia had a major impact due to their high frequency. Conclusions Adjustment of hospital cost according to the organism causing bacteremia and antibiotic sensitivity could improve prevention strategies and allow their prioritization according to their overall impact and costs. Infection reduction is a strategy to reduce resistance. PMID:27055117

Non-operative anti-caries agents and dental caries increment among adults at high caries risk: a retrospective cohort study.

PubMed

Chaffee, Benjamin W; Cheng, Jing; Featherstone, John D B

2015-09-24

Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized. This retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deemed to be at high risk for dental caries during baseline oral evaluations that were completed between July 1, 2007 and December 31, 2012 at a dental university in the United States. We calculated and compared adjusted mean estimates for the number of new decayed or restored teeth (DFT increment) from baseline to the next completed oral evaluation (N = 2,724 patients with follow-up) across three categories of delivery of non-operative anti-caries agents (e.g., high-concentration fluoride toothpaste, chlorhexidine rinse, xylitol products): never, at a single appointment, or at ≥2 appointments ≥4 weeks apart. Estimates were adjusted for patient and provider characteristics, baseline dental status, losses-to-follow-up, and follow-up time. Approximately half the patients did not receive any form of non-operative anti-caries agent. Most that received anti-caries agents were given more than one type of product in combination. One-time delivery of anti-caries agents was associated with a similar DFT increment as receiving no such therapy (difference in increment: -0.04; 95% CI: -0.28, 0.21). However, repeated, spaced delivery of anti-caries agents was associated with approximately one decayed or restored tooth prevented over 18 months for every three patients treated (difference in increment: -0.35; 95% CI: -0.65, -0.08). These results lend evidence that repeatedly receiving anti-caries agents can reduce tooth decay among high-risk patients engaged in regular dental care.

Theoretical and Experimental Estimations of Volumetric Inductive Phase Shift in Breast Cancer Tissue

NASA Astrophysics Data System (ADS)

González, C. A.; Lozano, L. M.; Uscanga, M. C.; Silva, J. G.; Polo, S. M.

2013-04-01

Impedance measurements based on magnetic induction for breast cancer detection has been proposed in some studies. This study evaluates theoretical and experimentally the use of a non-invasive technique based on magnetic induction for detection of patho-physiological conditions in breast cancer tissue associated to its volumetric electrical conductivity changes through inductive phase shift measurements. An induction coils-breast 3D pixel model was designed and tested. The model involves two circular coils coaxially centered and a human breast volume centrally placed with respect to the coils. A time-harmonic numerical simulation study addressed the effects of frequency-dependent electrical properties of tumoral tissue on the volumetric inductive phase shift of the breast model measured with the circular coils as inductor and sensor elements. Experimentally; five female volunteer patients with infiltrating ductal carcinoma previously diagnosed by the radiology and oncology departments of the Specialty Clinic for Women of the Mexican Army were measured by an experimental inductive spectrometer and the use of an ergonomic inductor-sensor coil designed to estimate the volumetric inductive phase shift in human breast tissue. Theoretical and experimental inductive phase shift estimations were developed at four frequencies: 0.01, 0.1, 1 and 10 MHz. The theoretical estimations were qualitatively in agreement with the experimental findings. Important increments in volumetric inductive phase shift measurements were evident at 0.01MHz in theoretical and experimental observations. The results suggest that the tested technique has the potential to detect pathological conditions in breast tissue associated to cancer by non-invasive monitoring. Further complementary studies are warranted to confirm the observations.

Estimating the Health and Economic Impacts of Changes in Local Air Quality

PubMed Central

Carvour, Martha L.; Hughes, Amy E.; Fann, Neal

2018-01-01

Objectives. To demonstrate the benefits-mapping software Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE), which integrates local air quality data with previously published concentration–response and health–economic valuation functions to estimate the health effects of changes in air pollution levels and their economic consequences. Methods. We illustrate a local health impact assessment of ozone changes in the 10-county nonattainment area of the Dallas–Fort Worth region of Texas, estimating the short-term effects on mortality predicted by 2 scenarios for 3 years (2008, 2011, and 2013): an incremental rollback of the daily 8-hour maximum ozone levels of all area monitors by 10 parts per billion and a rollback-to-a-standard ambient level of 65 parts per billion at only monitors above that level. Results. Estimates of preventable premature deaths attributable to ozone air pollution obtained by the incremental rollback method varied little by year, whereas those obtained by the rollback-to-a-standard method varied by year and were sensitive to the choice of ordinality and the use of preloaded or imported data. Conclusions. BenMAP-CE allows local and regional public health analysts to generate timely, evidence-based estimates of the health impacts and economic consequences of potential policy options in their communities. PMID:29698094

Net primary productivity, allocation pattern and carbon use efficiency in an apple orchard assessed by integrating eddy covariance, biometric and continuous soil chamber measurements

NASA Astrophysics Data System (ADS)

Zanotelli, D.; Montagnani, L.; Manca, G.; Tagliavini, M.

2013-05-01

Carbon use efficiency (CUE), the ratio of net primary production (NPP) over gross primary production (GPP), is a functional parameter that could possibly link the current increasingly accurate global GPP estimates with those of net ecosystem exchange, for which global predictors are still unavailable. Nevertheless, CUE estimates are actually available for only a few ecosystem types, while information regarding agro-ecosystems is scarce, in spite of the simplified spatial structure of these ecosystems that facilitates studies on allocation patterns and temporal growth dynamics. We combined three largely deployed methods, eddy covariance, soil respiration and biometric measurements, to assess monthly values of CUE, NPP and allocation patterns in different plant organs in an apple orchard during a complete year (2010). We applied a measurement protocol optimized for quantifying monthly values of carbon fluxes in this ecosystem type, which allows for a cross check between estimates obtained from different methods. We also attributed NPP components to standing biomass increments, detritus cycle feeding and lateral exports. We found that in the apple orchard, both net ecosystem production and gross primary production on a yearly basis, 380 ± 30 g C m-2 and 1263 ± 189 g C m-2 respectively, were of a magnitude comparable to those of natural forests growing in similar climate conditions. The largest differences with respect to forests are in the allocation pattern and in the fate of produced biomass. The carbon sequestered from the atmosphere was largely allocated to production of fruit: 49% of annual NPP was taken away from the ecosystem through apple production. Organic material (leaves, fine root litter, pruned wood and early fruit falls) contributing to the detritus cycle was 46% of the NPP. Only 5% was attributable to standing biomass increment, while this NPP component is generally the largest in forests. The CUE, with an annual average of 0.71 ± 0.12, was higher than the previously suggested constant values of 0.47-0.50. Low nitrogen investment in fruit, the limited root apparatus, and the optimal growth temperature and nutritional condition observed at the site are suggested to be explanatory variables for the high CUE observed.

Estimating parameters of a forest ecosystem C model with measurements of stocks and fluxes as joint constraints

Treesearch

Andrew D. Richardson; Mathew Williams; David Y. Hollinger; David J.P. Moore; D. Bryan Dail; Eric A. Davidson; Neal A. Scott; Robert S. Evans; Holly. Hughes

2010-01-01

We conducted an inverse modeling analysis, using a variety of data streams (tower-based eddy covariance measurements of net ecosystem exchange, NEE, of CO2, chamber-based measurements of soil respiration, and ancillary ecological measurements of leaf area index, litterfall, and woody biomass increment) to estimate parameters and initial carbon (C...

Reduced Electromyographic Fatigue Threshold after Performing a Cognitive Fatiguing Task.

PubMed

Ferris, Justine R; Tomlinson, Mary A; Ward, Tayler N; Pepin, Marie E; Malek, Moh H

2018-02-22

Cognitive fatigue tasks performed prior to exercise may reduce exercise capacity. The electromyographic fatigue threshold (EMGFT) is the highest exercise intensity that can be maintained without significant increase in the EMG amplitude versus time relationship. To date, no studies have examined the effect of cognitive fatigue on the estimation of the EMGFT. The purpose of this study, therefore, was to determine whether or not cognitive fatigue prior to performing exercise reduces the estimated EMGFT. Eight healthy college-aged men were recruited from a university student population and visited the laboratory on multiple occasions. In a randomized order, subjects performed either the cognitive fatigue task (AX Continuous Performance Test; AX-CPT) for 60 min on one visit (experimental condition) or watched a video on trains for 60 min on the other visit (control condition). After each condition, subjects performed the incremental single-leg knee-extensor ergometry test while the EMG amplitude was recorded from the rectus femoris muscle and heart rate was monitored throughout. Thereafter, the EMGFT was calculated for each participant for each visit and compared using paired samples t-test. For exercise outcomes, there were no significant mean differences for maximal power output between the two conditions (control: 51 ± 5 vs. fatigue: 50 ± 3 W), but a significant decrease in EMGFT between the two conditions (control: 31 ± 3 vs. fatigue: 24 ± 2 W; p = 0.013). Moreover, maximal heart rate was significantly different between the two conditions (control: 151 ± 5 vs. fatigue: 132 ± 6; p = 0.027). These results suggest that performing the cognitive fatiguing task reduces the EMGFT with a corresponding reduction in maximal heart rate response.

Reproducibility of the exponential rise technique of CO(2) rebreathing for measuring P(v)CO(2) and C(v)CO(2 )to non-invasively estimate cardiac output during incremental, maximal treadmill exercise.

PubMed

Cade, W Todd; Nabar, Sharmila R; Keyser, Randall E

2004-05-01

The purpose of this study was to determine the reproducibility of the indirect Fick method for the measurement of mixed venous carbon dioxide partial pressure (P(v)CO(2)) and venous carbon dioxide content (C(v)CO(2)) for estimation of cardiac output (Q(c)), using the exponential rise method of carbon dioxide rebreathing, during non-steady-state treadmill exercise. Ten healthy participants (eight female and two male) performed three incremental, maximal exercise treadmill tests to exhaustion within 1 week. Non-invasive Q(c) measurements were evaluated at rest, during each 3-min stage, and at peak exercise, across three identical treadmill tests, using the exponential rise technique for measuring mixed venous PCO(2) and CCO(2) and estimating venous-arterio carbon dioxide content difference (C(v-a)CO(2)). Measurements were divided into measured or estimated variables [heart rate (HR), oxygen consumption (VO(2)), volume of expired carbon dioxide (VCO(2)), end-tidal carbon dioxide (P(ET)CO(2)), arterial carbon dioxide partial pressure (P(a)CO(2)), venous carbon dioxide partial pressure ( P(v)CO(2)), and C(v-a)CO(2)] and cardiorespiratory variables derived from the measured variables [Q(c), stroke volume (V(s)), and arteriovenous oxygen difference ( C(a-v)O(2))]. In general, the derived cardiorespiratory variables demonstrated acceptable (R=0.61) to high (R>0.80) reproducibility, especially at higher intensities and peak exercise. Measured variables, excluding P(a)CO(2) and C(v-a)CO(2), also demonstrated acceptable (R=0.6 to 0.79) to high reliability. The current study demonstrated acceptable to high reproducibility of the exponential rise indirect Fick method in measurement of mixed venous PCO(2) and CCO(2) for estimation of Q(c) during incremental treadmill exercise testing, especially at high-intensity and peak exercise.

Effect of age and gender on the number of motor units in healthy subjects estimated by the multipoint incremental MUNE method.

PubMed

Gawel, Malgorzata; Kostera-Pruszczyk, Anna

2014-06-01

Motor unit number estimation (MUNE) is a tool for estimating the number of motor units. The aim was to evaluate the multipoint incremental MUNE method in a healthy population, to analyze whether aging, gender, and the dominant hand side influence the motor unit number, and to assess reproducibility of MUNE with the Shefner modification. We studied 60 volunteers (mean age, 47 ± 17.7 years) in four groups aged 18 to 30, 31 to 45, 46 to 60, and above 60 years. Motor unit number estimation was calculated in the abductor pollicis brevis (APB) and the abductor digiti minimi (ADM) by dividing the single motor unit action potential amplitude into the maximal compound motor action potential amplitude. Test-retest variability was 7%. The mean value of MUNE for APB was 133.2 ± 43 and for ADM was 157.1 ± 39.4. Significant differences in MUNE results were found between groups aged 18 to 30 and 60 years or older and between groups aged 31 to 45 and 60 years or older. Motor unit number estimation results correlated negatively with the age of subjects for both APB and ADM. Single motor unit action potential, reflecting the size of motor unit, increased with the age of subjects only in APB. Compound motor action potential amplitude correlated negatively with the age of subjects in APB and ADM. Significant correlations were seen between MUNE in APB or ADM and compound motor action potential amplitude in these muscles and the age of female subjects. A similar relationship was not found in males. Multipoint incremental MUNE method with the Shefner modification is a noninvasive, easy to perform method with high reproducibility. The loss of motor neurons because of aging could be confirmed by our MUNE study and seems to be more pronounced in females.

Verification of the grid size and angular increment effects in lung stereotactic body radiation therapy using the dynamic conformal arc technique

NASA Astrophysics Data System (ADS)

Park, Hae-Jin; Suh, Tae-Suk; Park, Ji-Yeon; Lee, Jeong-Woo; Kim, Mi-Hwa; Oh, Young-Taek; Chun, Mison; Noh, O. Kyu; Suh, Susie

2013-06-01

The dosimetric effects of variable grid size and angular increment were systematically evaluated in the measured dose distributions of dynamic conformal arc therapy (DCAT) for lung stereotactic body radiation therapy (SBRT). Dose variations with different grid sizes (2, 3, and 4 mm) and angular increments (2, 4, 6, and 10°) for spherical planning target volumes (PTVs) were verified in a thorax phantom by using EBT2 films. Although the doses for identical PTVs were predicted for the different grid sizes, the dose discrepancy was evaluated using one measured dose distribution with the gamma tool because the beam was delivered in the same set-up for DCAT. The dosimetric effect of the angular increment was verified by comparing the measured dose area histograms of organs at risk (OARs) at each angular increment. When the difference in the OAR doses is higher than the uncertainty of the film dosimetry, the error is regarded as the angular increment effect in discretely calculated doses. In the results, even when a 2-mm grid size was used with an elaborate dose calculation, 4-mm grid size led to a higher gamma pass ratio due to underdosage, a steep-dose descent gradient, and lower estimated PTV doses caused by the smoothing effect in the calculated dose distribution. An undulating dose distribution and a difference in the maximum contralateral lung dose of up to 14% were observed in dose calculation using a 10° angular increment. The DCAT can be effectively applied for an approximately spherical PTV in a relatively uniform geometry, which is less affected by inhomogeneous materials and differences in the beam path length.

Swimming performance in juvenile shortnose sturgeon (Acipenser brevirostrum): the influence of time interval and velocity increments on critical swimming tests

PubMed Central

Kieffer, James D.

2017-01-01

Abstract The most utilized method to measure swimming performance of fishes has been the critical swimming speed (UCrit) test. In this test, the fish is forced to swim against an incrementally increasing flow of water until fatigue. Before the water velocity is increased, the fish swims at the water velocity for a specific, pre-arranged time interval. The magnitude of the velocity increments and the time interval for each swimming period can vary across studies making the comparison between and within species difficult. This issue has been acknowledged in the literature, however, little empirical evidence exists that tests the importance of velocity and time increments on swimming performance in fish. A practical application for fish performance is through the design of fishways that enable fish to bypass anthropogenic structures (e.g. dams) that block migration routes, which is one of the causes of world-wide decline in sturgeon populations. While fishways will improve sturgeon conservation, they need to be specifically designed to accommodate the swimming capabilities specific for sturgeons, and it is possible that current swimming methodologies have under-estimated the swimming performance of sturgeons. The present study assessed the UCrit of shortnose sturgeon using modified UCrit to determine the importance of velocity increment (5 and 10 cm s−1) and time (5, 15 and 30 min) intervals on swimming performance. UCrit was found to be influenced by both time interval and water velocity. UCrit was generally lower in sturgeon when they were swum using 5cm s−1 compared with 10 cm s−1 increments. Velocity increment influences the UCrit more than time interval. Overall, researchers must consider the impacts of using particular swimming criteria when designing their experiments. PMID:28835841

Impact of genetic risk information and type of disease on perceived risk, anticipated affect, and expected consequences of genetic tests.

PubMed

Cameron, Linda D; Sherman, Kerry A; Marteau, Theresa M; Brown, Paul M

2009-05-01

Genetic tests vary in their prediction of disease occurrence, with some mutations conferring relatively low risk and others indicating near certainty. The authors assessed how increments in absolute risk of disease influence risk perceptions, interest, and expected consequences of genetic tests for diseases of varying severity. Adults (N = 752), recruited from New Zealand, Australia, and the United Kingdom for an online analogue study, were randomly assigned to receive information about a test of genetic risk for diabetes, heart disease, colon cancer, or lung cancer. The lifetime risk varied across conditions by 10% increments, from 20% to 100%. Participants completed measures of perceived likelihood of disease for individuals with mutations, risk-related affect, interest, and testing consequences. Analyses revealed two increment clusters yielding differences in likelihood perceptions: A "moderate-risk" cluster (20%-70%), and a "high-risk" cluster (80%-100%). Risk increment influenced anticipated worry, feelings of risk, testing-induced distress, and family obligations, with nonlinear patterns including disproportionately high responses for the 50% increment. Risk increment did not alter testing interest or perceived benefits. These patterns of effects held across the four diseases. Magnitude of risk from genetic testing has a nonlinear influence on risk-related appraisals and affect but is unrelated to test interest.

Resilience and risk: a demographic model to inform conservation planning for polar bears

USGS Publications Warehouse

Regehr, Eric V.; Wilson, Ryan R.; Rode, Karyn D.; Runge, Michael C.

2015-01-01

Our modeling results suggest that harvest of polar bears is unlikely to accelerate population declines that result from declining carrying capacity caused by sea-ice loss, provided that several conditions are met: (1) the sustainable harvest rate reflects the population’s intrinsic growth rate, and the corresponding harvest level is obtained by applying this rate to an estimate of population size; (2) the sustainable harvest rate reflects the quality of population data (e.g., lower harvest when data are poor); and (3) the level of human-caused removals can be adjusted. Finally, our results suggest that stopgap measures (e.g., further reduction or cessation of harvest when the population size is less than a critical threshold) may be necessary to minimize the incremental risk associated with harvest, if environmental conditions are deteriorating rapidly. We suggest that the demographic model and approaches presented here can serve as a template for conservation planning for polar bears and other species facing similar challenges.

Estimate of within population incremental selection through branch imbalance in lineage trees

PubMed Central

Liberman, Gilad; Benichou, Jennifer I.C.; Maman, Yaakov; Glanville, Jacob; Alter, Idan; Louzoun, Yoram

2016-01-01

Incremental selection within a population, defined as limited fitness changes following mutation, is an important aspect of many evolutionary processes. Strongly advantageous or deleterious mutations are detected using the synonymous to non-synonymous mutations ratio. However, there are currently no precise methods to estimate incremental selection. We here provide for the first time such a detailed method and show its precision in multiple cases of micro-evolution. The proposed method is a novel mixed lineage tree/sequence based method to detect within population selection as defined by the effect of mutations on the average number of offspring. Specifically, we propose to measure the log of the ratio between the number of leaves in lineage trees branches following synonymous and non-synonymous mutations. The method requires a high enough number of sequences, and a large enough number of independent mutations. It assumes that all mutations are independent events. It does not require of a baseline model and is practically not affected by sampling biases. We show the method's wide applicability by testing it on multiple cases of micro-evolution. We show that it can detect genes and inter-genic regions using the selection rate and detect selection pressures in viral proteins and in the immune response to pathogens. PMID:26586802

Determination of season at death using dental cementum increment analysis.

PubMed

Wedel, Vicki L

2007-11-01

Dental cementum anchors teeth into their sockets via the periodontal ligament. In mammals, dental cementum is laid down in alternating opaque and translucent bands representing winter (dormant) and summer (growth) seasons. Each pair of bands represents 1 year of life. Estimates of age at death based on counting pairs of bands are highly accurate. If the timing of the transition between winter and summer bands could be identified in humans, dental cementum increment analysis could be used to specify the season at death. This pilot project attempts to determine when these transitions occur and thus provide forensic anthropologists with a technique that would refine our estimates of postmortem interval. Extracted teeth were obtained from a local oral surgeon, embedded, sectioned, ground, polished, and examined under transmitted polarized light. The outermost increment was identified and measured along with other randomly chosen like bands. A transition from translucent to opaque bands was observed in teeth extracted in early October, while teeth extracted in early April exhibited nascent translucent bands. Further, significant correlations were observed between band thickness and number of days into either season, suggesting that band width increases as either season progresses. In this blind study, extracted teeth were effectively sorted into the spring/summer or fall/winter season 99% of the time.

Costs of epilepsy in an intermediate care facility for persons with mental retardation.

PubMed

Burke, T A; McKee, J R; Pathak, D S; Donahue, R M; Parasuraman, T V; Batenhorst, A S

1999-03-01

Epilepsy is a significant comorbid condition in institutionalized persons with developmental disabilities and may contribute significant additional costs. This study was conducted to provide an estimate of the costs of epilepsy from the institutional perspective. Costs were measured retrospectively for 50 persons with epilepsy and 50 persons without epilepsy matched by severity of developmental disability. A time and motion study was employed to assign opportunity costs to documented nursing and physician activities. Two separate methods of attribution were used and incremental costs attributable to epilepsy were found to be approximately $825 and $918 per person over a 6-month period. The following categories accounted for costs: personnel (47.0%), drug (39.6%), hospitalization (9.4%), and laboratories/procedures (4.0%). Results are useful for describing the economic burden of epilepsy.

New approach to statistical description of fluctuating particle fluxes

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

Saenko, V. V.

2009-01-15

The probability density functions (PDFs) of the increments of fluctuating particle fluxes are investigated. It is found that the PDFs have heavy power-law tails decreasing as x{sup -{alpha}-1} at x {yields} {infinity}. This makes it possible to describe these PDFs in terms of fractionally stable distributions (FSDs) q(x; {alpha}, {beta}, {theta}, {lambda}). The parameters {alpha}, {beta}, {gamma}, and {lambda} were estimated statistically using as an example the time samples of fluctuating particle fluxes measured in the edge plasma of the L-2M stellarator. Two series of fluctuating fluxes measured before and after boronization of the vacuum chamber were processed. It ismore » shown that the increments of fluctuating fluxes are well described by DSDs. The effect of boronization on the parameters of FSDs is analyzed. An algorithm for statistically estimating the FSD parameters and a procedure for processing experimental data are described.« less

Comparison of Multifrequency Bioelectrical Impedance vs. Dual-Energy X-ray Absorptiometry for Assessing Body Composition Changes After Participation in a 10-Week Resistance Training Program.

PubMed

Schoenfeld, Brad J; Nickerson, Brett S; Wilborn, Colin D; Urbina, Stacie L; Hayward, Sara B; Krieger, James; Aragon, Alan A; Tinsley, Grant M

2018-06-20

Schoenfeld, BJ, Nickerson, BS, Wilborn, CD, Urbina, SL, Hayward, SB, Krieger, J, Aragon, AA, and Tinsley, G. Comparison of multifrequency bioelectrical impedance vs. dual-energy x-ray absorptiometry for assessing body composition changes after participation in a 10-week resistance training program. J Strength Cond Res XX(X): 000-000, 2018-The purpose of this study was to assess the ability of multifrequency bioelectrical impedance analysis (MF-BIA) to determine alterations in total and segmental body composition across a 10-week resistance training (RT) program in comparison with the criterion reference dual-energy X-ray absorptiometry (DXA). Twenty-one young male volunteers (mean ± SD; age = 22.9 ± 3.0 years; height = 175.5 ± 5.9 cm; body mass = 82.9 ± 13.6 kg; body mass index = 26.9 ± 3.6) performed an RT program that included exercises for all major muscle groups. Body composition was assessed using both methods before and after the intervention; change scores were determined by subtracting pre-test values from post-test values for percent body fat ([INCREMENT]%BF), fat mass ([INCREMENT]FM), and fat-free mass ([INCREMENT]FFM). Mean changes were not significantly different when comparing MF-BIA with DXA for [INCREMENT]%BF (-1.05 vs. -1.28%), [INCREMENT]FM (-1.13 vs. -1.19 kg), and FFM (0.10 vs. 0.37 kg, respectively). Both methods showed strong agreement for [INCREMENT]%BF (r = 0.75; standard error of the estimate [SEE] = 1.15%), [INCREMENT]FM (r = 0.84; SEE 1.0 kg), and [INCREMENT]FFM (r = 0.71; SEE of 1.5 kg). The 2 methods were poor predictors of each other in regards to changes in segmental measurements. Our data indicate that MF-BIA is an acceptable alternative for tracking changes in FM and FFM during a combined diet and exercise program in young, athletic men, but segmental lean mass measurements must be interpreted with circumspection.

Anytime synthetic projection: Maximizing the probability of goal satisfaction

NASA Technical Reports Server (NTRS)

Drummond, Mark; Bresina, John L.

1990-01-01

A projection algorithm is presented for incremental control rule synthesis. The algorithm synthesizes an initial set of goal achieving control rules using a combination of situation probability and estimated remaining work as a search heuristic. This set of control rules has a certain probability of satisfying the given goal. The probability is incrementally increased by synthesizing additional control rules to handle 'error' situations the execution system is likely to encounter when following the initial control rules. By using situation probabilities, the algorithm achieves a computationally effective balance between the limited robustness of triangle tables and the absolute robustness of universal plans.

Concordance with World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham Offspring cohort (1991-2008).

PubMed

Makarem, Nour; Lin, Yong; Bandera, Elisa V; Jacques, Paul F; Parekh, Niyati

2015-02-01

This prospective cohort study evaluates associations between healthful behaviors consistent with WCRF/AICR cancer prevention guidelines and obesity-related cancer risk, as a third of cancers are estimated to be preventable. The study sample consisted of adults from the Framingham Offspring cohort (n = 2,983). From 1991 to 2008, 480 incident doctor-diagnosed obesity-related cancers were identified. Data on diet, measured by a food frequency questionnaire, anthropometric measures, and self-reported physical activity, collected in 1991 was used to construct a 7-component score based on recommendations for body fatness, physical activity, foods that promote weight gain, plant foods, animal foods, alcohol, and food preservation, processing, and preparation. Multivariable Cox regression models were used to estimate associations between the computed score, its components, and subcomponents in relation to obesity-related cancer risk. The overall score was not associated with obesity-related cancer risk after adjusting for age, sex, smoking, energy, and preexisting conditions (HR 0.94, 95 % CI 0.86-1.02). When score components were evaluated separately, for every unit increment in the alcohol score, there was 29 % lower risk of obesity-related cancers (HR 0.71, 95 % CI 0.51-0.99) and 49-71 % reduced risk of breast, prostate, and colorectal cancers. Every unit increment in the subcomponent score for non-starchy plant foods (fruits, vegetables, and legumes) among participants who consume starchy vegetables was associated with 66 % reduced risk of colorectal cancer (HR 0.44, 95 % CI 0.22-0.88). Lower alcohol consumption and a plant-based diet consistent with the cancer prevention guidelines were associated with reduced risk of obesity-related cancers in this population.

Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.

PubMed

McPake, Barbara; Edoka, Ijeoma; Witter, Sophie; Kielmann, Karina; Taegtmeyer, Miriam; Dieleman, Marjolein; Vaughan, Kelsey; Gama, Elvis; Kok, Maryse; Datiko, Daniel; Otiso, Lillian; Ahmed, Rukhsana; Squires, Neil; Suraratdecha, Chutima; Cometto, Giorgio

2015-09-01

To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. Incremental cost-effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value. The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective. Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.

Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

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

Phadke, Amol; Shah, Nihar; Abhyankar, Nikit

Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant,and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. The finding that significant efficiency improvement is cost effective from a consumer perspective is robustmore » over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one-star level) should be evaluated rigorously considering significant benefits to consumers, energy security, and environment« less

On nonstationarity and antipersistency in global temperature series

NASA Astrophysics Data System (ADS)

KäRner, O.

2002-10-01

Statistical analysis is carried out for satellite-based global daily tropospheric and stratospheric temperature anomaly and solar irradiance data sets. Behavior of the series appears to be nonstationary with stationary daily increments. Estimating long-range dependence between the increments reveals a remarkable difference between the two temperature series. Global average tropospheric temperature anomaly behaves similarly to the solar irradiance anomaly. Their daily increments show antipersistency for scales longer than 2 months. The property points at a cumulative negative feedback in the Earth climate system governing the tropospheric variability during the last 22 years. The result emphasizes a dominating role of the solar irradiance variability in variations of the tropospheric temperature and gives no support to the theory of anthropogenic climate change. The global average stratospheric temperature anomaly proceeds like a 1-dim random walk at least up to 11 years, allowing good presentation by means of the autoregressive integrated moving average (ARIMA) models for monthly series.

Systems Engineering and Integration (SE and I)

NASA Technical Reports Server (NTRS)

Chevers, ED; Haley, Sam

1990-01-01

The issue of technology advancement and future space transportation vehicles is addressed. The challenge is to develop systems which can be evolved and improved in small incremental steps where each increment reduces present cost, improves, reliability, or does neither but sets the stage for a second incremental upgrade that does. Future requirements are interface standards for commercial off the shelf products to aid in the development of integrated facilities; enhanced automated code generation system slightly coupled to specification and design documentation; modeling tools that support data flow analysis; and shared project data bases consisting of technical characteristics cast information, measurement parameters, and reusable software programs. Topics addressed include: advanced avionics development strategy; risk analysis and management; tool quality management; low cost avionics; cost estimation and benefits; computer aided software engineering; computer systems and software safety; system testability; and advanced avionics laboratories - and rapid prototyping. This presentation is represented by viewgraphs only.

An assessment of adult risks of paresthesia due to mercury from coal combustion

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

Lipfert, F.; Moskowitz, P.; Fthenakis, V.

1993-11-01

This paper presents results from a probabilistic assessment of the mercury health risks associated with a hypothetical 1000 MW coal-fired power plant. The assessment draws on the extant knowledge in each of the important steps in the chain from emissions to health effects, based on methylmercury derived from seafood. For this assessment, we define three separate sources of dietary Hg: canned tuna (affected by global Hg), marine shellfish and finfish (affected by global Hg), and freshwater gamefish (affected by both global Hg and local deposition from nearby sources). We consider emissions of both reactive and elemental mercury from the hypotheticalmore » plant (assumed to burn coal with the US average Hg content) and estimate wet and dry deposition rates; atmospheric reactions are not considered. Mercury that is not deposited within 50 km is assumed to enter the global background pool. The incremental Hg in local fish is assumed to be proportional to the incremental total Hg deposition. Three alternative dose-response models were derived from published data on specific neurological responses, in this case, adult paresthesia (skin prickling or tingling of the extremities). Preliminary estimates show the upper 95th percentile of the baseline risk attributed to seafood consumption to be around 10{sup {minus}4} (1 chance in 10,000). Based on a doubling of Hg deposition in the immediate vicinity of the hypothetical plant, the incremental local risk from seafood would be about a factor of 4 higher. These risks should be compared to the estimated background prevalence rate of paresthesia, which is about 7%.« less

Trends in Health Care Expenditure in U.S. Adults With Diabetes: 2002–2011

PubMed Central

Ozieh, Mukoso N.; Bishu, Kinfe G.; Dismuke, Clara E.

2015-01-01

OBJECTIVE Direct medical cost of diabetes in the U.S. has been estimated to be 2.3 times higher relative to individuals without diabetes. This study examines trends in health care expenditures by expenditure category in U.S. adults with diabetes between 2002 and 2011. RESEARCH DESIGN AND METHODS We analyzed 10 years of data representing a weighted population of 189,013,514 U.S. adults aged ≥18 years from the Medical Expenditure Panel Survey. We used a novel two-part model to estimate adjusted mean and incremental medical expenditures by diabetes status, while adjusting for demographics, comorbidities, and time. RESULTS Relative to individuals without diabetes ($5,058 [95% CI 4,949–5,166]), individuals with diabetes ($12,180 [11,775–12,586]) had more than double the unadjusted mean direct expenditures over the 10-year period. After adjustment for confounders, individuals with diabetes had $2,558 (2,266–2,849) significantly higher direct incremental expenditures compared with those without diabetes. For individuals with diabetes, inpatient expenditures rose initially from $4,014 in 2002/2003 to $4,183 in 2004/2005 and then decreased continuously to $3,443 in 2010/2011, while rising steadily for individuals without diabetes. The estimated unadjusted total direct expenditures for individuals with diabetes were $218.6 billion/year and adjusted total incremental expenditures were approximately $46 billion/year. CONCLUSIONS Our findings show that compared with individuals without diabetes, individuals with diabetes had significantly higher health expenditures from 2002 to 2011 and the bulk of the expenditures came from hospital inpatient and prescription expenditures. PMID:26203060

The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.

PubMed

Gillespie, Paddy; O'Neill, Ciaran; Adams, Elisabeth; Turner, Katherine; O'Donovan, Diarmuid; Brugha, Ruairi; Vaughan, Deirdre; O'Connell, Emer; Cormican, Martin; Balfe, Myles; Coleman, Claire; Fitzgerald, Margaret; Fleming, Catherine

2012-04-01

The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves. The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94,717. For cost-effectiveness threshold values of €45,000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%. An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.

Reliability and validity of a brief method to assess nociceptive flexion reflex (NFR) threshold.

PubMed

Rhudy, Jamie L; France, Christopher R

2011-07-01

The nociceptive flexion reflex (NFR) is a physiological tool to study spinal nociception. However, NFR assessment can take several minutes and expose participants to repeated suprathreshold stimulations. The 4 studies reported here assessed the reliability and validity of a brief method to assess NFR threshold that uses a single ascending series of stimulations (Peak 1 NFR), by comparing it to a well-validated method that uses 3 ascending/descending staircases of stimulations (Staircase NFR). Correlations between the NFR definitions were high, were on par with test-retest correlations of Staircase NFR, and were not affected by participant sex or chronic pain status. Results also indicated the test-retest reliabilities for the 2 definitions were similar. Using larger stimulus increments (4 mAs) to assess Peak 1 NFR tended to result in higher NFR threshold estimates than using the Staircase NFR definition, whereas smaller stimulus increments (2 mAs) tended to result in lower NFR threshold estimates than the Staircase NFR definition. Neither NFR definition was correlated with anxiety, pain catastrophizing, or anxiety sensitivity. In sum, a single ascending series of electrical stimulations results in a reliable and valid estimate of NFR threshold. However, caution may be warranted when comparing NFR thresholds across studies that differ in the ascending stimulus increments. This brief method to assess NFR threshold is reliable and valid; therefore, it should be useful to clinical pain researchers interested in quickly assessing inter- and intra-individual differences in spinal nociceptive processes. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

HLA Amino Acid Polymorphisms and Kidney Allograft Survival

PubMed Central

Kamoun, Malek; McCullough, Keith P.; Maiers, Martin; Fernandez Vina, Marcelo A.; Li, Hongzhe; Teal, Valerie; Leichtman, Alan B.; Merion, Robert M.

2017-01-01

Background The association of HLA mismatching with kidney allograft survival has been well established. We examined whether amino acid (AA) mismatches (MMs) at the antigen recognition site of HLA molecules represent independent and incremental risk factors for kidney graft failure (GF) beyond those MMs assessed at the antigenic (2-digit) specificity. Methods Data on 240 024 kidney transplants performed between 1987 and 2009 were obtained from the Scientific Registry of Transplant Recipients. We imputed HLA-A, -B, and -DRB1 alleles and corresponding AA polymorphisms from antigenic specificity through the application of statistical and population genetics inferences. GF risk was evaluated using Cox proportional-hazards regression models adjusted for covariates including patient and donor risk factors and HLA antigen MMs. Results We show that estimated AA MMs at particular positions in the peptide-binding pockets of HLA-DRB1 molecule account for a significant incremental risk that was independent of the well-known association of HLA antigen MMs with graft survival. A statistically significant linear relationship between the estimated number of AA MMs and risk of GF was observed for HLA-DRB1 in deceased donor and living donor transplants. This relationship was strongest during the first 12 months after transplantation (hazard ratio, 1.30 per 15 DRB1 AA MM; P < 0.0001). Conclusions This study shows that independent of the well-known association of HLA antigen (2-digit specificity) MMs with kidney graft survival, estimated AA MMs at peptide-binding sites of the HLA-DRB1 molecule account for an important incremental risk of GF. PMID:28221244

Tier One Performance Screen Initial Operational Test and Evaluation: 2011 Annual Report

DTIC Science & Technology

2013-01-01

OPERATIONAL TEST AND EVALUATION: 2011 ANNUAL REPORT EXECUTIVE SUMMARY Research Requirement: In addition to educational, physical , and...34 Table 5.4. Incremental Validity Estimates for the TAPAS and TOPS Composite Scales over the AFQT for Predicting IMT Physical Fitness Criteria by...Validity Estimates for the TAPAS and TOPS Composite Scales over the AFQT for Predicting In-Unit Physical Fitness Criteria by Education Tier

Site productivity - current estimates, change, and possible enhancements for the Northern Research Station

Treesearch

Scott A. Pugh

2012-01-01

Site productivity (SP) is the inherent capacity to grow crops of industrial wood. SP identifies the potential growth in cubic feet/acre/year and is based on the culmination of mean annual increment of fully stocked natural stands. Changes in SP were summarized for timberland and the associated effects on net growth and removal estimates were investigated using data...

Wood density-moisture profiles in old-growth Douglas-fir and western hemlock.

Treesearch

W.Y. Pong; Dale R. Waddell; Lambert Michael B.

1986-01-01

Accurate estimation of the weight of each load of logs is necessary for safe and efficient aerial logging operations. The prediction of green density (lb/ft3) as a function of height is a critical element in the accurate estimation of tree bole and log weights. Two sampling methods, disk and increment core (Bergstrom xylodensimeter), were used to measure the density-...

Wood Specific Gravity Variation with Height and Its Implications for Biomass Estimation

Treesearch

Michael C. Wiemann; G. Bruce Williamson

2014-01-01

Wood specific gravity (SG) is widely employed by ecologists as a key variable in estimates of biomass. When it is important to have nondestructive methods for sampling wood for SG measurements, cores are extracted with an increment borer. While boring is a relatively difficult task even at breast height sampling, it is impossible at ground level and arduous at heights...

Planning Sustainability: A Master Plan For Stella, Missouri

EPA Science Inventory

Human Life is conditional upon intact ecosystems that provide goods and services required to sustain human life. Because development will incrementally and cumulative consume the biophysical environment, the conditions of intact ecosystems must be the basis for how the environme...

Health plan budget impact analysis for pimecrolimus.

PubMed

Chang, Jane; Sung, Jennifer

2005-01-01

Budget impact models are useful tools for managed care organizations to make drug formulary decisions. The objective of this study was to estimate the incremental budgetary change in per-member-per-month (PMPM) medical and pharmacy costs for atopic dermatitis (AD) or eczema after the introduction of pimecrolimus cream 1%, a topical calcineurin inhibitor. Estimates of the percentage of patients seeking care, treatment patterns, and quantities of medications dispensed for AD were measured using 2001 and 2002 medical and pharmacy records in a proprietary database for health plans distributed throughout the United States. Approximately 2.5 million health plan members had continuous health insurance coverage during the study period. Costs for medications were assigned using the 2003 wholesale acquisition cost, and costs for physician visits were based on average 2003 Medicare reimbursement rates. Efficacy data from clinical trials were used to model the impact of pimecrolimus on subsequent physician visits. Sensitivity analyses were performed to evaluate the impact of varying the percentage of patients seeking care, practice patterns, medication quantities, percentage of pimecrolimus users, and levels of patient cost sharing. The estimated percentage of health plan members seeking care for AD in 2001 was 3.2%. The estimated total cost PMPM for AD treatment prior to introduction of pimecrolimus was 0.362 dollars for all covered lives, assuming no patient cost sharing. In the year after its introduction, 5.2% of the AD population filled a prescription for pimecrolimus. The incremental increase in pharmacy benefit cost was 0.008 dollars PMPM in 2003 dollars, but the total incremental medical and pharmacy cost was 0.002 dollars PMPM after accounting for the projected reduction in physician visit costs, representing a 0.7% increase in all AD-related costs. Based on sensitivity analyses, the incremental total cost PMPM after the introduction of pimecrolimus ranged from -0.004 dollars to 0.026 dollars. Using claims data for the medical treatment of AD in 2001-2002 and the utilization of pimecrolimus, the addition of pimecrolimus as a treatment option for AD had a minimal impact on PMPM costs for AD-related care in 2003 dollars. As with all pharmacoeconomic models, health plans should perform their own budget forecasting using assumptions derived from their own pharmacy and medical claims data.

Striatal and Hippocampal Involvement in Motor Sequence Chunking Depends on the Learning Strategy

PubMed Central

Lungu, Ovidiu; Monchi, Oury; Albouy, Geneviève; Jubault, Thomas; Ballarin, Emanuelle; Burnod, Yves; Doyon, Julien

2014-01-01

Motor sequences can be learned using an incremental approach by starting with a few elements and then adding more as training evolves (e.g., learning a piano piece); conversely, one can use a global approach and practice the whole sequence in every training session (e.g., shifting gears in an automobile). Yet, the neural correlates associated with such learning strategies in motor sequence learning remain largely unexplored to date. Here we used functional magnetic resonance imaging to measure the cerebral activity of individuals executing the same 8-element sequence after they completed a 4-days training regimen (2 sessions each day) following either a global or incremental strategy. A network comprised of striatal and fronto-parietal regions was engaged significantly regardless of the learning strategy, whereas the global training regimen led to additional cerebellar and temporal lobe recruitment. Analysis of chunking/grouping of sequence elements revealed a common prefrontal network in both conditions during the chunk initiation phase, whereas execution of chunk cores led to higher mediotemporal activity (involving the hippocampus) after global than incremental training. The novelty of our results relate to the recruitment of mediotemporal regions conditional of the learning strategy. Thus, the present findings may have clinical implications suggesting that the ability of patients with lesions to the medial temporal lobe to learn and consolidate new motor sequences may benefit from using an incremental strategy. PMID:25148078

Striatal and hippocampal involvement in motor sequence chunking depends on the learning strategy.

PubMed

Lungu, Ovidiu; Monchi, Oury; Albouy, Geneviève; Jubault, Thomas; Ballarin, Emanuelle; Burnod, Yves; Doyon, Julien

2014-01-01

Motor sequences can be learned using an incremental approach by starting with a few elements and then adding more as training evolves (e.g., learning a piano piece); conversely, one can use a global approach and practice the whole sequence in every training session (e.g., shifting gears in an automobile). Yet, the neural correlates associated with such learning strategies in motor sequence learning remain largely unexplored to date. Here we used functional magnetic resonance imaging to measure the cerebral activity of individuals executing the same 8-element sequence after they completed a 4-days training regimen (2 sessions each day) following either a global or incremental strategy. A network comprised of striatal and fronto-parietal regions was engaged significantly regardless of the learning strategy, whereas the global training regimen led to additional cerebellar and temporal lobe recruitment. Analysis of chunking/grouping of sequence elements revealed a common prefrontal network in both conditions during the chunk initiation phase, whereas execution of chunk cores led to higher mediotemporal activity (involving the hippocampus) after global than incremental training. The novelty of our results relate to the recruitment of mediotemporal regions conditional of the learning strategy. Thus, the present findings may have clinical implications suggesting that the ability of patients with lesions to the medial temporal lobe to learn and consolidate new motor sequences may benefit from using an incremental strategy.

Quantification of baseline pupillary response and task-evoked pupillary response during constant and incremental task load.

PubMed

Mosaly, Prithima R; Mazur, Lukasz M; Marks, Lawrence B

2017-10-01

The methods employed to quantify the baseline pupil size and task-evoked pupillary response (TEPR) may affect the overall study results. To test this hypothesis, the objective of this study was to assess variability in baseline pupil size and TEPR during two basic working memory tasks: constant load of 3-letters memorisation-recall (10 trials), and incremental load memorisation-recall (two trials of each load level), using two commonly used methods (1) change from trail/load specific baseline, (2) change from constant baseline. Results indicated that there was a significant shift in baseline between the trails for constant load, and between the load levels for incremental load. The TEPR was independent of shifts in baseline using method 1 only for constant load, and method 2 only for higher levels of incremental load condition. These important findings suggest that the assessment of both the baseline and methods to quantify TEPR are critical in ergonomics application, especially in studies with small number of trials per subject per condition. Practitioner Summary: Quantification of TEPR can be affected by shifts in baseline pupil size that are most likely affected by non-cognitive factors when other external factors are kept constant. Therefore, quantification methods employed to compute both baseline and TEPR are critical in understanding the information processing of humans in practical ergonomics settings.

Health care costs associated with hospital acquired complications in patients with chronic kidney disease.

PubMed

Bohlouli, Babak; Jackson, Terri; Tonelli, Marcello; Hemmelgarn, Brenda; Klarenbach, Scott

2017-12-28

Patients with CKD are at increased risk of potentially preventable hospital acquired complications (HACs). Understanding the economic consequences of preventable HACs, may define the scope and investment of initiatives aimed at prevention. Adult patients hospitalized from April, 2003 to March, 2008 in Alberta, Canada comprised the study cohort. Healthcare costs were determined and categorized into 'index hospitalization' including hospital cost and in-hospital physician claims, and 'post discharge' including ambulatory care cost, physician claims, and readmission costs from discharge to 90 days. Multivariable regression was used to estimate the incremental healthcare costs associated with potentially preventable HACs. In fully adjusted models, the median incremental index hospitalization cost was CAN-$6169 (95% CI; 6003-6336) in CKD patients with ≥1 potentially preventable HACs, compared with those without. Post-discharge incremental costs were 1471(95% CI; 844-2099) in those patients with CKD who developed potentially preventable HACs within 90 days after discharge compared with patients without potentially preventable HACs. Additionally, the incremental costs associated with ≥1 potentially preventable HACs within 90 days from admission in patients with CKD were $7522 (95% CI; 7219-7824). A graded relation of the incremental costs was noted with the increasing number of complications. In patients without CKD but with ≥1 preventable HACs incremental costs within 90 days from hospital admission was $6688 (95% CI: 6612-6723). Potentially preventable HACs are associated with substantial increases in healthcare costs in people with CKD. Investment in implementing targeted strategies to reduce HACs may have a significant benefit for patient and health system outcomes.

Precipitable water vapor budget associated with MJO represented in newly-released JRA-55 reanalysis data

NASA Astrophysics Data System (ADS)

Yokoi, S.

2013-12-01

The Japan Meteorological Agency (JMA) recently released a new reanalysis dataset JRA-55 with the use of a JMA operational prediction model and 4D-VAR data assimilation. To evaluate merit in utilizing the JRA-55 dataset to investigate dynamics of the tropical intraseasonal variability (ISV) including the Madden-Julian Oscillation (MJO), this study examines ISV-scale precipitable water vapor (PWV) budget over the period 1989-2012. The ISV-scale PWV anomaly related to the boreal-winter MJO propagates eastward along with precipitation, consistent with the SSM/I PWV product. Decomposition of the PWV tendency into that simulated by the model and the analysis increment estimated by the data assimilation reveals that the model makes the PWV anomaly move eastward. On the other hand, the analysis increment exhibits positive values over the area where the PWV anomaly is positive, indicating that the model tends to damp the MJO signal. Note that the analysis increment over the Maritime Continent has comparable magnitude to the model tendency. The positive analysis increment may mainly be caused by an excess of precipitation anomaly with respect to the magnitude of PWV anomaly. In addition to the boreal-winter MJO, this study also examines the PWV budget associated with northward-propagating ISV during the boreal summer and find similar relationship between the PWV anomaly and analysis increment.

Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program.

PubMed

Wallace, Neal T; Cohen, Deborah J; Gunn, Rose; Beck, Arne; Melek, Steve; Bechtold, Donald; Green, Larry A

2015-01-01

Provide credible estimates of the start-up and ongoing effort and incremental practice expenses for the Advancing Care Together (ACT) behavioral health and primary care integration interventions. Expenditure data were collected from 10 practice intervention sites using an instrument with a standardized general format that could accommodate the unique elements of each intervention. Average start-up effort expenses were $44,076 and monthly ongoing effort expenses per patient were $40.39. Incremental expenses averaged $20,788 for start-up and $4.58 per patient for monthly ongoing activities. Variations in expenditures across practices reflect the differences in intervention specifics and organizational settings. Differences in effort to incremental expenditures reflect the extensive use of existing resources in implementing the interventions. ACT program incremental expenses suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. Practice effort expenses are not trivial and may pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider external support to practices that accounts for both incremental and effort expense levels. Existing knowledge transfer mechanisms should be employed to minimize developmental start-up expenses and payment reform focused toward value-based, Triple Aim-oriented reimbursement and purchasing mechanisms are likely needed. © Copyright 2015 by the American Board of Family Medicine.

Multi-Reanalysis Comparison of Variability in Analysis Increment of Column-Integrated Water Vapor Associated with Madden-Julian Oscillation

NASA Astrophysics Data System (ADS)

Yokoi, S.

2014-12-01

This study conducts a comparison of three reanalysis products (JRA-55, JRA-25, and ERA-Interim) in representation of Madden-Julian Oscillation (MJO), focusing on column-integrated water vapor (CWV) that is considered as an essential variable for discussing MJO dynamics. Besides the analysis fields of CWV, which exhibit spatio-temporal distributions that are quite similar to satellite observations, CWV tendency simulated by forecast models and analysis increment calculated by data assimilation are examined. For JRA-55, it is revealed that, while its forecast model is able to simulate eastward propagation of the CWV anomaly, it tends to weaken the amplitude, and data assimilation process sustains the amplitude. The multi-reanalysis comparison of the analysis increment further reveals that this weakening bias is probably caused by excessively weak cloud-radiative feedback represented by the model. This bias in the feedback strength makes anomalous moisture supply by the vertical advection term in the CWV budget equation too insensitive to precipitation anomaly, resulting in reduction of the amplitude of CWV anomaly. ERA-Interim has a nearly opposite feature; the forecast model represents excessively strong feedback and unrealistically strengthens the amplitude, while the data assimilation weakens it. These results imply the necessity of accurate representation of the cloud-radiative feedback strength for a short-term MJO forecast, and may be evidence to support the argument that this feedback is essential for the existence of MJO. Furthermore, this study demonstrates that the multi-reanalysis comparison of the analysis increment will provide useful information for identifying model biases and, potentially, for estimating parameters that are difficult to estimate solely from observation data, such as gross moist stability.

Dietary Flavonoid Intake and Lung Cancer—A Population-based Case-control Study

PubMed Central

Cui, Yan; Morgenstern, Hal; Greenland, Sander; Tashkin, Donald P.; Mao, Jenny T.; Cai, Lin; Cozen, Wendy; Mack, Thomas M.; Lu, Qing-Yi; Zhang, Zuo-Feng

2017-01-01

BACKGROUND Laboratory studies suggest that flavonoids are antimutagenic and anticarcinogenic. To investigate the associations between commonly consumed flavonoid compounds and lung cancer, the authors conducted a population-based case–control study of 558 lung cancer cases and a group of 837 controls. METHODS Dietary intakes of flavonoids were estimated by combining the intake frequency (collected by a food frequency questionnaire), portion size, and food composition data. Unconditional logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence limits (95% CLs) with an adjustment for potential confounders, including age, sex, race-ethnicity, years of schooling, smoking status, pack-years of tobacco smoking, and daily energy intake. RESULTS Lung cancer was associated inversely with the consumption of epicatechin (in 10 mg per day increment: OR, 0.64; 95% CL, 0.46–0.88), catechin (4 mg per day increment: OR, 0.49; 95% CL, 0.35–0.70), quercetin (9 mg per day increment: OR, 0.65; 95% CL, 0.44–0.95), and kaempferol (2 mg per day increment: OR, 0.68; 95% CL, 0.51–0.90) among tobacco smokers. There was little association between lung cancer and the flavonoid compounds mentioned above among nonsmokers. Regardless of smoking status, there was little association with total flavonoids: thearubigins, hesperetin, naringenin, and myricetin. In addition, consumption of vegetables, tea, and wine, all of which are rich sources of flavonoids, was associated inversely with lung cancer among tobacco smokers. CONCLUSIONS Certain flavonoid compounds, including epicatechin, catechin, quercetin, and kaempferol, were associated inversely with lung cancer among tobacco smokers, but not among nonsmokers. Further studies of these associations may be warranted. PMID:18327817

Comparative efficacy and incremental cost per responder of methotrexate versus apremilast for methotrexate-naïve patients with psoriasis.

PubMed

Armstrong, April W; Betts, Keith A; Sundaram, Murali; Thomason, Darren; Signorovitch, James E

2016-10-01

To our knowledge, no clinical trials directly compare apremilast with methotrexate (the standard of care for initial systemic treatment of psoriasis). We sought to compare apremilast's relative efficacy with that of methotrexate for moderate to severe psoriasis. An anchor-based indirect comparison was conducted for 75% improvement in Psoriasis Area and Severity Index score from baseline to week 16 (PASI 75) rates for systemic-naïve patients from Efficacy and Safety Trial Evaluating the Effects of apreMilast in psoriasis (ESTEEM) 1 and 2 (apremilast vs placebo) and Comparative study of HumirA vs. Methotrexate vs Placebo In psOriasis patieNts (CHAMPION) (adalimumab vs methotrexate vs placebo) trials. The difference-in-difference in PASI 75 response rates was calculated as the difference between the ESTEEM apremilast and placebo rates and the CHAMPION methotrexate versus placebo rates. Number needed to treat and incremental drug cost per responder were also estimated. No statistically significant difference was found between apremilast and methotrexate in PASI 75 (risk difference 13.1%; 95% confidence interval -1.8% to 28.0%; P = .09). Number needed to treat with apremilast versus methotrexate to gain 1 additional PASI 75 responder was 7.6. Annual incremental drug cost of this responder was estimated at $187,888.33. Few trials compare systemic-naïve patients. Only direct medication costs were considered. There was no statistical evidence of greater efficacy for apremilast versus methotrexate. The $187,888 incremental cost per PASI 75 may exceed what payers are willing to pay. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluating Expected Costs and Benefits of Granting Access to New Treatments on the Basis of Progression-Free Survival in Non-Small-Cell Lung Cancer.

PubMed

Lakdawalla, Darius N; Chou, Jacquelyn W; Linthicum, Mark T; MacEwan, Joanna P; Zhang, Jie; Goldman, Dana P

2015-05-01

Surrogate end points may be used as proxy for more robust clinical end points. One prominent example is the use of progression-free survival (PFS) as a surrogate for overall survival (OS) in trials for oncologic treatments. Decisions based on surrogate end points may expedite regulatory approval but may not accurately reflect drug efficacy. Payers and clinicians must balance the potential benefits of earlier treatment access based on surrogate end points against the risks of clinical uncertainty. To present a framework for evaluating the expected net benefit or cost of providing early access to new treatments on the basis of evidence of PFS benefits before OS results are available, using non-small-cell lung cancer (NSCLC) as an example. A probabilistic decision model was used to estimate expected incremental social value of the decision to grant access to a new treatment on the basis of PFS evidence. The model analyzed a hypothetical population of patients with NSCLC who could be treated during the period between PFS and OS evidence publication. Estimates for delay in publication of OS evidence following publication of PFS evidence, expected OS benefit given PFS benefit, incremental cost of new treatment, and other parameters were drawn from the literature on treatment of NSCLC. Incremental social value of early access for each additional patient per month (in 2014 US dollars). For "medium-value" model parameters, early reimbursement of drugs with any PFS benefit yields an incremental social cost of more than $170,000 per newly treated patient per month. In contrast, granting early access on the basis of PFS benefit between 1 and 3.5 months produces more than $73,000 in incremental social value. Across the full range of model parameter values, granting access for drugs with PFS benefit between 3 and 3.5 months is robustly beneficial, generating incremental social value ranging from $38,000 to more than $1 million per newly treated patient per month, whereas access for all drugs with any PFS benefit is usually not beneficial. The value of providing access to new treatments on the basis of surrogate end points, and PFS in particular, likely varies considerably. Payers and clinicians should carefully consider how to use PFS data in balancing potential benefits against costs in each particular disease.

Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda.

PubMed

Mayora, Chrispus; Ekirapa-Kiracho, Elizabeth; Bishai, David; Peters, David H; Okui, Olico; Baine, Sebastian Olikira

2014-01-01

High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services. This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply - side incentives on increasing access to maternal health services. The provider's perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated. The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively. Subsidizing maternal health care costs through demand and supply - side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda's Gross Domestic Product (GDP) per capita of US$55` (2012), the incremental cost per additional delivery (US$23.9) represents about 5% of GDP per capita to save a mother and probably her new born. For many low income countries, this may not be affordable, yet reliance on donor funding is often not sustainable. Alternative ways of raising additional resources for health must be explored. These include; encouraging private investments in critical sectors such as rural transport, health service provision; mobilizing households to save financial resources for preparedness, and financial targeting for the most vulnerable.

International Space Station Internal Thermal Control System Cold Plate/Fluid-Stability Test: Two Year Update

NASA Technical Reports Server (NTRS)

Wieland, Paul; Holt, Mike; Roman, Monsi; Cole, Harold; Daugherty, Steve

2003-01-01

Operation of the Internal Thermal Control System (ITCS) Cold Plate/Fluid-Stability Test Facility commenced on September 5, 2000. The facility was intended to provide advance indication of potential problems on board the International Space Station (ISS) and was designed: 1) To be materially similar to the flight ITCS. 2) To allow for monitoring during operation. 3) To run continuously for three years. During the first two years of operation the conditions of the coolant and components were remarkably stable. During this same period of time, the conditions of the ISS ITCS significantly diverged from the desired state. Due to this divergence, the test facility has not been providing information useful for predicting the flight ITCS condition. Results of the first two years are compared with flight conditions over the same time period, showing the similarities and divergences. To address the divergences, the test facility was modified incrementally to more closely match the flight conditions, and to gain insight into the reasons for the divergence. Results of these incremental changes are discussed and provide insight into the development of the conditions on orbit.

Viscous Corrections of the Time Incremental Minimization Scheme and Visco-Energetic Solutions to Rate-Independent Evolution Problems

NASA Astrophysics Data System (ADS)

Minotti, Luca; Savaré, Giuseppe

2018-02-01

We propose the new notion of Visco-Energetic solutions to rate-independent systems {(X, E,} d) driven by a time dependent energy E and a dissipation quasi-distance d in a general metric-topological space X. As for the classic Energetic approach, solutions can be obtained by solving a modified time Incremental Minimization Scheme, where at each step the dissipation quasi-distance d is incremented by a viscous correction {δ} (for example proportional to the square of the distance d), which penalizes far distance jumps by inducing a localized version of the stability condition. We prove a general convergence result and a typical characterization by Stability and Energy Balance in a setting comparable to the standard energetic one, thus capable of covering a wide range of applications. The new refined Energy Balance condition compensates for the localized stability and provides a careful description of the jump behavior: at every jump the solution follows an optimal transition, which resembles in a suitable variational sense the discrete scheme that has been implemented for the whole construction.

Health care costs attributable to the treatment of rheumatoid arthritis.

PubMed

Sørensen, J

2004-01-01

A 'programme budget' for the resources used in the treatment and care of patients with rheumatoid arthritis (RA) was developed with a view of helping decision-makers assess the appropriateness of the current use of resources and to discuss future resource allocation. The programme budget was developed using data from several national administrative registers. Patients with RA were identified by hospital diagnostic codes. The incremental cost of treating RA was defined as the difference in resource use for patients with and without RA. Incremental mortality due to RA was defined in similar way. Cost data were estimated for 5-year age groups. Patients with RA used on average 3.2 times as many health care resources as people without RA. The average 1997 incremental costs of primary and hospital care were EUR 253 and EUR 2.660 per patient respectively, corresponding to a national incremental cost of EUR 30 million (2000 price level). RA resulted in an annual loss of 1,549 life years. The programme budget approach is a useful tool in resource allocation decision-making, but discussions of alternative resource allocations must be based on robust studies of effectiveness and cost-effectiveness in the treatment of patients with RA.

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale

PubMed Central

Quentin, Wilm; Adu-Sarkodie, Yaw; Terris-Prestholt, Fern; Legood, Rosa; Opoku, Baafuor K; Mayaud, Philippe

2011-01-01

Objectives To estimate the incremental costs of visual inspection with acetic acid (VIA) and cryotherapy at cervical cancer screening facilities in Ghana; to explore determinants of costs through modelling; and to estimate national scale-up and annual programme costs. Methods Resource-use data were collected at four out of six active VIA screening centres, and unit costs were ascertained to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs and to calculate national costs. Results Incremental economic costs per woman screened with VIA ranged from 4.93 US$ to 14.75 US$, and costs of cryotherapy were between 47.26 US$ and 84.48 US$ at surveyed facilities. Under base case assumptions, our model estimated the costs of VIA to be 6.12 US$ per woman and those of cryotherapy to be 27.96 US$. Sensitivity analysis showed that the number of women screened per provider and treated per facility was the most important determinants of costs. National annual programme costs were estimated to be between 0.6 and 4.0 million US$ depending on assumed coverage and adopted screening strategy. Conclusion When choosing between different cervical cancer prevention strategies, the feasibility of increasing uptake to achieve economies of scale should be a major concern. PMID:21214692

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale.

PubMed

Quentin, Wilm; Adu-Sarkodie, Yaw; Terris-Prestholt, Fern; Legood, Rosa; Opoku, Baafuor K; Mayaud, Philippe

2011-03-01

To estimate the incremental costs of visual inspection with acetic acid (VIA) and cryotherapy at cervical cancer screening facilities in Ghana; to explore determinants of costs through modelling; and to estimate national scale-up and annual programme costs. Resource-use data were collected at four out of six active VIA screening centres, and unit costs were ascertained to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs and to calculate national costs. Incremental economic costs per woman screened with VIA ranged from 4.93 US$ to 14.75 US$, and costs of cryotherapy were between 47.26 US$ and 84.48 US$ at surveyed facilities. Under base case assumptions, our model estimated the costs of VIA to be 6.12 US$ per woman and those of cryotherapy to be 27.96 US$. Sensitivity analysis showed that the number of women screened per provider and treated per facility was the most important determinants of costs. National annual programme costs were estimated to be between 0.6 and 4.0 million US$ depending on assumed coverage and adopted screening strategy.   When choosing between different cervical cancer prevention strategies, the feasibility of increasing uptake to achieve economies of scale should be a major concern. © 2011 Blackwell Publishing Ltd.

Public Key Infrastructure Increment 2 (PKI Inc 2)

DTIC Science & Technology

2016-03-01

DoD - Department of Defense DoDAF - DoD Architecture Framework FD - Full Deployment FDD - Full Deployment Decision FY - Fiscal Year IA...experienced due to a delay in achieving the FDD . The Critical Change Report was provided to Congress on July 11, 2014. Firm, Fixed-Price Feasibility...to a delay in achieving the FDD . To support the Critical Change Report, the NSA Cost Estimating organization prepared a cost estimate that was

Proportion of patients needing an implantable cardioverter defibrillator on the basis of current guidelines: impact on healthcare resources in Italy and the USA. Data from the ALPHA study registry.

PubMed

Pedretti, Roberto F E; Curnis, Antonio; Massa, Riccardo; Morandi, Fabrizio; Tritto, Massimo; Manca, Lorenzo; Occhetta, Eraldo; Molon, Giulio; De Ferrari, Gaetano M; Sarzi Braga, Simona; Raciti, Giovanni; Klersy, Catherine; Salerno-Uriarte, Jorge A

2010-08-01

Implantable cardioverter defibrillators (ICD) improve survival in selected patients with left ventricular dysfunction or heart failure (HF). The objective is to estimate the number of ICD candidates and to assess the potential impact on public health expenditure in Italy and the USA. Data from 3513 consecutive patients (ALPHA study registry) were screened. A model based on international guidelines inclusion criteria and epidemiological data was used to estimate the number of eligible patients. A comparison with current ICD implant rate was done to estimate the necessary incremental rate to treat eligible patients within 5 years. Up to 54% of HF patients are estimated to be eligible for ICD implantation. An implantation policy based on guidelines would significantly increase the ICD number to 2671 implants per million inhabitants in Italy and to 4261 in the USA. An annual increment of prophylactic ICD implants of 20% in the USA and 68% in Italy would be necessary to treat all indicated patients in a 5-year timeframe. Implantable cardioverter defibrillator implantation policy based on current evidence may have significant impact on public health expenditure. Effective risk stratification may be useful in order to maximize benefit of ICD therapy and its cost-effectiveness in primary prevention.

Validation of daily increments periodicity in otoliths of spotted gar

USGS Publications Warehouse

Snow, Richard A.; Long, James M.; Frenette, Bryan D.

2017-01-01

Accurate age and growth information is essential in successful management of fish populations and for understanding early life history. We validated daily increment deposition, including the timing of first ring formation, for spotted gar (Lepisosteus oculatus) through 127 days post hatch. Fry were produced from hatchery-spawned specimens, and up to 10 individuals per week were sacrificed and their otoliths (sagitta, lapillus, and asteriscus) removed for daily age estimation. Daily age estimates for all three otolith pairs were significantly related to known age. The strongest relationships existed for measurements from the sagitta (r2 = 0.98) and the lapillus (r2 = 0.99) with asteriscus (r2 = 0.95) the lowest. All age prediction models resulted in a slope near unity, indicating that ring deposition occurred approximately daily. Initiation of ring formation varied among otolith types, with deposition beginning 3, 7, and 9 days for the sagitta, lapillus, and asteriscus, respectively. Results of this study suggested that otoliths are useful to estimate daily age of spotted gar juveniles; these data may be used to back calculate hatch dates, estimate early growth rates, and correlate with environmental factor that influence spawning in wild populations. is early life history information will be valuable in better understanding the ecology of this species. 

Age estimation from dental cementum incremental lines and periodontal disease.

PubMed

Dias, P E M; Beaini, T L; Melani, R F H

2010-12-01

Age estimation by counting incremental lines in cementum added to the average age of tooth eruption is considered an accurate method by some authors, while others reject it stating weak correlation between estimated and actual age. The aim of this study was to evaluate this technique and check the influence of periodontal disease on age estimates by analyzing both the number of cementum lines and the correlation between cementum thickness and actual age on freshly extracted teeth. Thirty one undecalcified ground cross sections of approximately 30 µm, from 25 teeth were prepared, observed, photographed and measured. Images were enhanced by software and counts were made by one observer, and the results compared with two control-observers. There was moderate correlation ((r)=0.58) for the entire sample, with mean error of 9.7 years. For teeth with periodontal pathologies, correlation was 0.03 with a mean error of 22.6 years. For teeth without periodontal pathologies, correlation was 0.74 with mean error of 1.6 years. There was correlation of 0.69 between cementum thickness and known age for the entire sample, 0.25 for teeth with periodontal problems and 0.75 for teeth without periodontal pathologies. The technique was reliable for periodontally sound teeth, but not for periodontally diseased teeth.

Ocean heat content variability in an ensemble of twentieth century ocean reanalyses

NASA Astrophysics Data System (ADS)

de Boisséson, Eric; Balmaseda, Magdalena Alonso; Mayer, Michael

2017-08-01

This paper presents a ten-member ensemble of twentieth century Ocean ReAnalyses called ORA-20C. ORA-20C assimilates temperature and salinity profiles and is forced by the ECMWF twentieth century atmospheric reanalysis (ERA-20C) over the 1900-2010 period. This study attempts to identify robust signals of ocean heat content change in ORA-20C and detect contamination by model errors, initial condition uncertainty, surface fluxes and observing system changes. It is shown that ORA-20C trends and variability in the first part of the century result from the surface fluxes and model drift towards a warmer mean state and weak meridional overturning circulation. The impact of the observing system in correcting the mean state causes the deceleration of the warming trend and alters the long-term climate signal. The ensemble spread reflects the long-lasting memory of the initial conditions and the convergence of the system to a solution compatible with surface fluxes, the ocean model and observational constraints. Observations constrain the ocean heat uptake trend in the last decades of the twentieth century, which is similar to trend estimations from the post-satellite era. An ocean heat budget analysis attributes ORA-20C heat content changes to surface fluxes in the first part of the century. The heat flux variability reflects spurious signals stemming from ERA-20C surface fields, which in return result from changes in the atmospheric observing system. The influence of the temperature assimilation increments on the heat budget is growing with time. Increments control the most recent ocean heat uptake signals, highlighting imbalances in forced reanalysis systems in the ocean as well as in the atmosphere.

The effects of climate change on instream nitrogen transport in the contiguous United States

NASA Astrophysics Data System (ADS)

Alam, M. J.; Goodall, J. L.

2011-12-01

Excessive nitrogen loading has caused significant environmental impacts such as eutrophication and hypoxia in waterbodies around the world. Nitrogen loading is largely dependent on nonpoint source pollution and nitrogen transport from nonpoint source pollution is greatly impacted by climate conditions. For example, increased precipitation leads to more runoff and a higher nitrogen yield. However, higher temperatures also impact nitrogen transport in that higher temperatures increase denitrification and therefore reduce nitrogen yield. The purpose of this research is to quantify potential changes in nitrogen yield for the contiguous United States under predicted climate change scenarios, specifically changes in precipitation and air temperature. The analysis was performed for high (A2) and low (B1) emission scenarios and for the year 2030, 2050 and 2090. We used 11 different IPCC (The Intergovernmental Panel on Climate Change) models predicted precipitation and temperature estimates to capture uncertainty. The SPARROW model was calibrated using historical nitrogen loading data and used to predict nitrogen yields for future climate conditions. We held nitrogen source data constant in order to isolate the impact of predicted precipitation and temperature changes for each model scenario. Preliminary results suggest an overall decrease in nitrogen yield if climate change impacts are considered in isolation. For the A2 scenario, the model results indicated an overall incremental nitrogen yield decrease of 2-17% by the year 2030, 4-26% by the year 2050, and 11-45% by the year 2090. The B1 emission scenario also indicated an incremental yield decrease, but at lesser amounts of 2-18%, 5-21% and 10-38% by the years 2030, 2050, and 2090, respectively. This decrease is mainly due to higher predicted temperatures that result in increased denitrification rates.

Sediment-Overlying Water Relationships Affecting Wintertime Dissolved Oxygen Conditions in the Big Eau Pleine Reservoir, Wisconsin.

DTIC Science & Technology

1992-07-01

22202-4302. and to the Office of Managel ent and Bidget . P worki Reduction Pfo4ect(07T4-016 Wahington. DC 20S03. -1. AGENCY USE ONLY (Leave blank) 2...higher pool elevation can not be maintained, it is likely that additional aerators must be installed for incremental use to meet periodic heavy oxygen...install additional aerators throughout the reservoir for incremental use as needed to enhance oxygen diffusion processes. The difficulty with this

National Trends in Direct Health Care Expenditures Among US Adults With Migraine: 2004 to 2013.

PubMed

Raval, Amit D; Shah, Anal

2017-01-01

Migraine is a common neurological disorder with significant economic burden in the United States. However, changes in the economic burden of migraine in the past decade have not been examined considering therapeutic advances at the national level. Therefore, we estimated cross-sectional trends in the incremental total and types of direct health care expenditures among individuals with migraine using nationally representative data, the Medical Expenditures Panel Survey. The analytic sample was comprised of an annually weighted population of 228,010,000 adults aged 18 years and older from 2004 to 2013. Two-part models were used to estimate the incremental total and types of annual direct health care expenditures (adjusted to 2013 US dollars) among individuals with migraine after adjusting for predisposing, enabling, need, personal health practice, and external environment factors selected on the basis of the Anderson Healthcare Behavior Model. The unadjusted average annual total health care expenditure for individuals with migraine was $8,033 (standard error [SE] = $292) which comprised major proportions of outpatient ($2,952, SE = $128), prescription drugs ($2,207, SE = $91), and inpatient ($1,784, SE = $178) expenditures. Individuals with migraine had $866 (SE = $298) and $1,519 (SE = $400) greater adjusted annual total direct health care expenditures in 2004/2005 and 2012/2013 compared with those without migraine. However, those with migraine in 2012/2013 did not have significant changes in the total direct health care expenditures compared with those having migraine in 2004/2005 (changes: -$330, SE = $480). The estimated adjusted incremental total direct health care expenditures for individuals with migraine was approximately $9.20 billion per year compared with those without migraine. Although annual incremental total direct health care expenditures among individuals with migraine did not change significantly from 2004 to 2013, expenditures remained significantly greater in the migraine population compared with those without migraine across the years. Our study findings suggest the need to design and implement policy and interventions to reduce excess health care expenditures among individuals with migraine. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Serological testing versus other strategies for diagnosis of active tuberculosis in India: a cost-effectiveness analysis.

PubMed

Dowdy, David W; Steingart, Karen R; Pai, Madhukar

2011-08-01

Undiagnosed and misdiagnosed tuberculosis (TB) drives the epidemic in India. Serological (antibody detection) TB tests are not recommended by any agency, but widely used in many countries, including the Indian private sector. The cost and impact of using serology compared with other diagnostic techniques is unknown. Taking a patient cohort conservatively equal to the annual number of serological tests done in India (1.5 million adults suspected of having active TB), we used decision analysis to estimate costs and effectiveness of sputum smear microscopy (US$3.62 for two smears), microscopy plus automated liquid culture (mycobacterium growth indicator tube [MGIT], US$20/test), and serological testing (anda-tb ELISA, US$20/test). Data on test accuracy and costs were obtained from published literature. We adopted the perspective of the Indian TB control sector and an analysis frame of 1 year. Our primary outcome was the incremental cost per disability-adjusted life year (DALY) averted. We performed one-way sensitivity analysis on all model parameters, with multiway sensitivity analysis on variables to which the model was most sensitive. If used instead of sputum microscopy, serology generated an estimated 14,000 more TB diagnoses, but also 121,000 more false-positive diagnoses, 102,000 fewer DALYs averted, and 32,000 more secondary TB cases than microscopy, at approximately four times the incremental cost (US$47.5 million versus US$11.9 million). When added to high-quality sputum smears, MGIT culture was estimated to avert 130,000 incremental DALYs at an incremental cost of US$213 per DALY averted. Serology was dominated by (i.e., more costly and less effective than) MGIT culture and remained less economically favorable than sputum smear or TB culture in one-way and multiway sensitivity analyses. In India, sputum smear microscopy remains the most cost-effective diagnostic test available for active TB; efforts to increase access to quality-assured microscopy should take priority. In areas where high-quality microscopy exists and resources are sufficient, MGIT culture is more cost-effective than serology as an additional diagnostic test for TB. These data informed a recently published World Health Organization policy statement against serological tests.

Water productivity of different land uses in watersheds assessed from satellite imagery Landsat 5 Thematic Mapper

NASA Astrophysics Data System (ADS)

Franco, Renato A. M.; Hernandez, Fernando B. T.; Teixeira, Antonio H. C.

2014-10-01

Water productivity (WP) of various classes of soil usage from watersheds was estimated using the SAFER - Simple Algorithm For Evapotranspiration Retrieving - algorithm and the Monteith equation to estimate the parameters of biomass production (BIO). Monteith's equation is used to quantify the absorbed photosynthetically active radiation (APAR) and Actual Evapotranspiration (ET) was estimated with the SAFER algorithm. The objective of the research is to analyze the spatial-temporal water productivity in watersheds with different uses and soil occupation during the period from 1996 to 2010, in conditions of drought and using the Monteith model to estimate the production of BIO and using the SAFER model for ET. Results indicated an increase of 153.2% in ET value during the period 1997-2010, showing that the irrigated areas were responsible for this increase in ET values. In September 2000, image of day of year (DOY) 210 showed high values of BIO, with averages of 80.67 kg ha-1d-1. In the year 2010 (DOY:177), the mean value of BIO was 62.90 kg ha-1d-1, with an irrigated area with a maximum value of 227.5 kg ha-1d-1. The highest incremental values of BIO is verified from the start of irrigated areas equal to the value of ET, because there is a relationship between BIO and ET. The maximum water productivity (WP) value occurred in June/2001, with 3,08 kg m-3, the second highest value was in 2010 (DOY:177), with a value of 2,97 kg m-3. Irrigated agriculture show the highest WP value, with maximum value of 6.7 kg m-3. The lowest WP was obtained for DOY 267, because of the dry season with condition of low soil moisture.

Plasticity in variation of xylem and phloem cell characteristics of Norway spruce under different local conditions

PubMed Central

Gričar, Jožica; Prislan, Peter; de Luis, Martin; Gryc, Vladimír; Hacurová, Jana; Vavrčík, Hanuš; Čufar, Katarina

2015-01-01

There is limited information on intra-annual plasticity of secondary tissues of tree species growing under different environmental conditions. To increase the knowledge about the plasticity of secondary growth, which allows trees to adapt to specific local climatic regimes, we examined climate–radial growth relationships of Norway spruce [Picea abies (L.) H. Karst.] from three contrasting locations in the temperate climatic zone by analyzing tree-ring widths for the period 1932–2010, and cell characteristics in xylem and phloem increments formed in the years 2009–2011. Variation in the structure of xylem and phloem increments clearly shows that plasticity in seasonal dynamics of cambial cell production and cell differentiation exists on xylem and phloem sides. Anatomical characteristics of xylem and phloem cells are predominantly site-specific characteristics, because they varied among sites but were fairly uniform among years in trees from the same site. Xylem and phloem tissues formed in the first part of the growing season seemed to be more stable in structure, indicating their priority over latewood and late phloem for tree performance. Long-term climate and radial growth analyses revealed that growth was in general less dependent on precipitation than on temperature; however, growth sensitivity to local conditions differed among the sites. Only partial dependence of radial growth of spruce on climatic factors on the selected sites confirms its strategy to adapt the structure of wood and phloem increments to function optimally in local conditions. PMID:26442044

Considering Environment, Economy, And Society In Land-Use: A Case Study - Stella, Missouri

EPA Science Inventory

Human life is conditional upon intact ecosystems that provide goods and services required to sustain human life. Because development will incrementally and cumulative consume the biophysical environment, the conditions of intact ecosystems must be the basis for how the environme...

Variational data assimilative modeling of the Gulf of Maine in spring and summer 2010

NASA Astrophysics Data System (ADS)

Li, Yizhen; He, Ruoying; Chen, Ke; McGillicuddy, Dennis J.

2015-05-01

A data assimilative ocean circulation model is used to hindcast the Gulf of Maine [GOM) circulation in spring and summer 2010. Using the recently developed incremental strong constraint 4D Variational data assimilation algorithm, the model assimilates satellite sea surface temperature and in situ temperature and salinity profiles measured by expendable bathythermograph, Argo floats, and shipboard CTD casts. Validation against independent observations shows that the model skill is significantly improved after data assimilation. The data-assimilative model hindcast reproduces the temporal and spatial evolution of the ocean state, showing that a sea level depression southwest of the Scotian Shelf played a critical role in shaping the gulf-wide circulation. Heat budget analysis further demonstrates that both advection and surface heat flux contribute to temperature variability. The estimated time scale for coastal water to travel from the Scotian Shelf to the Jordan Basin is around 60 days, which is consistent with previous estimates based on in situ observations. Our study highlights the importance of resolving upstream and offshore forcing conditions in predicting the coastal circulation in the GOM.

System for sensing droplet formation time delay in a flow cytometer

DOEpatents

Van den Engh, Ger; Esposito, Richard J.

1997-01-01

A droplet flow cytometer system which includes a system to optimize the droplet formation time delay based on conditions actually experienced includes an automatic droplet sampler which rapidly moves a plurality of containers stepwise through the droplet stream while simultaneously adjusting the droplet time delay. Through the system sampling of an actual substance to be processed can be used to minimize the effect of the substances variations or the determination of which time delay is optimal. Analysis such as cell counting and the like may be conducted manually or automatically and input to a time delay adjustment which may then act with analysis equipment to revise the time delay estimate actually applied during processing. The automatic sampler can be controlled through a microprocessor and appropriate programming to bracket an initial droplet formation time delay estimate. When maximization counts through volume, weight, or other types of analysis exists in the containers, the increment may then be reduced for a more accurate ultimate setting. This may be accomplished while actually processing the sample without interruption.

Motor Controller System For Large Dynamic Range of Motor Operation

NASA Technical Reports Server (NTRS)

Howard, David E. (Inventor); Alhorn, Dean C. (Inventor); Smith, Dennis A. (Inventor); Dutton, Kenneth R. (Inventor); Paulson, Mitchell Scott (Inventor)

2006-01-01

A motor controller system uses a rotary sensor with a plurality of signal conditioning units, coupled to the rotary sensor. Each of these units, which is associated with a particular range of motor output shaft rotation rates, generate a feedback signal indicative of the position of the motor s output shaft. A controller (i) converts a selected motor output shaft rotation rate to a corresponding incremental amount of rotational movement for a selected fixed time period, (ii) selects, at periodic completions of the selected fixed time period, the feedback signal from one of the signal conditioning units for which the particular range of motor output shaft rotation rates associated therewith encompasses the selected motor output shaft rotation rate, and (iii) generates a motor drive signal based on a difference between the incremental amount of rotational movement and the feedback signal from the selected one of the signal conditioning Units.

Biophotonic perception on Desmodesmus sp. VIT growth, lipid and carbohydrate content.

PubMed

Sriram, Srinivasan; Seenivasan, Ramasubbu

2015-12-01

Constant and fluctuating light intensity significantly affects the growth and biochemical composition of microalgae and it is essential to identify suitable illumination conditions for commercial microalgae biofuel production. In the present study, effects of light intensities, light:dark cycles, incremental light intensity strategies and fluctuating light intensities simulating different sky conditions in indoor photobioreactor on Desmodesmus sp. VIT growth, lipid and carbohydrate content were analyzed in batch culture. The results revealed that Desmodesmus sp. VIT obtained maximum lipid content (22.5%) and biomass production (1.033 g/L) under incremental light intensity strategy. The highest carbohydrate content of 25.4% was observed under constant light intensity of 16,000 lx and 16:08 h light:dark cycle. The maximum biomass productivity of Desmodesmus sp. VIT (53.38 mg/L/d) was occurred under fluctuating light intensity simulating intermediate overcast sky condition. Copyright © 2015 Elsevier Ltd. All rights reserved.

Convenient total variation diminishing conditions for nonlinear difference schemes

NASA Technical Reports Server (NTRS)

Tadmor, Eitan

1986-01-01

Convenient conditions for nonlinear difference schemes to be total-variation diminishing (TVD) are reviewed. It is shown that such schemes share the TVD property, provided their numerical fluxes meet a certain positivity condition at extrema values but can be arbitrary otherwise. The conditions are invariant under different incremental representations of the nonlinear schemes, and thus provide a simplified generalization of the TVD conditions due to Harten and others.

Cost-effectiveness of lumbar artificial intervertebral disc replacement: driven by the choice of comparator.

PubMed

Parkinson, Bonny; Goodall, Stephen; Thavaneswaran, Prema

2013-09-01

Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Methionine+cystine requirement of broiler chickens fed low-density diets under tropical conditions.

PubMed

Aftab, Usama; Ashraf, Muhammad

2009-03-01

Two experiments were conducted to determine the M+C requirement of straight-run broiler chickens (Hubbard x Hubbard) during the period 4-21 (Exp. 1) and 21-40 (Exp. 2) days of age. Experiments were conducted during summer months (July-August) in open-sided houses, thus exposing chicks to chronic heat stress. Daily min-max temperature averaged 26-37C (Exp. 1) and 23-36C (Exp. 2). M+C deficient basal diets were formulated to contain low-nutrient-density, i.e., 2750 kcal per kg ME, 20.1% CP (Exp. 1), and 2780 kcal per kg ME, 17.0% CP (Exp. 2). Diets were supplemented with DL-methionine to provide total M+C level ranging from 0.64 to 0.89 % (six increments) and 0.54 to 0.79% (six increments), respectively in experiment 1 and 2. Requirements (0.95 of the maximum quadratic response) were found to be 0.77 and 0.75% total M+C, respectively for gain and feed efficiency, during 4-21 days; and 0.67% total M+C for both gain and feed efficiency during 21-40 days of age. Calculated on the digestible M+C basis, the estimates were 0.67 and 0.65% respectively for gain and feed efficiency during 4-21 days of age; and 0.60% for gain and feed efficiency during 21-40 days of age.

Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs.

PubMed

Olmstead, Todd A; Sindelar, Jody L; Petry, Nancy M

2007-03-16

To evaluate the cost-effectiveness of a prize-based intervention as an addition to usual care for stimulant abusers. This cost-effectiveness analysis is based on a randomized clinical trial implemented within the National Drug Abuse Treatment Clinical Trials Network. The trial was conducted at eight community-based outpatient psychosocial drug abuse treatment clinics. Four hundred and fifteen stimulant abusers were assigned to usual care (N=206) or usual care plus abstinence-based incentives (N=209) for 12 weeks. Participants randomized to the incentive condition earned the chance to draw for prizes for submitting substance negative samples; the number of draws earned increased with continuous abstinence time. Incremental cost-effectiveness ratios were estimated to compare prize-based incentives relative to usual care. The primary patient outcome was longest duration of confirmed stimulant abstinence (LDA). Unit costs were obtained via surveys administered at the eight participating clinics. Resource utilizations and patient outcomes were obtained from the clinical trial. Acceptability curves are presented to illustrate the uncertainty due to the sample and to provide policy relevant information. The incremental cost to lengthen the LDA by 1 week was 258 US dollars (95% confidence interval, 191-401 US dollars). Sensitivity analyses on several key parameters show that this value ranges from 163 to 269 US dollars. Compared with the usual care group, the incentive group had significantly longer LDAs and significantly higher costs.

The cost-effectiveness of using payment to increase living donor kidneys for transplantation.

PubMed

Barnieh, Lianne; Gill, John S; Klarenbach, Scott; Manns, Braden J

2013-12-01

For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.

Cost-effectiveness analysis of apatinib treatment for chemotherapy-refractory advanced gastric cancer.

PubMed

Chen, Hong-Dou; Zhou, Jing; Wen, Feng; Zhang, Peng-Fei; Zhou, Ke-Xun; Zheng, Han-Rui; Yang, Yu; Li, Qiu

2017-02-01

Apatinib, a third-line or later treatment for advanced gastric cancer (aGC), was shown to improve overall survival and progression-free survival (PFS) compared with placebo in the phase III trial. Given the modest benefit with high costs, we further evaluated the cost-effectiveness of apatinib for patients with chemotherapy-refractory aGC. A Markov model was developed to simulate the disease process of aGC (PFS, progressive disease, and death) and estimate the incremental cost-effectiveness ratio (ICER) of apatinib to placebo. The health outcomes and utility scores were derived from the phase III trial and previously published sources, respectively. Total costs were calculated from the perspective of the Chinese health-care payer. Sensitivity analysis was used to explore model uncertainties. Treatment with apatinib was estimated to provide an incremental 0.09 quality-adjusted life years (QALYs) at an incremental cost of $8113.86 compared with placebo, which resulted in an ICER of $90,154.00 per QALY. Sensitivity analysis showed that across the wide variation of parameters, the ICER exceeded the willingness-to-pay threshold of $23,700.00 per QALY which was three times the Gross Domestic Product per Capita in China. Apatinib is not a cost-effective option for patients with aGC who experienced failure of at least two lines chemotherapy in China. However, for its positive clinical value and subliminal demand, apatinib can provide a new therapeutic option.

Regulatory Impact Analysis (RIA) for the Proposed Revisions to the Sulfur Dioxide National Ambient Air Quality Standards (NAAQS)

EPA Pesticide Factsheets

This Regulatory Impact Analysis (RIA) provides estimates of the incremental costs and monetized human health benefits of attaining a revised short‐term Sulfur Dioxide (SO2) NAAQS within the current monitoring network.

Final Regulatory Impact Analysis (RIA) for the NO2 National Ambient Air Quality Standards (NAAQS)

EPA Pesticide Factsheets

This RIA provides illustrative estimates, as of January 2010, of the incremental costs and monetized human health benefits of attaining the revised NO2 NAAQS within the the existing community-wide monitoring network of 409 monitors.

Cost-effectiveness of Haemophilus influenzae type b vaccine in Vietnam

PubMed Central

Le, Phuc; Griffiths, Ulla K.; Anh, Dang Duc; Franzini, Luisa; Chan, Wenyaw; Swint, J. Michael

2015-01-01

Background With GAVI support, Vietnam introduced Haemophilus influenzae type b (Hib) vaccine in 2010 without evidence on cost-effectiveness. We aimed to analyze the cost-effectiveness of Hib vaccine from societal and governmental perspectives. Method We constructed a decision-tree cohort model to estimate the costs and effectiveness of Hib vaccine versus no Hib vaccine for the 2011 birth cohort. The disease burden was estimated from local epidemiologic data and literature. Vaccine delivery costs were calculated from governmental reports and 2013 vaccine prices. A prospective cost-of-illness study was conducted to estimate treatment costs. The human capital approach was employed to estimate productivity loss. The incremental costs of Hib vaccine were divided by cases, deaths, and disability-adjusted life years (DALY) averted. We used the WHO recommended cost-effectiveness thresholds of an intervention being highly cost-effective if incremental costs per DALY were below GDP per capita. Result From the societal perspective, incremental costs per discounted case, death and DALY averted were US$ 6,252, US$ 26,476 and US$ 1,231, respectively; the break-even vaccine price was US$ 0.69/dose. From the governmental perspective, the results were US$ 6,954, US$ 29,449, and US$ 1,373, respectively; the break-even vaccine price was US$ 0.48/dose. Vietnam's GDP per capita was US$ 1,911 in 2013. In deterministic sensitivity analysis, morbidity and mortality parameters were among the most influential factors. In probabilistic sensitivity analysis, Hib vaccine had an 84% and 78% probability to be highly cost-effective from the societal and governmental perspectives, respectively. Conclusion Hib vaccine was highly cost-effective from both societal and governmental perspectives. However, with GAVI support ending in 2016, the government will face a six-fold increase in its vaccine budget at the 2013 vaccine price. The variability of vaccine market prices adds an element of uncertainty. Increased government commitment and improved resource allocation decision making will be necessary to retain Hib vaccine. PMID:26044493

Cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization schedule in Haryana State, India.

PubMed

Gupta, Madhu; Prinja, Shankar; Kumar, Rajesh; Kaur, Manmeet

2013-01-01

In India, Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization programme requires evidence of its potential health impact and cost-effectiveness, as it is a costly vaccine. Since childhood mortality, vaccination coverage and health service utilization vary across states, the cost-effectiveness of introducing Hib vaccine was studied in Haryana state. A mathematical model was used to compare scenarios with and without Hib vaccination to estimate the cost-effectiveness of Hib vaccine in Haryana from 2010 to 2024. Demographic and National Family Health Surveys were used to estimate vaccination coverage and mortality rates among children under 5. Hib pneumonia, Hib meningitis and invasive Hib disease incidence were based on Indian studies. Vaccine and syringe prices of the UNICEF supply division were used. Cost-effectiveness from government and societal perspectives was calculated as the net incremental cost per unit of health benefit gained [disability-adjusted life years (DALYs) averted, life years saved, Hib cases averted, Hib deaths averted]. Sensitivity analysis was done using variation in parameter estimates among different states of India. The incremental cost of Hib vaccine introduction from a government and a societal perspective was estimated to be US$81.4 and US$27.5 million, respectively, from 2010 to 2024. Vaccination of 73.3, 71.6 and 67.4 million children with first, second and third dose of pentavalent vaccine, respectively, would avert 7 067 817 cases, 31 331 deaths and 994 564 DALYs. Incremental cost per DALY averted from a government (US$819) and a societal perspective (US$277) was found to be less than the per capita gross national income of India in 2009. In sensitivity analysis, Hib vaccine introduction remained cost-effective for India. Hib vaccine introduction is a cost-effective strategy in India.

Heat Loss Testing of Schott's 2008 PTR70 Parabolic Trough Receiver

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

Burkholder, Frank; Kutscher, Chuck

2009-05-01

Two Schott 2008 model year PTR70 HCEs were tested on NREL's heat loss test stand from 100 - 500 deg C in 50 deg C increments. Absorber emittance was determined from the laboratory testing so that the performance of the HCEs could be modeled in a parabolic trough collector. Collector/HCE simulation results for many different field operation conditions were used to create heat loss correlationcoefficients for Excelergy and SAM. SAM estimates that the decreased emittance of the 2008 PTR70 will decrease the LCOE for parabolic trough power plants by 0.5 cents/kWh and increase the electricity generated by 5% relative tomore » previous PTR70s. These conclusions assume that the 2008 PTR70 is supplied at the same cost and with the same optical performance as earlier PTR70 models.« less

Ozone data assimilation with GEOS-Chem: a comparison between 3-D-Var, 4-D-Var, and suboptimal Kalman filter approaches

NASA Astrophysics Data System (ADS)

Singh, K.; Sandu, A.; Bowman, K. W.; Parrington, M.; Jones, D. B. A.; Lee, M.

2011-08-01

Chemistry transport models determine the evolving chemical state of the atmosphere by solving the fundamental equations that govern physical and chemical transformations subject to initial conditions of the atmospheric state and surface boundary conditions, e.g., surface emissions. The development of data assimilation techniques synthesize model predictions with measurements in a rigorous mathematical framework that provides observational constraints on these conditions. Two families of data assimilation methods are currently widely used: variational and Kalman filter (KF). The variational approach is based on control theory and formulates data assimilation as a minimization problem of a cost functional that measures the model-observations mismatch. The Kalman filter approach is rooted in statistical estimation theory and provides the analysis covariance together with the best state estimate. Suboptimal Kalman filters employ different approximations of the covariances in order to make the computations feasible with large models. Each family of methods has both merits and drawbacks. This paper compares several data assimilation methods used for global chemical data assimilation. Specifically, we evaluate data assimilation approaches for improving estimates of the summertime global tropospheric ozone distribution in August 2006 based on ozone observations from the NASA Tropospheric Emission Spectrometer and the GEOS-Chem chemistry transport model. The resulting analyses are compared against independent ozonesonde measurements to assess the effectiveness of each assimilation method. All assimilation methods provide notable improvements over the free model simulations, which differ from the ozonesonde measurements by about 20 % (below 200 hPa). Four dimensional variational data assimilation with window lengths between five days and two weeks is the most accurate method, with mean differences between analysis profiles and ozonesonde measurements of 1-5 %. Two sequential assimilation approaches (three dimensional variational and suboptimal KF), although derived from different theoretical considerations, provide similar ozone estimates, with relative differences of 5-10 % between the analyses and ozonesonde measurements. Adjoint sensitivity analysis techniques are used to explore the role of of uncertainties in ozone precursors and their emissions on the distribution of tropospheric ozone. A novel technique is introduced that projects 3-D-Variational increments back to an equivalent initial condition, which facilitates comparison with 4-D variational techniques.

Economic evaluation of everolimus versus sorafenib for the treatment of metastatic renal cell carcinoma after failure of first-line sunitinib.

PubMed

Casciano, Roman; Chulikavit, Maruit; Di Lorenzo, Giuseppe; Liu, Zhimei; Baladi, Jean-Francois; Wang, Xufang; Robertson, Justin; Garrison, Lou

2011-01-01

A recent indirect comparison study showed that sunitinib-refractory metastatic renal cell carcinoma (mRCC) patients treated with everolimus are expected to have improved overall survival outcomes compared to patients treated with sorafenib. This analysis examines the likely cost-effectiveness of everolimus versus sorafenib in this setting from a US payer perspective. A Markov model was developed to simulate a cohort of sunitinib-refractory mRCC patients and to estimate the cost per incremental life-years gained (LYG) and quality-adjusted life-years (QALYs) gained. Markov states included are stable disease without adverse events, stable disease with adverse events, disease progression, and death. Transition probabilities were estimated using a subset of the RECORD-1 patient population receiving everolimus after sunitinib, and a comparable population receiving sorafenib in a single-arm phase II study. Costs of antitumor therapies were based on wholesale acquisition cost. Health state costs accounted for physician visits, tests, adverse events, postprogression therapy, and end-of-life care. The model extrapolated beyond the trial time horizon for up to 6 years based on published trial data. Deterministic and probabilistic sensitivity analyses were conducted. The estimated gain over sorafenib treatment was 1.273 LYs (0.916 QALYs) at an incremental cost of $81,643. The deterministic analysis resulted in an incremental cost-effectiveness ratio (ICER) of $64,155/LYG ($89,160/QALY). The probabilistic sensitivity analysis demonstrated that results were highly consistent across simulations. As the ICER fell within the cost per QALY range for many other widely used oncology medicines, everolimus is projected to be a cost-effective treatment relative to sorafenib for sunitinib-refractory mRCC. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan.

PubMed

Yang, Szu-Chun; Lai, Wu-Wei; Lin, Chien-Chung; Su, Wu-Chou; Ku, Li-Jung; Hwang, Jing-Shiang; Wang, Jung-Der

2017-06-01

A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective. The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

How do initial signals of quality influence the diffusion of new medical products? The case of new cancer drug treatments.

PubMed

Conti, Rena M; Bernstein, Arielle; Meltzer, David O

2012-01-01

Objective measures of a new treatment's expected ability to improve patients' health are presumed to be significant factors influencing physicians' treatment decisions. Physicians' behavior may also be influenced by their patients' disease severity and insurance reimbursement policies, firm promotional activities and public media reports. This chapter examines how objective evidence of the incremental effectiveness of novel drugs to treat cancer ("chemotherapies") impacts the rate at which physicians' adopt these treatments into practice, holding constant other factors. The novelty of the analysis resides in the dataset and estimation strategy employed. Data is derived from a United States population-based chemotherapy order entry system, IntrinsiQ Intellidose. Quality/price endogeneity is overcome by employing sample selection methods and an estimation strategy that exploits quality variation at the molecule-indication level. Pooled diffusion rates across molecule-indication pairs are estimated using nonparametric hazard models. Results suggest incremental effectiveness is negatively and nonsignificantly associated with the diffusion of new chemotherapies; faster rates of diffusion are positively and significantly related to low five-year survival probabilities and measures of perceived clinical significance. Results are robust to numerous specification checks, including a measure of alternative therapeutic availability. We discuss the magnitude and potential direction of bias introduced by several threats to internal validity. Evidence of incremental effectiveness does not appear to motivate the rate of specialty physician diffusion of new medical treatment; in all models high risk of disease mortality and perceptions of therapeutic quality are significant drivers of physician use of novel chemotherapies. Understanding the rate of technological advance across different clinical settings, as well as the product-, provider-, and patient-level determinants of this rate, is an important subject for future research.

Experimental Investigation of two-phase nitrogen Cryo transfer line

NASA Astrophysics Data System (ADS)

Singh, G. K.; Nimavat, H.; Panchal, R.; Garg, A.; Srikanth, GLN; Patel, K.; Shah, P.; Tanna, V. L.; Pradhan, S.

2017-02-01

A 6-m long liquid nitrogen based cryo transfer line has been designed, developed and tested at IPR. The test objectives include the thermo-hydraulic characteristics of Cryo transfer line under single phase as well as two phase flow conditions. It is always easy in experimentation to investigate the thermo-hydraulic parameters in case of single phase flow of cryogen but it is real challenge when one deals with the two phase flow of cryogen due to availibity of mass flow measurements (direct) under two phase flow conditions. Established models have been reported in the literature where one of the well-known model of Lockhart-Martenelli relationship has been used to determine the value of quality at the outlet of Cryo transfer line. Under homogenous flow conditions, by taking the ratio of the single-phase pressure drop and the two-phase pressure drop, we estimated the quality at the outlet. Based on these equations, vapor quality at the outlet of the transfer line was predicted at different heat loads. Experimental rresults shown that from inlet to outlet, there is a considerable increment in the pressure drop and vapour quality of the outlet depending upon heat load and mass flow rate of nitrogen flowing through the line.

Plutons: Simmer between 350° and 500°C for 10 million years, then serve cold (Invited)

NASA Astrophysics Data System (ADS)

Coleman, D. S.; Davis, J.

2009-12-01

The growing recognition that continental plutons are assembled incrementally over millions of years requires reexamination of the thermal histories of intrusive rocks. With the exception of the suggestion that pluton magma chambers can be revitalized by mafic input at their deepest structural levels, most aspects of modern pluton petrology are built on the underlying assumption that silicic plutons intrude as discrete thermal packages that undergo subsequent monotonic decay back to a steady-state geothermal gradient. The recognition that homogeneous silicic plutons are constructed over timescales too great to be single events necessitates rethinking pluton intrusion mechanisms, textures, thermochronology, chemical evolution and links to volcanic rocks. Three-dimensional thermal modeling of sheeted (horizontal and vertical) incremental pluton assembly (using HEAT3D by Wohletz, 2007) yields several results that are largely independent of intrusive geometry and may help understand bothersome field and laboratory results from plutonic rocks. 1) All increments cool quickly below hornblende closure temperature. However, late increments are emplaced into walls warmed by earlier increments, and they cycle between hornblende and biotite closure temperatures, a range in which fluid-rich melts are likely to be present. These conditions persist until the increments are far from the region of new magma flux, or the addition of increments stops. These observations are supported by Ar thermochronology and may explain why heterogeneous early marginal intrusive phases often grade into younger homogeneous interior map units. 2) Early increments become the contact metamorphic wall rocks of later increments. This observation suggests that much of the contact metamorphism associated with a given volume of plutonic rock is “lost” via textural modification of early increments during intrusion of later increments. Johnson and Glazner (CMP, in press) argue that mappable variations in pluton texture can result from textural modification during thermal cycling associated with incremental assembly. 3) The thermal structure of the model pluton evolves toward roughly spheroidal isotherms even though the pluton is assembled from thin tabular sheets. The zone of melt-bearing rock and the shape of intrapluton contact metamorphic isograds bear little resemblance to the increments from which the pluton was built. Consequently, pluton contacts mapped by variations in texture that reflect the thermal cycling inherent to incremental assembly will inevitably be “blob” or diapir-like, but will yield little insight into magma intrusion geometry. 4) Although models yield large regions of melt-bearing rock, the melt fraction is low and the melt-bearing volume at any time is small compared to the total volume of the pluton. This observation raises doubts about the connections between zoned silicic plutons and large ignimbrite eruptions.

LANDSAT D user data processing study

NASA Technical Reports Server (NTRS)

1976-01-01

The major expected users of the LANDSAT D system and a preliminary system design of their required facilities are investigated. This system design will then be costed in order to provide an estimate of the incremental user costs necessitated by LANDSAT D. One major use of these cost estimates is as part of an overall economic cost/benefit argument being developed for the LANDSAT D system. The implication of this motive is key; the system design (and corresponding cost estimates) must be a credible one, but not necessarily an optimum one.

Capturing spiral radial growth of conifers using the superellipse to model tree-ring geometric shape

PubMed Central

Shi, Pei-Jian; Huang, Jian-Guo; Hui, Cang; Grissino-Mayer, Henri D.; Tardif, Jacques C.; Zhai, Li-Hong; Wang, Fu-Sheng; Li, Bai-Lian

2015-01-01

Tree-rings are often assumed to approximate a circular shape when estimating forest productivity and carbon dynamics. However, tree rings are rarely, if ever, circular, thereby possibly resulting in under- or over-estimation in forest productivity and carbon sequestration. Given the crucial role played by tree ring data in assessing forest productivity and carbon storage within a context of global change, it is particularly important that mathematical models adequately render cross-sectional area increment derived from tree rings. We modeled the geometric shape of tree rings using the superellipse equation and checked its validation based on the theoretical simulation and six actual cross sections collected from three conifers. We found that the superellipse better describes the geometric shape of tree rings than the circle commonly used. We showed that a spiral growth trend exists on the radial section over time, which might be closely related to spiral grain along the longitudinal axis. The superellipse generally had higher accuracy than the circle in predicting the basal area increment, resulting in an improved estimate for the basal area. The superellipse may allow better assessing forest productivity and carbon storage in terrestrial forest ecosystems. PMID:26528316

Capturing spiral radial growth of conifers using the superellipse to model tree-ring geometric shape.

PubMed

Shi, Pei-Jian; Huang, Jian-Guo; Hui, Cang; Grissino-Mayer, Henri D; Tardif, Jacques C; Zhai, Li-Hong; Wang, Fu-Sheng; Li, Bai-Lian

2015-01-01

Tree-rings are often assumed to approximate a circular shape when estimating forest productivity and carbon dynamics. However, tree rings are rarely, if ever, circular, thereby possibly resulting in under- or over-estimation in forest productivity and carbon sequestration. Given the crucial role played by tree ring data in assessing forest productivity and carbon storage within a context of global change, it is particularly important that mathematical models adequately render cross-sectional area increment derived from tree rings. We modeled the geometric shape of tree rings using the superellipse equation and checked its validation based on the theoretical simulation and six actual cross sections collected from three conifers. We found that the superellipse better describes the geometric shape of tree rings than the circle commonly used. We showed that a spiral growth trend exists on the radial section over time, which might be closely related to spiral grain along the longitudinal axis. The superellipse generally had higher accuracy than the circle in predicting the basal area increment, resulting in an improved estimate for the basal area. The superellipse may allow better assessing forest productivity and carbon storage in terrestrial forest ecosystems.

Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

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

Shah, Nihar; Abhyankar, Nikit; Park, Won Young

Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. We assess several efficiency levels, two of which are summarized below in the report.more » The finding that significant efficiency improvement is cost effective from a consumer perspective is robust over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one star level) should be evaluated rigorously considering significant benefits to consumers, energy security and environment.« less

Impact of side-effects of atypical antipsychotics on non-compliance, relapse and cost.

PubMed

Mortimer, A; Williams, P; Meddis, D

2003-01-01

Atypical antipsychotics generally have milder side-effects than conventional antipsychotics, but also differ among themselves in this respect. This study aimed to compare the impact of different side-effect profiles of individual atypical antipsychotics on non-compliance, relapse and cost in schizophrenia. A state-transition model was built using literature data supplemented by expert opinion. The model found that quetiapine and ziprasidone were similar in estimated non-compliance and relapse rates. Olanzapine and risperidone had higher estimated non-compliance and relapse rates, and incremental, 1-year, per-patient direct costs, using US-based cost data, of approximately $530 (95% confidence interval [CI] approximately $275, $800), and approximately $485 (95% CI approximately $235, $800), respectively, compared with quetiapine. Incremental costs attributable to different side-effect profiles were highly significant. This study shows that differing side-effect profiles of the newer antipsychotic agents are likely to lead to different compliance rates, and consequent variation in relapse rates. The cost implications of these heterogenous clinical outcomes are substantial.

Production of Referring Expressions for an Unknown Audience: A Computational Model of Communal Common Ground

PubMed Central

Kutlak, Roman; van Deemter, Kees; Mellish, Chris

2016-01-01

This article presents a computational model of the production of referring expressions under uncertainty over the hearer's knowledge. Although situations where the hearer's knowledge is uncertain have seldom been addressed in the computational literature, they are common in ordinary communication, for example when a writer addresses an unknown audience, or when a speaker addresses a stranger. We propose a computational model composed of three complimentary heuristics based on, respectively, an estimation of the recipient's knowledge, an estimation of the extent to which a property is unexpected, and the question of what is the optimum number of properties in a given situation. The model was tested in an experiment with human readers, in which it was compared against the Incremental Algorithm and human-produced descriptions. The results suggest that the new model outperforms the Incremental Algorithm in terms of the proportion of correctly identified entities and in terms of the perceived quality of the generated descriptions. PMID:27630592

Post-natal growth in the rat pineal gland: a stereological study.

PubMed

Erbagci, H; Kizilkan, N; Ozbag, D; Erkilic, S; Kervancioglu, P; Canan, S; Gumusburun, E

2012-10-01

The purpose was to observe the changes in a rat pineal gland using stereological techniques during lactation and post-weaning periods. Thirty Wistar albino rats were studied during different post-natal periods using light microscopy. Pineal gland volume was estimated using the Cavalieri Method. Additionally, the total number of pinealocytes was estimated using the optical fractionator technique. Pineal gland volume displayed statistically significant changes between lactation and after weaning periods. A significant increase in pineal gland volume was observed from post-natal day 10 to post-natal day 90. The numerical density of pinealocytes became stabilized during lactation and decreased rapidly after weaning. However, the total number of pinealocytes continuously increased during post-natal life of all rats in the study. However, this increment was not statistically significant when comparing the lactation and after weaning periods. The increase in post-natal pineal gland volume may depend on increment of immunoreactive fibres, capsule thickness or new synaptic bodies. © 2012 Blackwell Verlag GmbH.

Pharmacoeconomics of ruxolitinib therapy in patients with myelofibrosis.

PubMed

Vandewalle, Björn; Andreozzi, Valeska; Almeida, João; Félix, Jorge

2016-01-01

Overall survival (OS) and other important clinical trial end-points seem increasingly more elusive in supporting rapid and efficient incorporation of innovative cancer drugs in clinical practice. This study proposes a clinical trial based pharmacoeconomic framework to assess the therapeutic and economic value of ruxolitinib in patients with intermediate-2 or high-risk myelofibrosis. Individual patient level 144 week follow-up data from the COMFORT-II trial was used to account for the crossover effect on overall survival. Lifetime treatment benefits and costs were estimated considering detailed patterns of both ruxolitinib dose adjustments and blood transfusion needs. The authors estimate a 3.3 years increment in life expectancy (HR = 0.30; 95% CI = 0.17-0.55; p-value <0.001) and an incremental cost-effectiveness ratio of €40,000 per life year gained with the use of ruxolitinib. This study also demonstrates how valuable information from clinical trials can be used to support informed decisions about the early incorporation of innovative drugs.

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina.

PubMed

Orellano, Pablo Wenceslao; Vazquez, Nestor; Salomon, Oscar Daniel

2013-12-01

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

Value of Information Analysis for Time-lapse Seismic Data by Simulation-Regression

NASA Astrophysics Data System (ADS)

Dutta, G.; Mukerji, T.; Eidsvik, J.

2016-12-01

A novel method to estimate the Value of Information (VOI) of time-lapse seismic data in the context of reservoir development is proposed. VOI is a decision analytic metric quantifying the incremental value that would be created by collecting information prior to making a decision under uncertainty. The VOI has to be computed before collecting the information and can be used to justify its collection. Previous work on estimating the VOI of geophysical data has involved explicit approximation of the posterior distribution of reservoir properties given the data and then evaluating the prospect values for that posterior distribution of reservoir properties. Here, we propose to directly estimate the prospect values given the data by building a statistical relationship between them using regression. Various regression techniques such as Partial Least Squares Regression (PLSR), Multivariate Adaptive Regression Splines (MARS) and k-Nearest Neighbors (k-NN) are used to estimate the VOI, and the results compared. For a univariate Gaussian case, the VOI obtained from simulation-regression has been shown to be close to the analytical solution. Estimating VOI by simulation-regression is much less computationally expensive since the posterior distribution of reservoir properties given each possible dataset need not be modeled and the prospect values need not be evaluated for each such posterior distribution of reservoir properties. This method is flexible, since it does not require rigid model specification of posterior but rather fits conditional expectations non-parametrically from samples of values and data.

Subpixel urban impervious surface mapping: the impact of input Landsat images

NASA Astrophysics Data System (ADS)

Deng, Chengbin; Li, Chaojun; Zhu, Zhe; Lin, Weiying; Xi, Li

2017-11-01

Due to the heterogeneity of urban environments, subpixel urban impervious surface mapping is a challenging task in urban environmental studies. Factors, such as atmospheric correction, climate conditions, seasonal effect, urban settings, substantially affect fractional impervious surface estimation. Their impacts, however, have not been well studied and documented. In this research, we performed direct and comprehensive examinations to explore the impacts of these factors on subpixel estimation when using an effective machine learning technique (Random Forest) and provided solutions to alleviate these influences. Four conclusions can be drawn based on the repeatable experiments in three study areas under different climate conditions (humid continental, tropical monsoon, and Mediterranean climates). First, the performance of subpixel urban impervious surface mapping using top-of-atmosphere (TOA) reflectance imagery is comparable to, and even slightly better than, the surface reflectance imagery provided by U.S. Geological Services in all seasons and in all testing regions. Second, the effect of images with leaf-on/off season varies, and is contingent upon different climate regions. Specifically, humid continental areas may prefer the leaf-on imagery (e.g., summer), while the tropical monsoon and Mediterranean regions seem to favor the fall and winter imagery. Third, the overall estimation performance in the humid continental area is somewhat better than the other regions. Finally, improvements can be achieved by using multi-season imagery, but the increments become less obvious when including more than two seasons. The strategy and results of this research could improve and accommodate regional/national subpixel land cover mapping using Landsat images for large-scale environmental studies.

Attitude Determination Algorithm based on Relative Quaternion Geometry of Velocity Incremental Vectors for Cost Efficient AHRS Design

NASA Astrophysics Data System (ADS)

Lee, Byungjin; Lee, Young Jae; Sung, Sangkyung

2018-05-01

A novel attitude determination method is investigated that is computationally efficient and implementable in low cost sensor and embedded platform. Recent result on attitude reference system design is adapted to further develop a three-dimensional attitude determination algorithm through the relative velocity incremental measurements. For this, velocity incremental vectors, computed respectively from INS and GPS with different update rate, are compared to generate filter measurement for attitude estimation. In the quaternion-based Kalman filter configuration, an Euler-like attitude perturbation angle is uniquely introduced for reducing filter states and simplifying propagation processes. Furthermore, assuming a small angle approximation between attitude update periods, it is shown that the reduced order filter greatly simplifies the propagation processes. For performance verification, both simulation and experimental studies are completed. A low cost MEMS IMU and GPS receiver are employed for system integration, and comparison with the true trajectory or a high-grade navigation system demonstrates the performance of the proposed algorithm.

Comparative analysis of age dynamics of average values of body dimensions in children from birth to 7 years.

PubMed

Deryabin, Vasily E; Krans, Valentina M; Fedotova, Tatiana K

2005-07-01

Mean values of different body dimensions in different age cohorts of children make it possible to learn a lot about their dynamic changes. Their comparative analysis, as is usually practiced, in fact leads to a simple description of changes in measurement units (mm or cm) at the average level of some body dimension during a shorter or longer period of time. To estimate comparative intensity of the growth process of different body dimensions, the authors use the analogue of Mahalanobis distance, the so-called Kullback divergence (1967), which does not demand stability of dispersion or correlation coefficients of dimensions in compared cohorts of children. Most of the dimensions, excluding skinfolds, demonstrate growth dynamics with gradually reducing increments from birth to 7 years. Body length has the highest integrative increment, leg length about 94% of body length, body mass 77%, and trunk and extremities circumferences 56%. Skinfolds have a non-monotonic pattern of accumulated standardized increments with some increase until 1-2 years of age.

SfM with MRFs: discrete-continuous optimization for large-scale structure from motion.

PubMed

Crandall, David J; Owens, Andrew; Snavely, Noah; Huttenlocher, Daniel P

2013-12-01

Recent work in structure from motion (SfM) has built 3D models from large collections of images downloaded from the Internet. Many approaches to this problem use incremental algorithms that solve progressively larger bundle adjustment problems. These incremental techniques scale poorly as the image collection grows, and can suffer from drift or local minima. We present an alternative framework for SfM based on finding a coarse initial solution using hybrid discrete-continuous optimization and then improving that solution using bundle adjustment. The initial optimization step uses a discrete Markov random field (MRF) formulation, coupled with a continuous Levenberg-Marquardt refinement. The formulation naturally incorporates various sources of information about both the cameras and points, including noisy geotags and vanishing point (VP) estimates. We test our method on several large-scale photo collections, including one with measured camera positions, and show that it produces models that are similar to or better than those produced by incremental bundle adjustment, but more robustly and in a fraction of the time.

Two Different Views on the World Around Us: The World of Uniformity versus Diversity.

PubMed

Kwon, JaeHwan; Nayakankuppam, Dhananjay

2016-01-01

We propose that when individuals believe in fixed traits of personality (entity theorists), they are likely to expect a world of "uniformity." As such, they easily infer a population statistic from a small sample of data with confidence. In contrast, individuals who believe in malleable traits of personality (incremental theorists) are likely to presume a world of "diversity," such that they "hesitate" to infer a population statistic from a similarly sized sample. In four laboratory experiments, we found that compared to incremental theorists, entity theorists estimated a population mean from a sample with a greater level of confidence (Studies 1a and 1b), expected more homogeneity among the entities within a population (Study 2), and perceived an extreme value to be more indicative of an outlier (Study 3). These results suggest that individuals are likely to use their implicit self-theory orientations (entity theory versus incremental theory) to see a population in general as a constitution either of homogeneous or heterogeneous entities.

The effects of taurine on repeat sprint cycling after low or high cadence exhaustive exercise in females.

PubMed

Waldron, Mark; Knight, Francesca; Tallent, Jamie; Patterson, Stephen; Jeffries, Owen

2018-06-01

This study investigated the effects of taurine on repeated sprint exercise, performed after fixed incremental ramp exercise to exhaustion at isokinetic high (90 r/min) or low (50 r/min) cadences. In a double-blind, repeated measures design, nine females completed an incremental ramp test to volitional exhaustion, followed by 2 min active recovery and 6 × 10 s sprints on a cycle ergometer, in one of four conditions: high cadence (90 r/min) + taurine (50 mg/kg body mass); high cadence + placebo (3 mg/kg body mass maltodextrin); low cadence (50 r/min) + taurine; low cadence + placebo. Heart rate (HR) and blood lactate concentration B[La] were measured before and after the ramp test and after the sprints. Taurine lowered HR vs. placebo prior to the ramp test (P = 0.004; d = 2.1). There was an effect of condition on ramp performance (P < 0.001), with higher end-test power (d = 3.7) in taurine conditions. During repeated sprints, there was a condition × time interaction (P = 0.002), with higher peak sprint power in the placebo conditions compared to taurine (sprint 2-6; P < 0.05). B[La] was higher in taurine compared to placebo post-ramp (P = 0.004; d = 4.7). Taurine-lowered pre-exercise HR and improved incremental end-test power output, with subsequent detrimental effects on sprint performance, independent of cadence. Short endurance performance can be acutely enhanced after taurine ingestion but this effect might not be maintained across longer periods of exercise or induce the need for longer recovery periods.

Enhancing performance during inclined loaded walking with a powered ankle-foot exoskeleton.

PubMed

Galle, Samuel; Malcolm, Philippe; Derave, Wim; De Clercq, Dirk

2014-11-01

A simple ankle-foot exoskeleton that assists plantarflexion during push-off can reduce the metabolic power during walking. This suggests that walking performance during a maximal incremental exercise could be improved with an exoskeleton if the exoskeleton is still efficient during maximal exercise intensities. Therefore, we quantified the walking performance during a maximal incremental exercise test with a powered and unpowered exoskeleton: uphill walking with progressively higher weights. Nine female subjects performed two incremental exercise tests with an exoskeleton: 1 day with (powered condition) and another day without (unpowered condition) plantarflexion assistance. Subjects walked on an inclined treadmill (15%) at 5 km h(-1) and 5% of body weight was added every 3 min until exhaustion. At volitional termination no significant differences were found between the powered and unpowered condition for blood lactate concentration (respectively, 7.93 ± 2.49; 8.14 ± 2.24 mmol L(-1)), heart rate (respectively, 190.00 ± 6.50; 191.78 ± 6.50 bpm), Borg score (respectively, 18.57 ± 0.79; 18.93 ± 0.73) and VO₂ peak (respectively, 40.55 ± 2.78; 40.55 ± 3.05 ml min(-1) kg(-1)). Thus, subjects were able to reach the same (near) maximal effort in both conditions. However, subjects continued the exercise test longer in the powered condition and carried 7.07 ± 3.34 kg more weight because of the assistance of the exoskeleton. Our results show that plantarflexion assistance during push-off can increase walking performance during a maximal exercise test as subjects were able to carry more weight. This emphasizes the importance of acting on the ankle joint in assistive devices and the potential of simple ankle-foot exoskeletons for reducing metabolic power and increasing weight carrying capability, even during maximal intensities.

The design of transfer trajectory for Ivar asteroid exploration mission

NASA Astrophysics Data System (ADS)

Qiao, Dong; Cui, Hutao; Cui, Pingyuan

2009-12-01

An impending demand for exploring the small bodies, such as the comets and the asteroids, envisioned the Chinese Deep Space exploration mission to the Near Earth asteroid Ivar. A design and optimal method of transfer trajectory for asteroid Ivar is discussed in this paper. The transfer trajectory for rendezvous with asteroid Ivar is designed by means of Earth gravity assist with deep space maneuver (Delta-VEGA) technology. A Delta-VEGA transfer trajectory is realized by several trajectory segments, which connect the deep space maneuver and swingby point. Each trajectory segment is found by solving Lambert problem. Through adjusting deep maneuver and arrival time, the match condition of swingby is satisfied. To reduce the total mission velocity increments further, a procedure is developed which minimizes total velocity increments for this scheme of transfer trajectory for asteroid Ivar. The trajectory optimization problem is solved with a quasi-Newton algorithm utilizing analytic first derivatives, which are derived from the transversality conditions associated with the optimization formulation and primer vector theory. The simulation results show the scheme for transfer trajectory causes C3 and total velocity increments decrease of 48.80% and 13.20%, respectively.

Optimal Estimation of Clock Values and Trends from Finite Data

NASA Technical Reports Server (NTRS)

Greenhall, Charles

2005-01-01

We show how to solve two problems of optimal linear estimation from a finite set of phase data. Clock noise is modeled as a stochastic process with stationary dth increments. The covariance properties of such a process are contained in the generalized autocovariance function (GACV). We set up two principles for optimal estimation: with the help of the GACV, these principles lead to a set of linear equations for the regression coefficients and some auxiliary parameters. The mean square errors of the estimators are easily calculated. The method can be used to check the results of other methods and to find good suboptimal estimators based on a small subset of the available data.

Input-decomposition balance of heterotrophic processes in a warm-temperate mixed forest in Japan

NASA Astrophysics Data System (ADS)

Jomura, M.; Kominami, Y.; Ataka, M.; Makita, N.; Dannoura, M.; Miyama, T.; Tamai, K.; Goto, Y.; Sakurai, S.

2010-12-01

Carbon accumulation in forest ecosystem has been evaluated using three approaches. One is net ecosystem exchange (NEE) estimated by tower flux measurement. The second is net ecosystem production (NEP) estimated by biometric measurements. NEP can be expressed as the difference between net primary production and heterotrophic respiration. NEP can also be expressed as the annual increment in the plant biomass (ΔW) plus soil (ΔS) carbon pools defined as follows; NEP = ΔW+ΔS The third approach needs to evaluate annual carbon increment in soil compartment. Soil carbon accumulation rate could not be measured directly in a short term because of the small amount of annual accumulation. Soil carbon accumulation rate can be estimated by a model calculation. Rothamsted carbon model is a soil organic carbon turnover model and a useful tool to estimate the rate of soil carbon accumulation. However, the model has not sufficiently included variations in decomposition processes of organic matters in forest ecosystems. Organic matter in forest ecosystems have a different turnover rate that creates temporal variations in input-decomposition balance and also have a large variation in spatial distribution. Thus, in order to estimate the rate of soil carbon accumulation, temporal and spatial variation in input-decomposition balance of heterotrophic processes should be incorporated in the model. In this study, we estimated input-decomposition balance and the rate of soil carbon accumulation using the modified Roth-C model. We measured respiration rate of many types of organic matters, such as leaf litter, fine root litter, twigs and coarse woody debris using a chamber method. We can illustrate the relation of respiration rate to diameter of organic matters. Leaf and fine root litters have no diameter, so assumed to be zero in diameter. Organic matters in small size, such as leaf and fine root litter, have high decomposition respiration. It could be caused by the difference in structure of organic matter. Because coarse woody debris has shape of cylinder, microbes decompose from the surface of it. Thus, respiration rate of coarse woody debris is lower than that of leaf and fine root litter. Based on this result, we modified Roth-C model and estimate soil carbon accumulation rate in recent years. Based on the results from a soil survey, the forest soil stored 30tC ha-1 in O and A horizon. We can evaluate the modified model using this result. NEP can be expressed as the annual increment in the plant biomass plus soil carbon pools. So if we can estimate NEP using this approach, then we can evaluate NEP estimated by micrometeorological and ecological approaches and reduce uncertainty of NEP estimation.

Risk, Robustness and Water Resources Planning Under Uncertainty

NASA Astrophysics Data System (ADS)

Borgomeo, Edoardo; Mortazavi-Naeini, Mohammad; Hall, Jim W.; Guillod, Benoit P.

2018-03-01

Risk-based water resources planning is based on the premise that water managers should invest up to the point where the marginal benefit of risk reduction equals the marginal cost of achieving that benefit. However, this cost-benefit approach may not guarantee robustness under uncertain future conditions, for instance under climatic changes. In this paper, we expand risk-based decision analysis to explore possible ways of enhancing robustness in engineered water resources systems under different risk attitudes. Risk is measured as the expected annual cost of water use restrictions, while robustness is interpreted in the decision-theoretic sense as the ability of a water resource system to maintain performance—expressed as a tolerable risk of water use restrictions—under a wide range of possible future conditions. Linking risk attitudes with robustness allows stakeholders to explicitly trade-off incremental increases in robustness with investment costs for a given level of risk. We illustrate the framework through a case study of London's water supply system using state-of-the -art regional climate simulations to inform the estimation of risk and robustness.

Cost-effectiveness analysis of an early-initiated, continuous chain of rehabilitation after severe traumatic brain injury.

PubMed

Andelic, Nada; Ye, Jiajia; Tornas, Sveinung; Roe, Cecilie; Lu, Juan; Bautz-Holter, Erik; Moger, Tron; Sigurdardottir, Solrun; Schanke, Anne-Kristine; Aas, Eline

2014-07-15

The aim of this study is to estimate the long-term cost-effectiveness of two different rehabilitation trajectories after severe traumatic brain injury (sTBI). A decision tree model compared hospitalization costs, health effects, and incremental cost-effectiveness ratios (ICER) of a continuous chain versus a broken chain of rehabilitation. The expected costs were estimated by the reimbursement system using diagnosis-related group and based on point estimates of the Disability Rating Scale (DRS); the health effects were measured by means of area under the curve (AUC). The incremental health benefit was estimated as the difference in the AUCs between the chains. Lower values on the DRS scale indicate better health; thus, smaller AUCs were preferred. The modeled population was a cohort of 59 patients with sTBI (30 in continuous chain; 29 in broken chain) with 6-weeks, 1-year, and 5-year post-injury follow-ups. Regarding the DRS estimates, 5-year AUCs were 19.40 (continuous chain) and 23.46 (broken chain). Across 5 years, the continuous chain of rehabilitation had lower costs and better health effects. By replacing the broken chain with the continuous chain, NOK 37.000 could be saved and 4.06 DRS points gained. By means of probabilistic sensitivity analysis, the majority of ICER estimates (67% of the Monte Carlo simulations) indicated that a continuous chain of rehabilitation was less costly and more effective. These findings indicate that the trajectory of continuous rehabilitation represents a dominant strategy in that it reduces costs and improves outcomes after sTBI under reasonable assumptions.

Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

PubMed

Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

2014-01-01

Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon, results indicated that ticagrelor was the more cost-effective option compared to generic clopidogrel, with an incremental cost per LYG estimated at 21,566 PLN and an incremental costper QALY estimated at 24,965 PLN. In a lifetime horizon, which should be used when comparing technologies with different impacts on mortality, cost-effectiveness evaluation resulted in more favourable economic outcomes for ticagrelor than for generic clopidogrel, with the cost per QALY well below the recommended willingness to pay threshold in Poland (24,965 PLN vs. 111,381 PLN).

Effects of time-shifted data on flight determined stability and control derivatives

NASA Technical Reports Server (NTRS)

Steers, S. T.; Iliff, K. W.

1975-01-01

Flight data were shifted in time by various increments to assess the effects of time shifts on estimates of stability and control derivatives produced by a maximum likelihood estimation method. Derivatives could be extracted from flight data with the maximum likelihood estimation method even if there was a considerable time shift in the data. Time shifts degraded the estimates of the derivatives, but the degradation was in a consistent rather than a random pattern. Time shifts in the control variables caused the most degradation, and the lateral-directional rotary derivatives were affected the most by time shifts in any variable.

The impact of the ocean observing system on estimates of the California current circulation spanning three decades

NASA Astrophysics Data System (ADS)

Moore, Andrew M.; Jacox, Michael G.; Crawford, William J.; Laughlin, Bruce; Edwards, Christopher A.; Fiechter, Jérôme

2017-08-01

Data assimilation is now used routinely in oceanography on both regional and global scales for computing ocean circulation estimates and for making ocean forecasts. Regional ocean observing systems are also expanding rapidly, and observations from a wide array of different platforms and sensor types are now available. Evaluation of the impact of the observing system on ocean circulation estimates (and forecasts) is therefore of considerable interest to the oceanographic community. In this paper, we quantify the impact of different observing platforms on estimates of the California Current System (CCS) spanning a three decade period (1980-2010). Specifically, we focus attention on several dynamically related aspects of the circulation (coastal upwelling, the transport of the California Current and the California Undercurrent, thermocline depth and eddy kinetic energy) which in many ways describe defining characteristics of the CCS. The circulation estimates were computed using a 4-dimensional variational (4D-Var) data assimilation system, and our analyses also focus on the impact of the different elements of the control vector (i.e. the initial conditions, surface forcing, and open boundary conditions) on the circulation. While the influence of each component of the control vector varies between different metrics of the circulation, the impact of each observing system across metrics is very robust. In addition, the mean amplitude of the circulation increments (i.e. the difference between the analysis and background) remains relatively stable throughout the three decade period despite the addition of new observing platforms whose impact is redistributed according to the relative uncertainty of observations from each platform. We also consider the impact of each observing platform on CCS circulation variability associated with low-frequency climate variability. The low-frequency nature of the dominant climate modes in this region allows us to track through time the impact of each observation on the circulation, and illustrates how observations from some platforms can influence the circulation up to a decade into the future.

[Urban air pollution and children respiratory hospital admissions in Pisa (Italy): a time series and a case-crossover approach].

PubMed

Vigotti, Maria Angela; Serinelli, Maria; Marchini, Laura

2010-01-01

we evaluated the association of daily pollutants' concentrations with daily hospital admissions for respiratory causes in children residents in Pisa during 1998-2002. We compared the results obtained with two methods of statistical analyses. A total of 657 children under ten years and admitted to local hospitals for respiratory diseases (ICD 9: 460-469, 480- 519) were included in the study. both time-series and case-crossover analysis were applied, controlling for temperature, holidays, influenza epidemics,rain and relative humidity. Pollutants' effects are expressed as percentage increase (and 95% CI) of hospital admissions for an increase of 10 μg/m³ of pollutants (1 mg/m³ for CO). with both analyses, children's hospital admissions for respiratory conditions were significantly associated to increasing daily levels of PM10 and CO at different time lags, while no association was found for NO₂ and O₃. In the case-crossover analysis, for a daily increase of 10 μg/m³ in PM10, a significant increment of 8.5% (CI 95% 0.02; 17.6) in children respiratory admissions was observed at lag 0-3. Results were stronger for males and during the warm season. A 1 mg/m³ increment in daily CO levels was associated with an increase of respiratory admissions at lag 0 (20.2%, CI 95% 5.3; 37.2) and at all cumulative lags: the maximum value was observed at lag 0-3 (32.6%, CI 95%8.3; 62.2). Time series analyses provides similar results, although the estimates were lower than with the other method, in terms of percentage increment and length of confidence intervals. this study indicates adverse effects of air pollution on respiratory health of children living in urban environment. The results of both analyses were consistent.

Cost-effectiveness of endovascular versus open repair of acute complicated type B aortic dissections.

PubMed

Luebke, Thomas; Brunkwall, Jan

2014-05-01

This study weighed the cost and benefit of thoracic endovascular aortic repair (TEVAR) vs open repair (OR) in the treatment of an acute complicated type B aortic dissection by (TBAD) estimating the cost-effectiveness to determine an optimal treatment strategy based on the best currently available evidence. A cost-utility analysis from the perspective of the health system payer was performed using a decision analytic model. Within this model, the 1-year survival, quality-adjusted life-years (QALYs), and costs for a hypothetical cohort of patients with an acute complicated TBAD managed with TEVAR or OR were evaluated. Clinical effectiveness data, cost data, and transitional probabilities of different health states were derived from previously published high-quality studies or meta-analyses. Probabilistic sensitivity analyses were performed on uncertain model parameters. The base-case analysis showed, in terms of QALYs, that OR appeared to be more expensive (incremental cost of €17,252.60) and less effective (-0.19 QALYs) compared with TEVAR; hence, in terms of the incremental cost-effectiveness ratio, OR was dominated by TEVAR. As a result, the incremental cost-effectiveness ratio (ie, the cost per life-year saved) was not calculated. The average cost-effectiveness ratio of TEVAR and OR per QALY gained was €56,316.79 and €108,421.91, respectively. In probabilistic sensitivity analyses, TEVAR was economically dominant in 100% of cases. The probability that TEVAR was economically attractive at a willingness-to-pay threshold of €50,000/QALY gained was 100%. The present results suggest that TEVAR yielded more QALYs and was associated with lower 1-year costs compared with OR in patients with an acute complicated TBAD. As a result, from the cost-effectiveness point of view, TEVAR is the dominant therapy over OR for this disease under the predefined conditions. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help

PubMed Central

Majo, M. Cristina; Smit, Filip; van Straten, Annemieke; Kerkhof, Ad J.F.M

2012-01-01

Background Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants’ out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009. Results At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 − 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were −€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be −€5039/0.15 = −€34,727 after rounding (US −$41,325) for an additional treatment response, indicating annual cost savings per treatment responder. Conclusions This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended. PMID:23103835

Molecular dynamics simulations of highly crowded amino acid solutions: comparisons of eight different force field combinations with experiment and with each other

PubMed Central

Andrews, Casey T.

2013-01-01

Although it is now commonly accepted that the highly crowded conditions encountered inside biological cells have the potential to significantly alter the thermodynamic properties of biomolecules, it is not known to what extent the thermodynamics of fundamental types of interactions such as salt bridges and hydrophobic interactions are strengthened or weakened by high biomolecular concentrations. As one way of addressing this question we have performed a series of all-atom explicit solvent molecular dynamics (MD) simulations to investigate the effect of increasing solute concentration on the behavior of four types of zwitterionic amino acids in aqueous solution. We have simulated systems containing glycine, valine, phenylalanine or asparagine at concentrations of 50, 100, 200 and 300 mg/ml. Each molecular system has been simulated for 1 μs in order to obtain statistically converged estimates of thermodynamic parameters, and each has been conducted with 8 different force fields and water models; the combined simulation time is 128 μs. The density, viscosity, and dielectric increments of the four amino acids calculated from the simulations have been compared to corresponding experimental measurements. While all of the force fields perform well at reproducing the density increments, discrepancies for the viscosity and dielectric increments raise questions both about the accuracy of the simulation force fields and, in certain cases, the experimental data. We also observe large differences between the various force fields' descriptions of the interaction thermodynamics of salt bridges and, surprisingly, these differences also lead to qualitatively different predictions of their dependences on solute concentration. For the aliphatic interactions of valine sidechains, fewer differences are observed between the force fields, but significant differences are again observed for aromatic interactions of phenylalanine sidechains. Taken together, the results highlight the potential power of using explicit-solvent simulation methods to understand behavior in concentrated systems but also hint at potential difficulties in using these methods to obtain consistent views of behavior in intracellular environments. PMID:24409104

Evaluating MODIS satellite versus terrestrial data driven productivity estimates in Austria

NASA Astrophysics Data System (ADS)

Petritsch, R.; Boisvenue, C.; Pietsch, S. A.; Hasenauer, H.; Running, S. W.

2009-04-01

Sensors, such as the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite, are developed for monitoring global and/or regional ecosystem fluxes like net primary production (NPP). Although these systems should allow us to assess carbon sequestration issues, forest management impacts, etc., relatively little is known about the consistency and accuracy in the resulting satellite driven estimates versus production estimates driven from ground data. In this study we compare the following NPP estimation methods: (i) NPP estimates as derived from MODIS and available on the internet; (ii) estimates resulting from the off-line version of the MODIS algorithm; (iii) estimates using regional meteorological data within the offline algorithm; (iv) NPP estimates from a species specific biogeochemical ecosystem model adopted for Alpine conditions; and (v) NPP estimates calculated from individual tree measurements. Single tree measurements were available from 624 forested sites across Austria but only the data from 165 sample plots included all the necessary information for performing the comparison on plot level. To ensure independence of satellite-driven and ground-based predictions, only latitude and longitude for each site were used to obtain MODIS estimates. Along with the comparison of the different methods, we discuss problems like the differing dates of field campaigns (<1999) and acquisition of satellite images (2000-2005) or incompatible productivity definitions within the methods and come up with a framework for combining terrestrial and satellite data based productivity estimates. On average MODIS estimates agreed well with the output of the models self-initialization (spin-up) and biomass increment calculated from tree measurements is not significantly different from model results; however, correlation between satellite-derived versus terrestrial estimates are relatively poor. Considering the different scales as they are 9km² from MODIS and 1000m² from the sample plots together with the heterogeneous landscape may qualify the low correlation, particularly as the correlation increases when strongly fragmented sites are left out.

Accuracy and equivalence testing of crown ratio models and assessment of their impact on diameter growth and basal area increment predictions of two variants of the Forest Vegetation Simulator

Treesearch

Laura P. Leites; Andrew P. Robinson; Nicholas L. Crookston

2009-01-01

Diameter growth (DG) equations in many existing forest growth and yield models use tree crown ratio (CR) as a predictor variable. Where CR is not measured, it is estimated from other measured variables. We evaluated CR estimation accuracy for the models in two Forest Vegetation Simulator variants: the exponential and the logistic CR models used in the North...

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

PubMed Central

Akazawa, Manabu; Stearns, Sally C; Biddle, Andrea K

2008-01-01

Objective To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources Claims between 1997 and 2005 from a large managed care database. Study Design Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods COPD patients aged 40 or older with ≥15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients ≥50 years old, ICS was cost saving 57 percent of time. Conclusions ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates. PMID:18671750

Concentrations, loads, and yields of total phosphorus, total nitrogen, and suspended sediment and bacteria concentrations in the Wister Lake Basin, Oklahoma and Arkansas, 2011-13

USGS Publications Warehouse

Buck, Stephanie D.

2014-01-01

The Poteau Valley Improvement Authority uses Wister Lake in southeastern Oklahoma as a public water supply. Total phosphorus, total nitrogen, and suspended sediments from agricultural runoff and discharges from wastewater treatment plants and other sources have degraded water quality in the lake. As lake-water quality has degraded, water-treatment cost, chemical usage, and sludge production have increased for the Poteau Valley Improvement Authority. The U.S. Geological Survey (USGS), in cooperation with the Poteau Valley Improvement Authority, investigated and summarized concentrations of total phosphorus, total nitrogen, suspended sediment, and bacteria (Escherichia coli and Enterococcus sp.) in surface water flowing to Wister Lake. Estimates of total phosphorus, total nitrogen, and suspended sediment loads, yields, and flow-weighted mean concentrations of total phosphorus and total nitrogen concentrations were made for the Wister Lake Basin for a 3-year period from October 2010 through September 2013. Data from water samples collected at fixed time increments during base-flow conditions and during runoff conditions at the Poteau River at Loving, Okla. (USGS station 07247015), the Poteau River near Heavener, Okla. (USGS station 07247350), and the Fourche Maline near Leflore, Okla. (USGS station 07247650), water-quality stations were used to evaluate water quality over the range of streamflows in the basin. These data also were collected to estimate annual constituent loads and yields by using regression models. At the Poteau River stations, total phosphorus, total nitrogen, and suspended sediment concentrations in surface-water samples were significantly larger in samples collected during runoff conditions than in samples collected during base-flow conditions. At the Fourche Maline station, in contrast, concentrations of these constituents in water samples collected during runoff conditions were not significantly larger than concentrations during base-flow conditions. Flow-weighted mean total phosphorus concentrations at all three stations from 2011 to 2013 were several times larger than the Oklahoma State Standard for Scenic Rivers (0.037 milligrams per liter [mg/L]), with the largest flow-weighted phosphorus concentrations typically being measured at the Poteau River at Loving, Okla., station. Flow-weighted mean total nitrogen concentrations did not vary substantially between the Poteau River stations and the Fourche Maline near Leflore, Okla., station. At all of the sampled water-quality stations, bacteria (Escherichia coli and Enterococcus sp.) concentrations were substantially larger in water samples collected during runoff conditions than in water samples collected during base-flow conditions from 2011 to 2013. Estimated annual loads of total phosphorus, total nitrogen, and suspended sediment in the Poteau River stations during runoff conditions ranged from 82 to 98 percent of the total annual loads of those constituents. Estimated annual loads of total phosphorus, total nitrogen, and suspended sediment in the Fourche Maline during runoff conditions ranged from 86 to nearly 100 percent of the total annual loads. Estimated seasonal total phosphorus loads generally were smallest during base-flow and runoff conditions in autumn. Estimated seasonal total phosphorus loads during base-flow conditions tended to be largest in winter and during runoff conditions tended to be largest in the spring. Estimated seasonal total nitrogen loads tended to be smallest in autumn during base-flow and runoff conditions and largest in winter during runoff conditions. Estimated seasonal suspended sediment loads tended to be smallest during base-flow conditions in the summer and smallest during runoff conditions in the autumn. The largest estimated seasonal suspended sediment loads during runoff conditions typically were in the spring. The estimated mean annual total phosphorus yield was largest at the Poteau River at Loving, Okla., water-quality station. The estimated mean annual total phosphorus yield was largest during base flow at the Poteau River at Loving, Okla., water-quality station and at both of the Poteau River water-quality stations during runoff conditions. The estimated mean annual total nitrogen yields were largest at the Poteau River water-quality stations. Estimated mean annual total nitrogen yields were largest during base-flow and runoff conditions at the Poteau River at Loving, Okla., water-quality station. The estimated mean annual suspended sediment yield was largest at the Poteau River near Heavener, Okla., water-quality station during base-flow and runoff conditions. Flow-weighted mean concentrations indicated that total phosphorus inputs from the Poteau River Basin in the Wister Lake Basin were larger than from the Fourche Maline Basin. Flow-weighted mean concentrations of total nitrogen did not vary spatially in a consistent manner. The Poteau River and the Fourche Maline contributed estimated annual total phosphorus loads of 137 to 278 tons per year (tons/yr) to Wister Lake. Between 89 and 95 percent of the annual total phosphorus loads were transported to Wister Lake during runoff conditions. The Poteau River and the Fourche Maline contributed estimated annual total nitrogen loads of 657 to 1,294 tons/yr, with 86 to 94 percent of the annual total nitrogen loads being transported to Wister Lake during runoff conditions. The Poteau River and the Fourche Maline contributed estimated annual total suspended sediment loads of 110,919 to 234,637 tons/yr, with 94 to 99 percent of the annual suspended sediment loads being transported to Wister Lake during runoff conditions. Most of the total phosphorus and suspended sediment were delivered to Wister Lake during runoff conditions in the spring. The majority of the total nitrogen was delivered to Wister Lake during runoff conditions in winter.

Water productivity, yield, and berry composition in sustained versus regulated deficit irrigation of Merlot grapevines

USDA-ARS?s Scientific Manuscript database

The wine grape cultivar Merlot (Vitis vinifera L.) was irrigated at incremental fractions of estimated crop evapotranspiration or a regulated deficit (RDI) regime to identify which practice best optimized water productivity and berry composition without compromising yield. Three severities of susta...

Renewable Electricity Futures Study | Energy Analysis | NREL

Science.gov Websites

reductions in electric sector greenhouse gas emissions and water use. The direct incremental cost associated with high renewable generation is comparable to published cost estimates of other clean energy scenarios. Improvement in the cost and performance of renewable technologies is the most impactful lever for

Decadal changes in potassium, calcium, and magnesium in a deciduous forest soil.

Treesearch

D.W. Johnson; D.E. Todd; Carl C. Trettin; P.J. Mulholland

2009-01-01

Decadal changes in soil exchangeable K+, Ca2+, and Mg2+ concentrations and contents from 1972 to 2004 in eight intensively monitored plots on Walker Branch Watershed were compared with estimates of increments or decrements in vegetation and detritus. The results from these eight plots...

Constraining the Carbon Cycle through Tree Rings: A Case Study of the Valles Caldera, NM

NASA Astrophysics Data System (ADS)

Alexander, M. R.; Babst, F.; Moore, D. J.; Trouet, V.

2013-12-01

Terrestrial ecosystems take up approximately 120 Gt of carbon as Gross Primary Productivity (GPP) from the atmosphere annually, but it is challenging to track the allocation of that carbon throughout the biosphere. Here, we combine eddy covariance measurements of net carbon uptake with above ground biomass increments derived from tree-ring data to better understand the interannual variability associated with biomass accumulation. In the summer of 2012, we collected tree cores near two eddy covariance towers in the Jemez Mountains of northern New Mexico. One tower was located in an upper elevation mixed-conifer forest, and the other in a lower elevation Pinus ponderosa forest. Our analysis shows that the annual above ground biomass increment accounted for approximately 40% of the GPP at the lower elevation Pinus ponderosa site and approximately 70% of GPP at the upper elevation mixed-conifer site. We have also used the above ground biomass increment to constrain the Simple Photosynthesis EvapoTranspiration (SiPNET) model to gain a better understanding of allocation within the forest. Tree growth at both elevations was negatively influenced by spring (March-June) temperature and positively by cool season (October-April) precipitation and warm (May-September) and cool season PDSI. We also analyzed the six most extreme temperature and moisture (PDSI) years of the record to determine the response of productivity to climatic forcing. During the driest years, biomass production was reduced by 40% at the upper elevation site and 43% at the lower elevation site. During the hottest years of the record the biomass decreased 28% at the upper site and 45% at the lower site. Our results indicate that tree rings can be used to effectively constrain the above ground biomass component of a forest's carbon budget and to estimate allocation of carbon to woody biomass as a function of climate. However, many variables remain unknown. The combined results of the extreme year analyses and the derived biomass increments illustrate that the forests at the Valles Caldera are considerably less productive during years of extreme drought and warmer than average temperatures. With future projections calling for consecutive years of extreme conditions in the American Southwest, this could have a substantial effect on the overall productivity of these forests.

Applying and Individual-Based Model to Simultaneously Evaluate Net Ecosystem Production and Tree Diameter Increment

NASA Astrophysics Data System (ADS)

Fang, F. J.

2017-12-01

Reconciling observations at fundamentally different scales is central in understanding the global carbon cycle. This study investigates a model-based melding of forest inventory data, remote-sensing data and micrometeorological-station data ("flux towers" estimating forest heat, CO2 and H2O fluxes). The individual tree-based model FORCCHN was used to evaluate the tree DBH increment and forest carbon fluxes. These are the first simultaneous simulations of the forest carbon budgets from flux towers and individual-tree growth estimates of forest carbon budgets using the continuous forest inventory data — under circumstances in which both predictions can be tested. Along with the global implications of such findings, this also improves the capacity for forest sustainable management and the comprehensive understanding of forest ecosystems. In forest ecology, diameter at breast height (DBH) of a tree significantly determines an individual tree's cross-sectional sapwood area, its biomass and carbon storage. Evaluation the annual DBH increment (ΔDBH) of an individual tree is central to understanding tree growth and forest ecology. Ecosystem Carbon flux is a consequence of key ecosystem processes in the forest-ecosystem carbon cycle, Gross and Net Primary Production (GPP and NPP, respectively) and Net Ecosystem Respiration (NEP). All of these closely relate with tree DBH changes and tree death. Despite advances in evaluating forest carbon fluxes with flux towers and forest inventories for individual tree ΔDBH, few current ecological models can simultaneously quantify and predict the tree ΔDBH and forest carbon flux.

[Cost-effectiveness analysis of adjuvant anastrozol in post-menopausal women with breast cancer].

PubMed

Sasse, Andre Deeke; Sasse, Emma Chen

2009-01-01

Carry out an economic analysis of the incorporation of anastrozole as adjuvant hormone therapy in postmenopausal women with breast cancer in a Brazilian setting. The cost-effectiveness estimate comparing anastrozole to tamoxifen was made from the perspectives of the patient, private health insurance, and government. A Markov model was designed based on data from ATAC trial after 100 months follow-up in a hypothetical cohort of 1000 postmenopausal women in Brazil, using outcomes projections for a 25-year period. Resource utilization and associated costs were obtained from preselected sources and specialists' opinions. Treatment costs varied according to the perspective used. The incremental benefit was inserted in the model to obtain the cost of quality-adjusted life-year gained (QALY). Benefit extrapolations for a 25-year time line showed an estimate of 0.29 QALY gained with anastrozole compared to tamoxifen. The cost-effectiveness ratio per QALY gained depended on which perspective was used. There was an increment of R$ 32.403,00/QALY in the public health system/government, R$ 32.230,00/QALY for private health system, and R$ 55.270,00/QALY for patients. The benefit from adjuvant anastrozole in postmenopausal patients with breast cancer is associated to major differences in cost-effectiveness ratio and varies with the different perspectives. According to current WHO parameters, the increment is considered acceptable under public and private health system perspectives, but not from that of the patient.

Cost-effectiveness of obinutuzumab for chronic lymphocytic leukaemia in The Netherlands.

PubMed

Blommestein, Hedwig M; de Groot, Saskia; Aarts, Mieke J; Vemer, Pepijn; de Vries, Robin; van Abeelen, Annet F M; Posthuma, E F M Ward; Uyl-de Groot, Carin A

2016-11-01

Obinutuzumab combined with chlorambucil (GClb) has shown to be superior to rituximab combined with chlorambucil (RClb) and chlorambucil (Clb) in newly diagnosed patients with chronic lymphocytic leukaemia (CLL). This study evaluates the cost-effectiveness per life-year and quality-adjusted life-year (QALY) of GClb compared to RClb, Clb, and ofatumumab plus chlorambucil (OClb) in The Netherlands. A Markov model was developed to assess the cost-effectiveness of GClb, RClb, Clb and other treatments in the United Kingdom. A country adaptation was made to estimate the cost-effectiveness of these therapies in The Netherlands using Dutch unit costs and Dutch data sources for background mortality and post-progression survival. An incremental gain of 1.06 and 0.64 QALYs was estimated for GClb compared to Clb and RClb respectively, at additional costs of €23,208 and €7254 per patient. Corresponding incremental cost-effectiveness ratios (ICERs) were €21,823 and €11,344 per QALY. Indirect treatment comparisons showed an incremental gain varying from 0.44 to 0.77 QALYs for GClb compared to OClb and additional costs varying from €7041 to €5028 per patient. The ICER varied from €6556 to €16,180 per QALY. Sensitivity analyses showed the robustness of the results. GClb appeared to be a cost-effective treatment strategy compared to RClb, OClb and Clb. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation

PubMed Central

Barnieh, Lianne; Gill, John S.; Klarenbach, Scott

2013-01-01

Summary Background and objectives For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. Design, setting, participants, & measurements Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. Results Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. Conclusion Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors. PMID:24158797

The option value of delay in health technology assessment.

PubMed

Eckermann, Simon; Willan, Andrew R

2008-01-01

Processes of health technology assessment (HTA) inform decisions under uncertainty about whether to invest in new technologies based on evidence of incremental effects, incremental cost, and incremental net benefit monetary (INMB). An option value to delaying such decisions to wait for further evidence is suggested in the usual case of interest, in which the prior distribution of INMB is positive but uncertain. of estimating the option value of delaying decisions to invest have previously been developed when investments are irreversible with an uncertain payoff over time and information is assumed fixed. However, in HTA decision uncertainty relates to information (evidence) on the distribution of INMB. This article demonstrates that the option value of delaying decisions to allow collection of further evidence can be estimated as the expected value of sample of information (EVSI). For irreversible decisions, delay and trial (DT) is demonstrated to be preferred to adopt and no trial (AN) when the EVSI exceeds expected costs of information, including expected opportunity costs of not treating patients with the new therapy. For reversible decisions, adopt and trial (AT) becomes a potentially optimal strategy, but costs of reversal are shown to reduce the EVSI of this strategy due to both a lower probability of reversal being optimal and lower payoffs when reversal is optimal. Hence, decision makers are generally shown to face joint research and reimbursement decisions (AN, DT and AT), with the optimal choice dependent on costs of reversal as well as opportunity costs of delay and the distribution of prior INMB.

78 FR 29157 - Certain Digital Models, Digital Data, and Treatment Plans for Use, in Making Incremental Dental...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-17

... INTERNATIONAL TRADE COMMISSION Certain Digital Models, Digital Data, and Treatment Plans for Use... conditions in the United States economy, the production of like or directly competitive articles in the..., competitive conditions in the United States economy, the production of like or directly competitive articles...

An Effectiveness Trial of Contingency Management in a Felony Preadjudication Drug Court

ERIC Educational Resources Information Center

Marlowe, Douglas B.; Festinger, David S.; Dugosh, Karen L.; Arabia, Patricia L.; Kirby, Kimberly C.

2008-01-01

This study evaluated a contingency management (CM) program in a drug court. Gift certificates for compliance were delivered at 4- to 6-week intervals (total value = $390.00). Participants in one condition earned gift certificates that escalated by $5.00 increments. Participants in a second condition began earning higher magnitude gift…

Relations Between Rainfall and Postfire Debris-Flow and Flood Magnitudes for Emergency-Response Planning, San Gabriel Mountains, Southern California

USGS Publications Warehouse

Cannon, Susan H.; Boldt, Eric M.; Kean, Jason W.; Laber, Jayme; Staley, Dennis M.

2010-01-01

Following wildfires, emergency-response and public-safety agencies are faced often with making evacuation decisions and deploying resources both well in advance of each coming winter storm and during storms themselves. Information critical to this process is provided for recently burned areas in the San Gabriel Mountains of southern California. The National Weather Service (NWS) issues Quantitative Precipitation Forecasts (QPFs) for the San Gabriel Mountains twice a day, at approximately 4 a.m. and 4 p.m., along with unscheduled updates when conditions change. QPFs provide estimates of rainfall totals in 3-hour increments for the first 12-hour period and in 6-hour increments for the second 12-hour period. Estimates of one-hour rainfall intensities can be provided in the forecast narrative, along with probable peak intensities and timing, although with less confidence than rainfall totals. A compilation of information on the hydrologic response to winter storms from recently burned areas in southern California steeplands was used to develop a system for classifying the magnitude of the postfire hydrologic response. The four-class system is based on a combination of the reported volume of individual debris flows, the consequences of these events in an urban setting, and the spatial extent of the response to the triggering storm. Threshold rainfall conditions associated with debris flow and floods of different magnitude classes are defined by integrating local rainfall data with debris-flow and flood magnitude information. The within-storm rainfall accumulations (A) and durations (D) above which magnitude I events are expected are defined by A=0.3D0.6. The function A=0.5D0.6 defines the within-storm rainfall accumulations and durations above which a magnitude III event will occur in response to a regional-scale storm, and a magnitude II event will occur if the storm affects only a few drainage basins. The function A=1.0D0.5defines the rainfall conditions above which magnitude III events can be expected. Rainfall trigger-magnitude relations are linked with potential emergency-response actions in the form of an emergency-response decision chart. The chart leads a user through steps to determine potential event magnitudes, and identify possible evacuation and resource-deployment levels as a function of either individual storm forecasts or measured precipitation during storms. The ability to use this information in the planning and response decision-making process may result in significant financial savings and increased safety for both the public and emergency responders.

Increases in intramuscular pressure raise arterial blood pressure during dynamic exercise

NASA Technical Reports Server (NTRS)

Gallagher, K. M.; Fadel, P. J.; Smith, S. A.; Norton, K. H.; Querry, R. G.; Olivencia-Yurvati, A.; Raven, P. B.

2001-01-01

This investigation was designed to determine the role of intramuscular pressure-sensitive mechanoreceptors and chemically sensitive metaboreceptors in affecting the blood pressure response to dynamic exercise in humans. Sixteen subjects performed incremental (20 W/min) cycle exercise to fatigue under four conditions: control, exercise with thigh cuff occlusion of 90 Torr (Cuff occlusion), exercise with lower body positive pressure (LBPP) of 45 Torr, and a combination of thigh cuff occlusion and LBPP (combination). Indexes of central command (heart rate, oxygen uptake, ratings of perceived exertion, and electromyographic activity), cardiac output, stroke volume, and total peripheral resistance were not significantly different between the four conditions. Mechanical stimulation during LBPP and combination conditions resulted in significant elevations in intramuscular pressure and mean arterial pressure from control at rest and throughout the incremental exercise protocol (P < 0.05). Conversely, there existed no significant changes in mean arterial pressure when the metaboreflex was stimulated by cuff occlusion. These findings suggest that under normal conditions the mechanoreflex is tonically active and is the primary mediator of exercise pressor reflex-induced alterations in arterial blood pressure during submaximal dynamic exercise in humans.

A simplified method for elastic-plastic-creep structural analysis

NASA Technical Reports Server (NTRS)

Kaufman, A.

1984-01-01

A simplified inelastic analysis computer program (ANSYPM) was developed for predicting the stress-strain history at the critical location of a thermomechanically cycled structure from an elastic solution. The program uses an iterative and incremental procedure to estimate the plastic strains from the material stress-strain properties and a plasticity hardening model. Creep effects are calculated on the basis of stress relaxation at constant strain, creep at constant stress or a combination of stress relaxation and creep accumulation. The simplified method was exercised on a number of problems involving uniaxial and multiaxial loading, isothermal and nonisothermal conditions, dwell times at various points in the cycles, different materials and kinematic hardening. Good agreement was found between these analytical results and nonlinear finite element solutions for these problems. The simplified analysis program used less than 1 percent of the CPU time required for a nonlinear finite element analysis.

A simplified method for elastic-plastic-creep structural analysis

NASA Technical Reports Server (NTRS)

Kaufman, A.

1985-01-01

A simplified inelastic analysis computer program (ANSYPM) was developed for predicting the stress-strain history at the critical location of a thermomechanically cycled structure from an elastic solution. The program uses an iterative and incremental procedure to estimate the plastic strains from the material stress-strain properties and a plasticity hardening model. Creep effects are calculated on the basis of stress relaxation at constant strain, creep at constant stress or a combination of stress relaxation and creep accumulation. The simplified method was exercised on a number of problems involving uniaxial and multiaxial loading, isothermal and nonisothermal conditions, dwell times at various points in the cycles, different materials and kinematic hardening. Good agreement was found between these analytical results and nonlinear finite element solutions for these problems. The simplified analysis program used less than 1 percent of the CPU time required for a nonlinear finite element analysis.

Effects of shoe cleat position on physiology and performance of competitive cyclists.

PubMed

Paton, Carl D

2009-12-01

Aerobic economy is an important factor that affects the performance of competitive cyclists. It has been suggested that placing the foot more anteriorly on the bicycle pedals may improve economy over the traditional foot position by improving pedaling efficiency. The current study examines the effects of changing the anterior-posterior pedal foot position on the physiology and performance of well-trained cyclists. In a crossover study, 10 competitive cyclists completed two maximal incremental and two submaximal tests in either their preferred (control) or a forward (arch) foot position. Maximum oxygen consumption and peak power output were determined from the incremental tests for both foot positions. On two further occasions, cyclists also completed a two-part 60-min submaximal test that required them to maintain a constant power output (equivalent to 60% of their incremental peak power) for 30 min, during which respiratory and blood lactate samples were taken at predetermined intervals. Thereafter, subjects completed a 30-min self-paced maximal effort time trial. Relative to the control, the mean changes (+/-90% confidence limits) in the arch condition were as follows: maximum oxygen consumption, -0.5% (+/-2.0%); incremental peak power output, -0.8% (+/-1.3%); steady-state oxygen consumption at 60%, -2.4% (+/-1.1%); steady-state heart rate 60%, 0.4% (+/-1.7%); lactate concentration 60%, 8.7% (+/-14.4%); and mean time trial power, -1.5% (+/-2.9%). We conclude that there was no substantial physiological or performance advantage in this group using an arch-cleat shoe position in comparison with a cyclist's normal preferred condition.

Economic evaluation of the artificial liver support system MARS in patients with acute-on-chronic liver failure

PubMed Central

Hessel, Franz P

2006-01-01

Background Acute-on-chronic liver failure (ACLF) is a life threatening acute decompensation of a pre-existing chronic liver disease. The artificial liver support system MARS is a new emerging therapeutic option possible to be implemented in routine care of these patients. The medical efficacy of MARS has been demonstrated in first clinical studies, but economic aspects have so far not been investigated. Objective of this study was to estimate the cost-effectiveness of MARS. Methods In a clinical cohort trial with a prospective follow-up of 3 years 33 ACLF-patients treated with MARS were compared to 46 controls. Survival, health-related quality of life as well as direct medical costs for in- and outpatient treatment from a health care system perspective were determined. Based on the differences in outcome and indirect costs the cost-effectiveness of MARS expressed as incremental costs per life year gained and incremental costs per QALY gained was estimated. Results The average initial intervention costs for MARS were 14600 EUR per patient treated. Direct medical costs over 3 years follow up were overall 40000 EUR per patient treated with MARS respectively 12700 EUR in controls. The 3 year survival rate after MARS was 52% compared to 17% in controls. Kaplan-Meier analysis of cumulated survival probability showed a highly significant difference in favour of MARS. Incremental costs per life-year gained were 31400 EUR; incremental costs per QALY gained were 47200 EUR. Conclusion The results after 3 years follow-up of the first economic evaluation study of MARS based on empirical patient data are presented. Although high initial treatment costs for MARS occur the significantly better survival seen in this study led to reasonable costs per live year gained. Further randomized controlled trials investigating the medical efficacy and the cost-effectiveness are recommended. PMID:17022815

Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden.

PubMed

Borg, Sixten; Nahi, Hareth; Hansson, Markus; Lee, Dawn; Elvidge, Jamie; Persson, Ulf

2016-05-01

Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. We developed a health-economic discrete event simulation model of a patient's course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.

Incremental cost effectiveness evaluation in clinical research.

PubMed

Krummenauer, Frank; Landwehr, I

2005-01-28

The health economic evaluation of therapeutic and diagnostic strategies is of increasing importance in clinical research. Therefore also clinical trialists have to involve health economic aspects more frequently. However, whereas they are quite familiar with classical effect measures in clinical trials, the corresponding parameters in health economic evaluation of therapeutic and diagnostic procedures are still not this common. The concepts of incremental cost effectiveness ratios (ICERs) and incremental net health benefit (INHB) will be illustrated and contrasted along the cost effectiveness evaluation of cataract surgery with monofocal and multifocal intraocular lenses. ICERs relate the costs of a treatment to its clinical benefit in terms of a ratio expression (indexed as Euro per clinical benefit unit). Therefore ICERs can be directly compared to a pre-specified willingness to pay (WTP) benchmark, which represents the maximum costs, health insurers would invest to achieve one clinical benefit unit. INHBs estimate a treatment's net clinical benefit after accounting for its cost increase versus an established therapeutic standard. Resource allocation rules can be formulated by means of both effect measures. Both the ICER and the INHB approach enable the definition of directional resource allocation rules. The allocation decisions arising from these rules are identical, as long as the willingness to pay benchmark is fixed in advance. Therefore both strategies crucially call for a priori determination of both the underlying clinical benefit endpoint (such as gain in vision lines after cataract surgery or gain in quality-adjusted life years) and the corresponding willingness to pay benchmark. The use of incremental cost effectiveness and net health benefit estimates provides a rationale for health economic allocation discussions and founding decisions. It implies the same requirements on trial protocols as yet established for clinical trials, that is the a priori definition of primary hypotheses (formulated as an allocation rule involving a pre-specified willingness to pay benchmark) and the primary clinical benefit endpoint (as a rationale for effectiveness evaluation).

Sensitivity to gaze-contingent contrast increments in naturalistic movies: An exploratory report and model comparison

PubMed Central

Wallis, Thomas S. A.; Dorr, Michael; Bex, Peter J.

2015-01-01

Sensitivity to luminance contrast is a prerequisite for all but the simplest visual systems. To examine contrast increment detection performance in a way that approximates the natural environmental input of the human visual system, we presented contrast increments gaze-contingently within naturalistic video freely viewed by observers. A band-limited contrast increment was applied to a local region of the video relative to the observer's current gaze point, and the observer made a forced-choice response to the location of the target (≈25,000 trials across five observers). We present exploratory analyses showing that performance improved as a function of the magnitude of the increment and depended on the direction of eye movements relative to the target location, the timing of eye movements relative to target presentation, and the spatiotemporal image structure at the target location. Contrast discrimination performance can be modeled by assuming that the underlying contrast response is an accelerating nonlinearity (arising from a nonlinear transducer or gain control). We implemented one such model and examined the posterior over model parameters, estimated using Markov-chain Monte Carlo methods. The parameters were poorly constrained by our data; parameters constrained using strong priors taken from previous research showed poor cross-validated prediction performance. Atheoretical logistic regression models were better constrained and provided similar prediction performance to the nonlinear transducer model. Finally, we explored the properties of an extended logistic regression that incorporates both eye movement and image content features. Models of contrast transduction may be better constrained by incorporating data from both artificial and natural contrast perception settings. PMID:26057546

Multidirectional In Vivo Characterization of Skin Using Wiener Nonlinear Stochastic System Identification Techniques.

PubMed

Parker, Matthew D; Jones, Lynette A; Hunter, Ian W; Taberner, A J; Nash, M P; Nielsen, P M F

2017-01-01

A triaxial force-sensitive microrobot was developed to dynamically perturb skin in multiple deformation modes, in vivo. Wiener static nonlinear identification was used to extract the linear dynamics and static nonlinearity of the force-displacement behavior of skin. Stochastic input forces were applied to the volar forearm and thenar eminence of the hand, producing probe tip perturbations in indentation and tangential extension. Wiener static nonlinear approaches reproduced the resulting displacements with variances accounted for (VAF) ranging 94-97%, indicating a good fit to the data. These approaches provided VAF improvements of 0.1-3.4% over linear models. Thenar eminence stiffness measures were approximately twice those measured on the forearm. Damping was shown to be significantly higher on the palm, whereas the perturbed mass typically was lower. Coefficients of variation (CVs) for nonlinear parameters were assessed within and across individuals. Individual CVs ranged from 2% to 11% for indentation and from 2% to 19% for extension. Stochastic perturbations with incrementally increasing mean amplitudes were applied to the same test areas. Differences between full-scale and incremental reduced-scale perturbations were investigated. Different incremental preloading schemes were investigated. However, no significant difference in parameters was found between different incremental preloading schemes. Incremental schemes provided depth-dependent estimates of stiffness and damping, ranging from 300 N/m and 2 Ns/m, respectively, at the surface to 5 kN/m and 50 Ns/m at greater depths. The device and techniques used in this research have potential applications in areas, such as evaluating skincare products, assessing skin hydration, or analyzing wound healing.

Optimization of the p-xylene oxidation process by a multi-objective differential evolution algorithm with adaptive parameters co-derived with the population-based incremental learning algorithm

NASA Astrophysics Data System (ADS)

Guo, Zhan; Yan, Xuefeng

2018-04-01

Different operating conditions of p-xylene oxidation have different influences on the product, purified terephthalic acid. It is necessary to obtain the optimal combination of reaction conditions to ensure the quality of the products, cut down on consumption and increase revenues. A multi-objective differential evolution (MODE) algorithm co-evolved with the population-based incremental learning (PBIL) algorithm, called PBMODE, is proposed. The PBMODE algorithm was designed as a co-evolutionary system. Each individual has its own parameter individual, which is co-evolved by PBIL. PBIL uses statistical analysis to build a model based on the corresponding symbiotic individuals of the superior original individuals during the main evolutionary process. The results of simulations and statistical analysis indicate that the overall performance of the PBMODE algorithm is better than that of the compared algorithms and it can be used to optimize the operating conditions of the p-xylene oxidation process effectively and efficiently.

Evaluating the contribution of a neural component of ankle joint resistive torque in patients with stroke using a manual device.

PubMed

Kobayashi, Toshiki; Leung, Aaron K L; Akazawa, Yasushi; Hutchins, Stephen W

2011-01-01

To investigate the methodology using a manual ankle joint resistive torque measurement device to evaluate the contribution of the neural component of ankle joint resistive torque in patients with stroke. Within-subject comparison to compare the ankle joint resistive torque between fast and slow stretching conditions. Ten patients with stroke participated in this study. The incremental ratio of ankle joint resistive torque at the ankle angular position of 5degrees dorsiflexion under the fast stretching condition in comparison to the slow one was calculated in each patient. A significant increase (p<0.01) in the ankle joint resistive torque was demonstrated under the fast stretching condition in comparison to the slow one in all patients and the mean ankle joint resistive torque was 4.6 (SD=1.7) Nm under the slow stretching condition, while it was 8.4 (SD=4.1) Nm under the fast stretching condition at the ankle angular position of 5 degrees dorsiflexion. The incremental ratio ranged from 9.4-139.3% among the patients. The results of this study demonstrated the potential advantage of the device to evaluate the contribution of the neural component of ankle joint resistive torque.

Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza Region, Tanzania.

PubMed

Gilson, L; Mkanje, R; Grosskurth, H; Mosha, F; Picard, J; Gavyole, A; Todd, J; Mayaud, P; Swai, R; Fransen, L; Mabey, D; Mills, A; Hayes, R

A community-randomised trial was undertaken to assess the impact, cost, and cost-effectiveness of averting HIV-1 infection through improved management of sexually transmitted diseases (STDs) by primary-health-care workers in Mwanza Region, Tanzania. The impact of improved treatment services for STDs on HIV-1 incidence was assessed by comparison of six intervention communities with six matched communities. We followed up a random cohort of 12,537 adults aged 15-54 years for 2 years to record incidence of HIV-1 infection. The total and incremental costs of the intervention were estimated (ingredients approach) and used to calculate the total cost per case treated, the incremental cost per HIV-1 infection averted, and the incremental cost per disability-adjusted life-year (DALY) saved. During 2 years of follow-up, 11,632 cases of STDs were treated in the intervention health units. The baseline prevalence of HIV-1 infection was 4%. The incidence of HIV-1 infection during the 2 years was 1.16% in the intervention communities and 1.86% in the comparison communities. An estimated 252 HIV-1 infections were averted each year. The total annual cost of the intervention was US$59,060 (1993 prices), equivalent to $0.39 per head of population served. The cost for STD case treated was $10.15, of which the drug cost was $2.11. The incremental annual cost of the intervention was $54,839, equivalent to $217.62 per HIV-1 infection averted and $10.33 per DALY saved (based on Tanzanian life expectancy) or $9.45 per DALY saved (based on the assumptions of the World Development Report). In a sensitivity analysis of factors influencing cost-effectiveness, cost per DALY saved ranged from $2.51 to $47.86. Improved management of STDs in rural health units reduced the incidence of HIV-1 infection in the general population by about 40%. The estimated cost-effectiveness of this intervention ($10 per DALY) compares favourably with that of, for example, childhood immunisation programmes ($12-17 per DALY). Cost-effectiveness should be further improved when the intervention is applied on a larger scale. Resources should be made available for this highly cost-effective HIV control strategy.

Gender effect on pre-attentive change detection in major depressive disorder patients revealed by auditory MMN.

PubMed

Qiao, Zhengxue; Yang, Aiying; Qiu, Xiaohui; Yang, Xiuxian; Zhang, Congpei; Zhu, Xiongzhao; He, Jincai; Wang, Lin; Bai, Bing; Sun, Hailian; Zhao, Lun; Yang, Yanjie

2015-10-30

Gender differences in rates of major depressive disorder (MDD) are well established, but gender differences in cognitive function have been little studied. Auditory mismatch negativity (MMN) was used to investigate gender differences in pre-attentive information processing in first episode MDD. In the deviant-standard reverse oddball paradigm, duration auditory MMN was obtained in 30 patients (15 males) and 30 age-/education-matched controls. Over frontal-central areas, mean amplitude of increment MMN (to a 150-ms deviant tone) was smaller in female than male patients; there was no sex difference in decrement MMN (to a 50-ms deviant tone). Neither increment nor decrement MMN differed between female and male patients over temporal areas. Frontal-central MMN and temporal MMN did not differ between male and female controls in any condition. Over frontal-central areas, mean amplitude of increment MMN was smaller in female patients than female controls; there was no difference in decrement MMN. Neither increment nor decrement MMN differed between female patients and female controls over temporal areas. Frontal-central MMN and temporal MMN did not differ between male patients and male controls. Mean amplitude of increment MMN in female patients did not correlate with symptoms, suggesting this sex-specific deficit is a trait- not a state-dependent phenomenon. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Experimental studies of glued Aluminum-glass joints

NASA Astrophysics Data System (ADS)

Ligaj, B.; Wirwicki, M.; Karolewska, K.; Jasińska, A.

2018-04-01

Glued steel-glass or aluminum-glass joints are to be found, among other things, in vehicles (cars, buses, trains, trams) as windscreen assembly pieces for the supporting structure. For the purposes of the experiments, samples were made in which the top beam was made of the AW-2017A aluminum alloy and the bottom beam was made of thermally reinforced soda-lime glass whereas the glued joints were made of one-component polyurethane glue Körapur 175. The tests were performed under four-point bending conditions at monotonic incremental bending moment values on the Instron 5965 durability machine. The experimental study of the durability of glued joints under four-point bending conditions with the monotonic incremental bending moment allows to determine the values of stresses, whose value is related to initiation of damage of the tested joint.

Projection methods for incompressible flow problems with WENO finite difference schemes

NASA Astrophysics Data System (ADS)

de Frutos, Javier; John, Volker; Novo, Julia

2016-03-01

Weighted essentially non-oscillatory (WENO) finite difference schemes have been recommended in a competitive study of discretizations for scalar evolutionary convection-diffusion equations [20]. This paper explores the applicability of these schemes for the simulation of incompressible flows. To this end, WENO schemes are used in several non-incremental and incremental projection methods for the incompressible Navier-Stokes equations. Velocity and pressure are discretized on the same grid. A pressure stabilization Petrov-Galerkin (PSPG) type of stabilization is introduced in the incremental schemes to account for the violation of the discrete inf-sup condition. Algorithmic aspects of the proposed schemes are discussed. The schemes are studied on several examples with different features. It is shown that the WENO finite difference idea can be transferred to the simulation of incompressible flows. Some shortcomings of the methods, which are due to the splitting in projection schemes, become also obvious.

Extended rotations and culmination age of coast douglas-fir: Old studies speak to current issues. Forest Service research paper

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

Curtis, R.O.

1995-11-01

Trends of mean annual increment and periodic annual increment were examined in 17 long-term thinning studies in Douglas-fir (Pseuditsuga menziesii var. menziesii (Mirb.) Franco) in western Washington, western Oregon, and British Columbia. Problems in evaluating growth trends and culmination ages are discussed. None of the stands had clearly reached culmination of mean annual increment, although some seemed close. The observed trends seem generally consistent with some other recent comparisons. These comparisons indicate that rotations can be considerably extended without reducing long-term timber production; value production probably would increase. A major problem in such a strategy is design of thinning regimesmore » that can maintain a reasonable level of timber flow during the transition period while producing stand conditions compatible with other management objectives. The continuing value of long-term permanent plot studies is emphasized.« less

Thermal elastoplastic structural analysis of non-metallic thermal protection systems

NASA Technical Reports Server (NTRS)

Chung, T. J.; Yagawa, G.

1972-01-01

An incremental theory and numerical procedure to analyze a three-dimensional thermoelastoplastic structure subjected to high temperature, surface heat flux, and volume heat supply as well as mechanical loadings are presented. Heat conduction equations and equilibrium equations are derived by assuming a specific form of incremental free energy, entropy, stresses and heat flux together with the first and second laws of thermodynamics, von Mises yield criteria and Prandtl-Reuss flow rule. The finite element discretization using the linear isotropic three-dimensional element for the space domain and a difference operator corresponding to a linear variation of temperature within a small time increment for the time domain lead to systematic solutions of temperature distribution and displacement and stress fields. Various boundary conditions such as insulated surfaces and convection through uninsulated surface can be easily treated. To demonstrate effectiveness of the present formulation a number of example problems are presented.

Of travertine and time: otolith chemistry and microstructure detect provenance and demography of endangered humpback chub in Grand Canyon, USA

USGS Publications Warehouse

Limburg, Karin E.; Hayden, Todd A.; Pine, William E.; Yard, Michael D.; Kozdon, Reinhard; Valley, John W.

2013-01-01

We developed a geochemical atlas of the Colorado River in Grand Canyon and in its tributary, the Little Colorado River, and used it to identify provenance and habitat use by Federally Endangered humpback chub, Gila cypha. Carbon stable isotope ratios (δ13C) discriminate best between the two rivers, but fine scale analysis in otoliths requires rare, expensive instrumentation. We therefore correlated other tracers (SrSr, Ba, and Se in ratio to Ca) to δ13C that are easier to quantify in otoliths with other microchemical techniques. Although the Little Colorado River’s water chemistry varies with major storm events, at base flow or near base flow (conditions occurring 84% of the time in our study) its chemistry differs sufficiently from the mainstem to discriminate one from the other. Additionally, when fish egress from the natal Little Colorado River to the mainstem, they encounter cold water which causes the otolith daily growth increments to decrease in size markedly. Combining otolith growth increment analysis and microchemistry permitted estimation of size and age at first egress; size at first birthday was also estimated. Emigrants < 1 year old averaged 51.2 ± 4.4 (SE) days and 35.5 ± 3.6 mm at egress; older fish that had recruited to the population averaged 100 ± 7.8 days old and 51.0 ± 2.2 mm at egress, suggesting that larger, older emigrants recruit better. Back-calculated size at age 1 was unimodal and large (78.2 ± 3.3 mm) in Little Colorado caught fish but was bimodally distributed in Colorado mainstem caught fish (49.9 ± 3.6 and 79 ± 4.9 mm) suggesting that humpback chub can also rear in the mainstem. The study demonstrates the coupled usage of the two rivers by this fish and highlights the need to consider both rivers when making management decisions for humpback chub recovery.

An improved understanding of the Alaska coastal current: The application of a bivalve growth-temperature model to reconstruct freshwater-influenced paleoenvironments

USGS Publications Warehouse

Hallmann, N.; Schone, B.R.; Irvine, G.V.; Burchell, M.; Cokelet, E.D.; Hilton, M.R.

2011-01-01

Shells of intertidal bivalve mollusks contain sub-seasonally to interannually resolved records of temperature and salinity variations in coastal settings. Such data are essential to understand changing land-sea interactions through time, specifically atmospheric (precipitation rate, glacial meltwater, river discharge) and oceanographic circulation patterns; however, independent temperature and salinity proxies are currently not available. We established a model for reconstructing daily water temperatures with an average standard error of ???1.3 ??C based on variations in the width of lunar daily growth increments of Saxidomus gigantea from southwestern Alaska, United States. Temperature explains 70% of the variability in shell growth. When used in conjunction with stable oxygen isotope data, this approach can also be used to identify changes in past seawater salinity. This study provides a better understanding of the hydrological changes related to the Alaska Coastal Current (ACC). In combination with ??18Oshell values, increment-derived temperatures were used to estimate salinity changes with an average error of 1.4 ?? 1.1 PSU. Our model was calibrated and tested with modern shells and then applied to archaeological specimens. As derived from the model, the time interval of 988-1447 cal yr BP was characterized by ???1-2 ??C colder and much drier (2-5 PSU) summers. During that time, the ACC was likely flowing much more slowly than at present. In contrast, between 599-1014 cal yr BP, the Aleutian low may have been stronger, which resulted in a 3 ??C temperature decrease during summers and 1-2 PSU fresher conditions than today; the ACC was probably flowing more quickly at that time. The shell growth-temperature model can be used to estimate seasonal to interannual salinity and temperature changes in freshwater-influenced environments through time. ?? 2011 SEPM (Society for Sedimentary Geology).

Of Travertine and Time: Otolith Chemistry and Microstructure Detect Provenance and Demography of Endangered Humpback Chub in Grand Canyon, USA

PubMed Central

Limburg, Karin E.; Hayden, Todd A.; Pine, William E.; Yard, Michael D.; Kozdon, Reinhard; Valley, John W.

2013-01-01

We developed a geochemical atlas of the Colorado River in Grand Canyon and in its tributary, the Little Colorado River, and used it to identify provenance and habitat use by Federally Endangered humpback chub, Gila cypha.  Carbon stable isotope ratios (δ13C) discriminate best between the two rivers, but fine scale analysis in otoliths requires rare, expensive instrumentation. We therefore correlated other tracers (SrSr, Ba, and Se in ratio to Ca) to δ13C that are easier to quantify in otoliths with other microchemical techniques. Although the Little Colorado River’s water chemistry varies with major storm events, at base flow or near base flow (conditions occurring 84% of the time in our study) its chemistry differs sufficiently from the mainstem to discriminate one from the other. Additionally, when fish egress from the natal Little Colorado River to the mainstem, they encounter cold water which causes the otolith daily growth increments to decrease in size markedly. Combining otolith growth increment analysis and microchemistry permitted estimation of size and age at first egress; size at first birthday was also estimated. Emigrants < 1 year old averaged 51.2 ± 4.4 (SE) days and 35.5 ± 3.6 mm at egress; older fish that had recruited to the population averaged 100 ± 7.8 days old and 51.0 ± 2.2 mm at egress, suggesting that larger, older emigrants recruit better. Back-calculated size at age 1 was unimodal and large (78.2 ± 3.3 mm) in Little Colorado caught fish but was bimodally distributed in Colorado mainstem caught fish (49.9 ± 3.6 and 79 ± 4.9 mm) suggesting that humpback chub can also rear in the mainstem. The study demonstrates the coupled usage of the two rivers by this fish and highlights the need to consider both rivers when making management decisions for humpback chub recovery. PMID:24358346

Metabolizability and partitioning of energy and protein in green plants by yearling lesser snow geese

USGS Publications Warehouse

Sedinger, James S.; White, Robert G.; Hupp, Jerry W.

1995-01-01

We measured apparent metabolizability of organic matter, gross energy, nitrogen and cell wall constituents of pelleted alfalfa by Lesser Snow Geese (Chen caerulescens caerulescens. We also used simultaneous measurements of energy expenditure and apparent metabolizable energy intake to estimate heat increment of feeding and net energy for production and maintenance. Apparent metabolizability of energy was 46% as a result of substantial retention of dietary cellulose (45%). Mean slope of the relationship between energy expenditure and apparent metabolizable energy intake, which estimates heat increment at feeding, was 0.33. One minus the slope, 0.67, was our estimate of the proportion of apparent metabolizable energy available for maintenance and production. Resting metabolic rate at zero apparent metabolizable energy intake ranged from 361 kJ· kg-1· day-1 to 432 kJ· kg-1· day-1, while apparent metabolizable energy intake required for energy balance ranged from 455 kJ· kg-1· day-1 to 871 kJ· kg-1· day-1. Lesser Snow Geese (>2 kg mass) were more efficient at retaining dietary energy but possibly lost more of this energy as heat than smaller Black Brant (Branta bernicla nigricans)(∼1 kg mass), suggesting a possible relationship between body size and processing of energy in herbivorous birds.

A Probabilistic Method of Assessing Carbon Accumulation Rate at Imnavait Creek Peatland, Arctic Long Term Ecological Research Station, Alaska

NASA Technical Reports Server (NTRS)

Nichols, Jonathan E.; Peteet, Dorothy M.; Frolking, Steve; Karavias, John

2017-01-01

Arctic peatlands are an important part of the global carbon cycle, accumulating atmospheric carbon as organic matter since the Late glacial. Current methods for understanding the changing efficiency of the peatland carbon sink rely on peatlands with an undisturbed stratigraphy. Here we present a method of estimating primary carbon accumulation rate from a site where permafrost processes have either vertically or horizontally translocated nearby carbon-rich sediment out of stratigraphic order. Briefly, our new algorithm estimates the probability of the age of deposition of a random increment of sediment in the core. The method assumes that if sediment age is measured at even depth increments, dates are more likely to occur during intervals of higher accumulation rate and vice versa. Multiplying estimated sedimentation rate by measured carbon density yields carbon accumulation rate. We perform this analysis at the Imnavait Creek Peatland, near the Arctic Long Term Ecological Research network site at Toolik Lake, Alaska. Using classical radiocarbon age modeling, we find unreasonably high rates of carbon accumulation at various Holocene intervals. With our new method, we find accumulation rate changes that are in improved agreement within the context of other sites throughout Alaska and the rest of the Circum-Arctic region.

A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy.

PubMed

Berghout, Caspar C; Zevalkink, Jolien; Hakkaart-van Roijen, Leona

2010-01-01

Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility study, we examined the incremental cost-effectiveness ratio (ICER) of psychoanalysis versus psychoanalytic psychotherapy. Incremental costs and effects were estimated by means of cross-sectional measurements in a cohort design (psychoanalysis, n = 78; psychoanalytic psychotherapy, n = 104). Quality-adjusted life-years (QALYs) were estimated for each treatment strategy using the SF-6D. Total costs were calculated from a societal perspective (treatment costs plus other societal costs) and discounted at 4 percent. Psychoanalysis was more costly than psychoanalytic psychotherapy, but also more effective from a health-related quality of life perspective. The ICER--that is, the extra costs to gain one additional QALY by delivering psychoanalysis instead of psychoanalytic psychotherapy--was estimated at 52,384 euros per QALY gained. Our findings show that the cost-utility ratio of psychoanalysis relative to psychoanalytic psychotherapy is within an acceptable range. More research is needed to find out whether cost-utility ratios vary with different types of patients. We also encourage cost-utility analyses comparing psychoanalytic treatment to other forms of (long-term) treatment.

Magnetic field effects on peristaltic flow of blood in a non-uniform channel

NASA Astrophysics Data System (ADS)

Latha, R.; Rushi Kumar, B.

2017-11-01

The objective of this paper is to carry out the effect of the MHD on the peristaltic transport of blood in a non-uniform channel have been explored under long wavelength approximation with low (zero) Reynolds number. Blood is made of an incompressible, viscous and electrically conducting. Explicit expressions for the axial velocity, axial pressure gradient are derived using long wavelength assumptions with slip and regularity conditions. It is determined that the pressure gradient diminishes as the couple stress parameter increments and it decreases as the magnetic parameter increments. We additionally concentrate the embedded parameters through graphs.

A triangular thin shell finite element: Nonlinear analysis. [structural analysis

NASA Technical Reports Server (NTRS)

Thomas, G. R.; Gallagher, R. H.

1975-01-01

Aspects of the formulation of a triangular thin shell finite element which pertain to geometrically nonlinear (small strain, finite displacement) behavior are described. The procedure for solution of the resulting nonlinear algebraic equations combines a one-step incremental (tangent stiffness) approach with one iteration in the Newton-Raphson mode. A method is presented which permits a rational estimation of step size in this procedure. Limit points are calculated by means of a superposition scheme coupled to the incremental side of the solution procedure while bifurcation points are calculated through a process of interpolation of the determinants of the tangent-stiffness matrix. Numerical results are obtained for a flat plate and two curved shell problems and are compared with alternative solutions.

The size of the hydroxyl group and its contribution to the affinity of atropine for muscarine-sensitive acetylcholine receptors.

PubMed Central

Barlow, R. B.; Ramtoola, S.

1980-01-01

1 From measurements of the affinity constants of hydratropyltropine and its methiodide for muscarine-sensitive acetylcholine receptors in the guinea-pig ileum, the increment in log K for the hydroxyl group in atropine is 2.06 and in the methiodide it is 2.16. These effects are slightly bigger than any so far recorded with these receptors. 2 The estimate of the increment in apparent molal volume for the hydroxyl group is 1.1 cm3/mol in atropine and 1.0 cm3/mol in the methobromide. 3 The large effect of the group on affinity may be linked to its small apparent size in water as suggested in the previous paper. PMID:7470742

Inquiring Scaffolds in Laboratory Tasks: An Instance of a "Worked Laboratory Guide Effect"?

ERIC Educational Resources Information Center

Schmidt-Borcherding, Florian; Hänze, Martin; Wodzinski, Rita; Rincke, Karsten

2013-01-01

The study explores if established support devices for paper-pencil problem solving, namely worked examples and incremental scaffolds, are applicable to laboratory tasks. N?=?173 grade eight students solved in dyads a physics laboratory task in one of three conditions. In condition A (unguided problem solving), students were asked to determine the…

Urban climate modifies tree growth in Berlin

NASA Astrophysics Data System (ADS)

Dahlhausen, Jens; Rötzer, Thomas; Biber, Peter; Uhl, Enno; Pretzsch, Hans

2017-12-01

Climate, e.g., air temperature and precipitation, differs strongly between urban and peripheral areas, which causes diverse life conditions for trees. In order to compare tree growth, we sampled in total 252 small-leaved lime trees (Tilia cordata Mill) in the city of Berlin along a gradient from the city center to the surroundings. By means of increment cores, we are able to trace back their growth for the last 50 to 100 years. A general growth trend can be shown by comparing recent basal area growth with estimates from extrapolating a growth function that had been fitted with growth data from earlier years. Estimating a linear model, we show that air temperature and precipitation significantly influence tree growth within the last 20 years. Under consideration of housing density, the results reveal that higher air temperature and less precipitation led to higher growth rates in high-dense areas, but not in low-dense areas. In addition, our data reveal a significantly higher variance of the ring width index in areas with medium housing density compared to low housing density, but no temporal trend. Transferring the results to forest stands, climate change is expected to lead to higher tree growth rates.

Urban climate modifies tree growth in Berlin

NASA Astrophysics Data System (ADS)

Dahlhausen, Jens; Rötzer, Thomas; Biber, Peter; Uhl, Enno; Pretzsch, Hans

2018-05-01

Climate, e.g., air temperature and precipitation, differs strongly between urban and peripheral areas, which causes diverse life conditions for trees. In order to compare tree growth, we sampled in total 252 small-leaved lime trees ( Tilia cordata Mill) in the city of Berlin along a gradient from the city center to the surroundings. By means of increment cores, we are able to trace back their growth for the last 50 to 100 years. A general growth trend can be shown by comparing recent basal area growth with estimates from extrapolating a growth function that had been fitted with growth data from earlier years. Estimating a linear model, we show that air temperature and precipitation significantly influence tree growth within the last 20 years. Under consideration of housing density, the results reveal that higher air temperature and less precipitation led to higher growth rates in high-dense areas, but not in low-dense areas. In addition, our data reveal a significantly higher variance of the ring width index in areas with medium housing density compared to low housing density, but no temporal trend. Transferring the results to forest stands, climate change is expected to lead to higher tree growth rates.

Urban climate modifies tree growth in Berlin.

PubMed

Dahlhausen, Jens; Rötzer, Thomas; Biber, Peter; Uhl, Enno; Pretzsch, Hans

2018-05-01

Climate, e.g., air temperature and precipitation, differs strongly between urban and peripheral areas, which causes diverse life conditions for trees. In order to compare tree growth, we sampled in total 252 small-leaved lime trees (Tilia cordata Mill) in the city of Berlin along a gradient from the city center to the surroundings. By means of increment cores, we are able to trace back their growth for the last 50 to 100 years. A general growth trend can be shown by comparing recent basal area growth with estimates from extrapolating a growth function that had been fitted with growth data from earlier years. Estimating a linear model, we show that air temperature and precipitation significantly influence tree growth within the last 20 years. Under consideration of housing density, the results reveal that higher air temperature and less precipitation led to higher growth rates in high-dense areas, but not in low-dense areas. In addition, our data reveal a significantly higher variance of the ring width index in areas with medium housing density compared to low housing density, but no temporal trend. Transferring the results to forest stands, climate change is expected to lead to higher tree growth rates.

Management of Malignant Pleural Effusion: A Cost-Utility Analysis.

PubMed

Shafiq, Majid; Frick, Kevin D; Lee, Hans; Yarmus, Lonny; Feller-Kopman, David J

2015-07-01

Malignant pleural effusion (MPE) is associated with a significant impact on health-related quality of life. Palliative interventions abound, with varying costs and degrees of invasiveness. We examined the relative cost-utility of 5 therapeutic alternatives for MPE among adults. Original studies investigating the management of MPE were extensively researched, and the most robust and current data particularly those from the TIME2 trial were chosen to estimate event probabilities. Medicare data were used for cost estimation. Utility estimates were adapted from 2 original studies and kept consistent with prior estimations. The decision tree model was based on clinical guidelines and authors' consensus opinion. Primary outcome of interest was the incremental cost-effectiveness ratio for each intervention over a less effective alternative over an analytical horizon of 6 months. Given the paucity of data on rapid pleurodesis protocol, a sensitivity analysis was conducted to address the uncertainty surrounding its efficacy in terms of achieving long-term pleurodesis. Except for repeated thoracentesis (RT; least effective), all interventions had similar effectiveness. Tunneled pleural catheter was the most cost-effective option with an incremental cost-effectiveness ratio of $45,747 per QALY gained over RT, assuming a willingness-to-pay threshold of $100,000/QALY. Multivariate sensitivity analysis showed that rapid pleurodesis protocol remained cost-ineffective even with an estimated probability of lasting pleurodesis up to 85%. Tunneled pleural catheter is the most cost-effective therapeutic alternative to RT. This, together with its relative convenience (requiring neither hospitalization nor thoracoscopic procedural skills), makes it an intervention of choice for MPE.

Using Data Assimilation Diagnostics to Assess the SMAP Level-4 Soil Moisture Product

NASA Technical Reports Server (NTRS)

Reichle, Rolf; Liu, Qing; De Lannoy, Gabrielle; Crow, Wade; Kimball, John; Koster, Randy; Ardizzone, Joe

2018-01-01

The Soil Moisture Active Passive (SMAP) mission Level-4 Soil Moisture (L4_SM) product provides 3-hourly, 9-km resolution, global estimates of surface (0-5 cm) and root-zone (0-100 cm) soil moisture and related land surface variables from 31 March 2015 to present with approx.2.5-day latency. The ensemble-based L4_SM algorithm assimilates SMAP brightness temperature (Tb) observations into the Catchment land surface model. This study describes the spatially distributed L4_SM analysis and assesses the observation-minus-forecast (O-F) Tb residuals and the soil moisture and temperature analysis increments. Owing to the climatological rescaling of the Tb observations prior to assimilation, the analysis is essentially unbiased, with global mean values of approx. 0.37 K for the O-F Tb residuals and practically zero for the soil moisture and temperature increments. There are, however, modest regional (absolute) biases in the O-F residuals (under approx. 3 K), the soil moisture increments (under approx. 0.01 cu m/cu m), and the surface soil temperature increments (under approx. 1 K). Typical instantaneous values are approx. 6 K for O-F residuals, approx. 0.01 (approx. 0.003) cu m/cu m for surface (root-zone) soil moisture increments, and approx. 0.6 K for surface soil temperature increments. The O-F diagnostics indicate that the actual errors in the system are overestimated in deserts and densely vegetated regions and underestimated in agricultural regions and transition zones between dry and wet climates. The O-F auto-correlations suggest that the SMAP observations are used efficiently in western North America, the Sahel, and Australia, but not in many forested regions and the high northern latitudes. A case study in Australia demonstrates that assimilating SMAP observations successfully corrects short-term errors in the L4_SM rainfall forcing.

Global Assessment of the SMAP Level-4 Soil Moisture Product Using Assimilation Diagnostics

NASA Technical Reports Server (NTRS)

Reichle, Rolf; Liu, Qing; De Lannoy, Gabrielle; Crow, Wade; Kimball, John; Koster, Randy; Ardizzone, Joe

2018-01-01

The Soil Moisture Active Passive (SMAP) mission Level-4 Soil Moisture (L4_SM) product provides 3-hourly, 9-km resolution, global estimates of surface (0-5 cm) and root-zone (0-100 cm) soil moisture and related land surface variables from 31 March 2015 to present with approx. 2.5-day latency. The ensemble-based L4_SM algorithm assimilates SMAP brightness temperature (Tb) observations into the Catchment land surface model. This study describes the spatially distributed L4_SM analysis and assesses the observation-minus-forecast (O-F) Tb residuals and the soil moisture and temperature analysis increments. Owing to the climatological rescaling of the Tb observations prior to assimilation, the analysis is essentially unbiased, with global mean values of approx. 0.37 K for the O-F Tb residuals and practically zero for the soil moisture and temperature increments. There are, however, modest regional (absolute) biases in the O-F residuals (under approx. 3 K), the soil moisture increments (under approx. 0.01 cu m/cu m), and the surface soil temperature increments (under approx. 1 K). Typical instantaneous values are approx. 6 K for O-F residuals, approx. 0.01 (approx. 0.003) cu m/cu m for surface (root-zone) soil moisture increments, and approx. 0.6 K for surface soil temperature increments. The O-F diagnostics indicate that the actual errors in the system are overestimated in deserts and densely vegetated regions and underestimated in agricultural regions and transition zones between dry and wet climates. The O-F auto-correlations suggest that the SMAP observations are used efficiently in western North America, the Sahel, and Australia, but not in many forested regions and the high northern latitudes. A case study in Australia demonstrates that assimilating SMAP observations successfully corrects short-term errors in the L4_SM rainfall forcing.

Assessing and Adapting LiDAR-Derived Pit-Free Canopy Height Model Algorithm for Sites with Varying Vegetation Structure

NASA Astrophysics Data System (ADS)

Scholl, V.; Hulslander, D.; Goulden, T.; Wasser, L. A.

2015-12-01

Spatial and temporal monitoring of vegetation structure is important to the ecological community. Airborne Light Detection and Ranging (LiDAR) systems are used to efficiently survey large forested areas. From LiDAR data, three-dimensional models of forests called canopy height models (CHMs) are generated and used to estimate tree height. A common problem associated with CHMs is data pits, where LiDAR pulses penetrate the top of the canopy, leading to an underestimation of vegetation height. The National Ecological Observatory Network (NEON) currently implements an algorithm to reduce data pit frequency, which requires two height threshold parameters, increment size and range ceiling. CHMs are produced at a series of height increments up to a height range ceiling and combined to produce a CHM with reduced pits (referred to as a "pit-free" CHM). The current implementation uses static values for the height increment and ceiling (5 and 15 meters, respectively). To facilitate the generation of accurate pit-free CHMs across diverse NEON sites with varying vegetation structure, the impacts of adjusting the height threshold parameters were investigated through development of an algorithm which dynamically selects the height increment and ceiling. A series of pit-free CHMs were generated using three height range ceilings and four height increment values for three ecologically different sites. Height threshold parameters were found to change CHM-derived tree heights up to 36% compared to original CHMs. The extent of the parameters' influence on modelled tree heights was greater than expected, which will be considered during future CHM data product development at NEON. (A) Aerial image of Harvard National Forest, (B) standard CHM containing pits, appearing as black speckles, (C) a pit-free CHM created with the static algorithm implementation, and (D) a pit-free CHM created through varying the height threshold ceiling up to 82 m and the increment to 1 m.

Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.

PubMed

Vassall, Anna; Chandrashekar, Sudhashree; Pickles, Michael; Beattie, Tara S; Shetty, Govindraj; Bhattacharjee, Parinita; Boily, Marie-Claude; Vickerman, Peter; Bradley, Janet; Alary, Michel; Moses, Stephen; Watts, Charlotte

2014-01-01

Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India. An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model. The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving. Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.

Cost-effectiveness analysis of panitumumab plus mFOLFOX6 compared with bevacizumab plus mFOLFOX6 for first-line treatment of patients with wild-type RAS metastatic colorectal cancer.

PubMed

Graham, Christopher N; Hechmati, Guy; Hjelmgren, Jonas; de Liège, Frédérique; Lanier, Julie; Knox, Hediyyih; Barber, Beth

2014-11-01

To investigate the cost-effectiveness of panitumumab plus mFOLFOX6 (oxaliplatin, 5-fluorouracil and leucovorin) compared with bevacizumab plus mFOLFOX6 in first-line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC). A semi-Markov model was constructed from a French health collective perspective, with health states related to first-line treatment (progression-free), disease progression with and without subsequent active treatment, resection of metastases, disease-free after successful resection and death. Parametric survival analyses of patient-level progression-free and overall survival data from the only head-to-head clinical trial of panitumumab and bevacizumab (PEAK) were performed to estimate transitions to disease progression and death. Additional data from PEAK informed the amount of each drug consumed, duration of therapy, subsequent therapy use, and toxicities related to mCRC treatment. Literature and French public data sources were used to estimate unit costs associated with treatment and duration of subsequent active therapies. Utility weights were calculated from patient-level data from panitumumab trials in the first-, second- and third-line settings. A life-time perspective was applied. Scenario, one-way, and probabilistic sensitivity analyses were performed. Based on a head-to-head clinical trial that demonstrates better efficacy outcomes for patients with wild-type RAS mCRC who receive panitumumab plus mFOLFOX6 versus bevacizumab plus mFOLFOX6, the incremental cost per life-year gained was estimated to be €26,918, and the incremental cost per quality-adjusted life year (QALY) gained was estimated to be €36,577. Sensitivity analyses indicate the model is robust to alternative parameters and assumptions. The incremental cost per QALY gained indicates that panitumumab plus mFOLFOX6 represents good value for money in comparison to bevacizumab plus mFOLFOX6 and, with a willingness-to-pay ranging from €40,000 to €60,000, can be considered cost-effective in first-line treatment of patients with wild-type RAS mCRC. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Modeling the Frequency and Costs Associated with Postsurgical Gastrointestinal Adverse Events for Tapentadol IR versus Oxycodone IR

PubMed Central

Paris, Andrew; Kozma, Chris M.; Chow, Wing; Patel, Anisha M.; Mody, Samir H.; Kim, Myoung S.

2013-01-01

Background Few studies have estimated the economic effect of using an opioid that is associated with lower rates of gastrointestinal (GI) adverse events (AEs) than another opioid for postsurgical pain. Objective To estimate the number of postsurgical GI events and incremental hospital costs, including potential savings, associated with lower GI AE rates, for tapentadol immediate release (IR) versus oxycodone IR, using a literature-based calculator. Methods An electronic spreadsheet–based cost calculator was developed to estimate the total number of GI AEs (ie, nausea, vomiting, or constipation) and incremental costs to a hospital when using tapentadol IR 100 mg versus oxycodone IR 15 mg, in a hypothetical cohort of 1500 hospitalized patients requiring short-acting opioids for postsurgical pain. Data inputs were chosen from recently published, well-designed studies, including GI AE rates from a previously published phase 3 clinical trial of postsurgical patients who received these 2 opioids; GI event–related incremental length of stay from a large US hospital database; drug costs using wholesale acquisition costs in 2011 US dollars; and average hospitalization cost from the 2009 Healthcare Cost and Utilization Project database. The base case assumed that 5% (chosen as a conservative estimate) of patients admitted to the hospital would shift from oxycodone IR to tapentadol IR. Results In this hypothetical cohort of 1500 hospitalized patients, replacing 5% of oxycodone IR 15-mg use with tapentadol IR 100-mg use predicted reductions in the total number of GI events from 1095 to 1085, and in the total cost of GI AEs from $2,978,400 to $2,949,840. This cost reduction translates to a net savings of $22,922 after factoring in drug cost. For individual GI events, the net savings were $26,491 for nausea; $12,212 for vomiting; and $7187 for constipation. Conclusion Using tapentadol IR in place of a traditional μ-opioid shows the potential for reduced GI events and subsequent cost-savings in the postsurgical hospital setting. In the absence of sufficient real-world data, this literature-based cost calculator may assist hospital Pharmacy & Therapeutics committees in their evaluation of the costs of opioid-related GI events. PMID:24991383

Using decision modeling to determine pricing of new pharmaceuticals: the case of neurokinin-1 receptor antagonist antiemetics for cancer chemotherapy.

PubMed

Dranitsaris, George; Leung, Pauline

2004-01-01

Decision analysis is commonly used to perform economic evaluations of new pharmaceuticals. The outcomes of such studies are often reported as an incremental cost per quality-adjusted life year (QALY) gained with the new agent. Decision analysis can also be used in the context of estimating drug cost before market entry. The current study used neurokinin-1 (NK-1) receptor antagonists, a new class of antiemetics for cancer patients, as an example to illustrate the process using an incremental cost of dollars Can20,000 per QALY gained as the target threshold. A decision model was developed to simulate the control of acute and delayed emesis after cisplatin-based chemotherapy. The model compared standard therapy with granisetron and dexamethasone to the same protocol with the addition of an NK-1 before chemotherapy and continued twice daily for five days. The rates of complete emesis control were abstracted from a double-blind randomized trial. Costs of standard antiemetics and therapy for breakthrough vomiting were obtained from hospital sources. Utility estimates characterized as quality-adjusted emesis-free days were determined by interviewing twenty-five oncology nurses and pharmacists by using the Time Trade-Off technique. These data were then used to estimate the unit cost of the new antiemetic using a target threshold of dollars Can20,000 per QALY gained. A cost of dollars Can6.60 per NK-1 dose would generate an incremental cost of dollars Can20,000 per QALY. The sensitivity analysis on the unit cost identified a range from dollars Can4.80 to dollars Can10.00 per dose. For the recommended five days of therapy, the total cost should be dollars Can66.00 (dollars Can48.00-dollars Can100.00) for optimal economic efficiency relative to Canada's publicly funded health-care system. The use of decision modeling for estimating drug cost before product launch is a powerful technique to ensure value for money. Such information can be of value to both drug manufacturers and formulary committees, because it would facilitate negotiations for optimal pricing in a given jurisdiction.

Direct costs associated with the management of progressive early onset scoliosis: estimations based on gold standard technique or with magnetically controlled growing rods.

PubMed

Charroin, C; Abelin-Genevois, K; Cunin, V; Berthiller, J; Constant, H; Kohler, R; Aulagner, G; Serrier, H; Armoiry, X

2014-09-01

The main disadvantage of the surgical management of early onset scoliosis (EOS) using conventional growing rods is the need for iterative surgical procedures during childhood. The emergence of an innovative device using distraction-based magnetically controlled growing rods (MCGR) provides the opportunity to avoid such surgeries and therefore to improve the patient's quality of life. Despite the high cost of MCGR and considering its potential impact in reducing hospital stays, the use of MCGR could reduce medical resource consumption in a long-term view in comparison to traditional growing rod (TGR). A cost-simulation model was constructed to assess the incremental cost between the two strategies. The cost for each strategy was estimated based on probability of medical resource consumption determined from literature search as well as data from EOS patients treated in our centre. Some medical expenses were also estimated from expert interviews. The time horizon chosen was 4 years as from first surgical implantation. Costs were calculated in the perspective of the French sickness fund (using rates from year 2013) and were discounted by an annual rate of 4%. Sensitivity analyses were conducted to test model strength to various parameters. With a time horizon of 4 years, the estimated direct costs of TGR and MCGR strategies were 49,067 € and 42,752 €, respectively leading to an incremental costs of 6135 € in favour of MCGR strategy. In the first case, costs were mainly represented by hospital stays expenses (83.9%) whereas in the other the cost of MCGR contributed to 59.5% of the total amount. In the univariate sensitivity analysis, the tariffs of hospital stays, the tariffs of the MCG, and the frequency of distraction surgeries were the parameters with the most important impact on incremental cost. MCGR is a recent and promising innovation in the management of severe EOS. Besides improving the quality of life, its use in the treatment of severe EOS is likely to be offset by lower costs of hospital stays. Level IV, economic and decision analyses, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

PubMed Central

Profit, Jochen; Lee, Diana; Zupancic, John A.; Papile, LuAnn; Gutierrez, Cristina; Goldie, Sue J.; Gonzalez-Pier, Eduardo; Salomon, Joshua A.

2010-01-01

Background Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. Methods and Findings A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24–26, 27–29, and 30–33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24–26, 27–29, and 30–33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses. Conclusions Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis. Please see later in the article for the Editors' Summary PMID:21179496

Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction.

PubMed

Gaziano, Thomas A; Fonarow, Gregg C; Claggett, Brian; Chan, Wing W; Deschaseaux-Voinet, Celine; Turner, Stuart J; Rouleau, Jean L; Zile, Michael R; McMurray, John J V; Solomon, Scott D

2016-09-01

The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the United States. Data from US adults (mean [SD] age, 63.8 [11.5] years) with HF with reduced ejection fraction and characteristics similar to those in the PARADIGM-HF trial were used as inputs for a 2-state Markov model simulated HF. Risks of all-cause mortality and hospitalization from HF or other reasons were estimated with a 30-year time horizon. Quality of life was based on trial EQ-5D scores. Hospital costs combined Medicare and private insurance reimbursement rates; medication costs included the wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was used. Sensitivity analyses were performed on key inputs including: hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality-of-life estimates. Hospitalizations, quality-adjusted life-years (QALYs), costs, and incremental costs per QALY gained. The 2-state Markov model of US adult patients (mean age, 63.8 years) calculated that there would be 220 fewer hospital admissions per 1000 patients with HF treated with sacubitril/valsartan vs enalapril over 30 years. The incremental costs and QALYs gained with sacubitril/valsartan treatment were estimated at $35 512 and 0.78, respectively, compared with enalapril, equating to an incremental cost-effectiveness ratio (ICER) of $45 017 per QALY for the base-case. Sensitivity analyses demonstrated ICERs ranging from $35 357 to $75 301 per QALY. For eligible patients with HF with reduced ejection fraction, the Markov model calculated that sacubitril/valsartan would increase life expectancy at an ICER consistent with other high-value accepted cardiovascular interventions. Sensitivity analyses demonstrated sacubitril/valsartan would remain cost-effective vs enalapril.

Two Different Views on the World Around Us: The World of Uniformity versus Diversity

PubMed Central

Nayakankuppam, Dhananjay

2016-01-01

We propose that when individuals believe in fixed traits of personality (entity theorists), they are likely to expect a world of “uniformity.” As such, they easily infer a population statistic from a small sample of data with confidence. In contrast, individuals who believe in malleable traits of personality (incremental theorists) are likely to presume a world of “diversity,” such that they “hesitate” to infer a population statistic from a similarly sized sample. In four laboratory experiments, we found that compared to incremental theorists, entity theorists estimated a population mean from a sample with a greater level of confidence (Studies 1a and 1b), expected more homogeneity among the entities within a population (Study 2), and perceived an extreme value to be more indicative of an outlier (Study 3). These results suggest that individuals are likely to use their implicit self-theory orientations (entity theory versus incremental theory) to see a population in general as a constitution either of homogeneous or heterogeneous entities. PMID:27977788

Enabling Incremental Query Re-Optimization.

PubMed

Liu, Mengmeng; Ives, Zachary G; Loo, Boon Thau

2016-01-01

As declarative query processing techniques expand to the Web, data streams, network routers, and cloud platforms, there is an increasing need to re-plan execution in the presence of unanticipated performance changes. New runtime information may affect which query plan we prefer to run. Adaptive techniques require innovation both in terms of the algorithms used to estimate costs , and in terms of the search algorithm that finds the best plan. We investigate how to build a cost-based optimizer that recomputes the optimal plan incrementally given new cost information, much as a stream engine constantly updates its outputs given new data. Our implementation especially shows benefits for stream processing workloads. It lays the foundations upon which a variety of novel adaptive optimization algorithms can be built. We start by leveraging the recently proposed approach of formulating query plan enumeration as a set of recursive datalog queries ; we develop a variety of novel optimization approaches to ensure effective pruning in both static and incremental cases. We further show that the lessons learned in the declarative implementation can be equally applied to more traditional optimizer implementations.

Enabling Incremental Query Re-Optimization

PubMed Central

Liu, Mengmeng; Ives, Zachary G.; Loo, Boon Thau

2017-01-01

As declarative query processing techniques expand to the Web, data streams, network routers, and cloud platforms, there is an increasing need to re-plan execution in the presence of unanticipated performance changes. New runtime information may affect which query plan we prefer to run. Adaptive techniques require innovation both in terms of the algorithms used to estimate costs, and in terms of the search algorithm that finds the best plan. We investigate how to build a cost-based optimizer that recomputes the optimal plan incrementally given new cost information, much as a stream engine constantly updates its outputs given new data. Our implementation especially shows benefits for stream processing workloads. It lays the foundations upon which a variety of novel adaptive optimization algorithms can be built. We start by leveraging the recently proposed approach of formulating query plan enumeration as a set of recursive datalog queries; we develop a variety of novel optimization approaches to ensure effective pruning in both static and incremental cases. We further show that the lessons learned in the declarative implementation can be equally applied to more traditional optimizer implementations. PMID:28659658

Increased cost of illness among European patients with type 2 diabetes treated with insulin.

PubMed

Nuhoho, Solomon; Vietri, Jeffrey; Worbes-Cerezo, Melany

2017-01-01

To investigate the association between outcomes and different escalating combinations of non-insulin medications vs. insulin. Data were taken from the 2013 5EU NHWS, a cross-sectional survey including 62,000 respondents across France, Germany, Italy, Spain, and the UK. Costs were estimated from self-reported work impairment and healthcare visits using average wages and unit costs. Respondents taking antihyperglycemic medications (n = 2894) were compared according to treatment type using unadjusted comparisons followed by regression to adjust for confounders. Insulin users had the highest costs and worse outcomes, a pattern that remained after adjustment for a range of sociodemographic and disease characteristics. Incremental direct costs were approximately €800. Incremental indirect costs, applicable only to the employed, were larger than incremental direct costs, but were statistically significant only relative to non-insulin monotherapy. Escalation using oral agents rather than insulin is associated with better quality of life and lower costs, though these relationships may not be causal. Further research is warranted on escalation using oral agents among patients for whom insulin is not required.

Recursive estimators of mean-areal and local bias in precipitation products that account for conditional bias

NASA Astrophysics Data System (ADS)

Zhang, Yu; Seo, Dong-Jun

2017-03-01

This paper presents novel formulations of Mean field bias (MFB) and local bias (LB) correction schemes that incorporate conditional bias (CB) penalty. These schemes are based on the operational MFB and LB algorithms in the National Weather Service (NWS) Multisensor Precipitation Estimator (MPE). By incorporating CB penalty in the cost function of exponential smoothers, we are able to derive augmented versions of recursive estimators of MFB and LB. Two extended versions of MFB algorithms are presented, one incorporating spatial variation of gauge locations only (MFB-L), and the second integrating both gauge locations and CB penalty (MFB-X). These two MFB schemes and the extended LB scheme (LB-X) are assessed relative to the original MFB and LB algorithms (referred to as MFB-O and LB-O, respectively) through a retrospective experiment over a radar domain in north-central Texas, and through a synthetic experiment over the Mid-Atlantic region. The outcome of the former experiment indicates that introducing the CB penalty to the MFB formulation leads to small, but consistent improvements in bias and CB, while its impacts on hourly correlation and Root Mean Square Error (RMSE) are mixed. Incorporating CB penalty in LB formulation tends to improve the RMSE at high rainfall thresholds, but its impacts on bias are also mixed. The synthetic experiment suggests that beneficial impacts are more conspicuous at low gauge density (9 per 58,000 km2), and tend to diminish at higher gauge density. The improvement at high rainfall intensity is partly an outcome of the conservativeness of the extended LB scheme. This conservativeness arises in part from the more frequent presence of negative eigenvalues in the extended covariance matrix which leads to no, or smaller incremental changes to the smoothed rainfall amounts.

48 CFR 2452.216-70 - Estimated cost, base fee and award fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

...] increments on the schedule set forth in the Performance Evaluation Plan established by the government. The amount payable shall be based on the progress toward completion of contract tasks as determined by the... payments of the award fee in accordance with the schedule established in the Performance Evaluation Plan...

The Predictive Validity of the Short-Term Assessment of Risk and Treatability (START) for Multiple Adverse Outcomes in a Secure Psychiatric Inpatient Setting.

PubMed

O'Shea, Laura E; Picchioni, Marco M; Dickens, Geoffrey L

2016-04-01

The Short-Term Assessment of Risk and Treatability (START) aims to assist mental health practitioners to estimate an individual's short-term risk for a range of adverse outcomes via structured consideration of their risk ("Vulnerabilities") and protective factors ("Strengths") in 20 areas. It has demonstrated predictive validity for aggression but this is less established for other outcomes. We collated START assessments for N = 200 adults in a secure mental health hospital and ascertained 3-month risk event incidence using the START Outcomes Scale. The specific risk estimates, which are the tool developers' suggested method of overall assessment, predicted aggression, self-harm/suicidality, and victimization, and had incremental validity over the Strength and Vulnerability scales for these outcomes. The Strength scale had incremental validity over the Vulnerability scale for aggressive outcomes; therefore, consideration of protective factors had demonstrable value in their prediction. Further evidence is required to support use of the START for the full range of outcomes it aims to predict. © The Author(s) 2015.

Model parameter estimation approach based on incremental analysis for lithium-ion batteries without using open circuit voltage

NASA Astrophysics Data System (ADS)

Wu, Hongjie; Yuan, Shifei; Zhang, Xi; Yin, Chengliang; Ma, Xuerui

2015-08-01

To improve the suitability of lithium-ion battery model under varying scenarios, such as fluctuating temperature and SoC variation, dynamic model with parameters updated realtime should be developed. In this paper, an incremental analysis-based auto regressive exogenous (I-ARX) modeling method is proposed to eliminate the modeling error caused by the OCV effect and improve the accuracy of parameter estimation. Then, its numerical stability, modeling error, and parametric sensitivity are analyzed at different sampling rates (0.02, 0.1, 0.5 and 1 s). To identify the model parameters recursively, a bias-correction recursive least squares (CRLS) algorithm is applied. Finally, the pseudo random binary sequence (PRBS) and urban dynamic driving sequences (UDDSs) profiles are performed to verify the realtime performance and robustness of the newly proposed model and algorithm. Different sampling rates (1 Hz and 10 Hz) and multiple temperature points (5, 25, and 45 °C) are covered in our experiments. The experimental and simulation results indicate that the proposed I-ARX model can present high accuracy and suitability for parameter identification without using open circuit voltage.

Magma interaction in the root of an arc batholith

NASA Astrophysics Data System (ADS)

Chapman, T.; Robbins, V.; Clarke, G. L.; Daczko, N. R.; Piazolo, S.

2016-12-01

Fiordland, New Zealand, preserves extensive Cretaceous arc plutons, emplaced into parts of the Delamerian/Ross Orogen. Dioritic to gabbroic material emplaced at mid to lower crustal levels are exposed in the Malaspina Pluton (c. 1.2 GPa) and the Breaksea Orthogneiss (c. 1.8 GPa). Distinct magmatic pulses can be mapped in both of these plutons consistent with cycles of melt advection. Relationships are consistent with predictions from lower crustal processing zones (MASH and hot zones) considered important in the formation of Cordilleran margins. Metamorphic garnet growth is enhanced along magmatic contacts, such as where hornblende gabbronorite is cut by garnet-clinopyroxene-bearing diorite. Such features are consistent with cycles of incremental emplacement, younger magma having induced localised garnet granulite metamorphism in wall rock of older material. Temperature estimates and microstructures preserved in garnet granulite are consistent with sub-solidus, water-poor conditions in both the Malaspina and Breaksea Orthogneiss. The extent and conditions of the metamorphism implies conditions and duration was incapable of partially melting older wall rock material. The nature of interactions in intermediate to basic compositions are assessed in terms of magma genesis in the Cretaceous batholith. Most of the upper crustal felsic I-type magmatism along the margin being controlled by high-pressure garnet-clinopyroxene fractionation.

Bayesian inference based on stationary Fokker-Planck sampling.

PubMed

Berrones, Arturo

2010-06-01

A novel formalism for bayesian learning in the context of complex inference models is proposed. The method is based on the use of the stationary Fokker-Planck (SFP) approach to sample from the posterior density. Stationary Fokker-Planck sampling generalizes the Gibbs sampler algorithm for arbitrary and unknown conditional densities. By the SFP procedure, approximate analytical expressions for the conditionals and marginals of the posterior can be constructed. At each stage of SFP, the approximate conditionals are used to define a Gibbs sampling process, which is convergent to the full joint posterior. By the analytical marginals efficient learning methods in the context of artificial neural networks are outlined. Offline and incremental bayesian inference and maximum likelihood estimation from the posterior are performed in classification and regression examples. A comparison of SFP with other Monte Carlo strategies in the general problem of sampling from arbitrary densities is also presented. It is shown that SFP is able to jump large low-probability regions without the need of a careful tuning of any step-size parameter. In fact, the SFP method requires only a small set of meaningful parameters that can be selected following clear, problem-independent guidelines. The computation cost of SFP, measured in terms of loss function evaluations, grows linearly with the given model's dimension.

Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department.

PubMed

Neighbors, Charles J; Barnett, Nancy P; Rohsenow, Damaris J; Colby, Suzanne M; Monti, Peter M

2010-05-01

Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained. Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases. Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates. This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

[Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy].

PubMed

Machado, Flávia Mori Sarti; Simões, Arlete Naresse

2008-02-01

To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

Patterns of oxygen consumption during simultaneously occurring elevated metabolic states in the viviparous snake Thamnophis marcianus.

PubMed

Jackson, Alexander G S; Leu, Szu-Yun; Ford, Neil B; Hicks, James W

2015-11-01

Snakes exhibit large factorial increments in oxygen consumption during digestion and physical activity, and long-lasting sub-maximal increments during reproduction. Under natural conditions, all three physiological states may occur simultaneously, but the integrated response is not well understood. Adult male and female checkered gartersnakes (Thamnophis marcianus) were used to examine increments in oxygen consumption (i.e. V̇(O2)) and carbon dioxide production (i.e. V̇(CO2)) associated with activity (Act), digestion (Dig) and post-prandial activity (Act+Dig). For females, we carried out these trials in the non-reproductive state, and also during the vitellogenic (V) and embryogenic (E) phases of a reproductive cycle. Endurance time (i.e. time to exhaustion, TTE) was recorded for all groups during Act and Act+Dig trials. Our results indicate that male and non-reproductive female T. marcianus exhibit significant increments in V̇(O2) during digestion (∼5-fold) and activity (∼9-fold), and that Act+Dig results in a similar increment in V̇(O2) (∼9- to 10-fold). During reproduction, resting V̇(O2) increased by 1.6- to 1.7-fold, and peak increments during digestion were elevated by 30-50% above non-reproductive values, but values associated with Act and Act+Dig were not significantly different from non-reproductive values. During Act+Dig, endurance time remained similar for all of the groups in the present study. Overall, our results indicate that prioritization is the primary pattern of interaction in oxygen delivery exhibited by this species. We propose that the metabolic processes associated with digestion, and perhaps reproduction, are temporarily compromised during activity. © 2015. Published by The Company of Biologists Ltd.

Achieving a “Grand Convergence” in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030

PubMed Central

Boyle, Colin F.; Levin, Carol; Hatefi, Arian; Madriz, Solange; Santos, Nicole

2015-01-01

Background The Commission on Investing in Health published its report, GlobalHealth2035, in 2013, estimating an investment case for a grand convergence in health outcomes globally. In support of the drafting of the Sustainable Development Goals (SDGs), we estimate what the grand convergence investment case might achieve—and what investment would be required—by 2030. Methods and Findings Our projection focuses on a sub-set of low-income (LIC) or lower-middle-income countries (LMIC). We start with a country-based (bottom-up) analysis of the costs and impact of scaling up reproductive, maternal, and child health tools, and select HIV and malaria interventions. We then incorporate global (top-down) analyses of the costs and impacts of scaling up existing tools for tuberculosis, additional HIV interventions, the costs to strengthen health systems, and the costs and benefits from scaling up new health interventions over the time horizon of this forecast. These data are then allocated to individual countries to provide an aggregate projection of potential cost and impact at the country level. Finally, incremental costs of R&D for low-income economies and the costs of addressing NTDs are added to provide a global total cost estimate of the investment scenario. Results Compared with a constant coverage scenario, there would be more than 60 million deaths averted in LIC and 70 million deaths averted in LMIC between 2016 and 2030. For the years 2015, 2020, 2025, and 2030, the incremental costs of convergence in LIC would be (US billion) $24.3, $21.8, $24.7, and $27, respectively; in LMIC, the incremental costs would be (US billion) $34.75, $38.9, $48.7, and $56.3, respectively. Conclusion Key health outcomes in low- and low-middle income countries can significantly converge with those of wealthier countries by 2030, and the notion of a “grand convergence” may serve as a unifying theme for health indicators in the SDGs. PMID:26452263

Achieving a "Grand Convergence" in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030.

PubMed

Boyle, Colin F; Levin, Carol; Hatefi, Arian; Madriz, Solange; Santos, Nicole

2015-01-01

The Commission on Investing in Health published its report, GlobalHealth2035, in 2013, estimating an investment case for a grand convergence in health outcomes globally. In support of the drafting of the Sustainable Development Goals (SDGs), we estimate what the grand convergence investment case might achieve-and what investment would be required-by 2030. Our projection focuses on a sub-set of low-income (LIC) or lower-middle-income countries (LMIC). We start with a country-based (bottom-up) analysis of the costs and impact of scaling up reproductive, maternal, and child health tools, and select HIV and malaria interventions. We then incorporate global (top-down) analyses of the costs and impacts of scaling up existing tools for tuberculosis, additional HIV interventions, the costs to strengthen health systems, and the costs and benefits from scaling up new health interventions over the time horizon of this forecast. These data are then allocated to individual countries to provide an aggregate projection of potential cost and impact at the country level. Finally, incremental costs of R&D for low-income economies and the costs of addressing NTDs are added to provide a global total cost estimate of the investment scenario. Compared with a constant coverage scenario, there would be more than 60 million deaths averted in LIC and 70 million deaths averted in LMIC between 2016 and 2030. For the years 2015, 2020, 2025, and 2030, the incremental costs of convergence in LIC would be (US billion) $24.3, $21.8, $24.7, and $27, respectively; in LMIC, the incremental costs would be (US billion) $34.75, $38.9, $48.7, and $56.3, respectively. Key health outcomes in low- and low-middle income countries can significantly converge with those of wealthier countries by 2030, and the notion of a "grand convergence" may serve as a unifying theme for health indicators in the SDGs.

Uptake of Hepatitis C Screening, Characteristics of Patients Tested, and Intervention Costs in the BEST-C Study

PubMed Central

Brady, Joanne E.; Liffmann, Danielle K.; Yartel, Anthony; Kil, Natalie; Federman, Alex D.; Kannry, Joseph; Jordan, Cynthia; Massoud, Omar I.; Nerenz, David R; Brown, Kimberly A.; Smith, Bryce D.; Vellozzi, Claudia; Rein, David B.

2017-01-01

Background From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. Rationale To estimate the effects of interventions conducted as part of the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C study on hepatitis C virus (HCV) testing and costs among persons of the 1945–1965 birth-cohort (BC). Main Results Intervention resulted in substantially higher HCV testing rates compared to standard-of-care (26.9% vs. 1.4% for repeated-mailing, 30.9% vs. 3.6% for BPA, and 63.5% vs. 2.0% for patient-solicitation), and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% Confidence Interval (CI) 9.7–38.2] for repeated-mailing, 13.2 [95% CI 3.6–48.6] for BPA, and 32.9 [95% CI 19.3–56.1] for patient-solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1,691). Conclusion HCV testing interventions resulted in an increase in BC testing compared to standard-of-care but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared to the other interventions. PMID:27770543

Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study.

PubMed

Brady, Joanne E; Liffmann, Danielle K; Yartel, Anthony; Kil, Natalie; Federman, Alex D; Kannry, Joseph; Jordan, Cynthia; Massoud, Omar I; Nerenz, David R; Brown, Kimberly A; Smith, Bryce D; Vellozzi, Claudia; Rein, David B

2017-01-01

From December 2012 to March 2014, three randomized trials, each implementing a unique intervention in primary care settings (repeated mailing, an electronic health record best practice alert [BPA], and patient solicitation), evaluated hepatitis C virus (HCV) antibody testing, diagnosis, and costs for each of the interventions compared with standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. The goal of this study was to estimate the effects of interventions conducted as part of the Birth-Cohort Evaluation to Advance Screening and Testing for Hepatitis C study on HCV testing and costs among persons of the 1945-1965 birth cohort (BC). Intervention resulted in substantially higher HCV testing rates compared with standard-of-care testing (26.9% versus 1.4% for repeated mailing, 30.9% versus 3.6% for BPA, and 63.5% versus 2.0% for patient solicitation) and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% confidence interval (CI), 9.7-38.2] for repeated mailing, 13.2 [95% CI, 3.6-48.6] for BPA, and 32.9 [95% CI, 19.3-56.1] for patient solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1691). HCV testing interventions resulted in an increase in BC testing compared with standard-of-care testing but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared with the other interventions. (Hepatology 2017;65:44-53). © 2016 by the American Association for the Study of Liver Diseases.

The cost-effectiveness of targeted or universal screening for vasa praevia at 18-20 weeks of gestation in Ontario.

PubMed

Cipriano, L E; Barth, W H; Zaric, G S

2010-08-01

To estimate the cost-effectiveness of targeted and universal screening for vasa praevia at 18-20 weeks of gestation in singleton and twin pregnancies. Cost-utility analysis based on a decision-analytic model comparing relevant strategies and life-long outcomes for mother and infant(s). Ontario, Canada. A cohort of pregnant women in 1 year. We constructed a decision-analytic model to estimate the lifetime incremental costs and benefits of screening for vasa praevia. Inputs were estimated from the literature. Costs were collected from the London Health Sciences Centre, the Ontario Health Insurance Program, and other sources. We used one-way, scenario and probabilistic sensitivity analysis to determine the robustness of the results. Incremental costs, life expectancy, quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER). Universal transvaginal ultrasound screening of twin pregnancies has an ICER of $5488 per QALY-gained. Screening all singleton pregnancies with the risk factors low-lying placentas, in vitro fertilisation (IVF) conception, accessory placental lobes, or velamentous cord insertion has an ICER of $15,764 per QALY-gained even though identifying some of these risk factors requires routine use of colour Doppler during transabdominal examinations. Screening women with a marginal cord insertion costs an additional $27,603 per QALY-gained. Universal transvaginal screening for vasa praevia in singleton pregnancies costs $579,164 per QALY compared with targeted screening. Compared with current practice, screening all twin pregnancies for vasa praevia with transvaginal ultrasound is cost-effective. Among the alternatives considered, the use of colour Doppler at all transabdominal ultrasound examinations of singleton pregnancies and targeted use of transvaginal ultrasound for IVF pregnancies or when the placenta has been found to be associated with one or more risk factors is cost-effective. Universal screening of singleton pregnancies is not cost-effective compared with targeted screening.

Disentangling the effect of atmospheric CO2 enrichment on the halophyte Salicornia ramosissima J. Woods physiological performance under optimal and suboptimal saline conditions.

PubMed

Pérez-Romero, Jesús Alberto; Idaszkin, Yanina Lorena; Barcia-Piedras, Jose-Maria; Duarte, Bernardo; Redondo-Gómez, Susana; Caçador, Isabel; Mateos-Naranjo, Enrique

2018-06-01

A mesocosm experiment was designed to assess the effect of atmospheric CO 2 increment on the salinity tolerance of the C 3 halophyte Salicornia ramosissima. Thus, the combined effect of 400 ppm and 700 ppm CO 2 at 0, 171 and 510 mM NaCl on plants growth, gas exchange, chlorophyll fluorescence parameters, pigments profiles, antioxidative enzyme activities and water relations was studied. Our results highlighted a positive effect of atmospheric CO 2 increment on plant physiological performance under suboptimal salinity concentration (510 mM NaCl). Thus, we recorded higher net photosynthetic rate (A N ) values under saline conditions and 700 ppm CO 2 , being this effect mainly mediated by a reduction of mesophyll (g m ) and biochemical limitation imposed to salt excess. In addition, rising atmospheric CO 2 led to a better plant water balance, linked with a reduction of stomatal conductante (g s ) and an overall increment of osmotic potential (Ѱ o ) with NaCl concentration increment. In spite of these positive effects, there were no significant biomass variations between any treatments. Being this fact ascribed by the investment of the higher energy fixed for salinity stress defence mechanisms, which allowed plants to maintain more active the photochemical machinery even at high salinities, reducing the risk of ROS production, as indicated an improvement of the electron flux and a rise of the energy dissipation. Finally, the positive effect of the CO 2 was also supported by the modulation of pigments profiles (mainly zeaxhantin and violaxhantin) concentrations and anti-oxidative stress enzymes, such as superoxide dismutase (SOD) and ascorbate peroxidase (APx). Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The impact of therapeutic reference pricing on innovation in cardiovascular medicine.

PubMed

Sheridan, Desmond; Attridge, Jim

2006-12-01

Therapeutic reference pricing (TRP) places medicines to treat the same medical condition into groups or 'clusters' with a single common reimbursed price. Underpinning this economic measure is an implicit assumption that the products included in the cluster have an equivalent effect on a typical patient with this disease. 'Truly innovative' products can be exempt from inclusion in the cluster. This increasingly common approach to cost containment allocates products into one of two categories - truly innovative or therapeutically equivalent. This study examines the implications of TRP against the step-wise evolution of drugs for cardiovascular conditions over the past 50 years. It illustrates the complex interactions between advances in understanding of cellular and molecular disease mechanisms, diagnostic techniques, treatment concepts, and the synthesis, testing and commercialisation of products. It confirms the highly unpredictable and incremental nature of the innovation process. Medical progress in terms of improvement in patient outcomes over the long-term depends on the cumulative effect of year after year of painstaking incremental advances. It shows that the parallel processes of advances in scientific knowledge and the industrial 'investment-innovative cycle' involve highly developed sets of complementary capabilities and resources. A framework is developed to assess the impact of TRP upon research and development investment decisions and the development of therapeutic classes. We conclude that a simple categorisation of products as either 'truly innovative' or 'therapeutically equivalent' is inconsistent with the incremental processes of innovation and the resulting differentiated product streams revealed by our analysis. Widespread introduction of TRP would probably have prematurely curtailed development of many incremental innovations that became the preferred 'product of choice' by physicians for some indications and patients in managing the incidence of cardiovascular disease.

Regionalization of precipitation characteristics in Montana using L-moments

USGS Publications Warehouse

Parrett, C.

1998-01-01

Dimensionless precipitation-frequency curves for estimating precipitation depths having small exceedance probabilities were developed for 2-, 6-, and 24-hour storm durations for three homogeneous regions in Montana. L-moment statistics were used to help define the homogeneous regions. The generalized extreme value distribution was used to construct the frequency curves for each duration within each region. The effective record length for each duration in each region was estimated using a graphical method and was found to range from 500 years for 6-hour duration data in Region 2 to 5,100 years for 24-hour duration data in Region 3. The temporal characteristics of storms were analyzed, and methods for estimating synthetic storm hyetographs were developed. Dimensionless depth-duration data were grouped by independent duration (2,6, and 24 hours) and by region, and the beta distribution was fit to dimensionless depth data for various incremental time intervals. Ordinary least-squares regression was used to develop relations between dimensionless depths for a key, short duration - termed the kernel duration - and dimensionless depths for other durations. The regression relations were used, together with the probabilistic dimensionless depth data for the kernel duration, to calculate dimensionless depth-duration curves for exceedance probabilities from .1 to .9. Dimensionless storm hyetographs for each independent duration in each region were constructed for median value conditions based on an exceedance probability of .5.

Are Early-Life Socioeconomic Conditions Directly Related to Birth Outcomes? Grandmaternal Education, Grandchild Birth Weight, and Associated Bias Analyses

PubMed Central

Huang, Jonathan Y.; Gavin, Amelia R.; Richardson, Thomas S.; Rowhani-Rahbar, Ali; Siscovick, David S.; Enquobahrie, Daniel A.

2015-01-01

Grandmaternal education may be related to grandchild birth weight (GBW) through maternal early-life development; however, conventional regression models may be endogenously confounded. Alternative models employing explicit structural assumptions may provide incrementally clearer evidence. We used data from the US National Longitudinal Study of Adolescent to Adult Health (1995–2009; 1,681 mother-child pairs) to estimate “direct effects” of grandmaternal educational level (less than high school, high school diploma or equivalent, or college degree) at the time of the mother's birth on GBW, adjusted for maternal life-course factors: maltreatment as a child, education and income as an adult, prepregnancy overweight, and prenatal smoking. Using conventional and marginal structural model (MSM) approaches, we estimated 54-g (95% confidence interval: −14.0, 122.1) and 87-g (95% confidence interval: 10.9, 162.5) higher GBWs per increase in educational level, respectively. The MSM allowed simultaneous mediation by and adjustment for prepregnancy overweight. Estimates were insensitive to alternate structural assumptions and mediator parameterizations. Bias analysis suggested that a single unmeasured confounder would have to have a strong influence on GBW (approximately 150 g) or be greatly imbalanced across exposure groups (approximately 25%) to completely explain the findings. Coupling an MSM with sensitivity analyses provides some evidence that maternal early-life socioeconomic environment is directly associated with offspring birth weight. PMID:26283086

Direct medical expenditure associated with rheumatoid arthritis in a nationally representative sample from the medical expenditure panel survey.

PubMed

Kawatkar, Aniket A; Jacobsen, Steven J; Levy, Gerald D; Medhekar, Swati S; Venkatasubramaniam, Kumarapuram V; Herrinton, Lisa J

2012-11-01

To quantify the incremental direct medical expenditure associated with rheumatoid arthritis (RA) in the US population from a payer's perspective. A probability-weighted sample of adult respondents from the Medical Expenditure Panel Survey (2008) was used to identify a cohort of patients with RA and compared to a control cohort without RA. Annual expenditure outcomes, including total expenditure and subgroups related to pharmacy, office-based visits, emergency department visits, hospital inpatient stays, and residual expenditures were estimated. Differences between the RA and control cohort were adjusted for sociodemographic factors, employment status, insurance coverage, health behavior, and health status using a generalized linear model with log link and gamma distribution. Statistical inferences on difference in expenditures between RA and non-RA controls were based on nonparametric cluster bootstrapping using percentiles. The adjusted average annual total expenditure of the RA cohort in 2008 US dollars (USD) was $13,012 (95% confidence interval [95% CI] $1,737-$47,081), while that of the control cohort was $4,950 (95% CI $567-$17,425). The incremental total expenditure of the RA patients as compared to non-RA controls was $2,085 (95% CI $250-$7,822). RA patients also had a significantly higher pharmacy expenditure of $5,825 (95% CI $446-$30,998) that was on average $1,380 (95% CI $94-$7,492) higher as compared to the controls. The summated total incremental expenditure of all RA patients in the US was $22.3 billion (2008 USD). RA exerts considerable incremental economic burden on US health care, which is primarily driven by the incremental pharmacy expenditure. Copyright © 2012 by the American College of Rheumatology.

The cost-effectiveness of dapagliflozin versus sulfonylurea as an add-on to metformin in the treatment of Type 2 diabetes mellitus.

PubMed

Charokopou, M; McEwan, P; Lister, S; Callan, L; Bergenheim, K; Tolley, K; Postema, R; Townsend, R; Roudaut, M

2015-07-01

To assess the cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea, when added to metformin for treatment of UK people with Type 2 diabetes mellitus inadequately controlled on metformin alone. Clinical inputs sourced from a head-to-head randomized controlled trial (RCT) informed the Cardiff diabetes decision model. Risk equations developed from the United Kingdom Prospective Diabetes Study (UKPDS) were used in conjunction with the clinical inputs to predict disease progression and the incidence of micro- and macrovascular complications over a lifetime horizon. Cost and utility data were generated to present the incremental cost-effectiveness ratio (ICER) for both treatment arms, and sensitivity and scenario analyses were conducted to assess the impact of uncertainty on the final model results. The dapagliflozin treatment arm was associated with a mean incremental benefit of 0.467 quality-adjusted life years (QALYs) [95% confidence interval (CI): 0.420; 0.665], with an incremental cost of £1246 (95% CI: £613; £1637). This resulted in an ICER point estimate of £2671 per QALY gained. Incremental costs were shown to be insensitive to parameter variation, with only treatment-related weight change having a significant impact on the incremental QALYs. Probabilistic sensitivity analysis determined that dapagliflozin had a 100% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY. Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option compared with sulfonylurea from a UK healthcare perspective for people with Type 2 diabetes mellitus who are inadequately controlled on metformin monotherapy. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

An indirect comparison and cost per responder analysis of adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis.

PubMed

Betts, Keith A; Griffith, Jenny; Friedman, Alan; Zhou, Zheng-Yi; Signorovitch, James E; Ganguli, Arijit

2016-01-01

Apremilast was recently approved for the treatment of active psoriatic arthritis (PsA). However, no studies compare apremilast with methotrexate or biologic therapies, so its relative comparative efficacy remains unknown. This study compared the response rates and incremental costs per responder associated with methotrexate, apremilast, and biologics for the treatment of active PsA. A systematic literature review was performed to identify phase 3 randomized controlled clinical trials of approved biologics, methotrexate, and apremilast in the methotrexate-naïve PsA population. Using Bayesian methods, a network meta-analysis was conducted to indirectly compare rates of achieving a ≥20% improvement in American College of Rheumatology component scores (ACR20). The number needed to treat (NNT) and the incremental costs per ACR20 responder (2014 US$) relative to placebo were estimated for each of the therapies. Three trials (MIPA for methotrexate, PALACE-4 for apremilast, and ADEPT for adalimumab) met all inclusion criteria. The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. Among methotrexate-naïve PsA patients, the 16 week incremental costs per ACR20 responder were $3622 for methotrexate, $26,316 for adalimumab, and $45,808 for apremilast. The incremental costs per ACR20 responder were $222,488 for apremilast vs. methotrexate. Among methotrexate-naive PsA patients, adalimumab was found to have the lowest NNT for one additional ACR20 response and methotrexate was found to have the lowest incremental costs per ACR20 responder. There was no statistical evidence of greater efficacy for apremilast vs. methotrexate. A head-to-head trial between apremilast and methotrexate is recommended to confirm this finding.

Maximal lactate steady state determination with a single incremental test exercise.

PubMed

Laplaud, David; Guinot, Michel; Favre-Juvin, Anne; Flore, Patrice

2006-03-01

The aim of this study was to determine whether the power output associated with a maximal lactate steady state (MLSS) (.W(MLSS)) can be assessed using a single incremental cycling test. Eleven recreational sportsmen (age: 22+/-1 years, height: 175+/-6 cm, weight: 71+/-5 kg) volunteered to participate in the study. For each subject the first and second ventilatory thresholds (VT(1) and VT(2), respectively) and the power output corresponding to (respiratory exchange ratio) RER=1.00 were determined during an incremental test to exhaustion. Thereafter, each subject performed several 30-min constant load tests to determine MLSS. The workload used in the first constant test was set to the .W(RER=1.00) determined during the incremental test. .W(VT1) (175+/-24 W) and .W(VT2) (265+/-31 W) were significantly different from .W(MLSS )(220+/-36 W). Whereas, .W(RER=1.00) (224+/-33 W) was similar to .W(MLSS). HR, RER and .VE were significantly different between the 10th and the 30th minutes when exercising at .W(RER=1.00) and at .W(MLSS). In contrast, .VO(2) and .VCO(2) were stable over those 30-min constant tests. Power output at VT(1), RER=1.00 and VT(2) were all correlated to .W(MLSS) but the relationship was stronger between RER=1.00 and MLSS (R (2)=0.95). The present study shows that the power output associated with a RER value equal to 1.00 during an incremental test does not differ from that determined for MLSS. Hence, the MLSS can be estimated with a single exercise test.

Performance analysis of ‘Perturb and Observe’ and ‘Incremental Conductance’ MPPT algorithms for PV system

NASA Astrophysics Data System (ADS)

Lodhi, Ehtisham; Lodhi, Zeeshan; Noman Shafqat, Rana; Chen, Fieda

2017-07-01

Photovoltaic (PV) system usually employed The Maximum power point tracking (MPPT) techniques for increasing its efficiency. The performance of the PV system perhaps boosts by controlling at its apex point of power, in this way maximal power can be given to load. The proficiency of a PV system usually depends upon irradiance, temperature and array architecture. PV array shows a non-linear style for V-I curve and maximal power point on V-P curve also varies with changing environmental conditions. MPPT methods grantees that a PV module is regulated at reference voltage and to produce entire usage of the maximal output power. This paper gives analysis between two widely employed Perturb and Observe (P&O) and Incremental Conductance (INC) MPPT techniques. Their performance is evaluated and compared through theoretical analysis and digital simulation on the basis of response time and efficiency under varying irradiance and temperature condition using Matlab/Simulink.

Performance degradation of helicopter rotor in forward flight due to ice

NASA Technical Reports Server (NTRS)

Korkan, K. D.; Dadone, L.; Shaw, R. J.

1985-01-01

This study addresses the analytical assessment of the degradation in the forward flight performance of the front rotor Boeing Vertol CH47D helicopter in a rime ice natural icing encounter. The front rotor disk was divided into 24 15-deg sections and the local Mach number and angle of attack were evaluated as a function of azimuthal and radial location for a specified flight condition. Profile drag increments were then calculated as a function of azimuthal and radial position for different times of exposure to icing, and the rotor performance was re-evaluated including these drag increments. The results of the analytical prediction method, such as horsepower required to maintain a specific flight condition, as a function of icing time have been generated. The method to illustrate the value of such an approach in assessing performance changes experienced by a helicopter rotor as a result of rime ice accretion is described.

Making judgments about ability: the role of implicit theories of ability in moderating inferences from temporal and social comparison information.

PubMed

Butler, R

2000-05-01

Two studies examined the novel proposal that implicit theories of intelligence (C. S. Dweck & E. L. Leggett, 1988) moderate both the effects of performance trends on ability inferences and the perceived diagnosticity of temporal versus normative feedback. Results from 613 adolescents and 42 teachers confirmed that entity theorists perceived initial outcome as more diagnostic and inferred higher ability in another (Study 1) and in the self (Study 2) in a declining outcome condition; incremental theorists perceived last outcome as more diagnostic and inferred higher ability in an ascending condition. Experimental induction of beliefs about ability had similar effects. As predicted, self-appraisal was affected more by temporal feedback among incremental theorists and by normative feedback among entity theorists. Results help resolve prior mixed findings regarding order effects and responses to temporal and normative evaluation.

Repeated administration of LiCl produces an unconditioned stimulus preexposure effect in backward excitatory CTA but not habituation of the unconditioned increment in neophobia.

PubMed

De Brugada, Isabel; González, Felisa; Cándido, Antonio

2003-01-31

In one experiment using conditioned taste aversion and the unconditioned stimulus (US) preexposure procedure, one group of rats was given LiCl exposure for 3 days, whereas two other groups received saline. Following this phase, all groups were given a novel flavour (saccharine) to drink following either LiCl (group preexposed and one of the control groups) or saline injections (the remaining control group) and the consumption of the flavour was assessed. After this neophobia test, the acquired saccharine aversion was evaluated. The results show that three LiCl injections are enough to produce a US preexposure effect on backward excitatory taste aversion conditioning, whereas this number of injections procedure does not produce habituation of the increment in neophobia, an unconditioned response to the LiCl. The results are discussed taking into account different mechanisms involved in US preexposure effect.

Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading--evidence to guide future screening strategies.

PubMed

Houssami, Nehmat; Macaskill, Petra; Bernardi, Daniela; Caumo, Francesca; Pellegrini, Marco; Brunelli, Silvia; Tuttobene, Paola; Bricolo, Paola; Fantò, Carmine; Valentini, Marvi; Ciatto, Stefano

2014-07-01

We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-mammography or 2D/3D-mammography, based on the 'screening with tomosynthesis or standard mammography' (STORM) trial. STORM prospectively examined screen-reading in two sequential phases, 2D-mammography alone and integrated 2D/3D-mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each mammography screening strategy. Paired binary data were compared using McNemar's test. Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30-1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-mammography, 20 cancers were detected only with 2D/3D-mammography compared with none at 2D-mammography alone (p<0.001) and 10 cancers were not detected. For double-reading, 39 cancers were detected at 2D-mammography and 2D/3D-mammography, 20 were detected only with 2D/3D-mammography compared with none detected at 2D-mammography alone (p<0.001) and six cancers were not detected. The incremental CDR attributable to 2D/3D-mammography (versus 2D-mammography) of 2.7/1000 screens (95% CI: 1.6-4.2) was evident for single and for double-reading. Incremental CDR attributable to double-reading (versus single-reading) of 0.55/1000 screens (95% CI: -0.02-1.4) was evident for 2D-mammography and for 2D/3D-mammography. Estimated FP:TP ratios showed that 2D/3D-mammography screening strategies had more favourable FP to TP trade-off and higher sensitivity, applying single-reading or double-reading, relative to 2D-mammography screening. The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Real-world and trial-based cost-effectiveness analysis of bevacizumab in HER2-negative metastatic breast cancer patients: a study of the Southeast Netherlands Breast Cancer Consortium.

PubMed

van Kampen, R J W; Ramaekers, B L T; Lobbezoo, D J A; de Boer, M; Dercksen, M W; van den Berkmortel, F; Smilde, T J; van de Wouw, A J; Peters, F P J; van Riel, J M G; Peters, N A J B; Tjan-Heijnen, V C G; Joore, M A

2017-07-01

The aim of our analysis was to assess the real-world cost-effectiveness of bevacizumab in addition to taxane treatment versus taxane monotherapy for HER2-negative metastatic breast cancer compared with the cost-effectiveness based on the efficacy results from a trial. A state transition model was built to estimate costs, life years (LYs) and quality-adjusted life years (QALYs) for both treatments. Two scenarios were examined: a real-world scenario and a trial-based scenario in which transition probabilities were primarily based on a real-world cohort study and the E2100 trial, respectively. In both scenarios, costs and utility parameter estimates were extracted from the real-world cohort study. Moreover, the Dutch health care perspective was adopted. In both the real-world and trial scenarios, bevacizumab-taxane is more expensive (incremental costs of €56,213 and €52,750, respectively) and more effective (incremental QALYs of 0.362 and 0.189, respectively) than taxane monotherapy. In the real-world scenario, bevacizumab-taxane compared to taxane monotherapy led to an incremental cost-effectiveness ratio (ICER) of €155,261 per QALY gained. In the trial scenario, the ICER amounted to €278,711 per QALY gained. According to the Dutch informal threshold, bevacizumab in addition to taxane treatment was not considered cost-effective for HER2-negative metastatic breast cancer both in a real-world and in a trial scenario. Copyright © 2017 Elsevier Ltd. All rights reserved.

Operational and financial impact of physician screening in the ED.

PubMed

Soremekun, Olanrewaju A; Biddinger, Paul D; White, Benjamin A; Sinclair, Julia R; Chang, Yuchiao; Carignan, Sarah B; Brown, David F M

2012-05-01

Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. We aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center. We conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS. During the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%. In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact. Copyright © 2012 Elsevier Inc. All rights reserved.

Associated with Health Care-Associated Infections in Cardiac Surgery

PubMed Central

Greco, Giampaolo; Shi, Wei; Michler, Robert E.; Meltzer, David O.; Ailawadi, Gorav; Hohmann, Samuel F.; Thourani, Vinod; Argenziano, Michael; Alexander, John; Sankovic, Kathy; Gupta, Lopa; Blackstone, Eugene H.; Acker, Michael A.; Russo, Mark J.; Lee, Albert; Burks, Sandra G.; Gelijns, Annetine C.; Bagiella, Emilia; Moskowitz, Alan J.; Gardner, Timothy J.

2014-01-01

BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES To determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data, routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, adjusting for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients, mean age of 64 ± 13 years, 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%) and C. Difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions, among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAI was on average nearly three times as much as readmissions not related to HAI. CONCLUSIONS Hospital cost, length of stay, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. PMID:25572505

Coupling Adaptation Tipping Points and Engineering Options: New Insights for Resilient Water Infrastructure Replacement Planning

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2017-12-01

This work presents an innovative approach for replacement planning for aging water infrastructure given uncertain future conditions. We draw upon two existing methodologies to develop an integrated long-term replacement planning framework. We first expand the concept of Adaptation Tipping Points to generate long-term planning timelines that incorporate drivers of investment related to both internal structural processes as well as changes in external operating conditions. Then, we use Engineering Options to explore different actions taken at key moments in this timeline. Contrasting to the traditionally more static approach to infrastructure design, designing the next generation of infrastructure so it can be changed incrementally is a promising method to safeguard current investments given future uncertainty. This up-front inclusion of structural options in the system actively facilitates future adaptation, transforming uncertainty management in infrastructure planning from reactive to more proactive. A two-part model underpins this approach. A simulation model generates diverse future conditions, allowing development of timelines of intervention moments in the structure's life. This feeds into an economic model, evaluating the lifetime performance of different replacement strategies, making explicit the value of different designs and their flexibility. A proof of concept study demonstrates this approach for a pumping station. The strategic planning timelines for this structure demonstrate that moments when capital interventions become necessary due to reduced functionality from structural degradation or changed operating conditions are widely spread over the structure's life. The disparate timing of these necessary interventions supports an incremental, adaptive mindset when considering end-of-life and replacement decisions. The analysis then explores different replacement decisions, varying the size and specific options included in the proposed new structure. Results show that incremental adaptive designs and incorporating options can improve economic performance, as compared to traditional, "build it once & build it big" designs. The benefit from incorporating flexibility varies with structural functionality, future conditions and the specific options examined.

Sleep Disruption Medical Intervention Forecasting (SDMIF) Module for the Integrated Medical Model

NASA Technical Reports Server (NTRS)

Lewandowski, Beth; Brooker, John; Mallis, Melissa; Hursh, Steve; Caldwell, Lynn; Myers, Jerry

2011-01-01

The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.

Response rate and reinforcement rate in Pavlovian conditioning.

PubMed

Harris, Justin A; Carpenter, Joanne S

2011-10-01

Four experiments used delay conditioning of magazine approach in rats to investigate the relationship between the rate of responding, R, to a conditioned stimulus (CS) and the rate, r, at which the CS is reinforced with the unconditioned stimulus (US). Rats were concurrently trained with four variable-duration CSs with different rs, either as a result of differences in the mean CS-US interval or in the proportion of CS presentations that ended with the US. In each case, R was systematically related to r, and the relationship was very accurately characterized by a hyperbolic function, R = Ar/(r +c). Accordingly, the reciprocal of these two variables-response interval, I (= 1/R), and CS-US interval, i (= 1/r) - were related by a simple affine (straight line) transformation, I = mi+b. This latter relationship shows that each increment in the time that the rats had to wait for food produced a linear increment in the time they waited between magazine entries. We discuss the close agreement between our findings and the Matching Law (Herrnstein, 1970) and consider their implications for both associative theories (e.g., Rescorla & Wagner, 1972) and nonassociative theories (Gallistel & Gibbon, 2000) of conditioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved).