Fixed Base Modal Survey of the MPCV Orion European Service Module Structural Test Article

NASA Technical Reports Server (NTRS)

Winkel, James P.; Akers, J. C.; Suarez, Vicente J.; Staab, Lucas D.; Napolitano, Kevin L.

2017-01-01

Recently, the MPCV Orion European Service Module Structural Test Article (E-STA) underwent sine vibration testing using the multi-axis shaker system at NASA GRC Plum Brook Station Mechanical Vibration Facility (MVF). An innovative approach using measured constraint shapes at the interface of E-STA to the MVF allowed high-quality fixed base modal parameters of the E-STA to be extracted, which have been used to update the E-STA finite element model (FEM), without the need for a traditional fixed base modal survey. This innovative approach provided considerable program cost and test schedule savings. This paper documents this modal survey, which includes the modal pretest analysis sensor selection, the fixed base methodology using measured constraint shapes as virtual references and measured frequency response functions, and post-survey comparison between measured and analysis fixed base modal parameters.

Blind identification of full-field vibration modes of output-only structures from uniformly-sampled, possibly temporally-aliased (sub-Nyquist), video measurements

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

Yang, Yongchao; Dorn, Charles; Mancini, Tyler

Enhancing the spatial and temporal resolution of vibration measurements and modal analysis could significantly benefit dynamic modelling, analysis, and health monitoring of structures. For example, spatially high-density mode shapes are critical for accurate vibration-based damage localization. In experimental or operational modal analysis, higher (frequency) modes, which may be outside the frequency range of the measurement, contain local structural features that can improve damage localization as well as the construction and updating of the modal-based dynamic model of the structure. In general, the resolution of vibration measurements can be increased by enhanced hardware. Traditional vibration measurement sensors such as accelerometers havemore » high-frequency sampling capacity; however, they are discrete point-wise sensors only providing sparse, low spatial sensing resolution measurements, while dense deployment to achieve high spatial resolution is expensive and results in the mass-loading effect and modification of structure's surface. Non-contact measurement methods such as scanning laser vibrometers provide high spatial and temporal resolution sensing capacity; however, they make measurements sequentially that requires considerable acquisition time. As an alternative non-contact method, digital video cameras are relatively low-cost, agile, and provide high spatial resolution, simultaneous, measurements. Combined with vision based algorithms (e.g., image correlation or template matching, optical flow, etc.), video camera based measurements have been successfully used for experimental and operational vibration measurement and subsequent modal analysis. However, the sampling frequency of most affordable digital cameras is limited to 30–60 Hz, while high-speed cameras for higher frequency vibration measurements are extremely costly. This work develops a computational algorithm capable of performing vibration measurement at a uniform sampling frequency lower than what is required by the Shannon-Nyquist sampling theorem for output-only modal analysis. In particular, the spatio-temporal uncoupling property of the modal expansion of structural vibration responses enables a direct modal decoupling of the temporally-aliased vibration measurements by existing output-only modal analysis methods, yielding (full-field) mode shapes estimation directly. Then the signal aliasing properties in modal analysis is exploited to estimate the modal frequencies and damping ratios. Furthermore, the proposed method is validated by laboratory experiments where output-only modal identification is conducted on temporally-aliased acceleration responses and particularly the temporally-aliased video measurements of bench-scale structures, including a three-story building structure and a cantilever beam.« less

Blind identification of full-field vibration modes of output-only structures from uniformly-sampled, possibly temporally-aliased (sub-Nyquist), video measurements

DOE PAGES

Yang, Yongchao; Dorn, Charles; Mancini, Tyler; ...

2016-12-05

Enhancing the spatial and temporal resolution of vibration measurements and modal analysis could significantly benefit dynamic modelling, analysis, and health monitoring of structures. For example, spatially high-density mode shapes are critical for accurate vibration-based damage localization. In experimental or operational modal analysis, higher (frequency) modes, which may be outside the frequency range of the measurement, contain local structural features that can improve damage localization as well as the construction and updating of the modal-based dynamic model of the structure. In general, the resolution of vibration measurements can be increased by enhanced hardware. Traditional vibration measurement sensors such as accelerometers havemore » high-frequency sampling capacity; however, they are discrete point-wise sensors only providing sparse, low spatial sensing resolution measurements, while dense deployment to achieve high spatial resolution is expensive and results in the mass-loading effect and modification of structure's surface. Non-contact measurement methods such as scanning laser vibrometers provide high spatial and temporal resolution sensing capacity; however, they make measurements sequentially that requires considerable acquisition time. As an alternative non-contact method, digital video cameras are relatively low-cost, agile, and provide high spatial resolution, simultaneous, measurements. Combined with vision based algorithms (e.g., image correlation or template matching, optical flow, etc.), video camera based measurements have been successfully used for experimental and operational vibration measurement and subsequent modal analysis. However, the sampling frequency of most affordable digital cameras is limited to 30–60 Hz, while high-speed cameras for higher frequency vibration measurements are extremely costly. This work develops a computational algorithm capable of performing vibration measurement at a uniform sampling frequency lower than what is required by the Shannon-Nyquist sampling theorem for output-only modal analysis. In particular, the spatio-temporal uncoupling property of the modal expansion of structural vibration responses enables a direct modal decoupling of the temporally-aliased vibration measurements by existing output-only modal analysis methods, yielding (full-field) mode shapes estimation directly. Then the signal aliasing properties in modal analysis is exploited to estimate the modal frequencies and damping ratios. Furthermore, the proposed method is validated by laboratory experiments where output-only modal identification is conducted on temporally-aliased acceleration responses and particularly the temporally-aliased video measurements of bench-scale structures, including a three-story building structure and a cantilever beam.« less

Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

PubMed Central

Caruba, Thibaut; Katsahian, Sandrine; Schramm, Catherine; Charles Nelson, Anaïs; Durieux, Pierre; Bégué, Dominique; Juillière, Yves; Dubourg, Olivier

2014-01-01

Introduction and Objectives Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina. PMID:24896266

Low cost charged-coupled device (CCD) based detectors for Shiga toxins activity analysis

USDA-ARS?s Scientific Manuscript database

To improve food safety there is a need to develop simple, low-cost sensitive devices for detection of foodborne pathogens and their toxins. We describe a simple and relatively low-cost webcam-based detector which can be used for various optical detection modalities, including fluorescence, chemilumi...

Active control of panel vibrations induced by boundary-layer flow

NASA Technical Reports Server (NTRS)

Chow, Pao-Liu

1991-01-01

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

Alternating between pro- and antisaccades: switch-costs manifest via decoupling the spatial relations between stimulus and response.

PubMed

Heath, Matthew; Gillen, Caitlin; Samani, Ashna

2016-03-01

Antisaccades are a nonstandard task requiring a response mirror-symmetrical to the location of a target. The completion of an antisaccade has been shown to delay the reaction time (RT) of a subsequent prosaccade, whereas the converse switch elicits a null RT cost (i.e., the unidirectional prosaccade switch-cost). The present study sought to determine whether the prosaccade switch-cost arises from low-level interference specific to the sensory features of a target (i.e., modality-dependent) or manifests via the high-level demands of dissociating the spatial relations between stimulus and response (i.e., modality-independent). Participants alternated between pro- and antisaccades wherein the target associated with the response alternated between visual and auditory modalities. Thus, the present design involved task-switch (i.e., switching from a pro- to antisaccade and vice versa) and modality-switch (i.e., switching from a visual to auditory target and vice versa) trials as well as their task- and modality-repetition counterparts. RTs were longer for modality-switch than modality-repetition trials. Notably, however, modality-switch trials did not nullify or lessen the unidirectional prosaccade switch-cost; that is, the magnitude of the RT cost for task-switch prosaccades was equivalent across modality-switch and modality-repetition trials. Thus, competitive interference within a sensory modality does not contribute to the unidirectional prosaccade switch-cost. Instead, the modality-independent findings evince that dissociating the spatial relations between stimulus and response instantiates a high-level and inertially persistent nonstandard task-set that impedes the planning of a subsequent prosaccade.

Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease.

PubMed

Quist-Paulsen, Petter; Lydersen, Stian; Bakke, Per S; Gallefoss, Frode

2006-04-01

Smoking cessation is probably the most important action to reduce mortality after a coronary event. Smoking cessation programs are not widely implemented in patients with coronary heart disease, however, possibly because they are thought not to be worth their costs. Our objectives were to estimate the cost effectiveness of a smoking cessation program, and to compare it with other treatment modalities in cardiovascular medicine. A cost-effectiveness analysis was performed on the basis of a recently conducted randomized smoking cessation intervention trial in patients admitted for coronary heart disease. The cost per life year gained by the smoking cessation program was derived from the resources necessary to implement the program, the number needed to treat to get one additional quitter from the program, and the years of life gained if quitting smoking. The cost effectiveness was estimated in a low-risk group (i.e. patients with stable coronary heart disease) and a high-risk group (i.e. patients after myocardial infarction or unstable angina), using survival data from previously published investigations, and with life-time extrapolation of the survival curves by survival function modeling. In a lifetime perspective, the incremental cost per year of life gained by the smoking cessation program was euro 280 and euro 110 in the low and high-risk group, respectively (2000 prices). These costs compare favorably to other treatment modalities in patients with coronary heart disease, being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group. In a sensitivity analysis, the costs remained low in a wide range of assumptions. A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease.

Librarian instruction-delivery modality preferences for professional continuing education

PubMed Central

Lynn, Valerie A.; Bose, Arpita; Boehmer, Susan J.

2010-01-01

Objectives: Attending professional continuing education (CE) is an important component of librarianship. This research study identified librarians' preferences in delivery modalities of instruction for professional CE. The study also identified influential factors associated with attending CE classes. Methods: Five instruction-delivery modalities and six influential factors were identified for inclusion in an online survey. The survey completed by members of the American Library Association (ALA), Special Libraries Association (SLA), and Medical Library Association (MLA) provided the data for analysis of librarian preferences and influential factors. Results: The majority of respondents were MLA members, followed by ALA and SLA members. Librarians from all three library associations preferred the face-to-face instructional modality. The most influential factor associated with the decision to attend a professional CE class was cost. Conclusions: All five instruction-delivery modalities present useful structures for imparting professional CE. As librarians' experience with different modalities increases and as technology improves, preferences in instruction delivery may shift. But at present, face-to-face remains the most preferred modality. Based on the results of this study, cost was the most influential factor associated with attending a CE class. This may change as additional influential factors are identified and analyzed in future studies. PMID:20098656

Librarian instruction-delivery modality preferences for professional continuing education.

PubMed

Lynn, Valerie A; Bose, Arpita; Boehmer, Susan J

2010-01-01

Attending professional continuing education (CE) is an important component of librarianship. This research study identified librarians' preferences in delivery modalities of instruction for professional CE. The study also identified influential factors associated with attending CE classes. Five instruction-delivery modalities and six influential factors were identified for inclusion in an online survey. The survey completed by members of the American Library Association (ALA), Special Libraries Association (SLA), and Medical Library Association (MLA) provided the data for analysis of librarian preferences and influential factors. The majority of respondents were MLA members, followed by ALA and SLA members. Librarians from all three library associations preferred the face-to-face instructional modality. The most influential factor associated with the decision to attend a professional CE class was cost. All five instruction-delivery modalities present useful structures for imparting professional CE. As librarians' experience with different modalities increases and as technology improves, preferences in instruction delivery may shift. But at present, face-to-face remains the most preferred modality. Based on the results of this study, cost was the most influential factor associated with attending a CE class. This may change as additional influential factors are identified and analyzed in future studies.

Verifying different-modality properties for concepts produces switching costs.

PubMed

Pecher, Diane; Zeelenberg, René; Barsalou, Lawrence W

2003-03-01

According to perceptual symbol systems, sensorimotor simulations underlie the representation of concepts. It follows that sensorimotor phenomena should arise in conceptual processing. Previous studies have shown that switching from one modality to another during perceptual processing incurs a processing cost. If perceptual simulation underlies conceptual processing, then verifying the properties of concepts should exhibit a switching cost as well. For example, verifying a property in the auditory modality (e.g., BLENDER-loud) should be slower after verifying a property in a different modality (e.g., CRANBERRIES-tart) than after verifying a property in the same modality (e.g., LEAVES-rustling). Only words were presented to subjects, and there were no instructions to use imagery. Nevertheless, switching modalities incurred a cost, analogous to the cost of switching modalities in perception. A second experiment showed that this effect was not due to associative priming between properties in the same modality. These results support the hypothesis that perceptual simulation underlies conceptual processing.

PET/CT and contrast enhanced CT in single vs. two separate sessions: a cost analysis study.

PubMed

Picchio, M; Mansueto, M; Crivellaro, C; Guerra, L; Marcelli, S; Arosio, M; Sironi, S; Gianolli, L; Grimaldi, A; Messa, C

2012-06-01

Aim of the study was to quantify the economic impact of PET/CT and contrast enhanced (c.e.) CT performed in a single session examination vs. stand-alone modalities in oncological patients. One-hundred-forty-five cancer patients referred to both PET/CT and c.e. CT, to either stage (N.=46) or re-stage (N.=99) the disease, were included. Seventy-two/145 performed both studies in a single session (innovative method) and 73/145 in two different sessions (traditional method). The cost-minimization analysis was performed by evaluating: 1) institutional costs, data obtained by hospital accountability (staff, medical materials, equipment maintenance and depreciation, departments utilities); 2) patients costs, data obtained by a specific survey provided to patients (travel, food, accommodation costs, productivity loss). Economic data analysis showed that the costs for innovative method was lower than those of traditional method, both for Institution (106 € less per test) and for patient (21 € less per patient). The loss of productivity for patient and caregivers resulted lower for the innovative method than the traditional method (3 work-hour less per person). PET/CT and c.e. CT performed in a single session is more cost-effective than stand-alone modalities, by reducing both Institutional and patients costs. These advantages are mainly due to lower Institutional cost (single procedure) and to lower cost related to travel and housing.

Modal shifts in short-haul passenger travel and the consequent energy impacts. [Intercity travel under 500 miles

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

Not Available

1980-03-01

A study was performed to evaluate the impacts of strategies to effect modal shifts in short-haul passenger travel (defined herein as intercity travel under 500 miles) from energy-intensive modes to those modes that are less energy-intensive. A series of individual strategies, ranging from incentives to the less energy-intensive modes (bus, rail) to penalties to the more energy-intensive modes (auto, air) was examined to determine energy saved and policy implications relative to strategy implementation. The most effective of the individual strategies were then combined in all permutations, and the analysis was repeated. As part of the analytical process, effects of factorsmore » other than energy (user cost and time, emissions, government subsidy, and travel fatailities) were examined in a benefit/cost analysis. Finally, energy savings, benefit/cost impacts, implementation considerations, and policy implications were evaluated to arrive at conclusions as to the effectiveness of the more-influential strategies and to the overall effectiveness of induced modal shifts. The principal conclusion of the study is that the maximum 1980 energy saving that might be realized by modal shifts, discounting the concurrent effects of demand suppression and improvement of mode efficiency, is approximately 83 x 10/sup 12/ Btu (46,500 bbl gasoline per day), 3.8% of the total projected 1980 energy consumption in the short-haul transportation sector and 0.23% of the total US petroleum use. It was also concluded that strategies to achieve these small savings by modal shifts would result in significant economic, social, and business disruptions.« less

Multibody model reduction by component mode synthesis and component cost analysis

NASA Technical Reports Server (NTRS)

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

1990-01-01

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

Economic impact of a modification of the treatment trajectories of patients with end-stage renal disease

PubMed Central

Couchoud, Cécile; Couillerot, Anne-Line; Dantony, Emmanuelle; Elsensohn, Mad-Hélénie; Labeeuw, Michel; Villar, Emmanuel; Ecochard, René; Bongiovanni, Isabelle

2015-01-01

Background This study assumed that some patients currently treated at hospital-based haemodialysis centres can be treated with another renal replacement therapy (RRT) modality without any increase in mortality risk and sought to evaluate the monthly cost impact of replacing hospital-based haemodialysis, for which fees are highest, by different proportions of other modalities. Methods We used a deterministic model tool to predict the outcomes and trajectories of hypothetical cohorts of incident adult end-stage renal disease (ESRD) patients for 15 years of RRT (10 different modalities). Our estimates were based on data from 67 258 patients in the REIN registry and 65 662 patients in the French national health insurance information system. Patients were categorized into six subcohorts, stratified for age and diabetes at ESRD onset, and analyses run for each subcohort. We simulated new strategies of care by changing any or all of the following: initial distributions in treatment modalities, transition rates and some costs. Strategies were classified according to their monthly per-patient cost compared to current practices (cost-minimization analysis). Results Simulations of the status quo for the next 15 years predicted a per-patient monthly cost of €2684 for a patient aged 18–45 years without diabetes and €7361 for one older than 70 years with diabetes. All of the strategies we analysed had monthly per-patient costs lower than the status quo, except for daily home HD. None impaired expected survival. Savings varied by strategy. Conclusions Alternative strategies may well be less expensive than current practices. The decision to implement new strategies must nonetheless consider the number of patients concerned, feasibility of renal care reorganization, and investment costs. It must also take into account the role of patients' choice and the availability of professionals. PMID:26268714

Costs, charges, and revenues for hospital diagnostic imaging procedures: differences by modality and hospital characteristics.

PubMed

Sistrom, Christopher Lee; McKay, Niccie L

2005-06-01

This study examined financial data reported by Florida hospitals concerning costs, charges, and revenues related to imaging services. Financial reports to the Florida Hospital Uniform Reporting System by all licensed acute care facilities for fiscal year 2002 were used to calculate four financial indices on a per procedure basis. These included charge, net revenue, operating expense (variable cost), and contribution margin. Analysis, stratified by cost center (imaging modality), tested the effects of bed size, ownership, teaching status, and urban or rural status on the four indices. The mean operating expense and charge per procedure were as follows: computed tomography (CT): $51 and $1565; x-ray and ultrasound: $55 and $410; nuclear medicine (NM): $135 and $1138; and magnetic resonance imaging (MRI): $165 and $2048. With all four modalities, for-profit hospitals had higher charges than not-for-profit and public facilities. Excepting NM, however, the difference by ownership disappeared when considering net revenue. Operating expense did not differ by ownership type or bed size. Operating expense (variable cost) per procedure is considerably lower for CT than for MRI. Consequently, when diagnostically equivalent, CT is preferable to MRI in terms of costs for hospitals. If the cost structure of nonhospital imaging is at all similar to hospitals, the profit potential for performing CT and MRI seems to be substantial, which has relevance to the issue of imaging self-referral.

Fusion of 4D echocardiography and cine cardiac magnetic resonance volumes using a salient spatio-temporal analysis

NASA Astrophysics Data System (ADS)

Atehortúa, Angélica; Garreau, Mireille; Romero, Eduardo

2017-11-01

An accurate left (LV) and right ventricular (RV) function quantification is important to support evaluation, diagnosis and prognosis of cardiac pathologies such as the cardiomyopathies. Currently, diagnosis by ultrasound is the most cost-effective examination. However, this modality is highly noisy and operator dependent, hence prone to errors. Therefore, fusion with other cardiac modalities may provide complementary information and improve the analysis of the specific pathologies like cardiomyopathies. This paper proposes an automatic registration between two complementary modalities, 4D echocardiography and Magnetic resonance images, by mapping both modalities to a common space of salience where an optimal registration between them is estimated. The obtained matrix transformation is then applied to the MRI volume which is superimposed to the 4D echocardiography. Manually selected marks in both modalities are used to evaluate the precision of the superimposition. Preliminary results, in three evaluation cases, show the distance between these marked points and the estimated with the transformation is about 2 mm.

Reducing the uncertainty in robotic machining by modal analysis

NASA Astrophysics Data System (ADS)

Alberdi, Iñigo; Pelegay, Jose Angel; Arrazola, Pedro Jose; Ørskov, Klaus Bonde

2017-10-01

The use of industrial robots for machining could lead to high cost and energy savings for the manufacturing industry. Machining robots offer several advantages respect to CNC machines such as flexibility, wide working space, adaptability and relatively low cost. However, there are some drawbacks that are preventing a widespread adoption of robotic solutions namely lower stiffness, vibration/chatter problems and lower accuracy and repeatability. Normally due to these issues conservative cutting parameters are chosen, resulting in a low material removal rate (MRR). In this article, an example of a modal analysis of a robot is presented. For that purpose the Tap-testing technology is introduced, which aims at maximizing productivity, reducing the uncertainty in the selection of cutting parameters and offering a stable process free from chatter vibrations.

The costs and effects of contrast-enhanced magnetic resonance angiography and digital substraction angiography on quality of life in patients with peripheral arterial disease.

PubMed

Bosma, Jan; Dijksman, Lea M; Lam, Kayan; Wisselink, Willem; van Swijndregt, Alexander D Montauban; Vahl, Anco

2014-04-01

Contrast-enhanced magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) both have a high diagnostic performance in the imaging of peripheral arterial occlusive disease (PAOD). However, little is known about the effects of initial, preoperative imaging using MRA or DSA on quality of life (QoL) in relation to costs (cost-utility). To compare cost-utility of treatment strategies using either MRA or DSA as the principal imaging tool, related to QoL, in patients with PAOD. In a prospective subgroup analysis of patients randomized between MRA and DSA (n = 79) for preoperative imaging, QoL questionnaires (SF-36) were obtained at randomization and at 4-month follow-up. Cost-effectiveness from hospital perspective was subsequently compared between groups and the difference in gained or lost QoL per € spent assessed using bootstrap analysis. No difference in quality of life was found. A treatment trajectory employing MRA as the principal imaging modality was almost 20% cheaper, leading to a better cost-utility ratio in favor of MRA. A treatment plan for peripheral arterial occlusive disease employing MRA versus DSA as the principal imaging modality yields a better cost/QoL ratio for MRA.

Analysis of longitudinal data from the Puget Sound transportation panel : task E : modal split analysis

DOT National Transportation Integrated Search

1996-11-01

The Highway Economic Requirements System (HERS) is a computer model designed to simulate improvement selection decisions based on the relative benefit-cost merits of alternative improvement options. HERS is intended to estimate national level investm...

Novel parametric reduced order model for aeroengine blade dynamics

NASA Astrophysics Data System (ADS)

Yuan, Jie; Allegri, Giuliano; Scarpa, Fabrizio; Rajasekaran, Ramesh; Patsias, Sophoclis

2015-10-01

The work introduces a novel reduced order model (ROM) technique to describe the dynamic behavior of turbofan aeroengine blades. We introduce an equivalent 3D frame model to describe the coupled flexural/torsional mode shapes, with their relevant natural frequencies and associated modal masses. The frame configurations are identified through a structural identification approach based on a simulated annealing algorithm with stochastic tunneling. The cost functions are constituted by linear combinations of relative errors associated to the resonance frequencies, the individual modal assurance criteria (MAC), and on either overall static or modal masses. When static masses are considered the optimized 3D frame can represent the blade dynamic behavior with an 8% error on the MAC, a 1% error on the associated modal frequencies and a 1% error on the overall static mass. When using modal masses in the cost function the performance of the ROM is similar, but the overall error increases to 7%. The approach proposed in this paper is considerably more accurate than state-of-the-art blade ROMs based on traditional Timoshenko beams, and provides excellent accuracy at reduced computational time when compared against high fidelity FE models. A sensitivity analysis shows that the proposed model can adequately predict the global trends of the variations of the natural frequencies when lumped masses are used for mistuning analysis. The proposed ROM also follows extremely closely the sensitivity of the high fidelity finite element models when the material parameters are used in the sensitivity.

A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment.

PubMed

Ginsberg, Gary; Adunsky, Abraham; Rasooly, Iris

2013-01-01

The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

Cost Analysis of Spinal Versus General Anesthesia for Lumbar Diskectomy and Laminectomy Spine Surgery.

PubMed

Agarwal, Prateek; Pierce, John; Welch, William C

2016-05-01

Lumbar spine surgery can be performed using various anesthetic modalities, most notably general or spinal anesthesia. Because data comparing the cost of these anesthetic modalities in spine surgery are scarce, this study asks whether spinal anesthesia is less costly than general anesthesia. A total of 542 patients who underwent elective lumbar diskectomy or laminectomy spine surgery between 2007 and 2011 were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Mean direct operating cost, indirect cost (general support staff, insurance, taxes, floor space, facility, and administrative costs), and total cost were compared among patients who received general and spinal anesthesia. Linear multiple regression analysis was used to identify the effect of anesthesia type on cost and determine the factors underlying this effect, while controlling for patient and procedure characteristics. When controlling for patient and procedure characteristics, use of spinal anesthesia was associated with a 41.1% lower direct operating cost (-$3629 ± $343, P < 0.001), 36.6% lower indirect cost (-$1603 ± $168, P < 0.001), and 39.6% lower total cost (-$5232 ± $482, P < 0.001) compared with general anesthesia. Shorter hospital stay, shorter duration of anesthesia, shorter duration of operation, and lower estimated blood loss contributed to lower costs for spinal anesthesia, but other factors beyond these were also responsible for lower direct operating and total costs. When comparing the benefits of spinal and general anesthesia, spinal anesthesia is less costly when used in patients undergoing lumbar diskectomy and laminectomy spine surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

PubMed

Kowalczyk, David M; Jordan, J Randall; Stringer, Scott P

2018-03-30

The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. Literature review and cost-effectiveness analysis. A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. NA. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

New Tool for Benefit-Cost Analysis in Evaluating Transportation Alternatives

DOT National Transportation Integrated Search

1997-01-01

The Intermodal Surface Transportation Efficiency Act (ISTEA) emphasizes assessment of multi-modal alternatives and demand management strategies. In 1995, the Federal Highway Administration (FHWA) developed a corridor sketch planning tool called the S...

A break-even analysis of delivering a memory clinic by videoconferencing.

PubMed

Comans, Tracy A; Martin-Khan, Melinda; Gray, Leonard C; Scuffham, Paul A

2013-10-01

We analysed the costs of two kinds of dementia clinic. In the conventional clinic, held in a rural area, the specialist travels to the clinic from the city. In the videoconferencing clinic, patients are also seen in a rural area, but the specialist conducts the assessment by video from the city. The fixed costs common to both modalities, such as clinic infrastructure, were ignored. The total fixed cost of a monthly conventional clinic was $522 and the total fixed cost of a monthly videoconferencing clinic was $881. The additional variable cost of the specialist travelling to the conventional clinic was $2.62 per minute of the specialist's travelling time. The break-even point at which the cost of the two modalities is the same was just over two hours (138 min round trip). A sensitivity analysis showed that the break-even point was not particularly sensitive to changes in staff wages, but slightly more sensitive to the non labour costs of videoconferencing. Air travel is not an efficient alternative to travel by car. Reducing the number of clinics to six per year results in a much higher cost of running the videoconferencing service compared to the conventional service. Videoconferencing for the purpose of diagnosing dementia is both a reliable and cost effective method of health service provision when a specialist is required to drive for more than about two hours (round trip) to provide a memory disorder clinic service.

Comparación de costos y resultados sanitarios de usuarios con neumonia adquirida en comunidad atendidos en domicilio o en hospitalización tradicional: estudio exploratorio de 40 casos.

PubMed

Macaya, Mario Carvajal; Ridulfo, Alberto Hernández; Ramírez-Santana, Muriel

2015-12-01

Economic evaluations of health technologies and health interventions are considered in many countries as the fourth barrier for adopting new services or drugs; followed by safety, efficacy and quality. The validity and reliability of the results will depend on the perspective of the study, timeframe of the analysis, discount rate, the model used and the costs involved. This study aims to assess the cost effectiveness of home care treatment in users with diagnosis of uncomplicated community acquired pneumonia compared with traditional hospitalization at inpatient wards. The hypothesis is that home based care would be more cost effective compared to traditional hospitalization. The study perspective was from the health provider. Microcosting was used to determine the costs of both treatment modalities in a sample of 20 users treated with each modality during 2013 at main Hospitals of Coquimbo Region, Chile. The main outcome of effectiveness was the number of inpatient care days saved. Additionally, number of infections associated to health care (IAHC) and type of discharge were measured. The study concludes that there is a better cost effectiveness relationship for the home care modality, with fewer days of treatment, at lower costs and without risk of IAHC. However, further studies are needed in order to achieve accurate results. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Propensity-matched, longitudinal outcomes analysis of complications and cost: comparing abdominal free flaps and implant-based breast reconstruction.

PubMed

Fischer, John P; Wes, Ari M; Nelson, Jonas A; Basta, Marten; Rohrbach, Jeffrey I; Wu, Liza C; Serletti, Joseph M; Kovach, Stephen J

2014-08-01

Choosing a breast reconstructive modality after mastectomy is an important step in the reconstructive process. The authors hypothesized that autologous tissue is associated with a greater success rate and cost efficacy over time, relative to implant reconstruction. A retrospective review was performed of patients undergoing free tissue (FF) transfer and expander implant (E/I) reconstruction between 2005 and 2011. Variables evaluated included comorbidities, surgical timing, complications, overall outcomes, unplanned reoperations, and costs. A propensity-matching technique was used to account for the nonrandomized selection of modality. A total of 310 propensity-matched patients underwent 499 reconstructions. No statistically significant differences in preoperative variables were noted between propensity-matched cohorts. Operative characteristics were similar between FF and E/I reconstructions. The E/I reconstruction was associated with a significantly higher rate of reconstructive failure (5.6% vs 1.2%, p < 0.001). Expander implant reconstructions were associated with higher rates of seroma (p = 0.009) and lower rates of medical complications (p = 0.02), but overall significantly higher rates of unplanned operations (15.5% vs 5.8%, p = 0.002). The total cost of reconstruction did not differ significantly between groups ($23,120.49 ± $6,969.56 vs $22,739.91 ± $9,727.79, p = 0.060), but E/I reconstruction was associated with higher total cost for secondary procedures ($10,157.89 ± $8,741.77 vs $3,200.71 ± $4,780.64, p < 0.0001) and a higher cost of unplanned revisions over time (p < 0.05). Our matched outcomes analysis does demonstrate a higher overall, 2-year success rate using FF reconstruction and a significantly lower rate of unplanned surgical revisions and cost. Although autologous reconstruction is not ideal for every patient, these findings can be used to enhance preoperative discussions when choosing a reconstructive modality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2015-01-01

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

Paired split-plot designs of multireader multicase studies.

PubMed

Chen, Weijie; Gong, Qi; Gallas, Brandon D

2018-07-01

The widely used multireader multicase ROC study design for comparing imaging modalities is the fully crossed (FC) design: every reader reads every case of both modalities. We investigate paired split-plot (PSP) designs that may allow for reduced cost and increased flexibility compared with the FC design. In the PSP design, case images from two modalities are read by the same readers, thereby the readings are paired across modalities. However, within each modality, not every reader reads every case. Instead, both the readers and the cases are partitioned into a fixed number of groups and each group of readers reads its own group of cases-a split-plot design. Using a [Formula: see text]-statistic based variance analysis for AUC (i.e., area under the ROC curve), we show analytically that precision can be gained by the PSP design as compared with the FC design with the same number of readers and readings. Equivalently, we show that the PSP design can achieve the same statistical power as the FC design with a reduced number of readings. The trade-off for the increased precision in the PSP design is the cost of collecting a larger number of truth-verified patient cases than the FC design. This means that one can trade-off between different sources of cost and choose a least burdensome design. We provide a validation study to show the iMRMC software can be reliably used for analyzing data from both FC and PSP designs. Finally, we demonstrate the advantages of the PSP design with a reader study comparing full-field digital mammography with screen-film mammography.

Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.

PubMed

Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

2014-05-01

While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

Cost-effective hydrocele ablation.

PubMed

Fracchia, J A; Armenakas, N A; Kohan, A D

1998-03-01

The surgical repair of hydroceles can be relatively expensive in some cases in terms of costs and initial limitation of activity. We ascertain whether aspiration and sclerotherapy of hydroceles is a safe, efficient, cost-effective treatment modality in select patients. In 47 patients 51 hydroceles were treated in the office with aspiration and instillation of a sclerosing solution based on a sodium tetradecyl sulfate preparation. One treatment was done in 14 cases and 2 in the remainder. Medicare data for 1995 were used for charge analysis. The overall success rate was 61% (34 of 51 cases) with success defined as no perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and complete patient satisfaction. The failure rate was 39% (17 cases) with failure defined as perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and/or patient dissatisfaction. The charge differential of surgery versus aspiration and sclerotherapy was greater than 9:1. The aspiration and sclerotherapy technique that we used appears to be an efficacious, safe, cost-effective treatment modality in select patients with idiopathic hydroceles.

Cost-Effectiveness Data Regarding Spinal Cord Stimulation for Low Back Pain.

PubMed

Hoelscher, Christian; Riley, Jonathan; Wu, Chengyuan; Sharan, Ashwini

2017-07-15

Review of published literature pertaining to spinal cord stimulation (SCS) cost data analysis. To acquire, organize, and succinctly summarize the available literature regarding the costs associated with, and the cost-effectiveness of, SCS. Chronic back and limb pain is a pervasive complaint in modern society, with estimated annual costs of medical care greater than $100 billion. The traditional standard medical management with or without intermittent surgical decompression/fusion has been plagued by high costs and inconsistent results, leading to poor patient satisfaction and functional outcome, and questions from policy makers regarding use of limited healthcare resources. Neuromodulation techniques, including SCS have recently become more common in the treatment of chronic back/leg pain, with clinical studies showing a high degree of efficacy in alleviating otherwise intractable pain. Given the relatively high upfront costs associated with the hardware and implantation, policy makers have, however, questioned their use in the framework of cost-containment and resource utilization. We reviewed the available literature summarizing cost data of SCS in chronic back and limb pain, as an understanding of these data will be vital to justify continued payment for this expensive, but often very effective, treatment modality. We performed a PubMed literature search utilizing the following terms: "spinal cord stimulation," "SCS," "financial," "cost," "cost-effectiveness," and "cost-utility." All studies published in English and containing complete or partial cost evaluations of SCS for chronic back and limb pain were included. The search revealed 21 studies that evaluated cost data, with or without outcomes analysis and cost-utility analysis, for patients with chronic back and limb pain. The overwhelming majority of data presented shows that SCS is not only an effective treatment option for these patients, but also represents cost savings and efficient use of healthcare resources relative to current standards of care. Although not all studies performed cost-utility analyses, those that did tended to show SCS falling well within accepted thresholds of "willingness-to-pay" on the part of third-party payers. That being said, the articles included in this review were almost all small, retrospective, single-institution studies. In addition, many of them relied on modeling for their analyses, and published literature values for cost and/or outcomes data rather than prospectively collected patient data. Although the data presented in this review are encouraging, it should serve as a foundation for a thorough, prospective, cost-utility analysis of SCS in chronic back and limb pain so that the role of this important treatment modality may be cemented in the treatment paradigm for these patients without questions from third-party payers. The large majority of data covering costs of SCS argue in favor of the cost-effectiveness of this treatment modality for chronic neuropathic pain, especially in comparison to reoperation and medical management. Although most of the higher-quality evidence is relatively short-term, clinical experience with the durability of treatment benefit of SCS in these patients is promising. Given the pushback regarding high upfront costs of implantation, longer-term, prospective, randomized studies evaluating this topic will be important to help maintain third-party payer reimbursements for SCS. 5.

The Roles of Relative Linguistic Proficiency and Modality Switching in Language Switch Cost: Evidence from Chinese Visual Unimodal and Bimodal Bilinguals.

PubMed

Lu, Aitao; Wang, Lu; Guo, Yuyang; Zeng, Jiahong; Zheng, Dongping; Wang, Xiaolu; Shao, Yulan; Wang, Ruiming

2017-09-01

The current study investigated the mechanism of language switching in unbalanced visual unimodal bilinguals as well as balanced and unbalanced bimodal bilinguals during a picture naming task. All three groups exhibited significant switch costs across two languages, with symmetrical switch cost in balanced bimodal bilinguals and asymmetrical switch cost in unbalanced unimodal bilinguals and bimodal bilinguals. Moreover, the relative proficiency of the two languages but not their absolute proficiency had an effect on language switch cost. For the bimodal bilinguals the language switch cost also arose from modality switching. These findings suggest that the language switch cost might originate from multiple sources from both outside (e.g., modality switching) and inside (e.g., the relative proficiency of the two languages) the linguistic lexicon.

A scaling procedure for the response of an isolated system with high modal overlap factor

NASA Astrophysics Data System (ADS)

De Rosa, S.; Franco, F.

2008-10-01

The paper deals with a numerical approach that reduces some physical sizes of the solution domain to compute the dynamic response of an isolated system: it has been named Asymptotical Scaled Modal Analysis (ASMA). The proposed numerical procedure alters the input data needed to obtain the classic modal responses to increase the frequency band of validity of the discrete or continuous coordinates model through the definition of a proper scaling coefficient. It is demonstrated that the computational cost remains acceptable while the frequency range of analysis increases. Moreover, with reference to the flexural vibrations of a rectangular plate, the paper discusses the ASMA vs. the statistical energy analysis and the energy distribution approach. Some insights are also given about the limits of the scaling coefficient. Finally it is shown that the linear dynamic response, predicted with the scaling procedure, has the same quality and characteristics of the statistical energy analysis, but it can be useful when the system cannot be solved appropriately by the standard Statistical Energy Analysis (SEA).

Exploring Modality Switching Effects in Negated Sentences: Further Evidence for Grounded Representations

PubMed Central

Hald, Lea A.; Hocking, Ian; Vernon, David; Marshall, Julie-Ann; Garnham, Alan

2013-01-01

Theories of embodied cognition (e.g., Perceptual Symbol Systems Theory; Barsalou, 1999, 2009) suggest that modality specific simulations underlie the representation of concepts. Supporting evidence comes from modality switch costs: participants are slower to verify a property in one modality (e.g., auditory, BLENDER-loud) after verifying a property in a different modality (e.g., gustatory, CRANBERRIES-tart) compared to the same modality (e.g., LEAVES-rustling, Pecher et al., 2003). Similarly, modality switching costs lead to a modulation of the N400 effect in event-related potentials (ERPs; Collins et al., 2011; Hald et al., 2011). This effect of modality switching has also been shown to interact with the veracity of the sentence (Hald et al., 2011). The current ERP study further explores the role of modality match/mismatch on the processing of veracity as well as negation (sentences containing “not”). Our results indicate a modulation in the ERP based on modality and veracity, plus an interaction. The evidence supports the idea that modality specific simulations occur during language processing, and furthermore suggest that these simulations alter the processing of negation. PMID:23450002

Modality-specific, multitask locomotor deficits persist despite good recovery after a traumatic brain injury.

PubMed

McFadyen, Bradford J; Cantin, Jean-François; Swaine, Bonnie; Duchesneau, Guylaine; Doyon, Julien; Dumas, Denyse; Fait, Philippe

2009-09-01

To study the effects of sensory modality of simultaneous tasks during walking with and without obstacles after moderate to severe traumatic brain injury (TBI). Group comparison study. Gait analysis laboratory within a postacute rehabilitation facility. Volunteer sample (N=18). Persons with moderate to severe TBI (n=11) (9 men, 3 women; age, 37.56+/-13.79 y) and a comparison group (n=7) of subjects without neurologic problems matched on average for body mass index and age (4 men, 3 women; age, 39.19+/-17.35 y). Not applicable. Magnitudes and variability for walking speeds, foot clearance margins (ratio of foot clearance distance to obstacle height), and response reaction times (both direct and as a relative cost because of obstacle avoidance). The TBI group had well-recovered walking speeds and a general ability to avoid obstacles. However, these subjects did show lower trail limb toe clearances (P=.003) across all conditions. Response reaction times to the Stroop tasks were longer in general for the TBI group (P=.017), and this group showed significant increases in response reaction times for the visual modality within the more challenging obstacle avoidance task that was not observed for control subjects. A measure of multitask costs related to differences in response reaction times between obstructed and unobstructed trials also only showed increased attention costs for the visual over the auditory stimuli for the TBI group (P=.002). Mobility is a complex construct, and the present results provide preliminary findings that, even after good locomotor recovery, subjects with moderate to severe TBI show residual locomotor deficits in multitasking. Furthermore, our results suggest that sensory modality is important, and greater multitask costs occur during sensory competition (ie, visual interference).

Cost-effectiveness analysis of a statewide media campaign to promote adolescent physical activity.

PubMed

Peterson, Michael; Chandlee, Margaret; Abraham, Avron

2008-10-01

A cost-effectiveness analysis of a statewide social marketing campaign was performed using a statewide surveillance survey distributed to 6th through 12th graders, media production and placement costs, and 2000 census data. Exposure to all three advertisements had the highest impact on both intent and behavior with 65.6% of the respondents considering becoming more active and 58.3% reporting becoming more active. Average cost of the entire campaign was $4.01 per person to see an ad, $7.35 per person to consider being more active, and $8.87 per person to actually become more active, with billboards yielding the most positive cost-effectiveness. Findings highlight market research as an essential part of social marketing campaigns and the importance of using multiple marketing modalities to enhance cost-effectiveness and impact.

The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement

PubMed Central

French, Michael T.; Popovici, Ioana; Tapsell, Lauren

2008-01-01

Federal, State, and local government agencies require current and accurate cost information for publicly funded substance abuse treatment programs to guide program assessments and reimbursement decisions. The Center for Substance Abuse Treatment (CSAT) published a list of modality-specific cost bands for this purpose in 2002. However, the upper and lower values in these ranges are so wide that they offer little practical guidance for funding agencies. Thus, the dual purpose of this investigation was to assemble the most current and comprehensive set of economic cost estimates from the readily-available literature and then use these estimates to develop updated modality-specific cost bands for more reasonable reimbursement policies. Although cost estimates were scant for some modalities, the recommended cost bands are based on the best available economic research, and we believe these new ranges will be more useful and pertinent for all stakeholders of publicly-funded substance abuse treatment. PMID:18294803

If You Stay, It Might Be Easier: Switch Costs from Comprehension to Production in a Joint Switching Task

ERIC Educational Resources Information Center

Gambi, Chiara; Hartsuiker, Robert J.

2016-01-01

Switching language is costly for bilingual speakers and listeners, suggesting that language control is effortful in both modalities. But are the mechanisms underlying language control similar across modalities? In this study, we attempted to answer this question by testing whether bilingual speakers incur a cost when switching to a different…

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications.

PubMed

Foster, Brock D; Sivasundaram, Lakshmanan; Heckmann, Nathanael; Cohen, Jeremiah R; Pannell, William C; Wang, Jeffrey C; Ghiassi, Alidad

2017-03-01

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

The costs and cost-efficiency of providing food through schools in areas of high food insecurity.

PubMed

Gelli, Aulo; Al-Shaiba, Najeeb; Espejo, Francisco

2009-03-01

The provision of food in and through schools has been used to support the education, health, and nutrition of school-aged children. The monitoring of financial inputs into school health and nutrition programs is critical for a number of reasons, including accountability, transparency, and equity. Furthermore, there is a gap in the evidence on the costs, cost-efficiency, and cost-effectiveness of providing food through schools, particularly in areas of high food insecurity. To estimate the programmatic costs and cost-efficiency associated with providing food through schools in food-insecure, developing-country contexts, by analyzing global project data from the World Food Programme (WFP). Project data, including expenditures and number of schoolchildren covered, were collected through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. The average yearly expenditure per child, standardized over a 200-day on-site feeding period and an average ration, excluding school-level costs, was US$21.59. The costs varied substantially according to choice of food modality, with fortified biscuits providing the least costly option of about US$11 per year and take-home rations providing the most expensive option at approximately US$52 per year. Comparisons across the different food modalities suggested that fortified biscuits provide the most cost-efficient option in terms of micronutrient delivery (particularly vitamin A and iodine), whereas on-site meals appear to be more efficient in terms of calories delivered. Transportation and logistics costs were the main drivers for the high costs. The choice of program objectives will to a large degree dictate the food modality (biscuits, cooked meals, or take-home rations) and associated implementation costs. Fortified biscuits can provide substantial nutritional inputs at a fraction of the cost of school meals, making them an appealing option for service delivery in food-insecure contexts. Both costs and effects should be considered carefully when designing the appropriate school-based intervention. The costs estimates in this analysis do not include all school-level costs and are therefore lower-bound estimates of full implementation costs.

Nonlinear hybrid modal synthesis based on branch modes for dynamic analysis of assembled structure

NASA Astrophysics Data System (ADS)

Huang, Xing-Rong; Jézéquel, Louis; Besset, Sébastien; Li, Lin; Sauvage, Olivier

2018-01-01

This paper describes a simple and fast numerical procedure to study the steady state responses of assembled structures with nonlinearities along continuous interfaces. The proposed strategy is based on a generalized nonlinear modal superposition approach supplemented by a double modal synthesis strategy. The reduced nonlinear modes are derived by combining a single nonlinear mode method with reduction techniques relying on branch modes. The modal parameters containing essential nonlinear information are determined and then employed to calculate the stationary responses of the nonlinear system subjected to various types of excitation. The advantages of the proposed nonlinear modal synthesis are mainly derived in three ways: (1) computational costs are considerably reduced, when analyzing large assembled systems with weak nonlinearities, through the use of reduced nonlinear modes; (2) based on the interpolation models of nonlinear modal parameters, the nonlinear modes introduced during the first step can be employed to analyze the same system under various external loads without having to reanalyze the entire system; and (3) the nonlinear effects can be investigated from a modal point of view by analyzing these nonlinear modal parameters. The proposed strategy is applied to an assembled system composed of plates and nonlinear rubber interfaces. Simulation results have proven the efficiency of this hybrid nonlinear modal synthesis, and the computation time has also been significantly reduced.

[Cost-effectiveness analysis of an alternative for the provision of primary health care for beneficiaries of Seguro Popular in Mexico].

PubMed

Figueroa-Lara, Alejandro; González-Block, Miguel A

2016-01-01

To estimate the cost-effectiveness ratio of public and private health care providers funded by Seguro Popular. A pilot contracting primary care health care scheme in the state of Hidalgo, Mexico, was evaluated through a population survey to assess quality of care and detection decreased of vision. Costs were assessed from the payer perspective using institutional sources.The alternatives analyzed were a private provider with capitated and performance-based payment modalities, and a public provider funded through budget subsidies. Sensitivity analysis was performed using Monte Carlo simulations. The private provider is dominant in the quality and cost-effective detection of decreased vision. Strategic purchasing of private providers of primary care has shown promising results as an alternative to improving quality of health services and reducing costs.

Multi-Modal Performance Measures in Oregon: Developing a Transportation Cost Index Based Upon Multi-Modal Network and Land Use Information

DOT National Transportation Integrated Search

2016-02-01

Transportation Cost Index is a performance measure for transportation and land use systems originally proposed and piloted by Reiff and Gregor (2005). It fills important niches of existing similar measures in term of policy areas covered and type of ...

Development and evaluation of the impulse transfer function technique

NASA Technical Reports Server (NTRS)

Mantus, M.

1972-01-01

The development of the test/analysis technique known as the impulse transfer function (ITF) method is discussed. This technique, when implemented with proper data processing systems, should become a valuable supplement to conventional dynamic testing and analysis procedures that will be used in the space shuttle development program. The method can relieve many of the problems associated with extensive and costly testing of the shuttle for transient loading conditions. In addition, the time history information derived from impulse testing has the potential for being used to determine modal data for the structure under investigation. The technique could be very useful in determining the time-varying modal characteristics of structures subjected to thermal transients, where conventional mode surveys are difficult to perform.

An EGO-like optimization framework for sensor placement optimization in modal analysis

NASA Astrophysics Data System (ADS)

Morlier, Joseph; Basile, Aniello; Chiplunkar, Ankit; Charlotte, Miguel

2018-07-01

In aircraft design, ground/flight vibration tests are conducted to extract aircraft’s modal parameters (natural frequencies, damping ratios and mode shapes) also known as the modal basis. The main problem in aircraft modal identification is the large number of sensors needed, which increases operational time and costs. The goal of this paper is to minimize the number of sensors by optimizing their locations in order to reconstruct a truncated modal basis of N mode shapes with a high level of accuracy in the reconstruction. There are several methods to solve sensors placement optimization (SPO) problems, but for this case an original approach has been established based on an iterative process for mode shapes reconstruction through an adaptive Kriging metamodeling approach so called efficient global optimization (EGO)-SPO. The main idea in this publication is to solve an optimization problem where the sensors locations are variables and the objective function is defined by maximizing the trace of criteria so called AutoMAC. The results on a 2D wing demonstrate a reduction of sensors by 30% using our EGO-SPO strategy.

System identification of a tied arch bridge using reference-based wireless sensor networks

NASA Astrophysics Data System (ADS)

Hietbrink, Colby; Whelan, Matthew J.

2012-04-01

Vibration-based methods of structural health monitoring are generally founded on the principle that localized damage to a structure would exhibit changes within the global dynamic response. Upon this basis, accelerometers provide a unique health monitoring strategy in that a distributed network of sensors provides the technical feasibility to isolate the onset of damage without requiring that any sensor be located exactly on or in close proximity to the damage. While in theory this may be sufficient, practical experience has shown significant improvement in the application of damage diagnostic routines when mode shapes characterized by strongly localized behavior of specific elements are captured by the instrumentation array. In traditional applications, this presents a challenge since the cost and complexity of cable-based systems often effectively limits the number of instrumented locations thereby constraining the modal parameter extraction to only global modal responses. The advent of the low-cost RF chip transceiver with wireless networking capabilities has afforded a means by which a substantial number of output locations can be measured through referencebased testing using large-scale wireless sensor networks. In the current study, this approach was applied to the Prairie du Chien Bridge over the Mississippi River to extract operational mode shapes with high spatial reconstruction, including strongly localized modes. The tied arch bridge was instrumented at over 230 locations with single-axis accelerometers conditioned and acquired over a high-rate lossless wireless sensor network with simultaneous sampling capabilities. Acquisition of the dynamic response of the web plates of the arch rib was specifically targeted within the instrumentation array for diagnostic purposes. Reference-based operational modal analysis of the full structure through data-driven stochastic subspace identification is presented alongside finite element analysis results for confirmation of modal parameter plausibility. Particular emphasis is placed on the identification and reconstruction of modal response with large contribution from the arch rib web plates.

Comparison of modal test results - Multipoint sine versus single-point random. [for Mariner Jupiter/Saturn spacecraft

NASA Technical Reports Server (NTRS)

Leppert, E. L.; Lee, S. H.; Day, F. D.; Chapman, P. C.; Wada, B. K.

1976-01-01

The Mariner Jupiter/Saturn (MJS) spacecraft was subjected to the traditional multipoint sine dwell (MPSD) modal test using 111 accelerometer channels, and also to single-point random (SPR) testing using 26 accelerometer channels, and the two methods are compared according to cost, schedule, and technical criteria. A measure of comparison between the systems was devised in terms of the cumulative difference in the kinetic energy distribution of the common accelerometers. The SPR and MPSD method show acceptable agreement with respect to frequencies and mode damping. The merit of the SPR method is that the excitation points are minimized and the test article can be committed to other uses while data analysis is performed. The MPSD approach allows validity of the data to be determined as the test progresses. Costs are about the same for the two methods.

Alcoholism treatment and medical care costs from Project MATCH.

PubMed

Holder, H D; Cisler, R A; Longabaugh, R; Stout, R L; Treno, A J; Zweben, A

2000-07-01

This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. Longitudinal study with pre- and post-treatment initiation. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). Two hundred and seventy-nine patients. Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF. Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

Ground Vibration Test Planning and Pre-Test Analysis for the X-33 Vehicle

NASA Technical Reports Server (NTRS)

Bedrossian, Herand; Tinker, Michael L.; Hidalgo, Homero

2000-01-01

This paper describes the results of the modal test planning and the pre-test analysis for the X-33 vehicle. The pre-test analysis included the selection of the target modes, selection of the sensor and shaker locations and the development of an accurate Test Analysis Model (TAM). For target mode selection, four techniques were considered, one based on the Modal Cost technique, one based on Balanced Singular Value technique, a technique known as the Root Sum Squared (RSS) method, and a Modal Kinetic Energy (MKE) approach. For selecting sensor locations, four techniques were also considered; one based on the Weighted Average Kinetic Energy (WAKE), one based on Guyan Reduction (GR), one emphasizing engineering judgment, and one based on an optimum sensor selection technique using Genetic Algorithm (GA) search technique combined with a criteria based on Hankel Singular Values (HSV's). For selecting shaker locations, four techniques were also considered; one based on the Weighted Average Driving Point Residue (WADPR), one based on engineering judgment and accessibility considerations, a frequency response method, and an optimum shaker location selection based on a GA search technique combined with a criteria based on HSV's. To evaluate the effectiveness of the proposed sensor and shaker locations for exciting the target modes, extensive numerical simulations were performed. Multivariate Mode Indicator Function (MMIF) was used to evaluate the effectiveness of each sensor & shaker set with respect to modal parameter identification. Several TAM reduction techniques were considered including, Guyan, IRS, Modal, and Hybrid. Based on a pre-test cross-orthogonality checks using various reduction techniques, a Hybrid TAM reduction technique was selected and was used for all three vehicle fuel level configurations.

A more accurate modeling of the effects of actuators in large space structures

NASA Technical Reports Server (NTRS)

Hablani, H. B.

1981-01-01

The paper deals with finite actuators. A nonspinning three-axis stabilized space vehicle having a two-dimensional large structure and a rigid body at the center is chosen for analysis. The torquers acting on the vehicle are modeled as antisymmetric forces distributed in a small but finite area. In the limit they represent point torquers which also are treated as a special case of surface distribution of dipoles. Ordinary and partial differential equations governing the forced vibrations of the vehicle are derived by using Hamilton's principle. Associated modal inputs are obtained for both the distributed moments and the distributed forces. It is shown that the finite torquers excite the higher modes less than the point torquers. Modal cost analysis proves to be a suitable methodology to this end.

An investigation of response and stimulus modality transfer effects after dual-task training in younger and older.

PubMed

Lussier, Maxime; Gagnon, Christine; Bherer, Louis

2012-01-01

It has been shown that dual-task training leads to significant improvement in dual-task performance in younger and older adults. However, the extent to which training benefits to untrained tasks requires further investigation. The present study assessed (a) whether dual-task training leads to cross-modality transfer in untrained tasks using new stimuli and/or motor responses modalities, (b) whether transfer effects are related to improved ability to prepare and maintain multiple task-set and/or enhanced response coordination, (c) whether there are age-related differences in transfer effects. Twenty-three younger and 23 older adults were randomly assigned to dual-task training or control conditions. All participants were assessed before and after training on three dual-task transfer conditions; (1) stimulus modality transfer (2) response modality transfer (3) stimulus and response modalities transfer task. Training group showed larger improvement than the control group in the three transfer dual-task conditions, which suggests that training leads to more than specific learning of stimuli/response associations. Attentional costs analyses showed that training led to improved dual-task cost, only in conditions that involved new stimuli or response modalities, but not both. Moreover, training did not lead to a reduced task-set cost in the transfer conditions, which suggests some limitations in transfer effects that can be expected. Overall, the present study supports the notion that cognitive plasticity for attentional control is preserved in late adulthood.

Large-scale Cross-modality Search via Collective Matrix Factorization Hashing.

PubMed

Ding, Guiguang; Guo, Yuchen; Zhou, Jile; Gao, Yue

2016-09-08

By transforming data into binary representation, i.e., Hashing, we can perform high-speed search with low storage cost, and thus Hashing has collected increasing research interest in the recent years. Recently, how to generate Hashcode for multimodal data (e.g., images with textual tags, documents with photos, etc) for large-scale cross-modality search (e.g., searching semantically related images in database for a document query) is an important research issue because of the fast growth of multimodal data in the Web. To address this issue, a novel framework for multimodal Hashing is proposed, termed as Collective Matrix Factorization Hashing (CMFH). The key idea of CMFH is to learn unified Hashcodes for different modalities of one multimodal instance in the shared latent semantic space in which different modalities can be effectively connected. Therefore, accurate cross-modality search is supported. Based on the general framework, we extend it in the unsupervised scenario where it tries to preserve the Euclidean structure, and in the supervised scenario where it fully exploits the label information of data. The corresponding theoretical analysis and the optimization algorithms are given. We conducted comprehensive experiments on three benchmark datasets for cross-modality search. The experimental results demonstrate that CMFH can significantly outperform several state-of-the-art cross-modality Hashing methods, which validates the effectiveness of the proposed CMFH.

[Data sources, the data used, and the modality for collection].

PubMed

Mercier, G; Costa, N; Dutot, C; Riche, V-P

2018-03-01

The hospital costing process implies access to various sources of data. Whether a micro-costing or a gross-costing approach is used, the choice of the methodology is based on a compromise between the cost of data collection, data accuracy, and data transferability. This work describes the data sources available in France and the access modalities that are used, as well as the main advantages and shortcomings of: (1) the local unit costs, (2) the hospital analytical accounting, (3) the Angers database, (4) the National Health Cost Studies, (5) the INTER CHR/U databases, (6) the Program for Medicalizing Information Systems, and (7) the public health insurance databases. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Methodology for cost analysis of film-based and filmless portable chest systems

NASA Astrophysics Data System (ADS)

Melson, David L.; Gauvain, Karen M.; Beardslee, Brian M.; Kraitsik, Michael J.; Burton, Larry; Blaine, G. James; Brink, Gary S.

1996-05-01

Many studies analyzing the costs of film-based and filmless radiology have focused on multi- modality, hospital-wide solutions. Yet due to the enormous cost of converting an entire large radiology department or hospital to a filmless environment all at once, institutions often choose to eliminate film one area at a time. Narrowing the focus of cost-analysis may be useful in making such decisions. This presentation will outline a methodology for analyzing the cost per exam of film-based and filmless solutions for providing portable chest exams to Intensive Care Units (ICUs). The methodology, unlike most in the literature, is based on parallel data collection from existing filmless and film-based ICUs, and is currently being utilized at our institution. Direct costs, taken from the perspective of the hospital, for portable computed radiography chest exams in one filmless and two film-based ICUs are identified. The major cost components are labor, equipment, materials, and storage. Methods for gathering and analyzing each of the cost components are discussed, including FTE-based and time-based labor analysis, incorporation of equipment depreciation, lease, and maintenance costs, and estimation of materials costs. Extrapolation of data from three ICUs to model hypothetical, hospital-wide film-based and filmless ICU imaging systems is described. Performance of sensitivity analysis on the filmless model to assess the impact of anticipated reductions in specific labor, equipment, and archiving costs is detailed. A number of indirect costs, which are not explicitly included in the analysis, are identified and discussed.

Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study

PubMed Central

2010-01-01

Introduction Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other, and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites, and, to date, only single-center cost studies have been performed. The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU). Methods We performed a post hoc analysis of a prospective observational study among 53 centers from 23 countries, from September 2000 to December 2001. We estimated costs based on staffing, as well as dialysate and replacement fluid, anticoagulation and extracorporeal circuit. Results We found that the theoretic range of costs were from $3,629.80/day more with CRRT to $378.60/day more with IRRT. The median difference in cost between CRRT and IRRT was $289.60 (IQR 830.8-116.8) per day (greater with CRRT). Costs also varied greatly by region. Reducing replacement fluid volumes in CRRT to ≤ 25 ml/min (approximately 25 ml/kg/hr) would result in $67.20/day (23.2%) mean savings. Conclusions Cost considerations with RRT are important and vary substantially among centers. We identified the relative impact of four cost domains (nurse staffing, fluid, anticoagulation, and extracorporeal circuit) on overall cost differences, and hospitals can look to these areas to reduce costs associated with RRT. PMID:20346163

Tearing down the barriers to daily home hemodialysis and achieving the highest value renal therapy through holistic product design.

PubMed

Kenley, R S

1996-04-01

Renal therapy value can be defined as the ratio of outcomes achieved by a dialytic therapy to the total cost of providing that therapy. One desirable goal of any dialysis modality would be the achievement of maximum value. Unfortunately, with conventional hemodialysis and peritoneal dialysis modalities, improving outcomes has always been linked to a simultaneous increase in costs, thereby leaving value relatively unchanged. However, a new modality, daily home hemodialysis, finally may allow this linkage to be broken. The outcomes are dramatically improved as a result of a higher quantity and quality of dialysis dose resulting from the greater frequency of treatments. The costs can be reduced by minimizing the consumed items, avoiding the labor and overhead of dialysis clinics, and reducing the costs associated with morbidity. Provision of this therapy is, however, predicated on the availability of instrumentation designed specifically for it because conventional equipment designed for in-center use is not suitable. By starting with a clean sheet of paper and incorporating such features as insitu reuse of the entire extracorporeal circuit, remote telemonitoring, automated system disinfection, and integrated water purification, most of the impediments to performing this modality can be overcome.

Manufacturing Methods for High Speed Machining of Aluminum

DTIC Science & Technology

1978-02-01

Tests 53 4.4.3 Intergrmnular Corrosion Tests. ........... 53 4.4.4 Cost Analysis . .. ............... . .. .... 60 4.5 Conclusions...Corporat~ion and Others to equuip an existing Uwidstvahd, five-axes, Modal as-i, oidail with a 20,000 rVIL 20 hOW~pse spindle, Based anresults obtained...economic analysis for high-speed machining wan also conducted by Metout, and the results are given in Section 11.0. Xn Section 12.0, conclusions and

Simulation of crash tests for high impact levels of a new bridge safety barrier

NASA Astrophysics Data System (ADS)

Drozda, Jiří; Rotter, Tomáš

2017-09-01

The purpose is to show the opportunity of a non-linear dynamic impact simulation and to explain the possibility of using finite element method (FEM) for developing new designs of safety barriers. The main challenge is to determine the means to create and validate the finite element (FE) model. The results of accurate impact simulations can help to reduce necessary costs for developing of a new safety barrier. The introductory part deals with the creation of the FE model, which includes the newly-designed safety barrier and focuses on the application of an experimental modal analysis (EMA). The FE model has been created in ANSYS Workbench and is formed from shell and solid elements. The experimental modal analysis, which was performed on a real pattern, was employed for measuring the modal frequencies and shapes. After performing the EMA, the FE mesh was calibrated after comparing the measured modal frequencies with the calculated ones. The last part describes the process of the numerical non-linear dynamic impact simulation in LS-DYNA. This simulation was validated after comparing the measured ASI index with the calculated ones. The aim of the study is to improve professional public knowledge about dynamic non-linear impact simulations. This should ideally lead to safer, more accurate and profitable designs.

Cost-effectiveness of secondary screening modalities for hypertension.

PubMed

Wang, Y Claire; Koval, Alisa M; Nakamura, Miyabi; Newman, Jonathan D; Schwartz, Joseph E; Stone, Patricia W

2013-02-01

Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

Development of a universal medical X-ray imaging phantom prototype.

PubMed

Groenewald, Annemari; Groenewald, Willem A

2016-11-08

Diagnostic X-ray imaging depends on the maintenance of image quality that allows for proper diagnosis of medical conditions. Maintenance of image quality requires quality assurance programs on the various X-ray modalities, which consist of pro-jection radiography (including mobile X-ray units), fluoroscopy, mammography, and computed tomography (CT) scanning. Currently a variety of modality-specific phantoms are used to perform quality assurance (QA) tests. These phantoms are not only expensive, but suitably trained personnel are needed to successfully use them and interpret the results. The question arose as to whether a single universal phantom could be designed and applied to all of the X-ray imaging modalities. A universal phantom would reduce initial procurement cost, possibly reduce the time spent on QA procedures and simplify training of staff on the single device. The aim of the study was to design and manufacture a prototype of a universal phantom, suitable for image quality assurance in general X-rays, fluoroscopy, mammography, and CT scanning. The universal phantom should be easy to use and would enable automatic data analysis, pass/fail reporting, and corrective action recommendation. In addition, a universal phantom would especially be of value in low-income countries where finances and human resources are limited. The design process included a thorough investigation of commercially available phantoms. Image quality parameters necessary for image quality assurance in the different X-ray imaging modalities were determined. Based on information obtained from the above-mentioned investigations, a prototype of a universal phantom was developed, keeping ease of use and reduced cost in mind. A variety of possible phantom housing and insert materials were investigated, considering physical properties, machinability, and cost. A three-dimensional computer model of the first phantom prototype was used to manufacture the prototype housing and inserts. Some of the inserts were 3D-printed, others were machined from different materials. The different components were assembled to form the first prototype of the universal X-ray imaging phantom. The resulting prototype of the universal phantom conformed to the aims of a single phantom for multiple imag-ing modalities, which would be easy to use and manufacture at a reduced cost. A PCT International Patent Application No. PCT/IB2016/051165 has been filed for this technology. © 2016 The Authors.

A Cost-Effectiveness Analysis of Surgery for Middle-Aged Men with Severe Obstructive Sleep Apnea Intolerant of CPAP

PubMed Central

Tan, Kelvin B.; Toh, Song Tar; Guilleminault, Christian; Holty, Jon-Erik C.

2015-01-01

Study Objectives: Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Conventional OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective treatment modality, up to 50% of OSA patients are intolerant of CPAP. We explore whether surgical modalities developed for those intolerant of CPAP are cost-effective. Methods: We construct a lifetime semi-Markov model of OSA that accounts for observed increased risks of stroke, cardiovascular disease, and motor vehicle collisions for a 50-year-old male with untreated severe OSA. Using this model, we compare the cost-effectiveness of (1) no treatment, (2) CPAP only, and (3) CPAP followed by surgery (either palatopharyngeal reconstructive surgery [PPRS] or multilevel surgery [MLS]) for those intolerant to CPAP. Results: Compared with the CPAP only strategy, CPAP followed by PPRS (CPAP-PPRS) adds 0.265 quality adjusted life years (QALYs) for an increase of $2,767 (discounted 2010 dollars) and is highly cost effective with an incremental cost-effectiveness ratio (ICER) of $10,421/QALY for a 50-year-old male with severe OSA. Compared to a CPAP-PPRS strategy, the CPAP-MLS strategy adds 0.07 QALYs at an increase of $6,213 for an ICER of $84,199/QALY. The CPAP-PPRS strategy appears cost-effective over a wide range of parameter estimates. Conclusions: Palatopharyngeal reconstructive surgery appears cost-effective in middle-aged men with severe OSA intolerant of CPAP. Further research is warranted to better define surgical candidacy as well as short-term and long-term surgical outcomes. Commentary: A commentary on this article appears in this issue on page 509. Citation: Tan KB, Toh ST, Guilleminault C, Holty JE. A cost-effectiveness analysis of surgery for middle-aged men with severe obstructive sleep apnea intolerant of CPAP. J Clin Sleep Med 2015;11(5):525–535. PMID:25700871

Characteristics of future air cargo demand and impact on aircraft development - A report on the Cargo/Logistic Airlift Systems Study /CLASS/ project

NASA Technical Reports Server (NTRS)

Whitehead, A. H., Jr.

1978-01-01

The considered study has been conducted to evaluate the future potential for an advanced air cargo transport. A current operations analysis is discussed, taking into account the traffic structure, modal cost comparisons, terminal operations, containerization, and institutional factors. Attention is also given to case studies, a demand forecast, and an advanced air cargo systems analysis. The effects of potential improvements on reducing costs are shown. Improvement to the current infrastructure can occur from 1978 to 1985 with off-the-shelf technology, which when combined with higher load factors for aircraft and containers, can provide up to a 16 percent reduction in total operating costs and a 15 percent rate reduction. The results of the analysis indicate that the proposed changes in the infrastructure and improved cargo loading efficiencies are as important to improving the airlines' financial posture as is the anticipated large dedicated cargo aircraft.

Blind identification of full-field vibration modes from video measurements with phase-based video motion magnification

NASA Astrophysics Data System (ADS)

Yang, Yongchao; Dorn, Charles; Mancini, Tyler; Talken, Zachary; Kenyon, Garrett; Farrar, Charles; Mascareñas, David

2017-02-01

Experimental or operational modal analysis traditionally requires physically-attached wired or wireless sensors for vibration measurement of structures. This instrumentation can result in mass-loading on lightweight structures, and is costly and time-consuming to install and maintain on large civil structures, especially for long-term applications (e.g., structural health monitoring) that require significant maintenance for cabling (wired sensors) or periodic replacement of the energy supply (wireless sensors). Moreover, these sensors are typically placed at a limited number of discrete locations, providing low spatial sensing resolution that is hardly sufficient for modal-based damage localization, or model correlation and updating for larger-scale structures. Non-contact measurement methods such as scanning laser vibrometers provide high-resolution sensing capacity without the mass-loading effect; however, they make sequential measurements that require considerable acquisition time. As an alternative non-contact method, digital video cameras are relatively low-cost, agile, and provide high spatial resolution, simultaneous, measurements. Combined with vision based algorithms (e.g., image correlation, optical flow), video camera based measurements have been successfully used for vibration measurements and subsequent modal analysis, based on techniques such as the digital image correlation (DIC) and the point-tracking. However, they typically require speckle pattern or high-contrast markers to be placed on the surface of structures, which poses challenges when the measurement area is large or inaccessible. This work explores advanced computer vision and video processing algorithms to develop a novel video measurement and vision-based operational (output-only) modal analysis method that alleviate the need of structural surface preparation associated with existing vision-based methods and can be implemented in a relatively efficient and autonomous manner with little user supervision and calibration. First a multi-scale image processing method is applied on the frames of the video of a vibrating structure to extract the local pixel phases that encode local structural vibration, establishing a full-field spatiotemporal motion matrix. Then a high-spatial dimensional, yet low-modal-dimensional, over-complete model is used to represent the extracted full-field motion matrix using modal superposition, which is physically connected and manipulated by a family of unsupervised learning models and techniques, respectively. Thus, the proposed method is able to blindly extract modal frequencies, damping ratios, and full-field (as many points as the pixel number of the video frame) mode shapes from line of sight video measurements of the structure. The method is validated by laboratory experiments on a bench-scale building structure and a cantilever beam. Its ability for output (video measurements)-only identification and visualization of the weakly-excited mode is demonstrated and several issues with its implementation are discussed.

Cost-effectiveness of hospital treatment and outcomes of acute methanol poisoning during the Czech Republic mass poisoning outbreak.

PubMed

Rulisek, Jan; Balik, Martin; Polak, Ferdinand; Waldauf, Petr; Pelclova, Daniela; Belohlavek, Jan; Zakharov, Sergey

2017-06-01

During an outbreak of mass methanol poisoning in the Czech Republic in 2012-2014, we compared the total hospital costs and one-year medical costs in the patients treated with different antidotes (fomepizole versus ethanol) and modalities of hemodialysis (intermittent hemodialysis, IHD, versus continuous renal replacement therapy, CRRT). Cross-sectional study in 106 patients with confirmed diagnosis treated in 30 ICU settings. For each patient, the following data were analyzed: admission laboratory data, GCS, PSS, ICU length of stay, organ failures, treatment, outcome, and total hospital costs. Of 83 survivors, in 54 (65%) patients the follow-up examination, quality of life measurement with SF36 questionnaire two years after discharge, and one-year medical costs analysis were performed. The median total hospital costs were 7200 (IQR 1500-10,900) euros and the median one-year medical costs were 1447 (IQR 133-1163) euros in the study population. The total hospital costs were higher in the patients treated with fomepizole comparing to ethanol: 12,890 (IQR 6910-16,210) versus 5590 (IQR 1430-6940) euros (p<0.001). The hospital costs in the patients treated with IHD were 5400 (IQR 1520-6910) versus 12,410 (IQR 5380-16,960) euros in the patients with CRRT (p=0.317). The geometric mean ratio for increased hospital costs in the patients treated with fomepizole versus ethanol adjusted for the severity of poisoning was 3.30 (1.70-3.80 CI 95%), p<0.001, and in the patients treated with IHD versus CRRT - 0.70 (0.60-0.99 CI 95%), p=0.047. The patients with visual sequelae had higher total hospital costs than those without sequelae: 10,419 (IQR 2984-14,355) versus 4605 (IQR 1303-4505) euros (p=0.009). The patients with GCS≤13 on admission had higher one-year medical costs as well (p<0.001). No difference was found in physical and mental condition scores in the patients treated with different antidotes and modalities of hemodialysis two years after discharge (both p>0.05). The total hospital costs in the patients with acute methanol poisoning were more than three times higher in the patients treated with fomepizole than in the patients treated with ethanol after adjustment for the severity of poisoning. The dialysis modality did not affect the total hospital costs, but the trend to lower costs was present in IHD-group. Copyright © 2017 Elsevier Inc. All rights reserved.

Economic Evaluation of Frequent Home Nocturnal Hemodialysis Based on a Randomized Controlled Trial

PubMed Central

Tonelli, Marcello; Pauly, Robert; Walsh, Michael; Culleton, Bruce; So, Helen; Hemmelgarn, Brenda; Manns, Braden

2014-01-01

Provider and patient enthusiasm for frequent home nocturnal hemodialysis (FHNHD) has been renewed; however, the cost-effectiveness of this technique is unknown. We performed a cost-utility analysis of FHNHD compared with conventional hemodialysis (CvHD; 4 hours three times per week) from a health payer perspective over a lifetime horizon using patient information from the Alberta NHD randomized controlled trial. Costs, including training costs, were obtained using microcosting and administrative data (CAN$2012). We determined the incremental cost per quality-adjusted life year (QALY) gained. Robustness was assessed using scenario, sensitivity, and probabilistic sensitivity analyses. Compared with CvHD (61% in-center, 14% satellite, and 25% home dialysis), FHNHD led to incremental cost savings (−$6700) and an additional 0.38 QALYs. In sensitivity analyses, when the annual probability of technique failure with FHNHD increased from 7.6% (reference case) to ≥19%, FHNHD became unattractive (>$75,000/QALY). The cost/QALY gained became $13,000 if average training time for FHNHD increased from 3.7 to 6 weeks. In scenarios with alternate comparator modalities, FHNHD remained dominant compared with in-center CvHD; cost/QALYs gained were $18,500, $198,000, and $423,000 compared with satellite CvHD, home CvHD, and peritoneal dialysis, respectively. In summary, FHNHD is attractive compared with in-center CvHD in this cohort. However, the attractiveness of FHNHD varies by technique failure rate, training time, and dialysis modalities from which patients are drawn, and these variables should be considered when establishing FHNHD programs. PMID:24231665

THE MEASUREMENT OF BONE QUALITY USING GRAY LEVEL CO-OCCURRENCE MATRIX TEXTURAL FEATURES.

PubMed

Shirvaikar, Mukul; Huang, Ning; Dong, Xuanliang Neil

2016-10-01

In this paper, statistical methods for the estimation of bone quality to predict the risk of fracture are reported. Bone mineral density and bone architecture properties are the main contributors of bone quality. Dual-energy X-ray Absorptiometry (DXA) is the traditional clinical measurement technique for bone mineral density, but does not include architectural information to enhance the prediction of bone fragility. Other modalities are not practical due to cost and access considerations. This study investigates statistical parameters based on the Gray Level Co-occurrence Matrix (GLCM) extracted from two-dimensional projection images and explores links with architectural properties and bone mechanics. Data analysis was conducted on Micro-CT images of 13 trabecular bones (with an in-plane spatial resolution of about 50μm). Ground truth data for bone volume fraction (BV/TV), bone strength and modulus were available based on complex 3D analysis and mechanical tests. Correlation between the statistical parameters and biomechanical test results was studied using regression analysis. The results showed Cluster-Shade was strongly correlated with the microarchitecture of the trabecular bone and related to mechanical properties. Once the principle thesis of utilizing second-order statistics is established, it can be extended to other modalities, providing cost and convenience advantages for patients and doctors.

THE MEASUREMENT OF BONE QUALITY USING GRAY LEVEL CO-OCCURRENCE MATRIX TEXTURAL FEATURES

PubMed Central

Shirvaikar, Mukul; Huang, Ning; Dong, Xuanliang Neil

2016-01-01

In this paper, statistical methods for the estimation of bone quality to predict the risk of fracture are reported. Bone mineral density and bone architecture properties are the main contributors of bone quality. Dual-energy X-ray Absorptiometry (DXA) is the traditional clinical measurement technique for bone mineral density, but does not include architectural information to enhance the prediction of bone fragility. Other modalities are not practical due to cost and access considerations. This study investigates statistical parameters based on the Gray Level Co-occurrence Matrix (GLCM) extracted from two-dimensional projection images and explores links with architectural properties and bone mechanics. Data analysis was conducted on Micro-CT images of 13 trabecular bones (with an in-plane spatial resolution of about 50μm). Ground truth data for bone volume fraction (BV/TV), bone strength and modulus were available based on complex 3D analysis and mechanical tests. Correlation between the statistical parameters and biomechanical test results was studied using regression analysis. The results showed Cluster-Shade was strongly correlated with the microarchitecture of the trabecular bone and related to mechanical properties. Once the principle thesis of utilizing second-order statistics is established, it can be extended to other modalities, providing cost and convenience advantages for patients and doctors. PMID:28042512

Benefit-cost evaluation of an intra-regional air service in the Bay area

NASA Technical Reports Server (NTRS)

Haefner, L. E.

1977-01-01

Utilization of an iterative statistical model is presented to evaluate combinations of commuter airport sites and surface transportation facilities in confunction with service by a given commuter aircraft type in light of Bay Area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation options with respect to criteria of airline profitability, public acceptance, and public and private nonuser costs. It incorporates information modal split, peak and off-peak use of the air commuter fleet, terminal and airport cost, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytical capability, and performs exhaustive sensitivity analysis.

Dynamic stall characterization using modal analysis of phase-averaged pressure distributions

NASA Astrophysics Data System (ADS)

Harms, Tanner; Nikoueeyan, Pourya; Naughton, Jonathan

2017-11-01

Dynamic stall characterization by means of surface pressure measurements can simplify the time and cost associated with experimental investigation of unsteady airfoil aerodynamics. A unique test capability has been developed at University of Wyoming over the past few years that allows for time and cost efficient measurement of dynamic stall. A variety of rotorcraft and wind turbine airfoils have been tested under a variety of pitch oscillation conditions resulting in a range of dynamic stall behavior. Formation, development and separation of different flow structures are responsible for the complex aerodynamic loading behavior experienced during dynamic stall. These structures have unique signatures on the pressure distribution over the airfoil. This work investigates the statistical behavior of phase-averaged pressure distribution for different types of dynamic stall by means of modal analysis. The use of different modes to identify specific flow structures is being investigated. The use of these modes for different types of dynamic stall can provide a new approach for understanding and categorizing these flows. This work uses airfoil data acquired under Army contract W911W60160C-0021, DOE Grant DE-SC0001261, and a gift from BP Alternative Energy North America, Inc.

High productivity mould robotic milling in Al-5083

NASA Astrophysics Data System (ADS)

Urresti, Iker; Arrazola, Pedro Jose; Ørskov, Klaus Bonde; Pelegay, Jose Angel

2018-05-01

Industrial serial robots were usually limited to welding, handling or spray painting operations until very recent years. However, some industries have already realized about their important capabilities in terms of flexibility, working space, adaptability and cost. Hence, currently they are seriously being considered to carry out certain metal machining tasks. Therefore, robot based machining is presented as a cost-saving and flexible manufacturing alternative compared to conventional CNC machines especially for roughing or even pre-roughing of large parts. Nevertheless, there are still some drawbacks usually referred as low rigidity, accuracy and repeatability. Thus, the process productivity is usually sacrificed getting low Material Removal Rates (MRR), and consequently not being competitive. Nevertheless, in this paper different techniques to obtain increased productivity are presented, though an appropriate selection of cutting strategies and parameters that are essential for it. During this research some rough milling tests in Al-5083 are presented where High Feed Milling (HFM) is implemented as productive cutting strategy and the experimental modal analysis named Tap-testing is used for the suitable choice of cutting conditions. Competitive productivity rates are experienced while process stability is checked through the cutting forces measurements in order to prove the effectiveness of the experimental modal analysis for robotic machining.

Cost effectiveness of fecal DNA screening for colorectal cancer: a systematic review and quality appraisal of the literature.

PubMed

Skally, Mairead; Hanly, Paul; Sharp, Linda

2013-06-01

Fecal DNA (fDNA) testing is a noninvasive potential alternative to current colorectal cancer screening tests. We conducted a systematic review and quality assessment of studies of cost-effectiveness of fDNA as a colorectal cancer screening tool (compared with no screening and other screening modalities), and identified key variables that impinged on cost-effectiveness. We searched MEDLINE, Embase, and the Centre for Reviews and Dissemination for cost-effectiveness studies of fDNA-based screening, published in English by September 2011. Studies that undertook an economic evaluation of fDNA, using either a cost-effectiveness or cost-utility analysis, compared with other relevant screening modalities and/or no screening were included. Additional inclusion criteria related to the presentation of data pertaining to model variables including time horizon, costs, fDNA performance characteristics, screening uptake, and comparators. A total of 369 articles were initially identified for review. After removing duplicates and applying inclusion and exclusion criteria, seven articles were included in the final review. Data was abstracted on key descriptor variables including screening scenarios, time horizon, costs, test performance characteristics, screening uptake, comparators, and incremental cost-effectiveness ratios. Quality assessment was undertaken using a standard checklist for economic evaluations. Studies cited by cost-effectiveness articles as the source of data on fDNA test performance characteristics were also reviewed. Seven cost-effectiveness studies were included, from the USA (4), Canada (1), Israel (1), and Taiwan (1). Markov models (5), a partially observable Markov decision process model (1) and MISCAN and SimCRC (1) microsimulation models were used. All studies took a third-party payer perspective and one included, in addition, a societal perspective. Comparator screening tests, screening intervals, and specific fDNA tests varied between studies. fDNA sensitivity and specificity parameters were derived from 12 research studies and one meta-analysis. Outcomes assessed were life-years gained and quality-adjusted life-years gained. fDNA was cost-effective when compared with no screening in six studies. Compared with other screening modalities, fDNA was not considered cost-effective in any of the base-case analyses: in five studies it was dominated by all alternatives considered. Sensitivity analyses identified cost, compliance, and test parameters as key influential parameters. In general, poor presentation of "study design" and "data collection" details lowered the quality of included articles. Although the literature searches were designed for high sensitivity, the possibility cannot be excluded that some eligible studies may have been missed. Reports (such as Health Technology Assessments produced by government agencies) and other forms of grey literature were excluded because they are difficult to identify systematically and/or may not report methods and results in sufficient detail for assessment. On the basis of the available (albeit limited) evidence, while fDNA is cost-effective when compared with no screening, it is currently dominated by most of the other available screening options. Cost and test performance appear to be the main influences on cost-effectiveness.

ADMultiImg: a novel missing modality transfer learning based CAD system for diagnosis of MCI due to AD using incomplete multi-modality imaging data

NASA Astrophysics Data System (ADS)

Liu, Xiaonan; Chen, Kewei; Wu, Teresa; Weidman, David; Lure, Fleming; Li, Jing

2018-02-01

Alzheimer's Disease (AD) is the most common cause of dementia and currently has no cure. Treatments targeting early stages of AD such as Mild Cognitive Impairment (MCI) may be most effective to deaccelerate AD, thus attracting increasing attention. However, MCI has substantial heterogeneity in that it can be caused by various underlying conditions, not only AD. To detect MCI due to AD, NIA-AA published updated consensus criteria in 2011, in which the use of multi-modality images was highlighted as one of the most promising methods. It is of great interest to develop a CAD system based on automatic, quantitative analysis of multi-modality images and machine learning algorithms to help physicians more adequately diagnose MCI due to AD. The challenge, however, is that multi-modality images are not universally available for many patients due to cost, access, safety, and lack of consent. We developed a novel Missing Modality Transfer Learning (MMTL) algorithm capable of utilizing whatever imaging modalities are available for an MCI patient to diagnose the patient's likelihood of MCI due to AD. Furthermore, we integrated MMTL with radiomics steps including image processing, feature extraction, and feature screening, and a post-processing for uncertainty quantification (UQ), and developed a CAD system called "ADMultiImg" to assist clinical diagnosis of MCI due to AD using multi-modality images together with patient demographic and genetic information. Tested on ADNI date, our system can generate a diagnosis with high accuracy even for patients with only partially available image modalities (AUC=0.94), and therefore may have broad clinical utility.

Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: a prospective, randomized, single-blind trial.

PubMed

Sun, Da-Li; Li, Wei-Ming; Li, Shu-Min; Cen, Yun-Yun; Xu, Qing-Wen; Li, Yi-Jun; Sun, Yan-Bo; Qi, Yu-Xing; Lin, Yue-Ying; Yang, Ting; Lu, Qi-Ping; Xu, Peng-Yuan

2017-02-10

Early oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition. Consecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness. One hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P < 0.05). The median postoperative length of stay in the multimodal EON group was 8 days (6, 12) versus 10 days (7, 18) in the conventional care group (P < 0.001). The total cost of treatment and nutritional support were also less in the multi-modal early oral nutrition group (P < 0.001). The effectiveness was 84.9 and 79.9% in the multimodal EON and conventional care group, respectively (P = 0.475). However, the cost-effectiveness ratio was USD 537.6 (506.1, 589.3) and USD 637.8 (593.9, 710.3), respectively (P < 0.001). The multi-modal early oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery. Registration number: ChiCTR-TRC-14004395 . Registered 15 March 2014.

Multi-modal management of acromegaly: a value perspective.

PubMed

Kimmell, Kristopher T; Weil, Robert J; Marko, Nicholas F

2015-10-01

The Acromegaly Consensus Group recently released updated guidelines for medical management of acromegaly patients. We subjected these guidelines to a cost analysis. We conducted a cost analysis of the recommendations based on published efficacy rates as well as publicly available cost data. The results were compared to findings from a previously reported comparative effectiveness analysis of acromegaly treatments. Using decision tree software, two models were created based on the Acromegaly Consensus Group's recommendations and the comparative effectiveness analysis. The decision tree for the Consensus Group's recommendations was subjected to multi-way tornado analysis to identify variables that most impacted the value analysis of the decision tree. The value analysis confirmed the Consensus Group's recommendations of somatostatin analogs as first line therapy for medical management. Our model also demonstrated significant value in using dopamine agonist agents as upfront therapy as well. Sensitivity analysis identified the cost of somatostatin analogs and growth hormone receptor antagonists as having the most significant impact on the cost effectiveness of medical therapies. Our analysis confirmed the value of surgery as first-line therapy for patients with surgically accessible lesions. Surgery provides the greatest value for management of patients with acromegaly. However, in accordance with the Acromegaly Consensus Group's recent recommendations, somatostatin analogs provide the greatest value and should be used as first-line therapy for patients who cannot be managed surgically. At present, the substantial cost is the most significant negative factor in the value of medical therapies for acromegaly.

Hybrid motion sensing and experimental modal analysis using collocated smartphone camera and accelerometers

NASA Astrophysics Data System (ADS)

Ozer, Ekin; Feng, Dongming; Feng, Maria Q.

2017-10-01

State-of-the-art multisensory technologies and heterogeneous sensor networks propose a wide range of response measurement opportunities for structural health monitoring (SHM). Measuring and fusing different physical quantities in terms of structural vibrations can provide alternative acquisition methods and improve the quality of the modal testing results. In this study, a recently introduced SHM concept, SHM with smartphones, is focused to utilize multisensory smartphone features for a hybridized structural vibration response measurement framework. Based on vibration testing of a small-scale multistory laboratory model, displacement and acceleration responses are monitored using two different smartphone sensors, an embedded camera and accelerometer, respectively. Double-integration or differentiation among different measurement types is performed to combine multisensory measurements on a comparative basis. In addition, distributed sensor signals from collocated devices are processed for modal identification, and performance of smartphone-based sensing platforms are tested under different configuration scenarios and heterogeneity levels. The results of these tests show a novel and successful implementation of a hybrid motion sensing platform through multiple sensor type and device integration. Despite the heterogeneity of motion data obtained from different smartphone devices and technologies, it is shown that multisensory response measurements can be blended for experimental modal analysis. Getting benefit from the accessibility of smartphone technology, similar smartphone-based dynamic testing methodologies can provide innovative SHM solutions with mobile, programmable, and cost-free interfaces.

The Danish Centre for Strategic Research in Type 2 Diabetes (DD2) study: expected outcome from the DD2 project and two intervention studies

PubMed Central

Beck-Nielsen, Henning; Solomon, Thomas PJ; Lauridsen, Jørgen; Karstoft, Kristian; Pedersen, Bente K; Johnsen, Søren P; Nielsen, Jens Steen; Kryger, Tine Bjerregaard; Sortsø, Camilla; Vaag, Allan

2012-01-01

The overall aim of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) is to near-normalize metabolic control in newly diagnosed patients with type 2 diabetes (T2D) using an individualized treatment approach. We hypothesize that this will not only prevent complications and improve quality of life for T2D patients but also result in increased cost efficiency compared with current treatment modalities. This paper provides an overview of the expected outcomes from DD2, focusing on the two main intervention studies. The main data for the DD2 project are collected during patient enrollment and stored using the individual civil registration number. This enables subsequent linking to other national databases where supplemental data can be obtained. All data will be used for designing treatment guidelines and continuously monitoring the development of diabetic complications, thereby obtaining knowledge about predictors for the long-term outcome and identifying targets for new interventions. Further data are being collected from two intervention studies. The aim of the first intervention study is to improve T2D treatment using an individualized treatment modality optimizing medication according to individual metabolic responses and phenotypic characteristics. The aim of the second intervention study is to develop an evidence-based training protocol to be implemented as a treatment modality for T2D and used for initiating lifelong changes in physical activity levels in patients with T2D. An initial pilot study evaluating an interval-based walking protocol is ongoing, and preliminary results indicate that this protocol is an optimal “free-living” training intervention. An initial health-economic analysis will also be performed as a basis for analysis of the data collected during the project. A cost-benefit analysis of the two intervention studies will be conducted. The DD2 project is expected to lead to improved treatment modalities and increased knowledge about existing treatment guidelines, and will also provide a solid base for health-economic decision-making. PMID:23071408

Will biomedical innovation change the future of healthcare?

PubMed

Schmid, Esther F; Ashkenazy, Rebecca; Merson, James; Smith, Dennis A

2009-11-01

Healthcare costs in all industrial nations have increased and payors are starting to look at new ways to contain costs and at new funding models. The business model of pharmaceutical companies is also undergoing rapid changes - potentially disruptive new modalities, such as RNAi, therapeutic vaccines, and cell therapy are emerging, R&D costs have increased year on year, pressures on drug pricing and the efficacy and safety of medicines are mounting. Change is therefore inevitable and already ongoing in healthcare systems and pharmaceutical companies alike. This paper presents several major forces which could drive different future scenarios including: R&D costs, the source of payments for medicines and the emergence of new modalities.

Comparative analyses of spent nuclear fuel transport modal options: Transport options under existing site constraints

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

Brentlinger, L.A.; Hofmann, P.L.; Peterson, R.W.

1989-08-01

The movement of nuclear waste can be accomplished by various transport modal options involving different types of vehicles, transport casks, transport routes, and intermediate intermodal transfer facilities. A series of systems studies are required to evaluate modal/intermodal spent fuel transportation options in a consistent fashion. This report provides total life-cycle cost and life-cycle dose estimates for a series of transport modal options under existing site constraints. 14 refs., 7 figs., 28 tabs.

Alternative synthetic aperture radar (SAR) modalities using a 1D dynamic metasurface antenna

NASA Astrophysics Data System (ADS)

Boyarsky, Michael; Sleasman, Timothy; Pulido-Mancera, Laura; Imani, Mohammadreza F.; Reynolds, Matthew S.; Smith, David R.

2017-05-01

Synthetic aperture radar (SAR) systems conventionally rely on mechanically-actuated reflector dishes or large phased arrays for generating steerable directive beams. While these systems have yielded high-resolution images, the hardware suffers from considerable weight, high cost, substantial power consumption, and moving parts. Since these disadvantages are particularly relevant in airborne and spaceborne systems, a flat, lightweight, and low-cost solution is a sought-after goal. Dynamic metasurface antennas have emerged as a recent technology for generating waveforms with desired characteristics. Metasurface antennas consist of an electrically-large waveguide loaded with numerous subwavelength radiators which selectively leak energy from a guided wave into free space to form various radiation patterns. By tuning each radiating element, we can modulate the aperture's overall radiation pattern to generate steered directive beams, without moving parts or phase shifters. Furthermore, by using established manufacturing methods, these apertures can be made to be lightweight, low-cost, and planar, while maintaining high performance. In addition to their hardware benefits, dynamic metasurfaces can leverage their dexterity and high switching speeds to enable alternative SAR modalities for improved performance. In this work, we briefly discuss how dynamic metasurfaces can conduct existing SAR modalities with similar performance as conventional systems from a significantly simpler hardware platform. We will also describe two additional modalities which may achieve improved performance as compared to traditional modalities. These modalities, enhanced resolution stripmap and diverse pattern stripmap, offer the ability to circumvent the trade-off between resolution and region-of-interest size that exists within stripmap and spotlight. Imaging results with a simulated dynamic metasurface verify the benefits of these modalities and a discussion of implementation considerations and noise effects is also included. Ultimately, the hardware gains coupled with the additional modalities well-suited to dynamic metasurface antennas has poised them to propel the SAR field forward and open the door to exciting opportunities.

Statistical analysis of modal properties of a cable-stayed bridge through long-term structural health monitoring with wireless smart sensor networks

NASA Astrophysics Data System (ADS)

Asadollahi, Parisa; Li, Jian

2016-04-01

Understanding the dynamic behavior of complex structures such as long-span bridges requires dense deployment of sensors. Traditional wired sensor systems are generally expensive and time-consuming to install due to cabling. With wireless communication and on-board computation capabilities, wireless smart sensor networks have the advantages of being low cost, easy to deploy and maintain and therefore facilitate dense instrumentation for structural health monitoring. A long-term monitoring project was recently carried out for a cable-stayed bridge in South Korea with a dense array of 113 smart sensors, which feature the world's largest wireless smart sensor network for civil structural monitoring. This paper presents a comprehensive statistical analysis of the modal properties including natural frequencies, damping ratios and mode shapes of the monitored cable-stayed bridge. Data analyzed in this paper is composed of structural vibration signals monitored during a 12-month period under ambient excitations. The correlation between environmental temperature and the modal frequencies is also investigated. The results showed the long-term statistical structural behavior of the bridge, which serves as the basis for Bayesian statistical updating for the numerical model.

Benefit–Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment “Pay for Itself”?

PubMed Central

Ettner, Susan L; Huang, David; Evans, Elizabeth; Rose Ash, Danielle; Hardy, Mary; Jourabchi, Mickel; Hser, Yih-Ing

2006-01-01

Objective To examine costs and monetary benefits associated with substance abuse treatment. Data Sources Primary and administrative data on client outcomes and agency costs from 43 substance abuse treatment providers in 13 counties in California during 2000–2001. Study Design Using a social planner perspective, the estimated direct cost of treatment was compared with the associated monetary benefits, including the client's costs of medical care, mental health services, criminal activity, earnings, and (from the government's perspective) transfer program payments. The cost of the client's substance abuse treatment episode was estimated by multiplying the number of days that the client spent in each treatment modality by the estimated average per diem cost of that modality. Monetary benefits associated with treatment were estimated using a pre–posttreatment admission study design, i.e., each client served as his or her own control. Data Collection Treatment cost data were collected from providers using the Drug Abuse Treatment Cost Analysis Program instrument. For the main sample of 2,567 clients, information on medical hospitalizations, emergency room visits, earnings, and transfer payments was obtained from baseline and 9-month follow-up interviews, and linked to information on inpatient and outpatient mental health services use and criminal activity from administrative databases. Sensitivity analyses examined administrative data outcomes for a larger cohort (N=6,545) and longer time period (1 year). Principal Findings On average, substance abuse treatment costs $1,583 and is associated with a monetary benefit to society of $11,487, representing a greater than 7:1 ratio of benefits to costs. These benefits were primarily because of reduced costs of crime and increased employment earnings. Conclusions Even without considering the direct value to clients of improved health and quality of life, allocating taxpayer dollars to substance abuse treatment may be a wise investment. PMID:16430607

Autonomous stress imaging cores: from concept to reality

NASA Astrophysics Data System (ADS)

van der Velden, Stephen; Rajic, Nik; Brooks, Chris; Galea, Steve

2016-04-01

The historical reliance of thermoelastic stress analysis on cooled infrared detection has created significant cost and practical impediments to the widespread use of this powerful full-field stress measurement technique. The emergence of low-cost microbolometers as a practical alternative has allowed for an expansion of the traditional role of thermoelastic stress analysis, and raises the possibility that it may in future become a viable structural health monitoring modality. Experimental results are shown to confirm that high resolution stress imagery can be obtained from an uncooled thermal camera core significantly smaller than any infrared imaging device previously applied to TSA. The paper provides a summary of progress toward the development of an autonomous stress-imaging capability based on this core.

New benchmarks for costs and cost-efficiency of school-based feeding programs in food-insecure areas.

PubMed

Gelli, Aulo; Cavallero, Andrea; Minervini, Licia; Mirabile, Mariana; Molinas, Luca; de la Mothe, Marc Regnault

2011-12-01

School feeding is a popular intervention that has been used to support the education, health and nutrition of school children. Although the benefits of school feeding are well documented, the evidence on the costs of such programs is remarkably thin. Address the need for systematic estimates of the cost of different school feeding modalities, and of the determinants of the considerable cost variation among countries. WFP project data, including expenditures and number of schoolchildren covered, were collected for 78 projects in 62 countries through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. The standardized yearly average school feeding cost per child, not including school-level costs, was US$48. The yearly costs per child were lowest at US$23 for biscuit programs reaching school-going children and highest at US$75 for take-home rations programs reaching families of schoolgoing children. The average cost of programs combining on-site meals with extra take-home rations for children from vulnerable households was US$61. Commodity costs were on average 58% of total costs and were highest for biscuit and take-home rations programs (71% and 68%, respectively). Fortified biscuits provided the most cost-efficient option in terms of micronutrient delivery, whereas take-home rations were more cost-efficient in terms of food quantities delivered. Both costs and effects should be considered carefully when designing school feeding interventions. The average costs of school feeding estimated here are higher than those found in earlier studies but fall within the range of costs previously reported. Because this analysis does not include school-level costs, these findings highlight the higher nontransfer costs for programs delivering cooked meals in schools than for other school feeding modalities. The benchmarks presented here reflect the centralized WFP implementation model, which is not always relevant in terms of government school feeding programs, particularly those procuring within national boundaries using "home-grown" approaches.

CellProfiler and KNIME: open source tools for high content screening.

PubMed

Stöter, Martin; Niederlein, Antje; Barsacchi, Rico; Meyenhofer, Felix; Brandl, Holger; Bickle, Marc

2013-01-01

High content screening (HCS) has established itself in the world of the pharmaceutical industry as an essential tool for drug discovery and drug development. HCS is currently starting to enter the academic world and might become a widely used technology. Given the diversity of problems tackled in academic research, HCS could experience some profound changes in the future, mainly with more imaging modalities and smart microscopes being developed. One of the limitations in the establishment of HCS in academia is flexibility and cost. Flexibility is important to be able to adapt the HCS setup to accommodate the multiple different assays typical of academia. Many cost factors cannot be avoided, but the costs of the software packages necessary to analyze large datasets can be reduced by using Open Source software. We present and discuss the Open Source software CellProfiler for image analysis and KNIME for data analysis and data mining that provide software solutions which increase flexibility and keep costs low.

Reconfigurable wireless monitoring systems for bridges: validation on the Yeondae Bridge

NASA Astrophysics Data System (ADS)

Kim, Junhee; Lynch, Jerome P.; Zonta, Daniele; Lee, Jong-Jae; Yun, Chung-Bang

2009-03-01

The installation of a structural monitoring system on a medium- to large-span bridge can be a challenging undertaking due to high system costs and time consuming installations. However, these historical challenges can be eliminated by using wireless sensors as the primary building block of a structural monitoring system. Wireless sensors are low-cost data acquisition nodes that utilize wireless communication to transfer data from the sensor to the data repository. Another advantageous characteristic of wireless sensors is their ability to be easily removed and reinstalled in another sensor location on the same structure; this installation modularity is highlighted in this study. Wireless sensor nodes designed for structural monitoring applications are installed on the 180 m long Yeondae Bridge (Korea) to measure the dynamic response of the bridge to controlled truck loading. To attain a high nodal density with a small number (20) of wireless sensors, the wireless sensor network is installed three times with each installation concentrating sensors in one portion of the bridge. Using forced and free vibration response data from the three installations, the modal properties of the bridge are accurately identified. Intentional nodal overlapping of the three different sensor installations allows mode shapes from each installation to be stitched together into global mode shapes. Specifically, modal properties of the Yeondae Bridge are derived off-line using frequency domain decomposition (FDD) modal analysis methods.

Analysis of second order harmonic distortion due to transmitter non-linearity and chromatic and modal dispersion of optical OFDM SSB modulated signals in SMF-MMF fiber links

NASA Astrophysics Data System (ADS)

Patel, Dhananjay; Singh, Vinay Kumar; Dalal, U. D.

2017-01-01

Single mode fibers (SMF) are typically used in Wide Area Networks (WAN), Metropolitan Area Networks (MAN) and also find applications in Radio over Fiber (RoF) architectures supporting data transmission in Fiber to the Home (FTTH), Remote Antenna Units (RAUs), in-building networks etc. Multi-mode fibers (MMFs) with low cost, ease of installation and low maintenance are predominantly (85-90%) deployed in-building networks providing data access in local area networks (LANs). The transmission of millimeter wave signals through the SMF in WAN and MAN, along with the reuse of MMF in-building networks will not levy fiber reinstallation cost. The transmission of the millimeter waves experiences signal impairments due to the transmitter non-linearity and modal dispersion of the MMF. The MMF exhibiting large modal dispersion limits the bandwidth-length product of the fiber. The second and higher-order harmonics present in the optical signal fall within the system bandwidth. This causes degradation in the received signal and an unwanted radiation of power at the RAU. The power of these harmonics is proportional to the non-linearity of the transmitter and the modal dispersion of the MMF and should be maintained below the standard values as per the international norms. In this paper, a mathematical model is developed for Second-order Harmonic Distortion (HD2) generated due to non-linearity of the transmitter and chromatic-modal dispersion of the SMF-MMF optic link. This is also verified using a software simulation. The model consists of a Mach Zehnder Modulator (MZM) that generates two m-QAM OFDM Single Sideband (SSB) signals based on phase shift of the hybrid coupler (90° and 120°). Our results show that the SSB signal with 120° hybrid coupler has suppresses the higher-order harmonics and makes the system more robust against the HD2 in the SMF-MMF optic link.

A Cost-Effectiveness Analysis of Surgery for Middle-Aged Men with Severe Obstructive Sleep Apnea Intolerant of CPAP.

PubMed

Tan, Kelvin B; Toh, Song Tar; Guilleminault, Christian; Holty, Jon-Erik C

2015-04-15

Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Conventional OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective treatment modality, up to 50% of OSA patients are intolerant of CPAP. We explore whether surgical modalities developed for those intolerant of CPAP are cost-effective. We construct a lifetime semi-Markov model of OSA that accounts for observed increased risks of stroke, cardiovascular disease, and motor vehicle collisions for a 50-year-old male with untreated severe OSA. Using this model, we compare the cost-effectiveness of (1) no treatment, (2) CPAP only, and (3) CPAP followed by surgery (either palatopharyngeal reconstructive surgery [PPRS] or multilevel surgery [MLS]) for those intolerant to CPAP. Compared with the CPAP only strategy, CPAP followed by PPRS (CPAP-PPRS) adds 0.265 quality adjusted life years (QALYs) for an increase of $2,767 (discounted 2010 dollars) and is highly cost effective with an incremental cost-effectiveness ratio (ICER) of $10,421/QALY for a 50-year-old male with severe OSA. Compared to a CPAP-PPRS strategy, the CPAP-MLS strategy adds 0.07 QALYs at an increase of $6,213 for an ICER of $84,199/QALY. The CPAP-PPRS strategy appears cost-effective over a wide range of parameter estimates. Palatopharyngeal reconstructive surgery appears cost-effective in middle-aged men with severe OSA intolerant of CPAP. Further research is warranted to better define surgical candidacy as well as short-term and long-term surgical outcomes. A commentary on this article appears in this issue on page 509. © 2015 American Academy of Sleep Medicine.

Stochastic response analysis, order reduction, and output feedback controllers for flexible spacecraft

NASA Technical Reports Server (NTRS)

Hablani, H. B.

1985-01-01

Real disturbances and real sensors have finite bandwidths. The first objective of this paper is to incorporate this finiteness in the 'open-loop modal cost analysis' as applied to a flexible spacecraft. Analysis based on residue calculus shows that among other factors, significance of a mode depends on the power spectral density of disturbances and the response spectral density of sensors at the modal frequency. The second objective of this article is to compare performances of an optimal and a suboptimal output feedback controller, the latter based on 'minimum error excitation' of Kosut. Both the performances are found to be nearly the same, leading us to favor the latter technique because it entails only linear computations. Our final objective is to detect an instability due to truncated modes by representing them as a multiplicative and an additive perturbation in a nominal transfer function. In an example problem it is found that this procedure leads to a narrow range of permissible controller gains, and that it labels a wrong mode as a cause of instability. A free beam is used to illustrate the analysis in this work.

Treatment Cost Analysis Tool (TCAT) for Estimating Costs of Outpatient Treatment Services

PubMed Central

Flynn, Patrick M.; Broome, Kirk M.; Beaston-Blaakman, Aaron; Knight, Danica K.; Horgan, Constance M.; Shepard, Donald S.

2009-01-01

A Microsoft® Excel-based workbook designed for research analysts to use in a national study was retooled for treatment program directors and financial officers to allocate, analyze, and estimate outpatient treatment costs in the U.S. This instrument can also be used as a planning and management tool to optimize resources and forecast the impact of future changes in staffing, client flow, program design, and other resources. The Treatment Cost Analysis Tool (TCAT) automatically provides feedback and generates summaries and charts using comparative data from a national sample of non-methadone outpatient providers. TCAT is being used by program staff to capture and allocate both economic and accounting costs, and outpatient service costs are reported for a sample of 70 programs. Costs for an episode of treatment in regular, intensive, and mixed types of outpatient treatment types were $882, $1,310, and $1,381 respectively (based on 20% trimmed means and 2006 dollars). An hour of counseling cost $64 in regular, $85 intensive, and $86 mixed. Group counseling hourly costs per client were $8, $11, and $10 respectively for regular, intensive, and mixed. Future directions include use of a web-based interview version, much like some of the commercially available tax preparation software tools, and extensions for use in other modalities of treatment. PMID:19004576

Treatment Cost Analysis Tool (TCAT) for estimating costs of outpatient treatment services.

PubMed

Flynn, Patrick M; Broome, Kirk M; Beaston-Blaakman, Aaron; Knight, Danica K; Horgan, Constance M; Shepard, Donald S

2009-02-01

A Microsoft Excel-based workbook designed for research analysts to use in a national study was retooled for treatment program directors and financial officers to allocate, analyze, and estimate outpatient treatment costs in the U.S. This instrument can also be used as a planning and management tool to optimize resources and forecast the impact of future changes in staffing, client flow, program design, and other resources. The Treatment Cost Analysis Tool (TCAT) automatically provides feedback and generates summaries and charts using comparative data from a national sample of non-methadone outpatient providers. TCAT is being used by program staff to capture and allocate both economic and accounting costs, and outpatient service costs are reported for a sample of 70 programs. Costs for an episode of treatment in regular, intensive, and mixed types of outpatient treatment were $882, $1310, and $1381 respectively (based on 20% trimmed means and 2006 dollars). An hour of counseling cost $64 in regular, $85 intensive, and $86 mixed. Group counseling hourly costs per client were $8, $11, and $10 respectively for regular, intensive, and mixed. Future directions include use of a web-based interview version, much like some of the commercially available tax preparation software tools, and extensions for use in other modalities of treatment.

Protons in head-and-neck cancer: bridging the gap of evidence.

PubMed

Ramaekers, Bram L T; Grutters, Janneke P C; Pijls-Johannesma, Madelon; Lambin, Philippe; Joore, Manuela A; Langendijk, Johannes A

2013-04-01

To use Normal Tissue Complication Probability (NTCP) models and comparative planning studies to explore the (cost-)effectiveness of swallowing sparing intensity modulated proton radiotherapy (IMPT) compared with swallowing sparing intensity modulated radiotherapy with photons (IMRT) in head and neck cancer (HNC). A Markov model was constructed to examine and compare the costs and quality-adjusted life years (QALYs) of the following strategies: (1) IMPT for all patients; (2) IMRT for all patients; and (3) IMPT if efficient. The assumption of equal survival for IMPT and IMRT in the base case analysis was relaxed in a sensitivity analysis. Intensity modulated proton radiation therapy and IMRT for all patients yielded 6.620 and 6.520 QALYs and cost €50,989 and €41,038, respectively. Intensity modulated proton radiation therapy if efficient yielded 6.563 QALYs and cost €43,650. The incremental cost-effectiveness ratio of IMPT if efficient versus IMRT for all patients was €60,278 per QALY gained. In the sensitivity analysis, IMRT was more effective (0.967 QALYs) and less expensive (€8218) and thus dominated IMPT for all patients. Cost-effectiveness analysis based on normal tissue complication probability models and planning studies proved feasible and informative and enables the analysis of individualized strategies. The increased effectiveness of IMPT does not seem to outweigh the higher costs for all head-and-neck cancer patients. However, when assuming equal survival among both modalities, there seems to be value in identifying those patients for whom IMPT is cost-effective. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparing multilayer brain networks between groups: Introducing graph metrics and recommendations.

PubMed

Mandke, Kanad; Meier, Jil; Brookes, Matthew J; O'Dea, Reuben D; Van Mieghem, Piet; Stam, Cornelis J; Hillebrand, Arjan; Tewarie, Prejaas

2018-02-01

There is an increasing awareness of the advantages of multi-modal neuroimaging. Networks obtained from different modalities are usually treated in isolation, which is however contradictory to accumulating evidence that these networks show non-trivial interdependencies. Even networks obtained from a single modality, such as frequency-band specific functional networks measured from magnetoencephalography (MEG) are often treated independently. Here, we discuss how a multilayer network framework allows for integration of multiple networks into a single network description and how graph metrics can be applied to quantify multilayer network organisation for group comparison. We analyse how well-known biases for single layer networks, such as effects of group differences in link density and/or average connectivity, influence multilayer networks, and we compare four schemes that aim to correct for such biases: the minimum spanning tree (MST), effective graph resistance cost minimisation, efficiency cost optimisation (ECO) and a normalisation scheme based on singular value decomposition (SVD). These schemes can be applied to the layers independently or to the multilayer network as a whole. For correction applied to whole multilayer networks, only the SVD showed sufficient bias correction. For correction applied to individual layers, three schemes (ECO, MST, SVD) could correct for biases. By using generative models as well as empirical MEG and functional magnetic resonance imaging (fMRI) data, we further demonstrated that all schemes were sensitive to identify network topology when the original networks were perturbed. In conclusion, uncorrected multilayer network analysis leads to biases. These biases may differ between centres and studies and could consequently lead to unreproducible results in a similar manner as for single layer networks. We therefore recommend using correction schemes prior to multilayer network analysis for group comparisons. Copyright © 2017 Elsevier Inc. All rights reserved.

Is robotic surgery cost-effective: yes.

PubMed

Liberman, Daniel; Trinh, Quoc-Dien; Jeldres, Claudio; Zorn, Kevin C

2012-01-01

With the expanding use of new technology in the treatment of clinically localized prostate cancer (PCa), the financial burden on the healthcare system and the individual has been important. Robotics offer many potential advantages to the surgeon and the patient. We assessed the potential cost-effectiveness of robotics in urological surgery and performed a comparative cost analysis with respect to other potential treatment modalities. The direct and indirect costs of purchasing, maintaining, and operating the robot must be compared to alternatives in treatment of localized PCa. Some expanding technologies including intensity-modulated radiation therapy are significantly more expensive than robotic surgery. Furthermore, the benefits of robotics including decreased length of stay and return to work are considerable and must be measured when evaluating its cost-effectiveness. Robot-assisted laparoscopic surgery comes at a high cost but can become cost-effective in mostly high-volume centers with high-volume surgeons. The device when utilized to its maximum potential and with eventual market-driven competition can become affordable.

Slice-to-Volume Nonrigid Registration of Histological Sections to MR Images of the Human Brain

PubMed Central

Osechinskiy, Sergey; Kruggel, Frithjof

2011-01-01

Registration of histological images to three-dimensional imaging modalities is an important step in quantitative analysis of brain structure, in architectonic mapping of the brain, and in investigation of the pathology of a brain disease. Reconstruction of histology volume from serial sections is a well-established procedure, but it does not address registration of individual slices from sparse sections, which is the aim of the slice-to-volume approach. This study presents a flexible framework for intensity-based slice-to-volume nonrigid registration algorithms with a geometric transformation deformation field parametrized by various classes of spline functions: thin-plate splines (TPS), Gaussian elastic body splines (GEBS), or cubic B-splines. Algorithms are applied to cross-modality registration of histological and magnetic resonance images of the human brain. Registration performance is evaluated across a range of optimization algorithms and intensity-based cost functions. For a particular case of histological data, best results are obtained with a TPS three-dimensional (3D) warp, a new unconstrained optimization algorithm (NEWUOA), and a correlation-coefficient-based cost function. PMID:22567290

Development of the mathematical model for design and verification of acoustic modal analysis methods

NASA Astrophysics Data System (ADS)

Siner, Alexander; Startseva, Maria

2016-10-01

To reduce the turbofan noise it is necessary to develop methods for the analysis of the sound field generated by the blade machinery called modal analysis. Because modal analysis methods are very difficult and their testing on the full scale measurements are very expensive and tedious it is necessary to construct some mathematical models allowing to test modal analysis algorithms fast and cheap. At this work the model allowing to set single modes at the channel and to analyze generated sound field is presented. Modal analysis of the sound generated by the ring array of point sound sources is made. Comparison of experimental and numerical modal analysis results is presented at this work.

Letter position coding across modalities: braille and sighted reading of sentences with jumbled words.

PubMed

Perea, Manuel; Jiménez, María; Martín-Suesta, Miguel; Gómez, Pablo

2015-04-01

This article explores how letter position coding is attained during braille reading and its implications for models of word recognition. When text is presented visually, the reading process easily adjusts to the jumbling of some letters (jugde-judge), with a small cost in reading speed. Two explanations have been proposed: One relies on a general mechanism of perceptual uncertainty at the visual level, and the other focuses on the activation of an abstract level of representation (i.e., bigrams) that is shared by all orthographic codes. Thus, these explanations make differential predictions about reading in a tactile modality. In the present study, congenitally blind readers read sentences presented on a braille display that tracked the finger position. The sentences either were intact or involved letter transpositions. A parallel experiment was conducted in the visual modality. Results revealed a substantially greater reading cost for the sentences with transposed-letter words in braille readers. In contrast with the findings with sighted readers, in which there is a cost of transpositions in the external (initial and final) letters, the reading cost in braille readers occurs serially, with a large cost for initial letter transpositions. Thus, these data suggest that the letter-position-related effects in visual word recognition are due to the characteristics of the visual stream.

Modal Traffic Impacts of Waterway User Charges : Volume 3. Data Appendix.

DOT National Transportation Integrated Search

1977-08-01

The report has considered waterway user charges, which have been proposed as a method of cost recovery of Federal expenditures. The report has examined possible modal carrier and traffic impacts due to user charges on the inland river system, and pot...

A cost-effectiveness analysis of prophylactic surgery versus gynecologic surveillance for women from hereditary non-polyposis colorectal cancer (HNPCC) Families.

PubMed

Yang, Kathleen Y; Caughey, Aaron B; Little, Sarah E; Cheung, Michael K; Chen, Lee-May

2011-09-01

Women at risk for Lynch Syndrome/HNPCC have an increased lifetime risk of endometrial and ovarian cancer. This study investigates the cost-effectiveness of prophylactic surgery versus surveillance in women with Lynch Syndrome. A decision analytic model was designed incorporating key clinical decisions and existing probabilities, costs, and outcomes from the literature. Clinical forum where risk-reducing surgery and surveillance were considered. A theoretical population of women with Lynch Syndrome at age 30 was used for the analysis. A decision analytic model was designed comparing the health outcomes of prophylactic hysterectomy with bilateral salpingo-oophorectomy at age 30 versus annual gynecologic screening versus annual gynecologic exam. The literature was searched for probabilities of different health outcomes, results of screening modalities, and costs of cancer diagnosis and treatment. Cost-effectiveness expressed in dollars per discounted life-years. Risk-reducing surgery is the least expensive option, costing $23,422 per patient for 25.71 quality-adjusted life-years (QALYs). Annual screening costs $68,392 for 25.17 QALYs; and annual examination without screening costs $100,484 for 24.60 QALYs. Further, because risk-reducing surgery leads to both the lowest costs and the highest number of QALYs, it is a dominant strategy. Risk-reducing surgery is the most cost-effective option from a societal healthcare cost perspective.

Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer.

PubMed

Thaker, Nikhil G; Ali, Tariq N; Porter, Michael E; Feeley, Thomas W; Kaplan, Robert S; Frank, Steven J

2016-09-01

The transformation from volume to value will require communication of outcomes and costs of therapies; however, outcomes are usually nonstandardized, and cost of therapy differs among stakeholders. We developed a standardized value framework by using radar charts to visualize and communicate a wide range of patient outcomes and cost for three forms of prostate cancer treatment. We retrospectively reviewed data from men with low-risk prostate cancer who were treated with low-dose rate brachytherapy (LDR-BT), proton beam therapy, or robotic-assisted prostatectomy. Patient-reported outcomes comprised the Expanded Prostate Cancer Index Composite-50 domains for sexual function, urinary incontinence and/or bother, bowel bother, and vitality 12 months after treatment. Costs were measured by time-driven activity-based costing for the first 12 months of the care cycle. Outcome and cost data were plotted on a single radar chart for each treatment modality. Outcome and cost data from patients who were treated with robotic-assisted prostatectomy (n = 381), proton beam therapy (n = 165), and LDR-BT (n = 238) were incorporated into the radar chart. LDR-BT seemed to deliver the highest overall value of the three treatment modalities; however, incorporation of patient preferences regarding outcomes may allow other modalities to be considered high-value treatment options. Standardization and visualization of outcome and cost metrics may allow more comprehensive and collaborative discussions about the value of health care services. Communicating the value framework by using radar charts may be an effective method to present total value and the value of all outcomes and costs in a manner that is accessible to all stakeholders. Variations in plotting of costs and outcomes will require future focus group initiatives. Copyright © 2016 by American Society of Clinical Oncology.

Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer

PubMed Central

Thaker, Nikhil G.; Ali, Tariq N.; Porter, Michael E.; Feeley, Thomas W.; Kaplan, Robert S.

2016-01-01

Purpose: The transformation from volume to value will require communication of outcomes and costs of therapies; however, outcomes are usually nonstandardized, and cost of therapy differs among stakeholders. We developed a standardized value framework by using radar charts to visualize and communicate a wide range of patient outcomes and cost for three forms of prostate cancer treatment. Materials and Methods: We retrospectively reviewed data from men with low-risk prostate cancer who were treated with low-dose rate brachytherapy (LDR-BT), proton beam therapy, or robotic-assisted prostatectomy. Patient-reported outcomes comprised the Expanded Prostate Cancer Index Composite-50 domains for sexual function, urinary incontinence and/or bother, bowel bother, and vitality 12 months after treatment. Costs were measured by time-driven activity-based costing for the first 12 months of the care cycle. Outcome and cost data were plotted on a single radar chart for each treatment modality. Results: Outcome and cost data from patients who were treated with robotic-assisted prostatectomy (n = 381), proton beam therapy (n = 165), and LDR-BT (n = 238) were incorporated into the radar chart. LDR-BT seemed to deliver the highest overall value of the three treatment modalities; however, incorporation of patient preferences regarding outcomes may allow other modalities to be considered high-value treatment options. Conclusion: Standardization and visualization of outcome and cost metrics may allow more comprehensive and collaborative discussions about the value of health care services. Communicating the value framework by using radar charts may be an effective method to present total value and the value of all outcomes and costs in a manner that is accessible to all stakeholders. Variations in plotting of costs and outcomes will require future focus group initiatives. PMID:27577622

[Prospective economic evaluation of image-guided radiation therapy for prostate cancer in the framework of the national programme for innovative and costly therapies assessment].

PubMed

Pommier, P; Morelle, M; Perrier, L; de Crevoisier, R; Laplanche, A; Dudouet, P; Mahé, M-A; Chauvet, B; Nguyen, T-D; Créhange, G; Zawadi, A; Chapet, O; Latorzeff, I; Bossi, A; Beckendorf, V; Touboul, E; Muracciole, X; Bachaud, J-M; Supiot, S; Lagrange, J-L

2012-09-01

The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital's point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Medical ultrasonic tomographic system

NASA Technical Reports Server (NTRS)

Heyser, R. C.; Lecroissette, D. H.; Nathan, R.; Wilson, R. L.

1977-01-01

An electro-mechanical scanning assembly was designed and fabricated for the purpose of generating an ultrasound tomogram. A low cost modality was demonstrated in which analog instrumentation methods formed a tomogram on photographic film. Successful tomogram reconstructions were obtained on in vitro test objects by using the attenuation of the fist path ultrasound signal as it passed through the test object. The nearly half century tomographic methods of X-ray analysis were verified as being useful for ultrasound imaging.

Modal Traffic Impacts of Waterway User Charges : Volume 1. Recovery Options and Impacts Summary.

DOT National Transportation Integrated Search

1977-08-01

The report has considered waterway user charges, which have been proposed as a method of cost recovery of Federal expenditures. The report has examined possible modal carrier and traffic impacts due to user charges on the inland river system, and pot...

Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

PubMed

Thaker, Nikhil G; Orio, Peter F; Potters, Louis

Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Fast modal decomposition for optical fibers using digital holography.

PubMed

Lyu, Meng; Lin, Zhiquan; Li, Guowei; Situ, Guohai

2017-07-26

Eigenmode decomposition of the light field at the output end of optical fibers can provide fundamental insights into the nature of electromagnetic-wave propagation through the fibers. Here we present a fast and complete modal decomposition technique for step-index optical fibers. The proposed technique employs digital holography to measure the light field at the output end of the multimode optical fiber, and utilizes the modal orthonormal property of the basis modes to calculate the modal coefficients of each mode. Optical experiments were carried out to demonstrate the proposed decomposition technique, showing that this approach is fast, accurate and cost-effective.

Framework and implementation of a continuous network-wide health monitoring system for roadways

NASA Astrophysics Data System (ADS)

Wang, Ming; Birken, Ralf; Shahini Shamsabadi, Salar

2014-03-01

According to the 2013 ASCE report card America's infrastructure scores only a D+. There are more than four million miles of roads (grade D) in the U.S. requiring a broad range of maintenance activities. The nation faces a monumental problem of infrastructure management in the scheduling and implementation of maintenance and repair operations, and in the prioritization of expenditures within budgetary constraints. The efficient and effective performance of these operations however is crucial to ensuring roadway safety, preventing catastrophic failures, and promoting economic growth. There is a critical need for technology that can cost-effectively monitor the condition of a network-wide road system and provide accurate, up-to-date information for maintenance activity prioritization. The Versatile Onboard Traffic Embedded Roaming Sensors (VOTERS) project provides a framework and the sensing capability to complement periodical localized inspections to continuous network-wide health monitoring. Research focused on the development of a cost-effective, lightweight package of multi-modal sensor systems compatible with this framework. An innovative software infrastructure is created that collects, processes, and evaluates these large time-lapse multi-modal data streams. A GIS-based control center manages multiple inspection vehicles and the data for further analysis, visualization, and decision making. VOTERS' technology can monitor road conditions at both the surface and sub-surface levels while the vehicle is navigating through daily traffic going about its normal business, thereby allowing for network-wide frequent assessment of roadways. This deterioration process monitoring at unprecedented time and spatial scales provides unique experimental data that can be used to improve life-cycle cost analysis models.

[Effects of biphasic spiral CT, conventional and iron oxide enhanced MRI on therapy and therapy costs in patients with focal liver lesions].

PubMed

Helmberger, T; Gregor, M; Holzknecht, N; Rau, H; Scheidler, J; Reiser, M

2000-03-01

Evaluation of the diagnostic efficacy and cost-benefit of contrast enhanced CT (CT) and MRI pre- and post-SPIO-particles in focal hepatic disease with consideration of therapeutic outcome. In 52 patients with the suspicion of primary or secondary hepatic malignancy, biphasic spiral CT and breath-hold gradient-echo T1- and fast spin-echo T2-weighted MRI pre- and post-iron oxide administration (1.5 T, body-phased-array coil) were compared. The number of hepatic lesions and the related diagnoses resulting from each imaging modality were recorded and statistically correlated to the final diagnoses established by biopsy/OP (34/52), long term follow-up of 12 months (18/52), and a consensus reading of all imaging modalities considering all clinical imaging information. The most likely induced therapy resulting from each imaging test was correlated to the final therapy. Based on data from the hospitals accountants, the therapy-related costs were estimated without hospitalization costs. In 34/52 (65.4%) of the cases the correct diagnosis was primarily stated by CT (sensitivity [se.] 85.2%, specificity [sp.] 44.0%). In additional 10/52 of the cases unenhanced MRI (se. 91.4%, sp. 75.0%) enabled correct diagnoses, and in another 6 cases the diagnosis was established only by SPIO-MRI (se. 100%, sp. 86.7%). Considering the possible therapeutic recommendation arising from each modality, CT would have induced needles therapy costs of 191,042 DM, unenhanced MRI of 171,035 DM, and SPIO-MRI of 7,311 DM. In comparison to the real therapy costs of 221,873 DM, this would have corresponded to an unnecessary increase of therapy costs of 86.1%, 77.1%, and 3.3%, respectively. In two cases (1 hemangioma, 1 regenerative nodule) all modalities failed, causing unnecessary surgery in one patient. In this problem-oriented scenario unenhanced and SPIO-enhanced MRI proved to be superior to CT regarding diagnostic efficacy. The cost-benefit resulted mainly due to preserving patients from unnecessary surgical procedures.

The effects of stimulus modality and task integrality: Predicting dual-task performance and workload from single-task levels

NASA Technical Reports Server (NTRS)

Hart, S. G.; Shively, R. J.; Vidulich, M. A.; Miller, R. C.

1986-01-01

The influence of stimulus modality and task difficulty on workload and performance was investigated. The goal was to quantify the cost (in terms of response time and experienced workload) incurred when essentially serial task components shared common elements (e.g., the response to one initiated the other) which could be accomplished in parallel. The experimental tasks were based on the Fittsberg paradigm; the solution to a SternBERG-type memory task determines which of two identical FITTS targets are acquired. Previous research suggested that such functionally integrated dual tasks are performed with substantially less workload and faster response times than would be predicted by suming single-task components when both are presented in the same stimulus modality (visual). The physical integration of task elements was varied (although their functional relationship remained the same) to determine whether dual-task facilitation would persist if task components were presented in different sensory modalities. Again, it was found that the cost of performing the two-stage task was considerably less than the sum of component single-task levels when both were presented visually. Less facilitation was found when task elements were presented in different sensory modalities. These results suggest the importance of distinguishing between concurrent tasks that complete for limited resources from those that beneficially share common resources when selecting the stimulus modalities for information displays.

A custom multi-modal sensor suite and data analysis pipeline for aerial field phenotyping

NASA Astrophysics Data System (ADS)

Bartlett, Paul W.; Coblenz, Lauren; Sherwin, Gary; Stambler, Adam; van der Meer, Andries

2017-05-01

Our group has developed a custom, multi-modal sensor suite and data analysis pipeline to phenotype crops in the field using unpiloted aircraft systems (UAS). This approach to high-throughput field phenotyping is part of a research initiative intending to markedly accelerate the breeding process for refined energy sorghum varieties. To date, single rotor and multirotor helicopters, roughly 14 kg in total weight, are being employed to provide sensor coverage over multiple hectaresized fields in tens of minutes. The quick, autonomous operations allow for complete field coverage at consistent plant and lighting conditions, with low operating costs. The sensor suite collects data simultaneously from six sensors and registers it for fusion and analysis. High resolution color imagery targets color and geometric phenotypes, along with lidar measurements. Long-wave infrared imagery targets temperature phenomena and plant stress. Hyperspectral visible and near-infrared imagery targets phenotypes such as biomass and chlorophyll content, as well as novel, predictive spectral signatures. Onboard spectrometers and careful laboratory and in-field calibration techniques aim to increase the physical validity of the sensor data throughout and across growing seasons. Off-line processing of data creates basic products such as image maps and digital elevation models. Derived data products include phenotype charts, statistics, and trends. The outcome of this work is a set of commercially available phenotyping technologies, including sensor suites, a fully integrated phenotyping UAS, and data analysis software. Effort is also underway to transition these technologies to farm management users by way of streamlined, lower cost sensor packages and intuitive software interfaces.

Language Switching across Modalities: Evidence from Bimodal Bilinguals

ERIC Educational Resources Information Center

Dias, Patricia; Villameriel, Saúl; Giezen, Marcel R.; Costello, Brendan; Carreiras, Manuel

2017-01-01

This study investigated whether language control during language production in bilinguals generalizes across modalities, and to what extent the language control system is shaped by competition for the same articulators. Using a cued language-switching paradigm, we investigated whether switch costs are observed when hearing signers switch between a…

Healthcare systems and end-stage renal disease (ESRD) therapies--an international review: costs and reimbursement/funding of ESRD therapies.

PubMed

De Vecchi, A F; Dratwa, M; Wiedemann, M E

1999-01-01

In healthcare economics, the cost factor plays a leading role, particularly for chronic diseases such as end-stage renal disease because of the growing number of patients. An international comparison was made of the costs and reimbursement/funding of a selection of key dialysis modalities--centre haemodialysis (CHD), limited care haemodialysis (LCHD), home haemodialysis (home HD), continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD)--in various industrial countries. The focus was on treatment costs plus erythropoietin medication and reimbursement of transportation costs. Reimbursement/funding of dialysis is different from country to country, with some healthcare system-specific commonalities: in 'public' systems, the funding is based more on global budgets, whereas in mixed public and private countries it is based mainly on reimbursement rates per treatment. Only in the 'private system' of the US is there one DRG (diagnostic-related group)-type rate for dialysis. By comparing the costs (in public countries) or reimbursements (in mixed countries) of treatment modalities within each country, we could see similar curves: the costs were the highest for public CHD, followed by private CHD. They were lower on LCHD and the lowest for home HD and CAPD, which were at nearly the same level. The cost level for APD was almost the same as that of LCHD. The reimbursements followed the cost pattern. Some countries introduced increases for CAPD and APD with the intention of increasing the share of home care. The costs and reimbursement patterns in the majority of countries (except the US and Japan) were very similar and therefore did not explain the different distribution of modalities in these countries. One explanation could be, however, the difference in microeconomics, CHD being a treatment with high fixed costs (personnel and structure) and CAPD being a treatment with low fixed costs, but high variable costs (supplies) and a low need for investments. The choice of treatment modality seems to be influenced strongly by the provider's perspective, being either public with limited HD capacity or private having invested in HD capacity. For public providers (and healthcare payers), CAPD is less expensive than CHD and offers a number of potential savings. In many countries, two CAPD patients could be treated for the same costs as one CHD patient. The microeconomics of private centres, however, are meant to use the investments maximally for CHD. Only if capacity limits are reached, is PD, with mainly supply costs, interesting. The future with constantly increasing numbers of patients and growing cost constraints will force all providers to make the best use of their resources by also offering home therapies such as PD to patients. The latter are cost efficient and offer comparable survival and quality of life.

Peritoneal dialysis vs. haemodialysis in the management of paediatric acute kidney injury in Kano, Nigeria: a cost analysis.

PubMed

Obiagwu, Patience N; Abdu, Aliyu

2015-01-01

To determine the cost of the dialytic management of paediatric acute kidney injury in a low-income country. All children under the age of 15 years, who had either peritoneal dialysis or haemodialysis for acute kidney injury in Aminu Kano Teaching Hospital over a 1-year period, were studied. The average cost of each dialysis modality was estimated. Of 20 children, who had dialysis for acute kidney injury, 12 (60%) had haemodialysis and 8 (40%) had peritoneal dialysis. The mean cost for haemodialysis exceeded that of peritoneal dialysis ($363.33 vs. $311.66, t = 1.04, P = 0.313) with the mean cost of consumables significantly accounting for most of the cost variation ($248.49 vs. $164.73, t = 2.91, P = 0.009). Mean costs of nephrologist visit and nursing were not found to be significant. Peritoneal dialysis is the less costly alternative for managing acute kidney injury in children in our environment. © 2014 John Wiley & Sons Ltd.

[Cost analysis of dialysis treatment at the Odense University Hospital and the Sønderborg Hospital].

PubMed

Maschoreck, T R; Sørensen, M C; Andresen, M; Høgsberg, I M; Rasmussen, P; Søgaard, J

1998-12-14

The major purpose of this paper is to investigate the treatment costs of dialysis treatment by modality. In this study Odense University Hospital (OUH) and Sønderborg Hospital were chosen as cases. The costs of haemodialysis (HD) treatment are estimated to DKK 341-392,000 per patient during the first year, and DKK 328-379,000 per year the following years. The costs of continuous ambulatory peritoneal dialysis (CAPD) treatment are estimated to DKK 262-291,000 per patient during the first year, and DKK 251-277,000 per year the following years. The costs of CCPD (peritoneal dialysis with the aid of a machine), treatment are estimated to DKK 312-325,000 per patient during the first year, and DKK 296-308,000 per year the following years. The treatment costs of HD are lower than expected, while the treatment costs of PD are higher than expected. As a result of this the differences in treatment costs (HD versus PD) are much lower than expected, DKK 130,000 at the most.

Computing the modal mass from the state space model in combined experimental-operational modal analysis

NASA Astrophysics Data System (ADS)

Cara, Javier

2016-05-01

Modal parameters comprise natural frequencies, damping ratios, modal vectors and modal masses. In a theoretic framework, these parameters are the basis for the solution of vibration problems using the theory of modal superposition. In practice, they can be computed from input-output vibration data: the usual procedure is to estimate a mathematical model from the data and then to compute the modal parameters from the estimated model. The most popular models for input-output data are based on the frequency response function, but in recent years the state space model in the time domain has become popular among researchers and practitioners of modal analysis with experimental data. In this work, the equations to compute the modal parameters from the state space model when input and output data are available (like in combined experimental-operational modal analysis) are derived in detail using invariants of the state space model: the equations needed to compute natural frequencies, damping ratios and modal vectors are well known in the operational modal analysis framework, but the equation needed to compute the modal masses has not generated much interest in technical literature. These equations are applied to both a numerical simulation and an experimental study in the last part of the work.

Measuring the cost of care in benign prostatic hyperplasia using time-driven activity-based costing (TDABC).

PubMed

Kaplan, A L; Agarwal, N; Setlur, N P; Tan, H J; Niedzwiecki, D; McLaughlin, N; Burke, M A; Steinberg, K; Chamie, K; Saigal, C S

2015-03-01

Determining '"value'" in health care, defined as outcomes per unit cost, depends on accurately measuring cost. We used time-driven activity-based costing (TDABC) to determine the cost of care in men with benign prostatic hyperplasia (BPH) - a common urologic condition. We implemented TDABC across the entire care pathway for BPH including primary and specialist care in both inpatient and outpatient settings. A team of expert stakeholders created detailed process maps, determined space and product costs, and calculated personnel capacity cost rates. A model pathway was derived from practice guidelines and calculated costs were applied. Although listed as 'optional' in practice guidelines, invasive diagnostic testing can increase costs by 150% compared with the standalone urology clinic visit. Of five different surgical options, a 400% cost discrepancy exists between the most and least expensive treatments. TDABC can be used to measure cost across an entire care pathway in a large academic medical center. Sizable cost variation exists between diagnostic and surgical modalities for men with BPH. As financial risk is shifted toward providers, understanding the cost of care will be vital. Future work is needed to determine outcome discrepancy between the diagnostic and surgical modalities in BPH. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of enhanced pacing modalities on health care resource utilization and costs in bradycardia patients: An analysis of the randomized MINERVA trial.

PubMed

Boriani, Giuseppe; Manolis, Antonis S; Tukkie, Raymond; Mont, Lluis; Pürerfellner, Helmut; Santini, Massimo; Inama, Giuseppe; Serra, Paolo; Gulizia, Michele; Samoilenko, Igor Vasilyevich; Wolff, Claudia; Holbrook, Reece; Gavazza, Federica; Padeletti, Luigi

2015-06-01

Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

A call to arms: economic barriers to optimal dialysis care.

PubMed

McFarlane, P A; Mendelssohn, D C

2000-01-01

Epidemic growth rates and the enormous cost of dialysis pressure end-stage renal disease (ESRD) delivery systems around the world. Payers of dialysis services can constrain costs through (1) limiting access to dialysis, (2) reducing the quality of dialysis, and (3) placing constraints on modality distribution. In order to secure the necessary resources for ESRD care, we propose that the nephrology community consider the following suggestions: First, future leaders in dialysis should acquire additional advanced training in innovative pathways such as health care economics, business and health care administration, and health care policy. Second, the international nephrology community must strongly engage in ongoing advocacy for accessible, high quality, cost-effective care.Third, efforts should be made to better define and then implement optimal dialysis modality distributions that maximize patient outcomes but limit unnecessary costs. Fourth, industry should be encouraged to lower the unit cost of dialysis, allowing for improved access to dialysis, especially in developing countries. Fifth, research should be encouraged that seeks to identify measures that will reduce dialysis costs but will not impair quality of care. Finally, early referral of patients with progressive renal disease to nephrology clinics, empowerment of informed patient choice of dialysis modality, and proper and timely access creation should be encouraged and can be expected to help limit overall expenditures. Ongoing efforts in these areas by the nephrology community will be essential if we are to overcome the challenges of ESRD growth in this new decade.

Analysis of structural response data using discrete modal filters. M.S. Thesis

NASA Technical Reports Server (NTRS)

Freudinger, Lawrence C.

1991-01-01

The application of reciprocal modal vectors to the analysis of structural response data is described. Reciprocal modal vectors are constructed using an existing experimental modal model and an existing frequency response matrix of a structure, and can be assembled into a matrix that effectively transforms the data from the physical space to a modal space within a particular frequency range. In other words, the weighting matrix necessary for modal vector orthogonality (typically the mass matrix) is contained within the reciprocal model matrix. The underlying goal of this work is mostly directed toward observing the modal state responses in the presence of unknown, possibly closed loop forcing functions, thus having an impact on both operating data analysis techniques and independent modal space control techniques. This study investigates the behavior of reciprocol modal vectors as modal filters with respect to certain calculation parameters and their performance with perturbed system frequency response data.

The association between hospital outcomes and diagnostic imaging: early findings.

PubMed

Lee, David W; Foster, David A

2009-11-01

Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization.

Strain Modal Analysis of Small and Light Pipes Using Distributed Fibre Bragg Grating Sensors

PubMed Central

Huang, Jun; Zhou, Zude; Zhang, Lin; Chen, Juntao; Ji, Chunqian; Pham, Duc Truong

2016-01-01

Vibration fatigue failure is a critical problem of hydraulic pipes under severe working conditions. Strain modal testing of small and light pipes is a good option for dynamic characteristic evaluation, structural health monitoring and damage identification. Unique features such as small size, light weight, and high multiplexing capability enable Fibre Bragg Grating (FBG) sensors to measure structural dynamic responses where sensor size and placement are critical. In this paper, experimental strain modal analysis of pipes using distributed FBG sensors ispresented. Strain modal analysis and parameter identification methods are introduced. Experimental strain modal testing and finite element analysis for a cantilever pipe have been carried out. The analysis results indicate that the natural frequencies and strain mode shapes of the tested pipe acquired by FBG sensors are in good agreement with the results obtained by a reference accelerometer and simulation outputs. The strain modal parameters of a hydraulic pipe were obtained by the proposed strain modal testing method. FBG sensors have been shown to be useful in the experimental strain modal analysis of small and light pipes in mechanical, aeronautic and aerospace applications. PMID:27681728

The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures: A Computer Model-Based Evaluation of Three Operative Modalities.

PubMed

Rajan, Prashant V; Qudsi, Rameez A; Dyer, George S M; Losina, Elena

2018-02-07

There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation. We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient's lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty. From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning. When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Multiset singular value decomposition for joint analysis of multi-modal data: application to fingerprint analysis

NASA Astrophysics Data System (ADS)

Emge, Darren K.; Adalı, Tülay

2014-06-01

As the availability and use of imaging methodologies continues to increase, there is a fundamental need to jointly analyze data that is collected from multiple modalities. This analysis is further complicated when, the size or resolution of the images differ, implying that the observation lengths of each of modality can be highly varying. To address this expanding landscape, we introduce the multiset singular value decomposition (MSVD), which can perform a joint analysis on any number of modalities regardless of their individual observation lengths. Through simulations, the inter modal relationships across the different modalities which are revealed by the MSVD are shown. We apply the MSVD to forensic fingerprint analysis, showing that MSVD joint analysis successfully identifies relevant similarities for further analysis, significantly reducing the processing time required. This reduction, takes this technique from a laboratory method to a useful forensic tool with applications across the law enforcement and security regimes.

Executive summary: Benefit-cost evaluation of an intra-regional air service in the Bay Area and a technology assessment of transportation system investments. [regional planning for the San Francisco Bay area of California

NASA Technical Reports Server (NTRS)

Haefner, L. E.

1978-01-01

The benefits and costs that would result from an intra-regional air service operation in the San Francisco Bay area were determined by utilizing an iterative statistical decision model to evaluate combinations of commuter airport sites and surface transportation facilities in conjunction with service by a given commuter aircraft type in light of area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation option with respect to criteria of airline profitability, public acceptance, and public and private non-user costs. In so doing, it incorporates information on modal split, peak and off-peak use of the air commuter fleet, terminal and airport costs, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytic capability, and performs exhaustive sensitivity analysis.

An augmented Lagrangian trust region method for inclusion boundary reconstruction using ultrasound/electrical dual-modality tomography

NASA Astrophysics Data System (ADS)

Liang, Guanghui; Ren, Shangjie; Dong, Feng

2018-07-01

The ultrasound/electrical dual-modality tomography utilizes the complementarity of ultrasound reflection tomography (URT) and electrical impedance tomography (EIT) to improve the speed and accuracy of image reconstruction. Due to its advantages of no-invasive, no-radiation and low-cost, ultrasound/electrical dual-modality tomography has attracted much attention in the field of dual-modality imaging and has many potential applications in industrial and biomedical imaging. However, the data fusion of URT and EIT is difficult due to their different theoretical foundations and measurement principles. The most commonly used data fusion strategy in ultrasound/electrical dual-modality tomography is incorporating the structured information extracted from the URT into the EIT image reconstruction process through a pixel-based constraint. Due to the inherent non-linearity and ill-posedness of EIT, the reconstructed images from the strategy suffer from the low resolution, especially at the boundary of the observed inclusions. To improve this condition, an augmented Lagrangian trust region method is proposed to directly reconstruct the shapes of the inclusions from the ultrasound/electrical dual-modality measurements. In the proposed method, the shape of the target inclusion is parameterized by a radial shape model whose coefficients are used as the shape parameters. Then, the dual-modality shape inversion problem is formulated by an energy minimization problem in which the energy function derived from EIT is constrained by an ultrasound measurements model through an equality constraint equation. Finally, the optimal shape parameters associated with the optimal inclusion shape guesses are determined by minimizing the constrained cost function using the augmented Lagrangian trust region method. To evaluate the proposed method, numerical tests are carried out. Compared with single modality EIT, the proposed dual-modality inclusion boundary reconstruction method has a higher accuracy and is more robust to the measurement noise.

Modal Analysis of Space-rocket Equipment Components

NASA Astrophysics Data System (ADS)

Igolkin, A. A.; Safin, A. I.; Prokofiev, A. B.

2018-01-01

In order to prevent vibration damage an analysis of natural frequencies and mode shapes of elements of rocket and space technology should be developed. This paper discusses technique of modal analysis on the example of the carrier platform. Modal analysis was performed by using mathematical modeling and laser vibrometer. Experimental data was clarified by using Test.Lab software. As a result of modal analysis amplitude-frequency response of carrier platform was obtained and the parameters of the elasticity was clarified.

Evaluation and economic impact analysis of different treatment options for ankle distortions in occupational accidents.

PubMed

Audenaert, Amaryllis; Prims, Jente; Reniers, Genserik L L; Weyns, Dirk; Mahieu, Peter; Audenaert, Emmanuel

2010-10-01

Appropriate use of diagnostic and treatment modalities are essential for rational use of resources. The aim of this study is to evaluate the use of diagnostic modalities and different treatment options and their economic impacts following an acute ankle distortion resulting from an occupational accident. We evaluated the type-of-treatment impact on the victims' course of recovery as well as its impact on the associated accident costs. Research was carried out in Belgium. An ankle distortion victims' database consisting of 200 cases of (Belgian) occupational accidents during the period 2005-2007 was analysed. Patients who were prescribed immobilization or the use of adjuvant support or physical therapy (118 cases) were not employed during a period of 37 days on average, with a mean total cost of 3140.14 Euros caused by the ankle sprain. Patients without any adjuvant therapy (82 cases) were characterized by an unemployment rate of 15 days on average, and a total cost of 1077.86 Euros. Cast immobilization, although its application is not supported by evidence-based literature, was still applied in 36% of the population studied and resulted in the longest average absence of work of 42 days with an obvious significant increase in medical and total costs. Our results show a high rate of inappropriate use of cast immobilizations for ankle distortions. From an economic point of view and for the same clinical endpoint (being full resumption of the occupational activities), simple conventional treatment, consisting of rest, ice, compression and elevation at diagnosis with allowance of early weight bearing in the further clinical course, leads to the quickest full resumption of activities in combination with the lowest medical costs, if compared with any other kind of treatment. © 2010 Blackwell Publishing Ltd.

A cost analysis of reusable and disposable flexible optical scopes for intubation.

PubMed

Tvede, M F; Kristensen, M S; Nyhus-Andreasen, M

2012-05-01

Intubation using a flexible optical scope (FOS) is a cornerstone technique for managing the predicted and unpredicted difficult airway. The term FOS covers both fibre-optic scopes and videoscopes. The total costs of using flexible scopes for intubation are unknown. The recent introduction of a disposable flexible scope for intubation merits closer scrutiny of the total costs associated with both modalities. The costs incurred during intubations using FOSs at a large anaesthesia department were identified, and a series of intubations using a disposable scope were analyzed for comparison. Recognized health-economic methodology was applied. During a 1-year period, 360 FOS intubations were performed. In this clinical setting, the average cost of an intubation using a reusable FOS was €177.7. When using the disposable Ambu(®) aScope (Ambu A/S, Ballerup, Denmark), the cost was €204.4. The break-even point, i.e. the number of intubations per month where the cost of using disposable and non-disposable equipment is identical, was 22.5/month. A subgroup analysis looking solely at intubations performed with flexible videoscopes revealed that the cost per intubation was equal for disposable and reusable videoscopes. At our institution, the total cost of an intubation is greater when using disposable compared with reusable equipment (€204.4 vs. €177.7). If video equipment with an external monitor is considered mandatory, the expenses are of equal magnitude. The cost analysis is particularly sensitive to the actual number of flexible optic intubations performed; with fewer intubations, the total cost will begin to favour disposable equipment. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

The modal transfer analysis by adding transport costs. Case study: The use of bus and private vehicle student Institut Teknologi Sumatera

NASA Astrophysics Data System (ADS)

Muliarto, H.; Alhamidi; Syahbandi, M.

2017-06-01

Since the last two years the Institut Teknologi Sumatera to accept new students in large numbers. Increasing the number of students is directly proportional to the increase of private vehicles that enter the campus it is not in line with the policy of the Institut Teknologi Sumatera as Smart, Friendly, and Forest Campus. Institut Teknologi Sumatera as Smart, Friendly, and Forest Campus fact has made some deal with mass public transport, Damri, to provide bus transportation to the Institut Teknologi Sumatera, but the number of bus users is still inferior to the number of private vehicle users. This study was conducted to see the modal transfer of the entire academic community ITERA, from private cars to public transport such as buses, with the addition of transportation costs in the form of parking rates. This study shows the dominant displacement can occur if the respondent charged parking fees of IDR 4.000. Besides the displacement mode of transportation from using private vehicles be using the bus can occur if Trans Lampung fix three systems including bus departure and arrival schedules, facility service providers that support, and the addition of the Bus Trans Lampung.

Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities

PubMed Central

Pasquel, Francisco J.; Hendrick, Andrew M.; Ryan, Martha; Cason, Emily; Ali, Mohammed K.; Narayan, K. M. Venkat

2015-01-01

Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs. PMID:26719134

Delivering Vitamin A Supplements to Children Aged 6 to 59 Months: Comparing Delivery Through Mass Campaign and Through Routine Health Services in Ethiopia.

PubMed

Gatobu, Sospeter; Horton, Susan; Kiflie Aleyamehu, Yibeltal; Abraham, Gelila; Birhanu, Negalign; Greig, Alison

2017-12-01

The delivery of vitamin A supplements in Ethiopia has been shifting from Child Health Days (campaigns) to routine delivery via the community health services. The objective of this study was to compare the cost and effectiveness of these 2 delivery methods. No previous studies have done this. A mixed method approach was used. Quantitative data on costs were collected from interviews with key staff and coverage data from health facility records. Qualitative data on the 2 modalities were collected from key informants and community members from purposefully sampled communities using the 2 modalities. Communities appreciated the provision of vitamin A supplements to their under 5-year-old children. The small drop in coverage that occurred as a result of the change in modality can be attributed to normal changes that occur with any system change. Advantages of campaigns included greater ease of mobilization and better coverage of older children from more remote communities. Advantages of routine delivery included not omitting children who happened to miss the 1 day per round that supplementation occurred and not disrupting the availability of other health services for the 5 to 6 days each campaign requires. The cost of routine delivery is not easy to measure nor is the cost of disruption to normal services entailed by campaigns. Cost-effectiveness likely depends more on effectiveness than on cost. Overall, the routine approach can achieve good coverage and is sustainable in the long run, as long as the transition is well planned and implemented.

A Comparative Cost Analysis of Cleft Lip Adhesion and Nasoalveolar Molding before Formal Cleft Lip Repair.

PubMed

Shay, Paul L; Goldstein, Jesse A; Paliga, J Thomas; Wink, Jason; Jackson, Oksana A; Low, David; Bartlett, Scott P; Taylor, Jesse A

2015-12-01

Patients with complete cleft lip and palate may benefit from cleft lip adhesion or nasoalveolar molding before formal cleft lip repair. The authors compared the relative costs to insurers of these two treatment modalities and the burden of care to families. A retrospective analysis was performed of cleft lip and palate patients treated with nasoalveolar molding or cleft lip adhesion at The Children's Hospital of Philadelphia between January of 2007 and June of 2012. Demographic, appointment, and surgical data were reviewed; surgical, inpatient hospital, and orthodontic charges and costs were obtained. Multivariate linear regression and two-sample, two-tailed independent t tests were performed to compare cost and appointment data between groups. Forty-two cleft adhesion and 35 nasoalveolar molding patients met inclusion criteria. Mean costs for nasoalveolar molding were $3550.24 ± $667.27. Cleft adhesion costs, consisting of both hospital and surgical costs, were $9370.55 ± $1691.79. Analysis of log costs demonstrated a significant difference between the groups, with the mean total cost for nasoalveolar molding significantly lower than that for adhesion (p < 0.0001). Nasoalveolar molding patients had significantly more made, cancelled, no-show, and missed visits and a higher missed percentage than adhesion patients (p < 0.0001) for all except no-show appointments, (p = 0.0199), indicating a higher burden of care to families. Nasoalveolar molding may cost less before formal cleft lip repair treatment than cleft lip adhesion. Third-party payers who cover adhesion and not nasoalveolar molding may not be acting in their own best interest. Nasoalveolar molding places a higher burden of care on families, and this fact should be considered in planning treatment.

Acta Aeronautica et Astronautica Sinica,

DTIC Science & Technology

1983-07-28

substructural analysis in modal synthesis - two improved substructural assembling techniques 49 9-node quadrilateral isoparametric element 64 Application of laser...Time from Service Data, J. Aircraft, Vol. 15, No. 11, 1978. 48 MULTI-LEVEL SUBSTRUCTURAL ANALYSIS IN MODAL SYNTHESIS -- TWO IMPROVED SUBSTRUCTURAL...34 Modal Synthesis in Structural Dynamic Analysis ," Naching Institute of Aeronautics and Astronautics, 1979. 62a 8. Chang Te-wen, "Free-Interface Modal

A Comparison of the Characteristics of Acupuncture- and Non-Acupuncture-Preferred Consumers: A Secondary Analysis of NHIS 2012 Data.

PubMed

Zhang, Yan; Leach, Matthew J; Bishop, Felicity L; Leung, Brenda

2016-04-01

To determine whether acupuncture use, sociodemographic characteristics, and existing health conditions differ between acupuncture-preferred consumers (i.e., those who deem acupuncture to be one of the three most important complementary and alternative medicine [CAM] modalities used) and non-acupuncture-preferred consumers who used acupuncture in the past 12 months This is a secondary analysis of the National Health Interview Survey Sample Adult File and Adult Alternative Medicine datasets collected by the Centers for Disease Control and Prevention during 2012. The sample was drawn from the noninstitutionalized civilian population of the United States. The datasets yielded 34,525 respondents aged 18 years and older. Measures included in the analysis were acupuncture use in the past 12 months, sociodemographic characteristics, and existing health conditions. Analyses were performed by using Stata software, version 9.0 (Stata Corp., College Station, TX). Of the 10,158 adults who responded to the question regarding the "three most important" CAM modalities used, 572 (5.6%) had used acupuncture in the past 12 months. Of these, 456 (79.7%) chose acupuncture as one of the top three CAM modalities most important to their health. Acupuncture-preferred consumers reported significantly more visits to acupuncturists (7.46 versus 3.99 visits; p < 0.001), as well as higher out-of-pocket costs ($342.8 versus $246.4; p < 0.001), compared with non-acupuncture-preferred consumers. The logistic regression model revealed that with every additional CAM modality used, the likelihood of deeming acupuncture as one of the three CAM modalities most important to one's health decreased by 39% (odds ratio, 0.61; 95% confidence interval, 0.52-0.71; p < 0.001). Health conditions were not statistically significant predictors. A consumer's preference for acupuncture appeared not to be driven by health conditions but rather was related to sociodemographic factors. This suggests that health education regarding acupuncture may need to be tailored to certain consumer groups, such as those residing in the South, and could provide more information on the comparative effectiveness of acupuncture for various health conditions.

PGD for all cystic fibrosis carrier couples: novel strategy for preventive medicine and cost analysis.

PubMed

Tur-Kaspa, I; Aljadeff, G; Rechitsky, S; Grotjan, H E; Verlinsky, Y

2010-08-01

Over 1000 children affected with cystic fibrosis (CF) are born annually in the USA. Since IVF with preimplantation genetic diagnosis (PGD) is an alternative to raising a sick child or to aborting an affected fetus, a cost-benefit analysis was performed for a national IVF-PGD program for preventing CF. The amount spent to deliver healthy children for all CF carrier-couples by IVF-PGD was compared with the average annual and lifetime direct medical costs per CF patient avoided. Treating annually about 4000 CF carrier-couples with IVF-PGD would result in 3715 deliveries of non-affected children at a cost of $57,467 per baby. Because the average annual direct medical cost per CF patient was $63,127 and life expectancy is 37 years, savings would be $2.3 million per patient and $2.2 billion for all new CF patients annually in lifetime treatment costs. Cumulated net saving of an IVF-PGD program for all carrier-couples for 37 years would be $33.3 billion. A total of 618,714 cumulative years of patients suffering because of CF and thousands of abortions could be prevented. A national IVF-PGD program is a highly cost-effective novel modality of preventive medicine and would avoid most births of individuals affected with debilitating genetic disease. 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Cost characteristics of tilt-rotor, conventional air and high speed rail short-haul intercity passenger service

NASA Technical Reports Server (NTRS)

Schoendorfer, David L.; Morlok, Edward K.

1985-01-01

The cost analysis done to support an assessment of the potential for a small tilt-rotor aircraft to operate in short-haul intercity passenger service is described in detail. Anticipated costs of tilt-rotor air service were compared to the costs of two alternatives: conventional air and high speed rail (HSR). Costs were developed for corridor service, varying key market characteristics including distance, passenger volumes, and minimum frequency standards. The resulting cost vs output information can then be used to compare modal costs for essentially identical service quality and passenger volume or for different service levels and volumes for each mode, as appropriate. Extensive sensitivity analyses are performed. The cost-output features of these technologies are compared. Tilt-rotor is very attractive compared to HSR in terms of costs over the entire range of volume. It also has costs not dramatically different from conventional air, but tilt-rotor costs are generally higher. Thus some of its other advantages, such as the VTOL capability, must offset the cost disadvantage for it to be a preferred or competitive mode in any given market. These issues are addressed in the companion report which considers strategies for tilt-rotor development in commercial air service.

Decarbonizing urban transport in European cities: four cases show possibly high co-benefits

NASA Astrophysics Data System (ADS)

Creutzig, Felix; Mühlhoff, Rainer; Römer, Julia

2012-12-01

Cities worldwide are increasingly becoming agents of climate change mitigation, while simultaneously aiming for other goals, such as improved accessibility and clean air. Based on stakeholder interviews and data analysis, we assess the current state of urban mobility in the four European cities of Barcelona, Malmö, Sofia and Freiburg. We then provide scenarios of increasingly ambitious policy packages, reducing greenhouse gas emissions from urban transport by up to 80% from 2010 to 2040. We find significant concurrent co-benefits in cleaner air, reduced noise ambience, fewer traffic-related injuries and deaths, more physical activity, less congestion and monetary fuel savings. Our scenarios suggest that non-motorized transport, especially bicycles, can occupy high modal shares, particularly in cities with less than 0.5 million inhabitants. We think that this kind of multi-criteria assessment of social costs and benefits is a useful complement to cost-benefit analysis of climate change mitigation measures.

Noise elimination algorithm for modal analysis

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

Bao, X. X., E-mail: baoxingxian@upc.edu.cn; Li, C. L.; Xiong, C. B.

2015-07-27

Modal analysis is an ongoing interdisciplinary physical issue. Modal parameters estimation is applied to determine the dynamic characteristics of structures under vibration excitation. Modal analysis is more challenging for the measured vibration response signals are contaminated with noise. This study develops a mathematical algorithm of structured low rank approximation combined with the complex exponential method to estimate the modal parameters. Physical experiments using a steel cantilever beam with ten accelerometers mounted, excited by an impulse load, demonstrate that this method can significantly eliminate noise from measured signals and accurately identify the modal frequencies and damping ratios. This study provides amore » fundamental mechanism of noise elimination using structured low rank approximation in physical fields.« less

Smartphone spectroscopy: three unique modalities for point-of-care testing

NASA Astrophysics Data System (ADS)

Long, Kenneth D.; Yu, Hojeong; Cunningham, Brian T.

2015-06-01

Here we demonstrate three principle modalities for a smartphone-based spectrometer: absorption, fluorescence, and photonic crystal (PC)-based label-free detection. When combined with some simple optical components, the rear-facing CMOS camera in a mobile device can provide spectrometric data that rivals that of laboratory instruments, but at a fraction of the cost. The use of a smartphone-based platform poses significant advantages based upon the rise of smartphone apps, which allow for user-interface and data-processing algorithms to be packaged and distributed within environments that are externally maintained with potential for integration with services such as cloud storage, GIS-tagging, and remote expert analysis. We demonstrate the absorption modality of our device by performing an enzyme-linked immunosorbent assay (ELISA) on both a cancer biomarker and a peanut allergen, demonstrating clinically relevant limits of detection (LOD). Second, we demonstrate the success of a molecular beacon (MB)-based assay on the smartphone platform, achieving an LOD of 1.3 pM for a specific RNA sequence, less than that of a commercial benchtop instrument. Finally, we use a PC biosensor to perform label-free detection of a representative biological interaction: Protein A and human immunoglobulin G (IgG) in the nanomolar regime. Our work represents the first demonstration of smartphone-based spectroscopy for biological assays, and the first mobile-device-enabled detection instrument that serves to measure three distinct sensing modalities (label-free biosensing, absorption spectroscopy, and fluorescence spectroscopy). The smartphone platform has the potential to expand the use of spectrometric analysis to environments assay from the laboratory, which may include rural or remote locations, low-resource settings, and consumer markets.

Incremental cost-effectiveness of laser therapy for choroidal neovascularization associated with histoplasmosis.

PubMed

Brown, G C; Brown, M M; Sharma, S; Busbee, B; Brown, H

2000-01-01

Laser photocoagulation has been shown in a large clinical trial to be efficacious in reducing the degree of vision loss occurring secondary to choroidal neovascularization (CNV) associated with ocular histoplasmosis. Nevertheless, data are lacking concerning the impact of the therapy on quality of life and its value to stakeholders in health care. Recently, information concerning the utility value of visual states has become available. Accordingly, the authors undertook to ascertain the cost-effectiveness of laser photocoagulation for the treatment of extrafoveal CNV occurring in eyes with ocular histoplasmosis. Design--A computer simulation, econometric model is presented to evaluate the incremental cost-effectiveness of laser photocoagulation therapy, as compared with the natural course of the disease, for the treatment of patients with extrafoveal CNV associated with ocular histoplasmosis. The model applies long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life), decision analysis with Markov modeling, and present value analysis with discounting to account for the time value of money. Outcome measure--Cost per quality-adjusted life-year gained from treatment. Laser photocoagulation therapy for extrafoveal CNV associated with ocular histoplasmosis costs $4167 1999 US dollars (at a 3% discount rate) for each quality-adjusted life-year gained from treatment. Sensitivity analysis shows that changing the discount rate substantially alters the cost-effectiveness, with a value of $1339 at a 0% discount rate and $56,250 at a 10% discount rate. Compared with therapeutic modalities for other disease entities, laser therapy for the treatment of extrafoveal CNV associated with ocular histoplasmosis appears to be a cost-effective treatment from the patient preference-based point of view.

Modal Vibration Analysis of Large Castings

NASA Technical Reports Server (NTRS)

Werlink, Rudolph J.; Margasahayam, Ravi N.

2009-01-01

The art of experimental modal vibration analysis (MVA) has been extended to apply to large castings. This extension was made to enable the use of experimental MVA as a relatively inexpensive, simple means of assessing the internal structural integrity of tread shoes of crawler transporters used to move spacecraft to the launch pad at Kennedy Space Center. Each tread shoe is made from cast iron and weighs about a ton (has a mass .907 kg). The present extended version of experimental MVA could also be applied to other large castings. It could be especially useful to manufacturers as a means of rapidly discriminating against large castings that contain unacceptably large concentrations of internal defects. The use of experimental MVA to assess structural integrity is not new. What are new here are those aspects of the extension of experimental MVA that pertain to the application of MVA to objects so massive that it may not be practical or cost effective to mount them in special test fixtures that impose special test boundary conditions to test them in place under normal conditions of use.

Resolvent analysis of shear flows using One-Way Navier-Stokes equations

NASA Astrophysics Data System (ADS)

Rigas, Georgios; Schmidt, Oliver; Towne, Aaron; Colonius, Tim

2017-11-01

For three-dimensional flows, questions of stability, receptivity, secondary flows, and coherent structures require the solution of large partial-derivative eigenvalue problems. Reduced-order approximations are thus required for engineering prediction since these problems are often computationally intractable or prohibitively expensive. For spatially slowly evolving flows, such as jets and boundary layers, the One-Way Navier-Stokes (OWNS) equations permit a fast spatial marching procedure that results in a huge reduction in computational cost. Here, an adjoint-based optimization framework is proposed and demonstrated for calculating optimal boundary conditions and optimal volumetric forcing. The corresponding optimal response modes are validated against modes obtained in terms of global resolvent analysis. For laminar base flows, the optimal modes reveal modal and non-modal transition mechanisms. For turbulent base flows, they predict the evolution of coherent structures in a statistical sense. Results from the application of the method to three-dimensional laminar wall-bounded flows and turbulent jets will be presented. This research was supported by the Office of Naval Research (N00014-16-1-2445) and Boeing Company (CT-BA-GTA-1).

Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

PubMed

Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

2017-10-01

Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

The financial impact of increasing home-based high dose haemodialysis and peritoneal dialysis.

PubMed

Liu, Frank Xiaoqing; Treharne, Catrin; Culleton, Bruce; Crowe, Lydia; Arici, Murat

2014-10-02

Evidence suggests that high dose haemodialysis (HD) may be associated with better health outcomes and even cost savings (if conducted at home) versus conventional in-centre HD (ICHD). Home-based regimens such as peritoneal dialysis (PD) are also associated with significant cost reductions and are more convenient for patients. However, the financial impact of increasing the use of high dose HD at home with an increased tariff is uncertain. A budget impact analysis was performed to investigate the financial impact of increasing the proportion of patients receiving home-based dialysis modalities from the perspective of the England National Health Service (NHS) payer. A Markov model was constructed to investigate the 5 year budget impact of increasing the proportion of dialysis patients receiving home-based dialysis, including both high dose HD at home and PD, under the current reimbursement tariff and a hypothetically increased tariff for home HD (£575/week). Five scenarios were compared with the current England dialysis modality distribution (prevalent patients, 14.1% PD, 82.0% ICHD, 3.9% conventional home HD; incident patients, 22.9% PD, 77.1% ICHD) with all increases coming from the ICHD population. Under the current tariff of £456/week, increasing the proportion of dialysis patients receiving high dose HD at home resulted in a saving of £19.6 million. Conducting high dose HD at home under a hypothetical tariff of £575/week was associated with a budget increase (£19.9 million). The costs of high dose HD at home were totally offset by increasing the usage of PD to 20-25%, generating savings of £40.0 million - £94.5 million over 5 years under the increased tariff. Conversely, having all patients treated in-centre resulted in a £172.6 million increase in dialysis costs over 5 years. This analysis shows that performing high dose HD at home could allow the UK healthcare system to capture the clinical and humanistic benefits associated with this therapy while limiting the impact on the dialysis budget. Increasing the usage of PD to 20-25%, the levels observed in 2005-2008, will totally offset the additional costs and generate further savings.

Clinical and economic impact of TENS in patients with chronic low back pain: analysis of a nationwide database.

PubMed

Pivec, Robert; Stokes, Michael; Chitnis, Abhishek S; Paulino, Carl B; Harwin, Steven F; Mont, Michael A

2013-12-01

This study evaluated patients who were given transcutaneous electrical nerve stimulation (TENS) compared with a matched group without TENS prior to intervention and at 1-year follow-up. Patients who were treated with TENS had significantly fewer hospital and clinic visits, used less diagnostic imaging (31 vs 46 events per 100 patients), had fewer physical therapy visits (94 vs 107), and required less back surgery (7.5 vs 9.2 surgeries) than patients receiving other treatment modalities. Total annual costs for chronic low back pain patients without neurological involvement were lower in TENS patients ($17,957 vs $17,986 for non-TENS), even when the cost of the device was taken into account.

Modality-specific effects on crosstalk in task switching: evidence from modality compatibility using bimodal stimulation.

PubMed

Stephan, Denise Nadine; Koch, Iring

2016-11-01

The present study was aimed at examining modality-specific influences in task switching. To this end, participants switched either between modality compatible tasks (auditory-vocal and visual-manual) or incompatible spatial discrimination tasks (auditory-manual and visual-vocal). In addition, auditory and visual stimuli were presented simultaneously (i.e., bimodally) in each trial, so that selective attention was required to process the task-relevant stimulus. The inclusion of bimodal stimuli enabled us to assess congruence effects as a converging measure of increased between-task interference. The tasks followed a pre-instructed sequence of double alternations (AABB), so that no explicit task cues were required. The results show that switching between two modality incompatible tasks increases both switch costs and congruence effects compared to switching between two modality compatible tasks. The finding of increased congruence effects in modality incompatible tasks supports our explanation in terms of ideomotor "backward" linkages between anticipated response effects and the stimuli that called for this response in the first place. According to this generalized ideomotor idea, the modality match between response effects and stimuli would prime selection of a response in the compatible modality. This priming would cause increased difficulties to ignore the competing stimulus and hence increases the congruence effect. Moreover, performance would be hindered when switching between modality incompatible tasks and facilitated when switching between modality compatible tasks.

Blood transfusion versus hydroxyurea in beta-thalassemia in Iran: a cost-effectiveness study.

PubMed

Ravangard, Ramin; Mirzaei, Zahra; Keshavarz, Khosro; Haghpanah, Sezaneh; Karimi, Mehran

2017-11-21

Thalassemia intermedia is a type of anemia which has several treatments modalities. We aimed to study the cost effectiveness of two treatments, including blood transfusion and hydroxyurea, in patients with beta-thalassemia intermedia in south of Iran referred to a referral center affiliated to Iran, Shiraz University of Medical Sciences in 2015. This was a cost-effectiveness study which was conducted on 122 patients with beta-thalassemia intermedia. The indicator of effectiveness in this study was the reduction of growth disorder (normal BMI). Data analysis was done using SPSS 21, Excel 2010 and Treeage 2011. Finally, the one-way sensitivity analysis was performed to determine the robustness of the results. The average annual costs of blood transfusion and the use of hydroxyurea in 2015 were 20733.27 purchasing power parity (PPP)$ and 7040.29 PPP$, respectively. The effectiveness of blood transfusion was57.4% while in hydroxyurea group was 60.7%. The results showed that the cost effectiveness of using hydroxyurea was more than that of blood transfusion. Therefore, it is recommended that the use of hydroxyurea in the treatment of patients with beta-thalassemia intermedia would become the first priority, and more basic and supplementary insurance coverage for treating such patients using hydroxyurea should be considered.

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

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

VoxelStats: A MATLAB Package for Multi-Modal Voxel-Wise Brain Image Analysis.

PubMed

Mathotaarachchi, Sulantha; Wang, Seqian; Shin, Monica; Pascoal, Tharick A; Benedet, Andrea L; Kang, Min Su; Beaudry, Thomas; Fonov, Vladimir S; Gauthier, Serge; Labbe, Aurélie; Rosa-Neto, Pedro

2016-01-01

In healthy individuals, behavioral outcomes are highly associated with the variability on brain regional structure or neurochemical phenotypes. Similarly, in the context of neurodegenerative conditions, neuroimaging reveals that cognitive decline is linked to the magnitude of atrophy, neurochemical declines, or concentrations of abnormal protein aggregates across brain regions. However, modeling the effects of multiple regional abnormalities as determinants of cognitive decline at the voxel level remains largely unexplored by multimodal imaging research, given the high computational cost of estimating regression models for every single voxel from various imaging modalities. VoxelStats is a voxel-wise computational framework to overcome these computational limitations and to perform statistical operations on multiple scalar variables and imaging modalities at the voxel level. VoxelStats package has been developed in Matlab(®) and supports imaging formats such as Nifti-1, ANALYZE, and MINC v2. Prebuilt functions in VoxelStats enable the user to perform voxel-wise general and generalized linear models and mixed effect models with multiple volumetric covariates. Importantly, VoxelStats can recognize scalar values or image volumes as response variables and can accommodate volumetric statistical covariates as well as their interaction effects with other variables. Furthermore, this package includes built-in functionality to perform voxel-wise receiver operating characteristic analysis and paired and unpaired group contrast analysis. Validation of VoxelStats was conducted by comparing the linear regression functionality with existing toolboxes such as glim_image and RMINC. The validation results were identical to existing methods and the additional functionality was demonstrated by generating feature case assessments (t-statistics, odds ratio, and true positive rate maps). In summary, VoxelStats expands the current methods for multimodal imaging analysis by allowing the estimation of advanced regional association metrics at the voxel level.

Design of a piezoelectric-based structural health monitoring system for damage detection in composite materials

NASA Astrophysics Data System (ADS)

Kessler, Seth S.; Spearing, S. Mark

2002-07-01

Cost-effective and reliable damage detection is critical for the utilization of composite materials. This paper presents the conclusions of an experimental and analytical survey of candidate methods for in-situ damage detection in composite structures. Experimental results are presented for the application of modal analysis and Lamb wave techniques to quasi-isotropic graphite/epoxy test specimens containing representative damage. Piezoelectric patches were used as actuators and sensors for both sets of experiments. Modal analysis methods were reliable for detecting small amounts of global damage in a simple composite structure. By comparison, Lamb wave methods were sensitive to all types of local damage present between the sensor and actuator, provided useful information about damage presence and severity, and present the possibility of estimating damage type and location. Analogous experiments were also performed for more complex built-up structures. These techniques are suitable for structural health monitoring applications since they can be applied with low power conformable sensors and can provide useful information about the state of a structure during operation. Piezoelectric patches could also be used as multipurpose sensors to detect damage by a variety of methods such as modal analysis, Lamb wave, acoustic emission and strain based methods simultaneously, by altering driving frequencies and sampling rates. This paper present guidelines and recommendations drawn from this research to assist in the design of a structural health monitoring system for a vehicle. These systems will be an important component in future designs of air and spacecraft to increase the feasibility of their missions.

Cost-effectiveness modelling in diagnostic imaging: a stepwise approach.

PubMed

Sailer, Anna M; van Zwam, Wim H; Wildberger, Joachim E; Grutters, Janneke P C

2015-12-01

Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this article we provide a comprehensive framework of direct and indirect effects that should be considered for CEA in DI, suitable for all imaging modalities. We describe and explain the methodology of decision analytic modelling in six steps aiming to transfer theory of CEA to clinical research by demonstrating key principles of CEA in a practical approach. We thereby provide radiologists with an introduction to the tools necessary to perform and interpret CEA as part of their research and clinical practice. • DI influences medical decision making, affecting both costs and health outcome. • This article provides a comprehensive framework for CEA in DI. • A six-step methodology for conducting and interpreting cost-effectiveness modelling is proposed.

Recruitment strategies for an osteoporosis clinical trial: analysis of effectiveness.

PubMed

Heard, Allison; March, Rachel; Maguire, Patricia; Reilly, Penny; Helmore, Joy; Cameron, Sheryl; Frampton, Christopher; Nicholls, Gary; Gilchrist, Nigel

2012-09-01

To examine the effectiveness of a planned rapid recruitment strategy in an osteoporosis clinical trial. Multiple recruitment methods were explored, including media advertising, searching bone density scan and X-ray results in specialist and primary practice databases, community initiatives, and generation of research centre and study-specific pamphlets. Of 246 women screened, 41 consenting to the study, only 14 were randomised. Thus, 232 (94%) volunteers were screen failures, ineligible or declined to participate. With regard to the cost-effectiveness of all recruitment strategies, searching the research centre database was the most successful, with four women randomised at a cost of approximately NZ$302 per volunteer. Other strategies were less cost-effective. Obtaining a specific study cohort can be achieved by a comprehensive, targeted, rapid recruitment program. A research centre database search was the most successful and cost-effective recruitment modality in this small study. © 2012 Canterbury Geriatric Medical Research Trust. Australasian Journal on Ageing © 2012 ACOTA.

Crossmodal attention switching: auditory dominance in temporal discrimination tasks.

PubMed

Lukas, Sarah; Philipp, Andrea M; Koch, Iring

2014-11-01

Visual stimuli are often processed more efficiently than accompanying stimuli in another modality. In line with this "visual dominance", earlier studies on attentional switching showed a clear benefit for visual stimuli in a bimodal visual-auditory modality-switch paradigm that required spatial stimulus localization in the relevant modality. The present study aimed to examine the generality of this visual dominance effect. The modality appropriateness hypothesis proposes that stimuli in different modalities are differentially effectively processed depending on the task dimension, so that processing of visual stimuli is favored in the dimension of space, whereas processing auditory stimuli is favored in the dimension of time. In the present study, we examined this proposition by using a temporal duration judgment in a bimodal visual-auditory switching paradigm. Two experiments demonstrated that crossmodal interference (i.e., temporal stimulus congruence) was larger for visual stimuli than for auditory stimuli, suggesting auditory dominance when performing temporal judgment tasks. However, attention switch costs were larger for the auditory modality than for visual modality, indicating a dissociation of the mechanisms underlying crossmodal competition in stimulus processing and modality-specific biasing of attentional set. Copyright © 2014 Elsevier B.V. All rights reserved.

Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer

PubMed Central

Richard, Patrick J.; Zeng, Jing; Apisarnthanarax, Smith; Rengan, Ramesh; Phillips, Mark H.

2018-01-01

Background Although proton radiation treatments are more costly than photon/X-ray therapy, they may lower overall treatment costs through reducing rates of severe toxicities and the costly management of those toxicities. To study this issue, we created a decision-model comparing proton vs. X-ray radiotherapy for locally advanced non-small cell lung cancer patients. Methods An influence diagram was created to model for radiation delivery, associated 6-month pneumonitis/esophagitis rates, and overall costs (radiation plus toxicity costs). Pneumonitis (age, chemo type, V20, MLD) and esophagitis (V60) predictors were modeled to impact toxicity rates. We performed toxicity-adjusted, rate-adjusted, risk group-adjusted, and radiosensitivity analyses. Results Upfront proton treatment costs exceeded that of photons [$16,730.37 (3DCRT), $23,893.83 (IMRT), $41,061.80 (protons)]. Based upon expected population pneumonitis and esophagitis rates for each modality, protons would be expected to recover $1,065.62 and $1,139.63 of the cost difference compared to 3DCRT or IMRT. For patients treated with IMRT experiencing grade 4 pneumonitis or grade 4 esophagitis, costs exceeded patients treated with protons without this toxicity. 3DCRT patients with grade 4 esophagitis had higher costs than proton patients without this toxicity. For the risk group analysis, high risk patients (age >65, carboplatin/paclitaxel) benefited more from proton therapy. A biomarker may allow patient selection for proton therapy, although the AUC alone is not sufficient to determine if the biomarker is clinically useful. Conclusions The comparison between proton and photon/X-ray radiation therapy for NSCLC needs to consider both the up-front cost of treatment and the possible long term cost of complications. In our analysis, current costs favor X-ray therapy. However, relatively small reductions in the cost of proton therapy may result in a shift to the preference for proton therapy.

Fourier Spectral Filter Array for Optimal Multispectral Imaging.

PubMed

Jia, Jie; Barnard, Kenneth J; Hirakawa, Keigo

2016-04-01

Limitations to existing multispectral imaging modalities include speed, cost, range, spatial resolution, and application-specific system designs that lack versatility of the hyperspectral imaging modalities. In this paper, we propose a novel general-purpose single-shot passive multispectral imaging modality. Central to this design is a new type of spectral filter array (SFA) based not on the notion of spatially multiplexing narrowband filters, but instead aimed at enabling single-shot Fourier transform spectroscopy. We refer to this new SFA pattern as Fourier SFA, and we prove that this design solves the problem of optimally sampling the hyperspectral image data.

Modality matters for the expression of inducible defenses: introducing a concept of predator modality.

PubMed

Herzog, Quirin; Laforsch, Christian

2013-11-18

Inducible defenses are a common and widespread form of phenotypic plasticity. A fundamental factor driving their evolution is an unpredictable and heterogeneous predation pressure. This heterogeneity is often used synonymously to quantitative changes in predation risk, depending on the abundance and impact of predators. However, differences in 'modality', that is, the qualitative aspect of natural selection caused by predators, can also cause heterogeneity. For instance, predators of the small planktonic crustacean Daphnia have been divided into two functional groups of predators: vertebrates and invertebrates. Predators of both groups are known to cause different defenses, yet predators of the same group are considered to cause similar responses. In our study we question that thought and address the issue of how multiple predators affect the expression and evolution of inducible defenses. We exposed D. barbata to chemical cues released by Triops cancriformis and Notonecta glauca, respectively. We found for the first time that two invertebrate predators induce different shapes of the same morphological defensive traits in Daphnia, rather than showing gradual or opposing reaction norms. Additionally, we investigated the adaptive value of those defenses in direct predation trials, pairing each morphotype (non-induced, Triops-induced, Notonecta-induced) against the other two and exposed them to one of the two predators. Interestingly, against Triops, both induced morphotypes offered equal protection. To explain this paradox we introduce a 'concept of modality' in multipredator regimes. Our concept categorizes two-predator-prey systems into three major groups (functionally equivalent, functionally inverse and functionally diverse). Furthermore, the concept includes optimal responses and costs of maladaptions of prey phenotypes in environments where both predators co-occur or where they alternate. With D. barbata, we introduce a new multipredator-prey system with a wide array of morphological inducible defenses. Based on a 'concept of modality', we give possible explanations how evolution can favor specialized defenses over a general defense. Additionally, our concept not only helps to classify different multipredator-systems, but also stresses the significance of costs of phenotype-environment mismatching in addition to classic 'costs of plasticity'. With that, we suggest that 'modality' matters as an important factor in understanding and explaining the evolution of inducible defenses.

Current and Under Development Treatment Modalities of Psoriasis: A Review.

PubMed

Albaghdadi, Abdullah

2017-01-01

Psoriasis is a chronic and complex autoimmune inflammatory skin disease that affects over 125 million people worldwide. It can exhibit at any age, in spite of the fact that children are less normally influenced than adults. It is characterized by distinct erythematous plaques shielded with conspicuous silvery scales that shows up in different areas of the skin. Knowledge of pathophysiology, especially the pathogenesis of psoriasis, has significantly progressed in the recent decade. Advancement in molecular knowledge leads to better understanding of the disease, thus influencing the development of efficient treatment modalities. However, even with the availability of various options of treatment most of the efficient treatment modalities are costly. Expenses of health care bring about major financial weight to the patients as well as to health care systems. Thus, it was important to review the available current treatment options and those which are under development, in terms of efficacy, safety and cost to assist in selecting the most appropriate treatment for psoriasis patients. Literatures were searched by using key words psoriasis, topical treatment, systemic treatment, biologics and phototherapies, on Embase, Medline, Jstor, Cochrane and Merck Index databases. Life-style choices such as smoking, alcohol consumption, obesity and stress are recognised as risk factors and triggers associated with psoriasis. Psoriasis poses psycho-social and economic burden on affected patients that sometimes leads to depression, reduced social interaction and suicidal tendencies in patients. Depending on the type, severity and extent of the disease, comorbidities, patient preference, efficacy and safety profile, numerous treatment modalities and therapeutic agents are available such as topical, systemic, biologic and phototherapeutic treatments. However, it was found that among all the current available treatments for psoriasis, biologic agents and phototherapeutic modalities are the most commonly employed treatment modalities for moderate to severe psoriasis. Evaluation of present-day available treatment alternatives will surely help physician to select a suitable module for each patient while keeping in mind the financial status of the patient. Future research should aim to develop therapies which are efficient, safe and cost-effective. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Comparative Investigation on Modal analysis of LM25 Aluminium alloy with other Aluminim alloys using Finite element analysis software

NASA Astrophysics Data System (ADS)

Arunkumar, S.; Baskaralal, V. P. M.; Muthuraman, V.

2017-03-01

The rudimentary steps of the modal analysis and simulation are carried out. The modal analysis is carried out on the different Aluminum Alloys cantilever beam. The cantilever beam is designed in the graphical environment of the ANSYS. The cantilever beam was fine-tuned on one end with all degree of liberation on this end were taken, beam cannot move and rotate. Mode shapes and natural frequencies are premeditated in platforms ANSYS with arithmetical formulation of the direct solver including the block Lanczos method. Aluminum alloys are widely utilized in much application due to their estimable weight to vigor property. Many examination works have been distributed out to make developments the mechanical properties of aluminum alloys. The composition of alloying elements plays a consequential role in deciding the properties of an alloy. In this study a numerical analysis implement i.e., finite element analysis (FEA) is utilized. The work obtainable in this paper is aimed at the study of effect of modal analysis of different aluminum alloys. The modeling and analysis is carried out utilizing ANSYS FEA software. A modal analysis is carried out to understand the modes of frequency demeanor of the material considered. The modal analysis play a vital role in the design of components subjected to high vibration.

Potential Cost Savings of Contrast-Enhanced Digital Mammography.

PubMed

Patel, Bhavika K; Gray, Richard J; Pockaj, Barbara A

2017-06-01

The purpose of this article is to discuss whether the sensitivity and specificity of contrast-enhanced digital mammography (CEDM) render it a viable diagnostic alternative to breast MRI. That CEDM couples low-energy images (comparable to the diagnostic quality of standard mammography) and subtracted contrast-enhanced mammograms make it a cost-effective modality and a realistic substitute for the more costly breast MRI.

Manual on Cost-Effectiveness of Training Modalities in Population Education. Population Education Programme Service Series.

ERIC Educational Resources Information Center

United Nations Educational, Scientific and Cultural Organization, Bangkok (Thailand). Principal Regional Office for Asia and the Pacific.

This manual is the result of a regional training workshop on the cost-effectiveness of different training strategies in population education by Unesco in Kathmandu, Nepal, June 1-8, 1987. The purpose of the manual is to enable project staff to initiate studies to determine cost-effective training strategies in population growth control education.…

Control of large flexible structures - An experiment on the NASA Mini-Mast facility

NASA Technical Reports Server (NTRS)

Hsieh, Chen; Kim, Jae H.; Liu, Ketao; Zhu, Guoming; Skelton, Robert E.

1991-01-01

The output variance constraint controller design procedure is integrated with model reduction by modal cost analysis. A procedure is given for tuning MIMO controller designs to find the maximal rms performance of the actual system. Controller designs based on a finite-element model of the system are compared with controller designs based on an identified model (obtained using the Q-Markov Cover algorithm). The identified model and the finite-element model led to similar closed-loop performance, when tested in the Mini-Mast facility at NASA Langley.

Ground Vibration Testing Options for Space Launch Vehicles

NASA Technical Reports Server (NTRS)

Patterson, Alan; Smith, Robert K.; Goggin, David; Newsom, Jerry

2011-01-01

New NASA launch vehicles will require development of robust systems in a fiscally-constrained environment. NASA, Department of Defense (DoD), and commercial space companies routinely conduct ground vibration tests as an essential part of math model validation and launch vehicle certification. Although ground vibration testing must be a part of the integrated test planning process, more affordable approaches must also be considered. A study evaluated several ground vibration test options for the NASA Constellation Program flight test vehicles, Orion-1 and Orion-2, which concluded that more affordable ground vibration test options are available. The motivation for ground vibration testing is supported by historical examples from NASA and DoD. The approach used in the present study employed surveys of ground vibration test subject-matter experts that provided data to qualitatively rank six test options. Twenty-five experts from NASA, DoD, and industry provided scoring and comments for this study. The current study determined that both element-level modal tests and integrated vehicle modal tests have technical merits. Both have been successful in validating structural dynamic math models of launch vehicles. However, element-level testing has less overall cost and schedule risk as compared to integrated vehicle testing. Future NASA launch vehicle development programs should anticipate that some structural dynamics testing will be necessary. Analysis alone will be inadequate to certify a crew-capable launch vehicle. At a minimum, component and element structural dynamic tests are recommended for new vehicle elements. Three viable structural dynamic test options were identified. Modal testing of the new vehicle elements and an integrated vehicle test on the mobile launcher provided the optimal trade between technical, cost, and schedule.

Development of 300 mesh Soy Bean Crusher for Tofu Material Processing

NASA Astrophysics Data System (ADS)

Lee, E. S.; Pratama, P. S.; Supeno, D.; Jeong, S. W.; Byun, J. Y.; Woo, J. H.; Park, C. S.; Choi, W. S.

2018-03-01

A machine such as bean crusher machine is subjected to different loads and vibration. Due to this vibration there will be certain deformations which affect the performance of the machine in adverse manner. This paper proposed a vibration analysis of bean crusher machine using ANSYS. The effect of vibration on the structure was studied in order to ensure the safety using finite element analysis. This research supports the machine designer to create a better product with lower cost and faster development time. To do this, firstly, using Inventor, a CAD model is prepared. Secondly, the analysis is to be carried out using ANSYS 15. The modal analysis and random vibration analysis of the structure was conducted. The analysis shows that the proposed design was successfully shows the minimum deformation when the vibration was applied in normal condition.

A Cost Analysis of Kidney Replacement Therapy Options in Palestine

PubMed Central

Jabr, Samer; Al-Khatib, Abdallah; Forgione, Dana; Hartmann, Michael; Kisa, Adnan

2015-01-01

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16 277 for the first year; the estimated cost of HD per patient averaged US$16 085 per year—nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life. PMID:25765018

A cost analysis of kidney replacement therapy options in Palestine.

PubMed

Younis, Mustafa; Jabr, Samer; Al-Khatib, Abdallah; Forgione, Dana; Hartmann, Michael; Kisa, Adnan

2015-01-01

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16,277 for the first year; the estimated cost of HD per patient averaged US$16,085 per year--nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life. © The Author(s) 2015.

Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome.

PubMed

Hyeda, Adriano; Costa, Élide Sbardellotto Mariano da

2017-01-01

To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died. Realizar uma análise econômica de custos da terapia nutricional enteral e parenteral, conforme o tipo de doença e o desfecho (sobreviventes versus óbitos). Estudo transversal, observacional, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares de uma operadora de saúde da Região Sul do Brasil. Foram analisadas 301 contas hospitalares de usuários que utilizaram dieta enteral e parenteral. O custo total com dieta foi de 35,4% do custo total das contas hospitalares. A modalidade enteral representou 59,8% do custo total em dieta. Os maiores custos com dieta foram observados em internações relacionadas a infecções, cânceres e doenças cérebro-cardiovasculares. Os maiores custos com dieta parenteral foram observados nas internações relacionadas aos cânceres (64,52%) e às síndromes demenciais (46,17%). A maior relação entre o custo total com dieta e o custo total da conta foi na síndrome demencial (46,32%) e no câncer (41,2%). Os usuários que foram a óbito consumiram 51,26% dos custos totais das contas, sendo 32,81% com dieta (47,45% do valor total com dieta e 58,81% do custo na modalidade parenteral). As terapias nutricionais enteral e parenteral representaram uma parte importante dos custos no tratamento de indivíduos hospitalizados, principalmente nos casos dos cânceres e nas síndromes demenciais. O custo com dieta parenteral foi maior no grupo de usuários que foram a óbito.

LPV Modeling of a Flexible Wing Aircraft Using Modal Alignment and Adaptive Gridding Methods

NASA Technical Reports Server (NTRS)

Al-Jiboory, Ali Khudhair; Zhu, Guoming; Swei, Sean Shan-Min; Su, Weihua; Nguyen, Nhan T.

2017-01-01

One of the earliest approaches in gain-scheduling control is the gridding based approach, in which a set of local linear time-invariant models are obtained at various gridded points corresponding to the varying parameters within the flight envelop. In order to ensure smooth and effective Linear Parameter-Varying control, aligning all the flexible modes within each local model and maintaining small number of representative local models over the gridded parameter space are crucial. In addition, since the flexible structural models tend to have large dimensions, a tractable model reduction process is necessary. In this paper, the notion of s-shifted H2- and H Infinity-norm are introduced and used as a metric to measure the model mismatch. A new modal alignment algorithm is developed which utilizes the defined metric for aligning all the local models over the entire gridded parameter space. Furthermore, an Adaptive Grid Step Size Determination algorithm is developed to minimize the number of local models required to represent the gridded parameter space. For model reduction, we propose to utilize the concept of Composite Modal Cost Analysis, through which the collective contribution of each flexible mode is computed and ranked. Therefore, a reduced-order model is constructed by retaining only those modes with significant contribution. The NASA Generic Transport Model operating at various flight speeds is studied for verification purpose, and the analysis and simulation results demonstrate the effectiveness of the proposed modeling approach.

Organ recovery cost assessment in the French healthcare system from 2007 to 2014.

PubMed

Hrifach, Abdelbaste; Ganne, Christell; Couray-Targe, Sandrine; Brault, Coralie; Guerre, Pascale; Serrier, Hassan; Farge, Pierre; Colin, Cyrille

2018-03-23

Organ recovery costs should be assessed to allow efficient and sustainable integration of these costs into national healthcare budgets and policies. These costs are of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries. This study assessed organ recovery costs from 2007 to 2014 in the French healthcare system based on the national hospital discharge database and a national cost study. The secondary objective was to describe the variability in the population of deceased organ donors during this period. All stays for organ recovery in French hospitals between January 2007 and December 2014 were quantified from discharge abstracts and valued using a national cost study. Five cost evaluations were conducted to explore all aspects of organ recovery activities. A sensitivity analysis was conducted to test the methodological choice. Trends regarding organ recovery practices were assessed by monitoring indicators. The analysis included 12 629 brain death donors, with 28 482 organs recovered. The mean cost of a hospital stay was €7469 (SD = €10, 894). The mean costs of separate kidney, liver, pancreas, intestine, heart, lung and heart-lung block recovery regardless of the organs recovered were €1432 (SD = €1342), €502 (SD = €782), €354 (SD = €475), €362 (SD = €1559), €542 (SD = €955), €977 (SD = €1196) and €737 (SD = €637), respectively. Despite a marginal increase in donors, the number of organs recovered increased primarily due to improved practices. Although cost management is the main challenge for successful organ recovery, other aspects such as organization modalities should be considered to improve organ availability.

A highly sensitive x-ray imaging modality for hepatocellular carcinoma detection in vitro

NASA Astrophysics Data System (ADS)

Rand, Danielle; Walsh, Edward G.; Derdak, Zoltan; Wands, Jack R.; Rose-Petruck, Christoph

2015-01-01

Innovations that improve sensitivity and reduce cost are of paramount importance in diagnostic imaging. The novel x-ray imaging modality called spatial frequency heterodyne imaging (SFHI) is based on a linear arrangement of x-ray source, tissue, and x-ray detector, much like that of a conventional x-ray imaging apparatus. However, SFHI rests on a complete paradigm reversal compared to conventional x-ray absorption-based radiology: while scattered x-rays are carefully rejected in absorption-based x-ray radiology to enhance the image contrast, SFHI forms images exclusively from x-rays scattered by the tissue. In this study we use numerical processing to produce x-ray scatter images of hepatocellular carcinoma labeled with a nanoparticle contrast agent. We subsequently compare the sensitivity of SFHI in this application to that of both conventional x-ray imaging and magnetic resonance imaging (MRI). Although SFHI is still in the early stages of its development, our results show that the sensitivity of SFHI is an order of magnitude greater than that of absorption-based x-ray imaging and approximately equal to that of MRI. As x-ray imaging modalities typically have lower installation and service costs compared to MRI, SFHI could become a cost effective alternative to MRI, particularly in areas of the world with inadequate availability of MRI facilities.

Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?

PubMed

Api, Murat

2009-12-01

A number of novel surgical modalities that destroy or remove some ovarian tissue to restore ovarian function in patients with polycystic ovary syndrome have been described in the most recent literature. Although these modalities were reported to have easy applicability and low cost with shorter hospital stay, the efficacy and safety concerns need to be discussed extensively.

A modal analysis of flexible aircraft dynamics with handling qualities implications

NASA Technical Reports Server (NTRS)

Schmidt, D. K.

1983-01-01

A multivariable modal analysis technique is presented for evaluating flexible aircraft dynamics, focusing on meaningful vehicle responses to pilot inputs and atmospheric turbulence. Although modal analysis is the tool, vehicle time response is emphasized, and the analysis is performed on the linear, time-domain vehicle model. In evaluating previously obtained experimental pitch tracking data for a family of vehicle dynamic models, it is shown that flexible aeroelastic effects can significantly affect pitch attitude handling qualities. Consideration of the eigenvalues alone, of both rigid-body and aeroelastic modes, does not explain the simulation results. Modal analysis revealed, however, that although the lowest aeroelastic mode frequency was still three times greater than the short-period frequency, the rigid-body attitude response was dominated by this aeroelastic mode. This dominance was defined in terms of the relative magnitudes of the modal residues in selected vehicle responses.

Quality of Life and Cost Effectiveness of Prostate Cancer Treatment

DTIC Science & Technology

2008-03-01

Study objective is to assess the effects of different treatments for prostate cancer on quality of life and cost of care for two ethnic groups. It...across ethnic groups; and (3) analyze resource utilization patterns, treatment modalities and quality of life of men with prostate cancer between non-VA

Dual ant colony operational modal analysis parameter estimation method

NASA Astrophysics Data System (ADS)

Sitarz, Piotr; Powałka, Bartosz

2018-01-01

Operational Modal Analysis (OMA) is a common technique used to examine the dynamic properties of a system. Contrary to experimental modal analysis, the input signal is generated in object ambient environment. Operational modal analysis mainly aims at determining the number of pole pairs and at estimating modal parameters. Many methods are used for parameter identification. Some methods operate in time while others in frequency domain. The former use correlation functions, the latter - spectral density functions. However, while some methods require the user to select poles from a stabilisation diagram, others try to automate the selection process. Dual ant colony operational modal analysis parameter estimation method (DAC-OMA) presents a new approach to the problem, avoiding issues involved in the stabilisation diagram. The presented algorithm is fully automated. It uses deterministic methods to define the interval of estimated parameters, thus reducing the problem to optimisation task which is conducted with dedicated software based on ant colony optimisation algorithm. The combination of deterministic methods restricting parameter intervals and artificial intelligence yields very good results, also for closely spaced modes and significantly varied mode shapes within one measurement point.

The adoption of new adjuvant radiation therapy modalities among Medicare beneficiaries with breast cancer: clinical correlates and cost implications.

PubMed

Roberts, Kenneth B; Soulos, Pamela R; Herrin, Jeph; Yu, James B; Long, Jessica B; Dostaler, Edward; Gross, Cary P

2013-04-01

New radiation therapy modalities have broadened treatment options for older women with breast cancer, but it is unclear how clinical factors, geographic region, and physician preference affect the choice of radiation therapy modality. We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women diagnosed with stage I-III breast cancer from 1998 to 2007 who underwent breast-conserving surgery. We assessed the temporal trends in, and costs of, the adoption of intensity modulated radiation therapy (IMRT) and brachytherapy. Using hierarchical logistic regression, we evaluated the relationship between the use of these new modalities and patient and regional characteristics. Of 35,060 patients, 69.9% received conventional external beam radiation therapy (EBRT). Although overall radiation therapy use remained constant, the use of IMRT increased from 0.0% to 12.6% from 1998 to 2007, and brachytherapy increased from 0.7% to 9.0%. The statistical variation in brachytherapy use attributable to the radiation oncologist and geographic region was 41.4% and 9.5%, respectively (for IMRT: 23.8% and 22.1%, respectively). Women undergoing treatment at a free-standing radiation facility were significantly more likely to receive IMRT than were women treated at a hospital-based facility (odds ratio for IMRT vs EBRT: 3.89 [95% confidence interval, 2.78-5.45]). No such association was seen for brachytherapy. The median radiation therapy cost per treated patient increased from $5389 in 2001 to $8539 in 2007. IMRT and brachytherapy use increased substantially from 1998 to 2007; overall, radiation therapy costs increased by more than 50%. Radiation oncologists played an important role in treatment choice for both types of radiation therapy, whereas geographic region played a bigger role in the use of IMRT than brachytherapy. Copyright © 2013 Elsevier Inc. All rights reserved.

The Adoption of New Adjuvant Radiation Therapy Modalities Among Medicare Beneficiaries With Breast Cancer: Clinical Correlates and Cost Implications

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

Roberts, Kenneth B.; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut; Soulos, Pamela R.

2013-04-01

Purpose: New radiation therapy modalities have broadened treatment options for older women with breast cancer, but it is unclear how clinical factors, geographic region, and physician preference affect the choice of radiation therapy modality. Methods and Materials: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women diagnosed with stage I-III breast cancer from 1998 to 2007 who underwent breast-conserving surgery. We assessed the temporal trends in, and costs of, the adoption of intensity modulated radiation therapy (IMRT) and brachytherapy. Using hierarchical logistic regression, we evaluated the relationship between the use of these new modalities and patient andmore » regional characteristics. Results: Of 35,060 patients, 69.9% received conventional external beam radiation therapy (EBRT). Although overall radiation therapy use remained constant, the use of IMRT increased from 0.0% to 12.6% from 1998 to 2007, and brachytherapy increased from 0.7% to 9.0%. The statistical variation in brachytherapy use attributable to the radiation oncologist and geographic region was 41.4% and 9.5%, respectively (for IMRT: 23.8% and 22.1%, respectively). Women undergoing treatment at a free-standing radiation facility were significantly more likely to receive IMRT than were women treated at a hospital-based facility (odds ratio for IMRT vs EBRT: 3.89 [95% confidence interval, 2.78-5.45]). No such association was seen for brachytherapy. The median radiation therapy cost per treated patient increased from $5389 in 2001 to $8539 in 2007. Conclusions: IMRT and brachytherapy use increased substantially from 1998 to 2007; overall, radiation therapy costs increased by more than 50%. Radiation oncologists played an important role in treatment choice for both types of radiation therapy, whereas geographic region played a bigger role in the use of IMRT than brachytherapy.« less

Dynamic Testing of a Pre-stretched Flexible Tube for Identifying the Factors Affecting Modal Parameter Estimation

NASA Astrophysics Data System (ADS)

Unnikrishnan, Madhusudanan; Rajan, Akash; Basanthvihar Raghunathan, Binulal; Kochupillai, Jayaraj

2017-08-01

Experimental modal analysis is the primary tool for obtaining the fundamental dynamic characteristics like natural frequency, mode shape and modal damping ratio that determine the behaviour of any structure under dynamic loading conditions. This paper discusses about a carefully designed experimental method for calculating the dynamic characteristics of a pre-stretched horizontal flexible tube made of polyurethane material. The factors that affect the modal parameter estimation like the application time of shaker excitation, pause time between successive excitation cycles, averaging and windowing of measured signal, as well as the precautions to be taken during the experiment are explained in detail. The modal parameter estimation is done using MEscopeVESTM software. A finite element based pre-stressed modal analysis of the flexible tube is also done using ANSYS ver.14.0 software. The experimental and analytical results agreed well. The proposed experimental methodology may be extended for carrying out the modal analysis of many flexible structures like inflatables, tires and membranes.

Identification of modal parameters including unmeasured forces and transient effects

NASA Astrophysics Data System (ADS)

Cauberghe, B.; Guillaume, P.; Verboven, P.; Parloo, E.

2003-08-01

In this paper, a frequency-domain method to estimate modal parameters from short data records with known input (measured) forces and unknown input forces is presented. The method can be used for an experimental modal analysis, an operational modal analysis (output-only data) and the combination of both. A traditional experimental and operational modal analysis in the frequency domain starts respectively, from frequency response functions and spectral density functions. To estimate these functions accurately sufficient data have to be available. The technique developed in this paper estimates the modal parameters directly from the Fourier spectra of the outputs and the known input. Instead of using Hanning windows on these short data records the transient effects are estimated simultaneously with the modal parameters. The method is illustrated, tested and validated by Monte Carlo simulations and experiments. The presented method to process short data sequences leads to unbiased estimates with a small variance in comparison to the more traditional approaches.

Cross-Modality Image Synthesis via Weakly Coupled and Geometry Co-Regularized Joint Dictionary Learning.

PubMed

Huang, Yawen; Shao, Ling; Frangi, Alejandro F

2018-03-01

Multi-modality medical imaging is increasingly used for comprehensive assessment of complex diseases in either diagnostic examinations or as part of medical research trials. Different imaging modalities provide complementary information about living tissues. However, multi-modal examinations are not always possible due to adversary factors, such as patient discomfort, increased cost, prolonged scanning time, and scanner unavailability. In additionally, in large imaging studies, incomplete records are not uncommon owing to image artifacts, data corruption or data loss, which compromise the potential of multi-modal acquisitions. In this paper, we propose a weakly coupled and geometry co-regularized joint dictionary learning method to address the problem of cross-modality synthesis while considering the fact that collecting the large amounts of training data is often impractical. Our learning stage requires only a few registered multi-modality image pairs as training data. To employ both paired images and a large set of unpaired data, a cross-modality image matching criterion is proposed. Then, we propose a unified model by integrating such a criterion into the joint dictionary learning and the observed common feature space for associating cross-modality data for the purpose of synthesis. Furthermore, two regularization terms are added to construct robust sparse representations. Our experimental results demonstrate superior performance of the proposed model over state-of-the-art methods.

Objective monitoring of mTOR inhibitor therapy by three-dimensional facial analysis.

PubMed

Baynam, Gareth S; Walters, Mark; Dawkins, Hugh; Bellgard, Matthew; Halbert, Anne R; Claes, Peter

2013-08-01

With advances in therapeutics for rare, genetic and syndromic diseases, there is an increasing need for objective assessments of phenotypic endpoints. These assessments will preferentially be high precision, non-invasive, non-irradiating, and relatively inexpensive and portable. We report a case of a child with an extensive lymphatic vascular malformation of the head and neck, treated with an mammalian target of Rapamycin (mTOR) inhibitor that was assessed using 3D facial analysis. This case illustrates that this technology is prospectively a cost-effective modality for treatment monitoring, and it supports that it may also be used for novel explorations of disease biology for conditions associated with disturbances in the mTOR, and interrelated, pathways.

The need for supplemental breast cancer screening modalities: a perspective of population-based breast cancer screening programs in Japan.

PubMed

Uematsu, Takayoshi

2017-01-01

This article discusses possible supplemental breast cancer screening modalities for younger women with dense breasts from a perspective of population-based breast cancer screening program in Japan. Supplemental breast cancer screening modalities have been proposed to increase the sensitivity and detection rates of early stage breast cancer in women with dense breasts; however, there are no global guidelines that recommend the use of supplemental breast cancer screening modalities in such women. Also, no criterion standard exists for breast density assessment. Based on the current situation of breast imaging in Japan, the possible supplemental breast cancer screening modalities are ultrasonography, digital breast tomosynthesis, and breast magnetic resonance imaging. An appropriate population-based breast cancer screening program based on the balance between cost and benefit should be a high priority. Further research based on evidence-based medicine is encouraged. It is very important that the ethnicity, workforce, workflow, and resources for breast cancer screening in each country should be considered when considering supplemental breast cancer screening modalities for women with dense breasts.

Breakeven, cost benefit, cost effectiveness, and willingness to pay for web-based versus face-to-face education delivery for health professionals.

PubMed

Maloney, Stephen; Haas, Romi; Keating, Jenny L; Molloy, Elizabeth; Jolly, Brian; Sims, Jane; Morgan, Prue; Haines, Terry

2012-04-02

The introduction of Web-based education and open universities has seen an increase in access to professional development within the health professional education marketplace. Economic efficiencies of Web-based education and traditional face-to-face educational approaches have not been compared under randomized controlled trial conditions. To compare costs and effects of Web-based and face-to-face short courses in falls prevention education for health professionals. We designed two short courses to improve the clinical performance of health professionals in exercise prescription for falls prevention. One was developed for delivery in face-to-face mode and the other for online learning. Data were collected on learning outcomes including participation, satisfaction, knowledge acquisition, and change in practice, and combined with costs, savings, and benefits, to enable a break-even analysis from the perspective of the provider, cost-effectiveness analysis from the perspective of the health service, and cost-benefit analysis from the perspective of the participant. Face-to-face and Web-based delivery modalities produced comparable outcomes for participation, satisfaction, knowledge acquisition, and change in practice. Break-even analysis identified the Web-based educational approach to be robustly superior to face-to-face education, requiring a lower number of enrollments for the program to reach its break-even point. Cost-effectiveness analyses from the perspective of the health service and cost-benefit analysis from the perspective of the participant favored face-to-face education, although the outcomes were contingent on the sensitivity analysis applied (eg, the fee structure used). The Web-based educational approach was clearly more efficient from the perspective of the education provider. In the presence of relatively equivocal results for comparisons from other stakeholder perspectives, it is likely that providers would prefer to deliver education via a Web-based medium. Australian New Zealand Clinical Trials Registry (ACTRN): 12610000135011; http://www.anzctr.org.au/trial_view.aspx?id=335135 (Archived by WebCite at http://www.webcitation.org/668POww4L).

Breakeven, Cost Benefit, Cost Effectiveness, and Willingness to Pay for Web-Based Versus Face-to-Face Education Delivery for Health Professionals

PubMed Central

Haas, Romi; Keating, Jenny L; Molloy, Elizabeth; Jolly, Brian; Sims, Jane; Morgan, Prue; Haines, Terry

2012-01-01

Background The introduction of Web-based education and open universities has seen an increase in access to professional development within the health professional education marketplace. Economic efficiencies of Web-based education and traditional face-to-face educational approaches have not been compared under randomized controlled trial conditions. Objective To compare costs and effects of Web-based and face-to-face short courses in falls prevention education for health professionals. Methods We designed two short courses to improve the clinical performance of health professionals in exercise prescription for falls prevention. One was developed for delivery in face-to-face mode and the other for online learning. Data were collected on learning outcomes including participation, satisfaction, knowledge acquisition, and change in practice, and combined with costs, savings, and benefits, to enable a break-even analysis from the perspective of the provider, cost-effectiveness analysis from the perspective of the health service, and cost-benefit analysis from the perspective of the participant. Results Face-to-face and Web-based delivery modalities produced comparable outcomes for participation, satisfaction, knowledge acquisition, and change in practice. Break-even analysis identified the Web-based educational approach to be robustly superior to face-to-face education, requiring a lower number of enrollments for the program to reach its break-even point. Cost-effectiveness analyses from the perspective of the health service and cost-benefit analysis from the perspective of the participant favored face-to-face education, although the outcomes were contingent on the sensitivity analysis applied (eg, the fee structure used). Conclusions The Web-based educational approach was clearly more efficient from the perspective of the education provider. In the presence of relatively equivocal results for comparisons from other stakeholder perspectives, it is likely that providers would prefer to deliver education via a Web-based medium. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN): 12610000135011; http://www.anzctr.org.au/trial_view.aspx?id=335135 (Archived by WebCite at http://www.webcitation.org/668POww4L) PMID:22469659

Incremenal Value of Cardiac Magnetic Resonance for Assessing Pulmonic Valve Regurgitation.

PubMed

Zdradzinski, Michael; Elkin, Rachel; Flamm, Scott; Krasuski, Richard

2015-07-01

Cardiac magnetic resonance (CMR) is the 'gold standard' for quantifying pulmonic regurgitation (PR) in adults with congenital heart disease, but remains costly and is less readily available than echocardiography. Qualitative echocardiographic assessment of PR is challenging, and guiding criteria are limited. It is unknown if echocardiography is sufficient to screen for significant PR. The study aim was to determine whether cardiac MRI provides additional benefit in the assessment of PR in adults with congenital heart disease. Patients with repaired tetralogy of Fallot or congenital pulmonic stenosis after valvotomy undergoing transthoracic echocardiography and CMR with no interval intervention were identified from a prospective registry. Patients with greater than mild pulmonic stenosis, residual ventricular septal defect or poor echocardiographic windows were excluded. Whole-cohort and subgroup (tetralogy of Fallot versus pulmonic stenosis) analyses for inter-modality agreement were performed. A total of 48 patients (24 men, 24 women; mean age 43 +/- 12 years) was included in the analysis. The unweighted kappa value for the two modalities was 0.30, suggesting 'fair' agreement, though only 52% had matching PR assessments. The indexed right ventricular end-systolic volume (RVESVi) correlated closely with cardiac MRI-monitored PR (p = 0.011 by analysis of variance), but not with that monitored with echocardiography (p = 0.081). Subgroup analysis demonstrated less inter-modality agreement in the tetralogy of Fallot population (kappa 0.25) than in the pulmonic stenosis population (kappa 0.35). CMR measurement of PR correlates closely with the RVESVi, and appears superior to echocardiography when assessing patients at risk for PR. The study results suggest a vital role for CMR whenever significant PR is suspected in the adult congenital heart disease population.

The costly filtering of potential distraction: evidence for a supramodal mechanism.

PubMed

Marini, Francesco; Chelazzi, Leonardo; Maravita, Angelo

2013-08-01

When dealing with significant sensory stimuli, performance can be hampered by distracting events. Attention mechanisms lessen such negative effects, enabling selection of relevant information while blocking potential distraction. Recent work shows that preparatory brain activity, occurring before a critical stimulus, may reflect mechanisms of attentional control aimed to filter upcoming distracters. However, it is unknown whether the engagement of these filtering mechanisms to counteract distraction in itself taxes cognitive-brain systems, leading to performance costs. Here we address this question and, specifically, seek the behavioral signature of a mechanism for the filtering of potential distraction within and between sensory modalities. We show that, in potentially distracting contexts, a filtering mechanism is engaged to cope with forthcoming distraction, causing a dramatic behavioral cost in no-distracter trials during a speeded tactile discrimination task. We thus demonstrate an impaired processing caused by a potential, yet absent, distracter. This effect generalizes across different sensory modalities, such as vision and audition, and across different manipulations of the context, such as the distracter's sensory modality and pertinence to the task. Moreover, activation of the filtering mechanism relies on both strategic and reactive processes, as shown by its dynamic dependence on probabilistic and cross-trial contingencies. Crucially, across participants, the observed strategic cost is inversely related to the interference exerted by a distracter on distracter-present trials. These results attest to a mechanism for the monitoring and filtering of potential distraction in the human brain. Although its activation is indisputably beneficial when distraction occurs, it leads to robust costs when distraction is actually expected but currently absent. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Factors influencing the cost of prosthetic joint infection treatment.

PubMed

Peel, T N; Cheng, A C; Lorenzo, Y P; Kong, D C M; Buising, K L; Choong, P F M

2013-11-01

Prosthetic joint infection (PJI) is associated with significant costs to the healthcare system. Current literature examines the cost of specific treatment modalities without assessing other cost drivers for PJI. To examine the overall cost of the treatment of PJI and to identify factors associated with management costs. The costs of treatment of prosthetic joint infections were examined in 139 patients across 10 hospitals over a 3-year period (January 2006 to December 2008). Cost calculations included hospitalization costs, surgical costs, hospital-in-the-home costs and antibiotic therapy costs. Negative binomial regression analysis was performed to model factors associated with total cost. The median cost of treating prosthetic joint infection per patient was Australian $34,800 (interquartile range: 20,305, 56,929). The following factors were associated with increased treatment costs: septic revision arthroplasty (67% increase in treatment cost; P = 0.02), hypotension at presentation (70% increase; P = 0.03), polymicrobial infections (41% increase; P = 0.009), surgical treatment with one-stage exchange (100% increase; P = 0.002) or resection arthroplasty (48% increase; P = 0.001) were independently associated with increased treatment costs. Culture-negative prosthetic joint infections were associated with decreased costs (29% decrease in treatment cost; P = 0.047). Treatment failure was associated with 156% increase in treatment costs. This study identifies clinically important factors influencing treatment costs that may be of relevance to policy-makers, particularly in the setting of hospital reimbursement and guiding future research into cost-effective preventive strategies. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation

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

Mailhot Vega, Raymond B.; Ishaq, Omar; Raldow, Ann

Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model wasmore » constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.« less

Decision analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

PubMed Central

Boyd, Kathleen A; Jones, Rob J; Paul, Jim; Birrell, Fiona; Briggs, Andrew H; Leung, Hing Y

2015-01-01

Objective To determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC). Design Cost-utility analysis using decision analytic modelling by a Markov model. Setting and methods Compared SC and androgen deprivation therapy (ADT) in a cohort of patients with RRPC (biopsy proven local recurrence, no evidence of metastatic disease). A literature review captured published data to inform the decision model, and resource use data were from the Scottish Prostate Cryotherapy Service. The model was run in monthly cycles for RRPC men, mean age of 70 years. The model was run over the patient lifetime, to assess changes in patient health states and the associated quality of life, survival and cost impacts. Results are reported in terms of the discounted incremental costs and discounted incremental quality-adjusted life years (QALYs) gained between the 2 alternative interventions. Probabilistic sensitivity analysis used a 10 000 iteration Monte Carlo simulation. Results SC has a high upfront treatment cost, but delays the ongoing monthly cost of ADT. SC is the dominant strategy over the patient lifetime; it is more effective with an incremental 0.56 QALY gain (95% CI 0.28 to 0.87), and less costly with a reduced lifetime cost of £29 719 (€37 619) (95% CI −51 985 to −9243). For a ceiling ratio of £30 000, SC has a 100% probability to be cost-effective. The cost neutral point was at 3.5 years, when the upfront cost of SC (plus any subsequent cumulative cost of side effects and ADT) equates the cumulative cost in the ADT arm. Limitations of our model may arise from its insensitivity to parameter or structural uncertainty. Conclusions The platform for SC versus ADT cost-effective analysis can be employed to evaluate other treatment modalities or strategies in RRPC. SC is the dominant strategy, costing less over a patient's lifetime with improvements in QALYs. Trial registration number This economic analysis was undertaken as part of the CROP RCT study ISRCTN:72677390; it was a pre-trial economic model developed and analysed during the pre-results stage of the RCT. PMID:26482768

Ares I-X In-Flight Modal Identification

NASA Technical Reports Server (NTRS)

Bartkowicz, Theodore J.; James, George H., III

2011-01-01

Operational modal analysis is a procedure that allows the extraction of modal parameters of a structure in its operating environment. It is based on the idealized premise that input to the structure is white noise. In some cases, when free decay responses are corrupted by unmeasured random disturbances, the response data can be processed into cross-correlation functions that approximate free decay responses. Modal parameters can be computed from these functions by time domain identification methods such as the Eigenvalue Realization Algorithm (ERA). The extracted modal parameters have the same characteristics as impulse response functions of the original system. Operational modal analysis is performed on Ares I-X in-flight data. Since the dynamic system is not stationary due to propellant mass loss, modal identification is only possible by analyzing the system as a series of linearized models over short periods of time via a sliding time-window of short time intervals. A time-domain zooming technique was also employed to enhance the modal parameter extraction. Results of this study demonstrate that free-decay time domain modal identification methods can be successfully employed for in-flight launch vehicle modal extraction.

Recent developments in photodetection for medical applications

NASA Astrophysics Data System (ADS)

Llosá, Gabriela

2015-07-01

The use of the most advanced technology in medical imaging results in the development of high performance detectors that can significantly improve the performance of the medical devices employed in hospitals. Scintillator crystals coupled to photodetectors remain to be essential detectors in terms of performance and cost for medical imaging applications in different imaging modalities. Recent advances in photodetectors result in an increase of the performance of the medical scanners. Solid state detectors can provide substantial performance improvement, but are more complex to integrate into clinical detectors due mainly to their higher cost. Solid state photodetectors (APDs, SiPMs) have made new detector concepts possible and have led to improvements in different imaging modalities. Recent advances in detectors for medical imaging are revised.

Estimating the Clinical Outcomes and Cost Differences Between Standard Care With and Without Cadexomer Iodine in the Management of Chronic Venous Leg Ulcers Using a Markov Model.

PubMed

Nherera, Leo M; Woodmansey, Emma; Trueman, Paul; Gibbons, Garry W

2016-06-01

Chronic venous leg ulcers (VLUs) affect up to 1% of the adult population in the developed world and present a significant financial and resource burden to health care systems. Cadexomer iodine (CI) is an antimicrobial dressing indicated for use in chronic exuding wounds. The aim of this study was to estimate the cost utility of using CI + standard care (SC) - ie, high compression multicomponent bandaging including debridement - compared with SC alone in the management of chronic (>6 months' duration) VLUs from a payer's perspective. A Markov model was constructed to evaluate the cost and clinical benefits (healing and decreased infection rates) of the 2 treatment modalities over a 1-year period using data from 4 randomized, controlled clinical studies (RCTs) included in a recent Cochrane review and cost data from a recently published economic evaluation of VLUs. Costs were calculated using 2014 United States dollars; wound outcomes in- cluded complete healing in 212 patients reported in the Cochrane meta-analysis and quality-adjusted life years (QALYs), with utility values obtained from 200 patients with VLUs calculated using standard gamble. Treatment with CI over 1 year was $7,259 compared to $7,901 for SC. This resulted in a cost savings of $643/patient in favor of CI compared with SC. More patients treated with CI (61%) had their wounds healed compared to 54% treated with SC. Furthermore, patients treated with CI+SC experienced 6 additional ulcer-free weeks compared to persons treated with SC alone (ie, 25 ulcer- free weeks compared to 19 ulcer-free weeks, respectively). Overall, CI resulted in 0.03 more QALYs (ie, 0.86 QALYs compared to 0.83 for SC). The use of CI in addition to SC compared to SC alone over 52 weeks resulted in more wounds healed and more QALYs along with a decrease of overall costs The results of this study suggest CI is cost effective com- pared to SC alone in the management of patients with chronic VLUs. Prospective, controlled clinical studies are needed to elucidate the effect and cost effectiveness of CI on VLUs with and without signs of infection as compared to SC, other antiseptics, and more advanced topical treatment modalities.

Analysis of flexible aircraft longitudinal dynamics and handling qualities. Volume 2: Data

NASA Technical Reports Server (NTRS)

Waszak, M. R.; Schmidt, D. K.

1985-01-01

Two analysis methods are applied to a family of flexible aircraft in order to investigate how and when structural (especially dynamic aeroelastic) effects affect the dynamic characteristics of aircraft. The first type of analysis is an open loop modal analysis technique. This method considers the effect of modal residue magnitudes on determining vehicle handling qualities. The second method is a pilot in the loop analysis procedure that considers several closed loop system characteristics. Both analyses indicated that dynamic aeroelastic effects caused a degradation in vehicle tracking performance, based on the evaluation of some simulation results. Volume 2 consists of the presentation of the state variable models of the flexible aircraft configurations used in the analysis applications mode shape plots for the structural modes, numerical results from the modal analysis frequency response plots from the pilot in the loop analysis and a listing of the modal analysis computer program.

Static aeroelastic analysis of wings using Euler/Navier-Stokes equations coupled with improved wing-box finite element structures

NASA Technical Reports Server (NTRS)

Guruswamy, Guru P.; MacMurdy, Dale E.; Kapania, Rakesh K.

1994-01-01

Strong interactions between flow about an aircraft wing and the wing structure can result in aeroelastic phenomena which significantly impact aircraft performance. Time-accurate methods for solving the unsteady Navier-Stokes equations have matured to the point where reliable results can be obtained with reasonable computational costs for complex non-linear flows with shock waves, vortices and separations. The ability to combine such a flow solver with a general finite element structural model is key to an aeroelastic analysis in these flows. Earlier work involved time-accurate integration of modal structural models based on plate elements. A finite element model was developed to handle three-dimensional wing boxes, and incorporated into the flow solver without the need for modal analysis. Static condensation is performed on the structural model to reduce the structural degrees of freedom for the aeroelastic analysis. Direct incorporation of the finite element wing-box structural model with the flow solver requires finding adequate methods for transferring aerodynamic pressures to the structural grid and returning deflections to the aerodynamic grid. Several schemes were explored for handling the grid-to-grid transfer of information. The complex, built-up nature of the wing-box complicated this transfer. Aeroelastic calculations for a sample wing in transonic flow comparing various simple transfer schemes are presented and discussed.

Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.

PubMed

Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2015-06-01

The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this assessment show that the cost utility of managing chronic, intractable low back pain with percutaneous adhesiolysis at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, spinal cord stimulation, and surgery. The limitations of this cost utility analysis are that it is a single-center evaluation, with the inclusion of costs of adhesiolysis procedures in an ambulatory surgery center and physician visits, rather than all related costs including drug therapy and costs of disability in multiple settings. This cost utility analysis of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome and lumbar central spinal stenosis shows the clinical effectiveness and cost utility of these procedures at USD $2,650 per one year of QALY when performed in an ambulatory surgery center. © 2014 World Institute of Pain.

Integrated Model Reduction and Control of Aircraft with Flexible Wings

NASA Technical Reports Server (NTRS)

Swei, Sean Shan-Min; Zhu, Guoming G.; Nguyen, Nhan T.

2013-01-01

This paper presents an integrated approach to the modeling and control of aircraft with exible wings. The coupled aircraft rigid body dynamics with a high-order elastic wing model can be represented in a nite dimensional state-space form. Given a set of desired output covariance, a model reduction process is performed by using the weighted Modal Cost Analysis (MCA). A dynamic output feedback controller, which is designed based on the reduced-order model, is developed by utilizing output covariance constraint (OCC) algorithm, and the resulting OCC design weighting matrix is used for the next iteration of the weighted cost analysis. This controller is then validated for full-order evaluation model to ensure that the aircraft's handling qualities are met and the uttering motion of the wings suppressed. An iterative algorithm is developed in CONDUIT environment to realize the integration of model reduction and controller design. The proposed integrated approach is applied to NASA Generic Transport Model (GTM) for demonstration.

An operational modal analysis method in frequency and spatial domain

NASA Astrophysics Data System (ADS)

Wang, Tong; Zhang, Lingmi; Tamura, Yukio

2005-12-01

A frequency and spatial domain decomposition method (FSDD) for operational modal analysis (OMA) is presented in this paper, which is an extension of the complex mode indicator function (CMIF) method for experimental modal analysis (EMA). The theoretical background of the FSDD method is clarified. Singular value decomposition is adopted to separate the signal space from the noise space. Finally, an enhanced power spectrum density (PSD) is proposed to obtain more accurate modal parameters by curve fitting in the frequency domain. Moreover, a simulation case and an application case are used to validate this method.

Modal characterization of the ASCIE segmented optics testbed: New algorithms and experimental results

NASA Technical Reports Server (NTRS)

Carrier, Alain C.; Aubrun, Jean-Noel

1993-01-01

New frequency response measurement procedures, on-line modal tuning techniques, and off-line modal identification algorithms are developed and applied to the modal identification of the Advanced Structures/Controls Integrated Experiment (ASCIE), a generic segmented optics telescope test-bed representative of future complex space structures. The frequency response measurement procedure uses all the actuators simultaneously to excite the structure and all the sensors to measure the structural response so that all the transfer functions are measured simultaneously. Structural responses to sinusoidal excitations are measured and analyzed to calculate spectral responses. The spectral responses in turn are analyzed as the spectral data become available and, which is new, the results are used to maintain high quality measurements. Data acquisition, processing, and checking procedures are fully automated. As the acquisition of the frequency response progresses, an on-line algorithm keeps track of the actuator force distribution that maximizes the structural response to automatically tune to a structural mode when approaching a resonant frequency. This tuning is insensitive to delays, ill-conditioning, and nonproportional damping. Experimental results show that is useful for modal surveys even in high modal density regions. For thorough modeling, a constructive procedure is proposed to identify the dynamics of a complex system from its frequency response with the minimization of a least-squares cost function as a desirable objective. This procedure relies on off-line modal separation algorithms to extract modal information and on least-squares parameter subset optimization to combine the modal results and globally fit the modal parameters to the measured data. The modal separation algorithms resolved modal density of 5 modes/Hz in the ASCIE experiment. They promise to be useful in many challenging applications.

Modality Switching Cost during Property Verification by 7 Years of Age

ERIC Educational Resources Information Center

Ambrosi, Solene; Kalenine, Solene; Blaye, Agnes; Bonthoux, Francoise

2011-01-01

Recent studies in neuroimagery and cognitive psychology support the view of sensory-motor based knowledge: when processing an object concept, neural systems would re-enact previous experiences with this object. In this experiment, a conceptual switching cost paradigm derived from Pecher, Zeelenberg, and Barsalou (2003, 2004) was used to…

On modal cross-coupling in the asymptotic modal limit

NASA Astrophysics Data System (ADS)

Culver, Dean; Dowell, Earl

2018-03-01

The conditions under which significant modal cross-coupling occurs in dynamical systems responding to high-frequency, broadband forcing that excites many modes is studied. The modal overlap factor plays a key role in the analysis of these systems as the modal density (the ratio of number of modes to the frequency bandwidth) becomes large. The modal overlap factor is effectively the ratio of the width of a resonant peak (the damping ratio times the resonant frequency) to the average frequency interval between resonant peaks (or rather, the inverse of the modal density). It is shown that this parameter largely determines whether substantial modal cross-coupling occurs in a given system's response. Here, two prototypical systems are considered. The first is a simple rectangular plate whose significant modal cross-coupling is the exception rather than the norm. The second is a pair of rectangular plates attached at a point where significant modal cross-coupling is more likely to occur. We show that, for certain cases of modal density and damping, non-negligible cross coupling occurs in both systems. Under similar circumstances, the constraint force between the two plates in the latter system becomes broadband. The implications of this for using Asymptotic Modal Analysis (AMA) in multi-component systems are discussed.

Dynamic Stability Analysis of Linear Time-varying Systems via an Extended Modal Identification Approach

NASA Astrophysics Data System (ADS)

Ma, Zhisai; Liu, Li; Zhou, Sida; Naets, Frank; Heylen, Ward; Desmet, Wim

2017-03-01

The problem of linear time-varying(LTV) system modal analysis is considered based on time-dependent state space representations, as classical modal analysis of linear time-invariant systems and current LTV system modal analysis under the "frozen-time" assumption are not able to determine the dynamic stability of LTV systems. Time-dependent state space representations of LTV systems are first introduced, and the corresponding modal analysis theories are subsequently presented via a stability-preserving state transformation. The time-varying modes of LTV systems are extended in terms of uniqueness, and are further interpreted to determine the system's stability. An extended modal identification is proposed to estimate the time-varying modes, consisting of the estimation of the state transition matrix via a subspace-based method and the extraction of the time-varying modes by the QR decomposition. The proposed approach is numerically validated by three numerical cases, and is experimentally validated by a coupled moving-mass simply supported beam experimental case. The proposed approach is capable of accurately estimating the time-varying modes, and provides a new way to determine the dynamic stability of LTV systems by using the estimated time-varying modes.

infoRAD: computers for clinical practice and education in radiology. Teleradiology, information transfer, and PACS: implications for diagnostic imaging in the 1990s.

PubMed

Schilling, R B

1993-05-01

Picture archiving and communication systems (PACS) provide image viewing at diagnostic, reporting, consultation, and remote workstations; archival on magnetic or optical media by means of short- or long-term storage devices; communications by means of local or wide area networks or public communication services; and integrated systems with modality interfaces and gateways to health care facilities and departmental information systems. Research indicates three basic needs for image and report management: (a) improved communication and turnaround time between radiologists and other imaging specialists and referring physicians, (b) fast reliable access to both current and previously obtained images and reports, and (c) space-efficient archival support. Although PACS considerations are much more complex than those associated with single modalities, the same basic purchase criteria apply. These criteria include technical leadership, image quality, throughput, life cost (eg, initial cost, maintenance, upgrades, and depreciation), and total service. Because a PACS takes much longer to implement than a single modality, the customer and manufacturer must develop a closer working relationship than has been necessary in the past.

Development and implementation of an integrated, multi-modality, user-centered interactive dietary change program

PubMed Central

Glasgow, Russell E.; Christiansen, Steve; Smith, K. Sabina; Stevens, Victor J.; Toobert, Deborah J.

2009-01-01

Computer-tailored behavior change programs offer the potential for reaching large populations at a much lower cost than individual or group-based programs. However, few of these programs to date appear to integrate behavioral theory with user choice, or combine different electronic modalities. We describe the development of an integrated CD-ROM and interactive voice response dietary change intervention that combines behavioral problem-solving theory with a high degree of user choice. The program, WISE CHOICES, is being evaluated as part of an ongoing trial. This paper describes the program development, emphasizing how user preferences are accommodated, and presents implementation and user satisfaction data. The program was successfully implemented; the linkages among the central database, the CD-ROM and the automated telephone components were robust, and participants liked the program almost as well as a counselor-delivered dietary change condition. Multi-modality programs that emphasize the strengths of each approach appear to be feasible. Future research is needed to determine the program impact and cost-effectiveness compared with counselor-delivered intervention. PMID:18711204

Asian Perspectives on Diagnostic and Therapeutic Strategies in Inflammatory Bowel Disease: Report and Analysis of a Survey with Questionnaires.

PubMed

Yoshida, Atsushi; Ueno, Fumiaki; Morizane, Toshio; Joh, Takashi; Kamiya, Takeshi; Takahashi, Shin''ichi; Tokunaga, Kengo; Iwakiri, Ryuichi; Kinoshita, Yoshikazu; Suzuki, Hidekazu; Naito, Yuji; Uchiyama, Kazuhiko; Fukodo, Shin; Chan, Francis K L; Halm, Ki-Baik; Kachintorn, Udom; Fock, Kwong Ming; Rani, Abdul Aziz; Syam, Ari Fahrial; Sollano, Jose D; Zhu, Qi

2017-01-01

Diagnostic and therapeutic strategies in inflammatory bowel disease (IBD) vary among countries in terms of availability of modalities, affordability of health care resource, health care policy and cultural background. This may be the case in different countries in Eastern Asia. The aim of this study was to determine and understand the differences in diagnostic and therapeutic strategies of IBD between Japan and the rest of Asian countries (ROA). Questionnaires with regard to clinical practice in IBD were distributed to members of the International Gastroenterology Consensus Symposium Study Group. The responders were allowed to select multiple items for each question, as multiple modalities are frequently utilized in the diagnosis and the management of IBD. Dependency and independency of selected items for each question were evaluated by the Bayesian network analysis. The selected diagnostic modalities were not very different between Japan and ROA, except for those related to small bowel investigations. Balloon-assisted enteroscopy and small bowel follow through are frequently used in Japan, while CT/MR enterography is popular in ROA. Therapeutic modalities for IBD depend on availability of such modalities in clinical practice. As far as modalities commonly available in both regions are concerned, there seemed to be similarity in the selection of each therapeutic modality. However, evaluation of dependency of separate therapeutic modalities by Bayesian network analysis disclosed some difference in therapeutic strategies between Japan and ROA. Although selected modalities showed some similarity, Bayesian network analysis elicited certain differences in the clinical approaches combining multiple modalities in various aspects of IBD between Japan and ROA. © 2016 S. Karger AG, Basel.

Asymptotic modal analysis of a rectangular acoustic cavity excited by wall vibration

NASA Technical Reports Server (NTRS)

Peretti, Linda F.; Dowell, Earl H.

1992-01-01

Asymptotic modal analysis, a method that has recently been developed for structural dynamical systems, has been applied to a rectangular acoustic cavity. The cavity had a flexible vibrating portion on one wall, and the other five walls were rigid. Banded white noise was transmitted through the flexible portion (plate) only. Both the location along the wall and the size of the plate were varied. The mean square pressure levels of the cavity interior were computed as a ratio of the result obtained from classical modal analysis to that obtained from asymptotic modal analysis for the various plate configurations. In general, this ratio converged to 1.0 as the number of responding modes increased. Intensification effects were found due to both the excitation location and the response location. The asymptotic modal analysis method was both efficient and accurate in solving the given problem. The method has advantages over the traditional methods that are used for solving dynamics problems with a large number of responding modes.

A population-based model for priority setting across the care continuum and across modalities

PubMed Central

Segal, Leonie; Mortimer, Duncan

2006-01-01

Background The Health-sector Wide (HsW) priority setting model is designed to shift the focus of priority setting away from 'program budgets' – that are typically defined by modality or disease-stage – and towards well-defined target populations with a particular disease/health problem. Methods The key features of the HsW model are i) a disease/health problem framework, ii) a sequential approach to covering the entire health sector, iii) comprehensiveness of scope in identifying intervention options and iv) the use of objective evidence. The HsW model redefines the unit of analysis over which priorities are set to include all mutually exclusive and complementary interventions for the prevention and treatment of each disease/health problem under consideration. The HsW model is therefore incompatible with the fragmented approach to priority setting across multiple program budgets that currently characterises allocation in many health systems. The HsW model employs standard cost-utility analyses and decision-rules with the aim of maximising QALYs contingent upon the global budget constraint for the set of diseases/health problems under consideration. It is recognised that the objective function may include non-health arguments that would imply a departure from simple QALY maximisation and that political constraints frequently limit degrees of freedom. In addressing these broader considerations, the HsW model can be modified to maximise value-weighted QALYs contingent upon the global budget constraint and any political constraints bearing upon allocation decisions. Results The HsW model has been applied in several contexts, recently to osteoarthritis, that has demonstrated both its practical application and its capacity to derive clear evidenced-based policy recommendations. Conclusion Comparisons with other approaches to priority setting, such as Programme Budgeting and Marginal Analysis (PBMA) and modality-based cost-effectiveness comparisons, as typified by Australia's Pharmaceutical Benefits Advisory Committee process for the listing of pharmaceuticals for government funding, demonstrate the value added by the HsW model notably in its greater likelihood of contributing to allocative efficiency. PMID:16566841

Modal Test/Analysis Correlation of Space Station Structures Using Nonlinear Sensitivity

NASA Technical Reports Server (NTRS)

Gupta, Viney K.; Newell, James F.; Berke, Laszlo; Armand, Sasan

1992-01-01

The modal correlation problem is formulated as a constrained optimization problem for validation of finite element models (FEM's). For large-scale structural applications, a pragmatic procedure for substructuring, model verification, and system integration is described to achieve effective modal correlation. The space station substructure FEM's are reduced using Lanczos vectors and integrated into a system FEM using Craig-Bampton component modal synthesis. The optimization code is interfaced with MSC/NASTRAN to solve the problem of modal test/analysis correlation; that is, the problem of validating FEM's for launch and on-orbit coupled loads analysis against experimentally observed frequencies and mode shapes. An iterative perturbation algorithm is derived and implemented to update nonlinear sensitivity (derivatives of eigenvalues and eigenvectors) during optimizer iterations, which reduced the number of finite element analyses.

Modal test/analysis correlation of Space Station structures using nonlinear sensitivity

NASA Technical Reports Server (NTRS)

Gupta, Viney K.; Newell, James F.; Berke, Laszlo; Armand, Sasan

1992-01-01

The modal correlation problem is formulated as a constrained optimization problem for validation of finite element models (FEM's). For large-scale structural applications, a pragmatic procedure for substructuring, model verification, and system integration is described to achieve effective modal correlations. The space station substructure FEM's are reduced using Lanczos vectors and integrated into a system FEM using Craig-Bampton component modal synthesis. The optimization code is interfaced with MSC/NASTRAN to solve the problem of modal test/analysis correlation; that is, the problem of validating FEM's for launch and on-orbit coupled loads analysis against experimentally observed frequencies and mode shapes. An iterative perturbation algorithm is derived and implemented to update nonlinear sensitivity (derivatives of eigenvalues and eigenvectors) during optimizer iterations, which reduced the number of finite element analyses.

Comparison of low‐dose, half‐rotation, cone‐beam CT with electronic portal imaging device for registration of fiducial markers during prostate radiotherapy

PubMed Central

Wee, Leonard; Hackett, Sara Lyons; Jones, Andrew; Lim, Tee Sin; Harper, Christopher Stirling

2013-01-01

This study evaluated the agreement of fiducial marker localization between two modalities — an electronic portal imaging device (EPID) and cone‐beam computed tomography (CBCT) — using a low‐dose, half‐rotation scanning protocol. Twenty‐five prostate cancer patients with implanted fiducial markers were enrolled. Before each daily treatment, EPID and half‐rotation CBCT images were acquired. Translational shifts were computed for each modality and two marker‐matching algorithms, seed‐chamfer and grey‐value, were performed for each set of CBCT images. The localization offsets, and systematic and random errors from both modalities were computed. Localization performances for both modalities were compared using Bland‐Altman limits of agreement (LoA) analysis, Deming regression analysis, and Cohen's kappa inter‐rater analysis. The differences in the systematic and random errors between the modalities were within 0.2 mm in all directions. The LoA analysis revealed a 95% agreement limit of the modalities of 2 to 3.5 mm in any given translational direction. Deming regression analysis demonstrated that constant biases existed in the shifts computed by the modalities in the superior–inferior (SI) direction, but no significant proportional biases were identified in any direction. Cohen's kappa analysis showed good agreement between the modalities in prescribing translational corrections of the couch at 3 and 5 mm action levels. Images obtained from EPID and half‐rotation CBCT showed acceptable agreement for registration of fiducial markers. The seed‐chamfer algorithm for tracking of fiducial markers in CBCT datasets yielded better agreement than the grey‐value matching algorithm with EPID‐based registration. PACS numbers: 87.55.km, 87.55.Qr PMID:23835391

Primary SWL Is an Efficient and Cost-Effective Treatment for Lower Pole Renal Stones Between 10 and 20 mm in Size: A Large Single Center Study.

PubMed

Chan, Luke H; Good, Daniel W; Laing, Karina; Phipps, Simon; Thomas, Ben G; Keanie, Julian Y; Tolley, David A; Cutress, Mark L

2017-05-01

To assess the clinical features, outcomes, complications, and cost-effectiveness of shockwave lithotripsy (SWL), flexible ureterorenoscopy (FURS), and percutaneous nephrolithotomy (PCNL) in the treatment of lower pole (LP) stones (10-20 mm) in a large tertiary referral center. Consecutive patients treated for solitary LP stones (10-20 mm) between 2008 and 2013 were identified from a prospective database. SWL was used as primary treatment in all cases (following a stone multidisciplinary team assessment), with FURS and PCNL reserved for SWL contraindications, failure, or patient choice. "Success" was defined as stone free and/or clinically insignificant stone fragments (≤3 mm) at 1 and 3 months follow-up. Effect of anatomy on SWL success was determined from using CT images and regression analysis. Average cost per treatment modality (including additional second-line treatments) was calculated for each group using the National Health Service England 2014/15 National Tariff Healthcare Resource Group codes. Two hundred twenty-five patients were included (mean age 54.9; median stone size 12 mm). One hundred ninety-eight (88%), 21 (9.3%), and 6 (2.7%) patients underwent SWL, FURS, and PCNL as primary treatments, respectively, for median stone sizes of 12, 12, and 20 mm. Overall success rates were 82.8%, 76.1%, and 66.7%, respectively (p < 0.05). Sixty-three percent of patients undergoing primary SWL were effectively treated after one session. Anatomical analysis determined infundibulopelvic angle and infundibular length to be significantly different in patients effectively treated with SWL (p = 0.04). The average cost per treatment modality was also significantly lower for SWL (£750) than for FURS (£1261) or PCNL (£2658) (p < 0.01). SWL is both an efficacious and cost-effective primary treatment for patients with solitary LP stones (10-20 mm). The majority of patients can be effectively treated with primary SWL in a dedicated stone center, with the benefits of a short length of stay, low complication, and auxiliary treatment rates. The referral of such patients to high-volume lithotripsy centers with demonstrable outcomes should be given due consideration.

Spatial working memory for locations specified by vision and audition: testing the amodality hypothesis.

PubMed

Loomis, Jack M; Klatzky, Roberta L; McHugh, Brendan; Giudice, Nicholas A

2012-08-01

Spatial working memory can maintain representations from vision, hearing, and touch, representations referred to here as spatial images. The present experiment addressed whether spatial images from vision and hearing that are simultaneously present within working memory retain modality-specific tags or are amodal. Observers were presented with short sequences of targets varying in angular direction, with the targets in a given sequence being all auditory, all visual, or a sequential mixture of the two. On two thirds of the trials, one of the locations was repeated, and observers had to respond as quickly as possible when detecting this repetition. Ancillary detection and localization tasks confirmed that the visual and auditory targets were perceptually comparable. Response latencies in the working memory task showed small but reliable costs in performance on trials involving a sequential mixture of auditory and visual targets, as compared with trials of pure vision or pure audition. These deficits were statistically reliable only for trials on which the modalities of the matching location switched from the penultimate to the final target in the sequence, indicating a switching cost. The switching cost for the pair in immediate succession means that the spatial images representing the target locations retain features of the visual or auditory representations from which they were derived. However, there was no reliable evidence of a performance cost for mixed modalities in the matching pair when the second of the two did not immediately follow the first, suggesting that more enduring spatial images in working memory may be amodal.

[From the x-ray department to the institute for imaging diagnosis].

PubMed

Voegeli, E; Steck, W

1985-02-01

The increasing sophistication of diagnostic radiology has led to rising emphasis on modality-related training and practice in radiological subspecialties. To accomplish both optimal patient management and a rational, cost-effective analysis of imaging procedures, a comprehensive approach to modern radiology is needed rather than a technology-related attitude. The imaging department, where the various imaging data are synthesized and correlation by a general practitioner of radiology, as opposed to the subspecialty radiologist, is the most suitable solution. The principles of management and the layout of such a center are described by the authors.

A wireless modular multi-modal multi-node patch platform for robust biosignal monitoring.

PubMed

Pantelopoulos, Alexandros; Saldivar, Enrique; Roham, Masoud

2011-01-01

In this paper a wireless modular, multi-modal, multi-node patch platform is described. The platform comprises low-cost semi-disposable patch design aiming at unobtrusive ambulatory monitoring of multiple physiological parameters. Owing to its modular design it can be interfaced with various low-power RF communication and data storage technologies, while the data fusion of multi-modal and multi-node features facilitates measurement of several biosignals from multiple on-body locations for robust feature extraction. Preliminary results of the patch platform are presented which illustrate the capability to extract respiration rate from three different independent metrics, which combined together can give a more robust estimate of the actual respiratory rate.

Understanding cost of care for patients on renal replacement therapy: looking beyond fixed tariffs.

PubMed

Li, Bernadette; Cairns, John A; Fotheringham, James; Tomson, Charles R; Forsythe, John L; Watson, Christopher; Metcalfe, Wendy; Fogarty, Damian G; Draper, Heather; Oniscu, Gabriel C; Dudley, Christopher; Johnson, Rachel J; Roderick, Paul; Leydon, Geraldine; Bradley, J Andrew; Ravanan, Rommel

2015-10-01

In a number of countries, reimbursement to hospitals providing renal dialysis services is set according to a fixed tariff. While the cost of maintenance dialysis and transplant surgery are amenable to a system of fixed tariffs, patients with established renal failure commonly present with comorbid conditions that can lead to variations in the need for hospitalization beyond the provision of renal replacement therapy. Patient-level cost data for incident renal replacement therapy patients in England were obtained as a result of linkage of the Hospital Episodes Statistics dataset to UK Renal Registry data. Regression models were developed to explore variations in hospital costs in relation to treatment modality, number of years on treatment and factors such as age and comorbidities. The final models were then used to predict annual costs for patients with different sets of characteristics. Excluding the cost of renal replacement therapy itself, inpatient costs generally decreased with number of years on treatment for haemodialysis and transplant patients, whereas costs for patients receiving peritoneal dialysis remained constant. Diabetes was associated with higher mean annual costs for all patients irrespective of treatment modality and hospital setting. Age did not have a consistent effect on costs. Combining predicted hospital costs with the fixed costs of renal replacement therapy showed that the total cost differential for a patient continuing on dialysis rather than receiving a transplant is considerable following the first year of renal replacement therapy, thus reinforcing the longer-term economic advantage of transplantation over dialysis for the health service. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

A Highly Sensitive X-ray Imaging Modality for Hepatocellular Carcinoma Detection in Vitro

PubMed Central

Rand, Danielle; Walsh, Edward G.; Derdak, Zoltan; Wands, Jack R.; Rose-Petruck, Christoph

2015-01-01

Innovations that improve sensitivity and reduce cost are of paramount importance in diagnostic imaging. The novel x-ray imaging modality called Spatial Frequency Heterodyne Imaging (SFHI) is based on a linear arrangement of x-ray source, tissue, and x-ray detector, much like that of a conventional x-ray imaging apparatus. However, SFHI rests on a complete paradigm reversal compared to conventional x-ray absorption-based radiology: while scattered x-rays are carefully rejected in absorption-based x-ray radiology to enhance the image contrast, SFHI forms images exclusively from x-rays scattered by the tissue. In this study we use numerical processing to produce x-ray scatter images of Hepatocellular Carcinoma (HCC) labeled with a nanoparticle contrast agent. We subsequently compare the sensitivity of SFHI in this application to that of both conventional x-ray imaging and Magnetic Resonance Imaging (MRI). Although SFHI is still in the early stages of its development, our results show that the sensitivity of SFHI is an order of magnitude greater than that of absorption-based x-ray imaging and approximately equal to that of MRI. As x-ray imaging modalities typically have lower installation and service costs compared to MRI, SFHI could become a cost effective alternative to MRI, particularly in areas of the world with inadequate availability of MRI facilities. PMID:25559398

A highly sensitive x-ray imaging modality for hepatocellular carcinoma detection in vitro

DOE PAGES

Rand, Danielle; Walsh, Edward G.; Derdak, Zoltan; ...

2015-01-05

Innovations that improve sensitivity and reduce cost are of paramount importance in diagnostic imaging. The novel x-ray imaging modality called Spatial Frequency Heterodyne Imaging (SFHI) is based on a linear arrangement of x-ray source, tissue, and x-ray detector, much like that of a conventional x-ray imaging apparatus. However, SFHI rests on a complete paradigm reversal compared to conventional x-ray absorption-based radiology: while scattered x-rays are carefully rejected in absorption-based x-ray radiology to enhance the image contrast, SFHI forms images exclusively from x-rays scattered by the tissue. Here in this study we use numerical processing to produce x-ray scatter images ofmore » Hepatocellular Carcinoma (HCC) labeled with a nanoparticle contrast agent. We subsequently compare the sensitivity of SFHI in this application to that of both conventional x-ray imaging and Magnetic Resonance Imaging (MRI). Although SFHI is still in the early stages of its development, our results show that the sensitivity of SFHI is an order of magnitude greater than that of absorption-based x-ray imaging and approximately equal to that of MRI. Lastly, as x-ray imaging modalities typically have lower installation and service costs compared to MRI, SFHI could become a cost effective alternative to MRI, particularly in areas of the world with inadequate availability of MRI facilities.« less

Is Attentional Resource Allocation Across Sensory Modalities Task-Dependent?

PubMed

Wahn, Basil; König, Peter

2017-01-01

Human information processing is limited by attentional resources. That is, via attentional mechanisms, humans select a limited amount of sensory input to process while other sensory input is neglected. In multisensory research, a matter of ongoing debate is whether there are distinct pools of attentional resources for each sensory modality or whether attentional resources are shared across sensory modalities. Recent studies have suggested that attentional resource allocation across sensory modalities is in part task-dependent. That is, the recruitment of attentional resources across the sensory modalities depends on whether processing involves object-based attention (e.g., the discrimination of stimulus attributes) or spatial attention (e.g., the localization of stimuli). In the present paper, we review findings in multisensory research related to this view. For the visual and auditory sensory modalities, findings suggest that distinct resources are recruited when humans perform object-based attention tasks, whereas for the visual and tactile sensory modalities, partially shared resources are recruited. If object-based attention tasks are time-critical, shared resources are recruited across the sensory modalities. When humans perform an object-based attention task in combination with a spatial attention task, partly shared resources are recruited across the sensory modalities as well. Conversely, for spatial attention tasks, attentional processing does consistently involve shared attentional resources for the sensory modalities. Generally, findings suggest that the attentional system flexibly allocates attentional resources depending on task demands. We propose that such flexibility reflects a large-scale optimization strategy that minimizes the brain's costly resource expenditures and simultaneously maximizes capability to process currently relevant information.

Biomarkers in Sporadic and Familial Alzheimer's Disease.

PubMed

Lista, Simone; O'Bryant, Sid E; Blennow, Kaj; Dubois, Bruno; Hugon, Jacques; Zetterberg, Henrik; Hampel, Harald

2015-01-01

Most forms of Alzheimer's disease (AD) are sporadic (sAD) or inherited in a non-Mendelian fashion, and less than 1% of cases are autosomal-dominant. Forms of sAD do not exhibit familial aggregation and are characterized by complex genetic and environmental interactions. Recently, the expansion of genomic methodologies, in association with substantially larger combined cohorts, has resulted in various genome-wide association studies that have identified several novel genetic associations of AD. Currently, the most effective methods for establishing the diagnosis of AD are defined by multi-modal pathways, starting with clinical and neuropsychological assessment, cerebrospinal fluid (CSF) analysis, and brain-imaging procedures, all of which have significant cost- and access-to-care barriers. Consequently, research efforts have focused on the development and validation of non-invasive and generalizable blood-based biomarkers. Among the modalities conceptualized by the systems biology paradigm and utilized in the "exploratory biomarker discovery arena", proteome analysis has received the most attention. However, metabolomics, lipidomics, transcriptomics, and epigenomics have recently become key modalities in the search for AD biomarkers. Interestingly, biomarker changes for familial AD (fAD), in many but not all cases, seem similar to those for sAD. The integration of neurogenetics with systems biology/physiology-based strategies and high-throughput technologies for molecular profiling is expected to help identify the causes, mechanisms, and biomarkers associated with the various forms of AD. Moreover, in order to hypothesize the dynamic trajectories of biomarkers through disease stages and elucidate the mechanisms of biomarker alterations, updated and more sophisticated theoretical models have been proposed for both sAD and fAD.

Operational modal analysis applied to the concert harp

NASA Astrophysics Data System (ADS)

Chomette, B.; Le Carrou, J.-L.

2015-05-01

Operational modal analysis (OMA) methods are useful to extract modal parameters of operating systems. These methods seem to be particularly interesting to investigate the modal basis of string instruments during operation to avoid certain disadvantages due to conventional methods. However, the excitation in the case of string instruments is not optimal for OMA due to the presence of damped harmonic components and low noise in the disturbance signal. Therefore, the present study investigates the least-square complex exponential (LSCE) and the modified least-square complex exponential methods in the case of a string instrument to identify modal parameters of the instrument when it is played. The efficiency of the approach is experimentally demonstrated on a concert harp excited by some of its strings and the two methods are compared to a conventional modal analysis. The results show that OMA allows us to identify modes particularly present in the instrument's response with a good estimation especially if they are close to the excitation frequency with the modified LSCE method.

The Shock and Vibration Digest. Volume 16, Number 4

DTIC Science & Technology

1984-04-01

The 2nd International Modal Analysis Conference, which was held in Orlando, Florida, this past February, was highly successful in all respects. A...announcement of the formation of a new technical society dedicated to advancing the modal analysis technology, the International Society for Modal Testing and... Analysis . This new society is I unique in two respects. First, it is dedicated to a specific branch of a specialized technical field..Second, it is a

Asymptotic modal analysis of a rectangular acoustic cavity and characterization of its intensification zones

NASA Technical Reports Server (NTRS)

Peretti, Linda F.; Dowell, Earl H.

1989-01-01

Asymptotic modal analysis (AMA) is used to study a rectangular cavity with a flexible vibrating portion on one wall and five rigid walls. The agreement between mean square pressure levels of the cavity interior calculated from classical modal analysis and from the AMA method improved as the number of responding modes increased. It is shown that intensification effects were due to both the excitation location and the response location.

Modal Analysis and Testing of Missile Systems

DTIC Science & Technology

1988-12-01

TECHNICAL REPORT -Rb-ST-eS MODAL ANALY AND TESMG OF MISSU E SYSTEMS Lfl 0 N Larry C. Mixon John A4 Schaeffel , Jr. Peter L. Green ,I iLT Roque L...Include Stcurty Claz ficaDin) MODAL ANALYSIS AND TESTING OF MISSILE SYSTEMS 12. PERSONAL AUTHOR(S) Larry C. Mixon, John A. Schaeffel , Jr., Peter L. Green

All-Fiber Laser Curvature Sensor Using an In-Fiber Modal Interferometer Based on a Double Clad Fiber and a Multimode Fiber Structure

PubMed Central

Durán-Sánchez, Manuel; Prieto-Cortés, Patricia; Salceda-Delgado, Guillermo; Castillo-Guzmán, Arturo A.; Selvas-Aguilar, Romeo; Ibarra-Escamilla, Baldemar; Kuzin, Evgeny A.

2017-01-01

An all-fiber curvature laser sensor by using a novel modal interference in-fiber structure is proposed and experimentally demonstrated. The in-fiber device, fabricated by fusion splicing of multimode fiber and double-clad fiber segments, is used as wavelength filter as well as the sensing element. By including a multimode fiber in an ordinary modal interference structure based on a double-clad fiber, the fringe visibility of the filter transmission spectrum is significantly increased. By using the modal interferometer as a curvature sensitive wavelength filter within a ring cavity erbium-doped fiber laser, the spectral quality factor Q is considerably increased. The results demonstrate the reliability of the proposed curvature laser sensor with advantages of robustness, ease of fabrication, low cost, repeatability on the fabrication process and simple operation. PMID:29182527

All-Fiber Laser Curvature Sensor Using an In-Fiber Modal Interferometer Based on a Double Clad Fiber and a Multimode Fiber Structure.

PubMed

Álvarez-Tamayo, Ricardo I; Durán-Sánchez, Manuel; Prieto-Cortés, Patricia; Salceda-Delgado, Guillermo; Castillo-Guzmán, Arturo A; Selvas-Aguilar, Romeo; Ibarra-Escamilla, Baldemar; Kuzin, Evgeny A

2017-11-28

An all-fiber curvature laser sensor by using a novel modal interference in-fiber structure is proposed and experimentally demonstrated. The in-fiber device, fabricated by fusion splicing of multimode fiber and double-clad fiber segments, is used as wavelength filter as well as the sensing element. By including a multimode fiber in an ordinary modal interference structure based on a double-clad fiber, the fringe visibility of the filter transmission spectrum is significantly increased. By using the modal interferometer as a curvature sensitive wavelength filter within a ring cavity erbium-doped fiber laser, the spectral quality factor Q is considerably increased. The results demonstrate the reliability of the proposed curvature laser sensor with advantages of robustness, ease of fabrication, low cost, repeatability on the fabrication process and simple operation.

Detecting Parkinson's disease from sustained phonation and speech signals.

PubMed

Vaiciukynas, Evaldas; Verikas, Antanas; Gelzinis, Adas; Bacauskiene, Marija

2017-01-01

This study investigates signals from sustained phonation and text-dependent speech modalities for Parkinson's disease screening. Phonation corresponds to the vowel /a/ voicing task and speech to the pronunciation of a short sentence in Lithuanian language. Signals were recorded through two channels simultaneously, namely, acoustic cardioid (AC) and smart phone (SP) microphones. Additional modalities were obtained by splitting speech recording into voiced and unvoiced parts. Information in each modality is summarized by 18 well-known audio feature sets. Random forest (RF) is used as a machine learning algorithm, both for individual feature sets and for decision-level fusion. Detection performance is measured by the out-of-bag equal error rate (EER) and the cost of log-likelihood-ratio. Essentia audio feature set was the best using the AC speech modality and YAAFE audio feature set was the best using the SP unvoiced modality, achieving EER of 20.30% and 25.57%, respectively. Fusion of all feature sets and modalities resulted in EER of 19.27% for the AC and 23.00% for the SP channel. Non-linear projection of a RF-based proximity matrix into the 2D space enriched medical decision support by visualization.

Defining the Value Framework for Prostate Brachytherapy using Patient-Centered Outcome Metrics and Time-Driven Activity-Based Costing

PubMed Central

Thaker, Nikhil G.; Pugh, Thomas J.; Mahmood, Usama; Choi, Seungtaek; Spinks, Tracy E.; Martin, Neil E.; Sio, Terence T.; Kudchadker, Rajat J.; Kaplan, Robert S.; Kuban, Deborah A.; Swanson, David A.; Orio, Peter F.; Zelefsky, Michael J.; Cox, Brett W.; Potters, Louis; Buchholz, Thomas A.; Feeley, Thomas W.; Frank, Steven J.

2017-01-01

PURPOSE Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. METHODS AND MATERIALS Patients with low-risk PCa treated with low-dose rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement (ICHOM) standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes. Patient-level costs to one year after PBT were collected using TDABC. Process mapping and radar chart analyses were conducted to visualize this value framework. RESULTS A total of 238 men were eligible for analysis. Median age was 64 (range, 46–81). Median follow-up was 5 years (0.5–12.1). There were no acute grade 3–5 complications. EPIC-50 scores were favorable, with no clinically significant changes from baseline to last follow-up at 48 months for urinary incontinence/bother, bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource utilization for PBT, with 41% and 10% of costs occurring in the operating room and with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes and costs. CONCLUSIONS We successfully created a visual framework to define the value of PBT using the ICHOM standard set and TDABC costs. PBT is associated with excellent outcomes and low costs. Widespread adoption of this methodology will enable value comparisons across providers, institutions, and treatment modalities. PMID:26916105

Acoustic environmental accuracy requirements for response determination

NASA Technical Reports Server (NTRS)

Pettitt, M. R.

1983-01-01

A general purpose computer program was developed for the prediction of vehicle interior noise. This program, named VIN, has both modal and statistical energy analysis capabilities for structural/acoustic interaction analysis. The analytic models and their computer implementation were verified through simple test cases with well-defined experimental results. The model was also applied in a space shuttle payload bay launch acoustics prediction study. The computer program processes large and small problems with equal efficiency because all arrays are dynamically sized by program input variables at run time. A data base is built and easily accessed for design studies. The data base significantly reduces the computational costs of such studies by allowing the reuse of the still-valid calculated parameters of previous iterations.

Sensitivity Analysis for Coupled Aero-structural Systems

NASA Technical Reports Server (NTRS)

Giunta, Anthony A.

1999-01-01

A novel method has been developed for calculating gradients of aerodynamic force and moment coefficients for an aeroelastic aircraft model. This method uses the Global Sensitivity Equations (GSE) to account for the aero-structural coupling, and a reduced-order modal analysis approach to condense the coupling bandwidth between the aerodynamic and structural models. Parallel computing is applied to reduce the computational expense of the numerous high fidelity aerodynamic analyses needed for the coupled aero-structural system. Good agreement is obtained between aerodynamic force and moment gradients computed with the GSE/modal analysis approach and the same quantities computed using brute-force, computationally expensive, finite difference approximations. A comparison between the computational expense of the GSE/modal analysis method and a pure finite difference approach is presented. These results show that the GSE/modal analysis approach is the more computationally efficient technique if sensitivity analysis is to be performed for two or more aircraft design parameters.

Radiation costing methods: a systematic review

PubMed Central

Rahman, F.; Seung, S.J.; Cheng, S.Y.; Saherawala, H.; Earle, C.C.; Mittmann, N.

2016-01-01

Objective Costs for radiation therapy (rt) and the methods used to cost rt are highly diverse across the literature. To date, no study has compared various costing methods in detail. Our objective was to perform a thorough review of the radiation costing literature to identify sources of costs and methods used. Methods A systematic review of Ovid medline, Ovid oldmedline, embase, Ovid HealthStar, and EconLit from 2005 to 23 March 2015 used search terms such as “radiation,” “radiotherapy,” “neoplasm,” “cost,” “ cost analysis,” and “cost benefit analysis” to locate relevant articles. Original papers were reviewed for detailed costing methods. Cost sources and methods were extracted for papers investigating rt modalities, including three-dimensional conformal rt (3D-crt), intensity-modulated rt (imrt), stereotactic body rt (sbrt), and brachytherapy (bt). All costs were translated into 2014 U.S. dollars. Results Most of the studies (91%) reported in the 33 articles retrieved provided rt costs from the health system perspective. The cost of rt ranged from US$2,687.87 to US$111,900.60 per treatment for imrt, followed by US$5,583.28 to US$90,055 for 3D-crt, US$10,544.22 to US$78,667.40 for bt, and US$6,520.58 to US$19,602.68 for sbrt. Cost drivers were professional or personnel costs and the cost of rt treatment. Most studies did not address the cost of rt equipment (85%) and institutional or facility costs (66%). Conclusions Costing methods and sources were widely variable across studies, highlighting the need for consistency in the reporting of rt costs. More work to promote comparability and consistency across studies is needed. PMID:27536189

Asymptotic modal analysis and statistical energy analysis

NASA Technical Reports Server (NTRS)

Dowell, Earl H.

1992-01-01

Asymptotic Modal Analysis (AMA) is a method which is used to model linear dynamical systems with many participating modes. The AMA method was originally developed to show the relationship between statistical energy analysis (SEA) and classical modal analysis (CMA). In the limit of a large number of modes of a vibrating system, the classical modal analysis result can be shown to be equivalent to the statistical energy analysis result. As the CMA result evolves into the SEA result, a number of systematic assumptions are made. Most of these assumptions are based upon the supposition that the number of modes approaches infinity. It is for this reason that the term 'asymptotic' is used. AMA is the asymptotic result of taking the limit of CMA as the number of modes approaches infinity. AMA refers to any of the intermediate results between CMA and SEA, as well as the SEA result which is derived from CMA. The main advantage of the AMA method is that individual modal characteristics are not required in the model or computations. By contrast, CMA requires that each modal parameter be evaluated at each frequency. In the latter, contributions from each mode are computed and the final answer is obtained by summing over all the modes in the particular band of interest. AMA evaluates modal parameters only at their center frequency and does not sum the individual contributions from each mode in order to obtain a final result. The method is similar to SEA in this respect. However, SEA is only capable of obtaining spatial averages or means, as it is a statistical method. Since AMA is systematically derived from CMA, it can obtain local spatial information as well.

The role of economies of scale in the cost of dialysis across the world: a macroeconomic perspective.

PubMed

Karopadi, Akash Nayak; Mason, Giacomo; Rettore, Enrico; Ronco, Claudio

2014-04-01

The treatment of chronic kidney disease through dialysis is a considerable expense in most health systems. The two chief methods of providing dialysis, haemodialysis (HD) and peritoneal dialysis (PD) have significant differences in cost composition and factors of production. The aim of this article is to identify and quantify the macroeconomic variables that influence the relative cost of such modalities across different countries. From previously published literature, we extracted the estimates of HD/PD cost ratios in a total of 46 countries. We conducted a multivariate regression analysis using the estimated HD/PD cost ratio in each country, with several country level indicators as explanatory variables. We found a strong statistical effect of the following variables on the HD/PD cost ratio: country's level of development, economies of scale and percentage of private health-care expenditure. The statistical effects on HD/PD ratio by local manufacturing and relaxed import regulation of PD equipment were calculated and were found to be very significant. it is possible for a country to still reap the benefits of economies of scale in provision of PD, even in the absence of a large enough market to make local production of PD equipment feasible in that country.

Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease: 5-Year Follow-up.

PubMed

Ament, Jared D; Yang, Zhuo; Nunley, Pierce; Stone, Marcus B; Lee, Darrin; Kim, Kee D

2016-07-01

The cervical total disc replacement (cTDR) was developed to treat cervical degenerative disc disease while preserving motion. Cost-effectiveness of this intervention was established by looking at 2-year follow-up, and this update reevaluates our analysis over 5 years. Data were derived from a randomized trial of 330 patients. Data from the 12-Item Short Form Health Survey were transformed into utilities by using the SF-6D algorithm. Costs were calculated by extracting diagnosis-related group codes and then applying 2014 Medicare reimbursement rates. A Markov model evaluated quality-adjusted life years (QALYs) for both treatment groups. Univariate and multivariate sensitivity analyses were conducted to test the stability of the model. The model adopted both societal and health system perspectives and applied a 3% annual discount rate. The cTDR costs $1687 more than anterior cervical discectomy and fusion (ACDF) over 5 years. In contrast, cTDR had $34 377 less productivity loss compared with ACDF. There was a significant difference in the return-to-work rate (81.6% compared with 65.4% for cTDR and ACDF, respectively; P = .029). From a societal perspective, the incremental cost-effective ratio (ICER) for cTDR was -$165 103 per QALY. From a health system perspective, the ICER for cTDR was $8518 per QALY. In the sensitivity analysis, the ICER for cTDR remained below the US willingness-to-pay threshold of $50 000 per QALY in all scenarios (-$225 816 per QALY to $22 071 per QALY). This study is the first to report the comparative cost-effectiveness of cTDR vs ACDF for 2-level degenerative disc disease at 5 years. The authors conclude that, because of the negative ICER, cTDR is the dominant modality. ACDF, anterior cervical discectomy and fusionAWP, average wholesale priceCE, cost-effectivenessCEA, cost-effectiveness analysisCPT, Current Procedural TerminologycTDR, cervical total disc replacementCUA, cost-utility analysisDDD, degenerative disc diseaseDRG, diagnosis-related groupFDA, US Food and Drug AdministrationICER, incremental cost-effectiveness ratioIDE, Investigational Device ExemptionNDI, neck disability indexQALY, quality-adjusted life yearsRCT, randomized controlled trialRTW, return-to-workSF-12, 12-Item Short Form Health SurveyVAS, visual analog scaleWTP, willingness-to-pay.

Remote-Controlled Rotorcraft Blade Vibration and Modal Analysis at Low Frequencies

DTIC Science & Technology

2016-02-01

modal analysis, remote-controlled helicopter , remote-controlled rotorcraft, HUMS for rotorcraft 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...Experimental Setup 1 4. Results 4 4.1 Rotor Blade Acceleration 4 4.2 Modal Analysis: Using an Impact Hammer 7 4.3 Dynamic Response Revisited 8 5... Rotor blade response to shaker outputting 1-V sine wave at 100 Hz ....5 Fig. 6 Rotor blade response to shaker outputting 1-V sine sweep from 20- to 100

Potential and Limitations of the Modal Characterization of a Spacecraft Bus Structure by Means of Active Structure Elements

NASA Technical Reports Server (NTRS)

Grillenbeck, Anton M.; Dillinger, Stephan A.; Elliott, Kenny B.

1998-01-01

Theoretical and experimental studies have been performed to investigate the potential and limitations of the modal characterization of a typical spacecraft bus structure by means of active structure elements. The aim of these studies has been test and advance tools for performing an accurate on-orbit modal identification which may be characterized by the availability of a generally very limited test instrumentation, autonomous excitation capabilities by active structure elements and a zero-g environment. The NASA LARC CSI Evolutionary Testbed provided an excellent object for the experimental part of this study program. The main subjects of investigation were: (1) the selection of optimum excitation and measurement to unambiguously identify modes of interest; (2) the applicability of different types of excitation means with focus on active structure elements; and (3) the assessment of the modal identification potential of different types of excitation functions and modal analysis tools. Conventional as well as dedicated modal analysis tools were applied to determine modal parameters and mode shapes. The results will be presented and discussed based on orthogonality checks as well as on suitable indicators for the quality of the acquired modes with respect to modal purity. In particular, the suitability for modal analysis of the acquired frequency response functions as obtained by excitation with active structure elements will be demonstrated with the help of reciprocity checks. Finally, the results will be summarized in a procedure to perform an on-orbit modal identification, including an indication of limitation to be observed.

Experimental strain modal analysis for beam-like structure by using distributed fiber optics and its damage detection

NASA Astrophysics Data System (ADS)

Cheng, Liangliang; Busca, Giorgio; Cigada, Alfredo

2017-07-01

Modal analysis is commonly considered as an effective tool to obtain the intrinsic characteristics of structures including natural frequencies, modal damping ratios, and mode shapes, which are significant indicators for monitoring the health status of engineering structures. The complex mode indicator function (CMIF) can be regarded as an effective numerical tool to perform modal analysis. In this paper, experimental strain modal analysis based on the CMIF has been introduced. Moreover, a distributed fiber-optic sensor, as a dense measuring device, has been applied to acquire strain data along a beam surface. Thanks to the dense spatial resolution of the distributed fiber optics, more detailed mode shapes could be obtained. In order to test the effectiveness of the method, a mass lump—considered as a linear damage component—has been attached to the surface of the beam, and damage detection based on strain mode shape has been carried out. The results manifest that strain modal parameters can be estimated effectively by utilizing the CMIF based on the corresponding simulations and experiments. Furthermore, damage detection based on strain mode shapes benefits from the accuracy of strain mode shape recognition and the excellent performance of the distributed fiber optics.

The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial.

PubMed

Chun, K R Julian; Brugada, Josep; Elvan, Arif; Gellér, Laszlo; Busch, Matthias; Barrera, Alberto; Schilling, Richard J; Reynolds, Matthew R; Hokanson, Robert B; Holbrook, Reece; Brown, Benedict; Schlüter, Michael; Kuck, Karl-Heinz

2017-07-27

This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were €640, £364, and $925 in favor of cryoballoon ablation ( P =0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and $355 000. When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation. URL: http://www.clinicaltrials.gov. Identifier: NCT01490814. © 2017 The Authors and Medtronic. Published on behalf of the American Heart Association, Inc., by Wiley.

Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging.

PubMed

Wildman-Tobriner, Benjamin; Parente, Victoria M; Maxfield, Charles M

2017-12-01

Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, P<0.001) knew that nuclear medicine utilizes ionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost.

Bayesian operational modal analysis with asynchronous data, part I: Most probable value

NASA Astrophysics Data System (ADS)

Zhu, Yi-Chen; Au, Siu-Kui

2018-01-01

In vibration tests, multiple sensors are used to obtain detailed mode shape information about the tested structure. Time synchronisation among data channels is required in conventional modal identification approaches. Modal identification can be more flexibly conducted if this is not required. Motivated by the potential gain in feasibility and economy, this work proposes a Bayesian frequency domain method for modal identification using asynchronous 'output-only' ambient data, i.e. 'operational modal analysis'. It provides a rigorous means for identifying the global mode shape taking into account the quality of the measured data and their asynchronous nature. This paper (Part I) proposes an efficient algorithm for determining the most probable values of modal properties. The method is validated using synthetic and laboratory data. The companion paper (Part II) investigates identification uncertainty and challenges in applications to field vibration data.

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study).

PubMed

Kurogi, Ryota; Kada, Akiko; Nishimura, Kunihiro; Kamitani, Satoru; Nishimura, Ataru; Sayama, Tetsuro; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Yoshimura, Shinichi; Okuchi, Kazuo; Suzuki, Akifumi; Nakamura, Fumiaki; Onozuka, Daisuke; Hagihara, Akihito; Iihara, Koji

2018-05-01

OBJECTIVE Although heterogeneity in patient outcomes following subarachnoid hemorrhage (SAH) has been observed across different centers, the relative merits of clipping and coiling for SAH remain unknown. The authors sought to compare the patient outcomes between these therapeutic modalities using a large nationwide discharge database encompassing hospitals with different comprehensive stroke center (CSC) capabilities. METHODS They analyzed data from 5214 patients with SAH (clipping 3624, coiling 1590) who had been urgently hospitalized at 393 institutions in Japan in the period from April 2012 to March 2013. In-hospital mortality, modified Rankin Scale (mRS) score, cerebral infarction, complications, hospital length of stay, and medical costs were compared between the clipping and coiling groups after adjustment for patient-level and hospital-level characteristics by using mixed-model analysis. RESULTS Patients who had undergone coiling had significantly higher in-hospital mortality (12.4% vs 8.7%, OR 1.3) and a shorter median hospital stay (32.0 vs 37.0 days, p < 0.001) than those who had undergone clipping. The respective proportions of patients discharged with mRS scores of 3-6 (46.4% and 42.9%) and median medical costs (thousands US$, 35.7 and 36.7) were not significantly different between the groups. These results remained robust after further adjustment for CSC capabilities as a hospital-related covariate. CONCLUSIONS Despite the increasing use of coiling, clipping remains the mainstay treatment for SAH. Regardless of CSC capabilities, clipping was associated with reduced in-hospital mortality, similar unfavorable functional outcomes and medical costs, and a longer hospital stay as compared with coiling in 2012 in Japan. Further study is required to determine the influence of unmeasured confounders.

Comparison of Modal Analysis Methods Applied to a Vibro-Acoustic Test Article

NASA Technical Reports Server (NTRS)

Pritchard, Jocelyn; Pappa, Richard; Buehrle, Ralph; Grosveld, Ferdinand

2001-01-01

Modal testing of a vibro-acoustic test article referred to as the Aluminum Testbed Cylinder (ATC) has provided frequency response data for the development of validated numerical models of complex structures for interior noise prediction and control. The ATC is an all aluminum, ring and stringer stiffened cylinder, 12 feet in length and 4 feet in diameter. The cylinder was designed to represent typical aircraft construction. Modal tests were conducted for several different configurations of the cylinder assembly under ambient and pressurized conditions. The purpose of this paper is to present results from dynamic testing of different ATC configurations using two modal analysis software methods: Eigensystem Realization Algorithm (ERA) and MTS IDEAS Polyreference method. The paper compares results from the two analysis methods as well as the results from various test configurations. The effects of pressurization on the modal characteristics are discussed.

Modal strain energies in COSMIC NASTRAN

NASA Technical Reports Server (NTRS)

Snyder, B. D.; Venkayya, V. B.

1989-01-01

A computer program was developed to take a NASTRAN output file from a normal modes analysis and calculate the modal strain energies of selected elements. The FORTRAN program can determine the modal strain energies for CROD, CBAR, CELAS, CTRMEM, CQDMEM2, and CSHEAR elements. Modal strain energies are useful in estimating damping in structures.

Biological Parametric Mapping: A Statistical Toolbox for Multi-Modality Brain Image Analysis

PubMed Central

Casanova, Ramon; Ryali, Srikanth; Baer, Aaron; Laurienti, Paul J.; Burdette, Jonathan H.; Hayasaka, Satoru; Flowers, Lynn; Wood, Frank; Maldjian, Joseph A.

2006-01-01

In recent years multiple brain MR imaging modalities have emerged; however, analysis methodologies have mainly remained modality specific. In addition, when comparing across imaging modalities, most researchers have been forced to rely on simple region-of-interest type analyses, which do not allow the voxel-by-voxel comparisons necessary to answer more sophisticated neuroscience questions. To overcome these limitations, we developed a toolbox for multimodal image analysis called biological parametric mapping (BPM), based on a voxel-wise use of the general linear model. The BPM toolbox incorporates information obtained from other modalities as regressors in a voxel-wise analysis, thereby permitting investigation of more sophisticated hypotheses. The BPM toolbox has been developed in MATLAB with a user friendly interface for performing analyses, including voxel-wise multimodal correlation, ANCOVA, and multiple regression. It has a high degree of integration with the SPM (statistical parametric mapping) software relying on it for visualization and statistical inference. Furthermore, statistical inference for a correlation field, rather than a widely-used T-field, has been implemented in the correlation analysis for more accurate results. An example with in-vivo data is presented demonstrating the potential of the BPM methodology as a tool for multimodal image analysis. PMID:17070709

Economic Analysis of Screening Strategies for Rupture of Silicone Gel Breast Implants

PubMed Central

Chung, Kevin C.; Malay, Sunitha; Shauver, Melissa J.; Kim, H. Myra

2012-01-01

Background In 2006, the U.S. Food and Drug Administration (FDA) recommended screening of all women with silicone gel breast implants with magnetic resonance imaging (MRI) three years after implantation and every two years thereafter to assess their integrity. The cost for these serial examinations over the lifetime of the breast implants is an added burden to insurance payers and to women. We perform an economic analysis to determine the most optimal screening strategies by considering the diagnostic accuracy of the screening tests, the costs of the tests and subsequent implant removal. Methods We determined aggregate/pooled values for sensitivity and specificity of the screening tests ultrasound (US) and MRI in detecting silicone breast implant ruptures from the data obtained from published literature. We compiled costs, based on Medicare reimbursements for 2011, for the following elements: imaging modalities, anesthesia and 3 surgical treatment options for detected ruptures. We used decision tree to compare three alternate screening strategies of US only, MRI only and US followed by MRI in asymptomatic and symptomatic women. Results The cost per rupture of screening and management of rupture with US in asymptomatic women was $1,090, whereas in symptomatic women it was $1,622. Similar cost for MRI in asymptomatic women was $2,067, whereas in symptomatic women it was $2,143. Similar cost for US followed by MRI in asymptomatic women was $637, whereas in symptomatic women it was $2,908. Conclusion Screening with US followed by MRI was optimal for asymptomatic women and screening with US was optimal for symptomatic women. PMID:22743887

Cost-Effectiveness Analysis (CEA) of Four Interventions for Adolescents with a Substance Use Disorder

PubMed Central

French, Michael T.; Zavala, Silvana K.; McCollister, Kathryn E.; Waldron, Holly B.; Turner, Charles W.; Ozechowski, Timothy J.

2008-01-01

Alcohol, tobacco, and illicit drug use among adolescents in the U.S. continues to be a serious public health challenge. A variety of outpatient treatments for adolescent substance use disorders have been developed and evaluated. Although no specific treatment modality is effective in all settings, a number of promising adolescent interventions have emerged. As policy makers try to prioritize which programs to fund with limited public resources, the need for systematic economic evaluations of these programs is critical. The present study attempted a cost-effectiveness analysis (CEA) of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. The results indicated that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4-month and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost effective. However, this study encountered numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation. These challenges are explained and recommendations are proposed to guide future economic evaluations in this area. PMID:17600651

Application of Artificial Boundary Conditions in Sensitivity-Based Updating of Finite Element Models

DTIC Science & Technology

2007-06-01

is known as the impedance matrix[ ]( )Z Ω . [ ] [ ] 1( ) ( )Z H −Ω = Ω (12) where [ ] 2( )Z K M j C ⎡ ⎤Ω = −Ω + Ω⎣ ⎦ (13) A. REDUCED ORDER...D.L. A correlation coefficient for modal vector analysis. Proceedings of 1st International Modal Analysis Conference, 1982, 110-116. Anton , H ... Rorres , C ., (2005). Elementary Linear Algebra. New York: John Wiley and Sons. Avitable, Peter (2001, January) Experimental Modal Analysis, A Simple

CALIPSO: an interactive image analysis software package for desktop PACS workstations

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Huang, H. K.

1990-07-01

The purpose of this project is to develop a low cost workstation for quantitative analysis of multimodality images using a Macintosh II personal computer. In the current configuration the Macintosh operates as a stand alone workstation where images are imported either from a central PACS server through a standard Ethernet network or recorded through video digitizer board. The CALIPSO software developed contains a large variety ofbasic image display and manipulation tools. We focused our effort however on the design and implementation ofquantitative analysis methods that can be applied to images from different imaging modalities. Analysis modules currently implemented include geometric and densitometric volumes and ejection fraction calculation from radionuclide and cine-angiograms Fourier analysis ofcardiac wall motion vascular stenosis measurement color coded parametric display of regional flow distribution from dynamic coronary angiograms automatic analysis ofmyocardial distribution ofradiolabelled tracers from tomoscintigraphic images. Several of these analysis tools were selected because they use similar color coded andparametric display methods to communicate quantitative data extracted from the images. 1. Rationale and objectives of the project Developments of Picture Archiving and Communication Systems (PACS) in clinical environment allow physicians and radiologists to assess radiographic images directly through imaging workstations (''). This convenient access to the images is often limited by the number of workstations available due in part to their high cost. There is also an increasing need for quantitative analysis ofthe images. During thepast decade

Multimodal freight investment criteria.

DOT National Transportation Integrated Search

2010-07-01

Literature was reviewed on multi-modal investment criteria for freight projects, examining measures and techniques for quantifying project benefits and costs, as well as ways to describe the economic importance of freight transportation. : A limited ...

HomER: a review of time-series analysis methods for near-infrared spectroscopy of the brain

PubMed Central

Huppert, Theodore J.; Diamond, Solomon G.; Franceschini, Maria A.; Boas, David A.

2009-01-01

Near-infrared spectroscopy (NIRS) is a noninvasive neuroimaging tool for studying evoked hemodynamic changes within the brain. By this technique, changes in the optical absorption of light are recorded over time and are used to estimate the functionally evoked changes in cerebral oxyhemoglobin and deoxyhemoglobin concentrations that result from local cerebral vascular and oxygen metabolic effects during brain activity. Over the past three decades this technology has continued to grow, and today NIRS studies have found many niche applications in the fields of psychology, physiology, and cerebral pathology. The growing popularity of this technique is in part associated with a lower cost and increased portability of NIRS equipment when compared with other imaging modalities, such as functional magnetic resonance imaging and positron emission tomography. With this increasing number of applications, new techniques for the processing, analysis, and interpretation of NIRS data are continually being developed. We review some of the time-series and functional analysis techniques that are currently used in NIRS studies, we describe the practical implementation of various signal processing techniques for removing physiological, instrumental, and motion-artifact noise from optical data, and we discuss the unique aspects of NIRS analysis in comparison with other brain imaging modalities. These methods are described within the context of the MATLAB-based graphical user interface program, HomER, which we have developed and distributed to facilitate the processing of optical functional brain data. PMID:19340120

Quasi-modal vibration control by means of active control bearings

NASA Technical Reports Server (NTRS)

Nonami, K.; Fleming, D. P.

1986-01-01

This paper investigates a design method of an active control bearing system with only velocity feedback. The study provides a new quasi-modal control method for a control system design of an active control bearing system in which feedback coefficients are determined on the basis of a modal analysis. Although the number of sensors and actuators is small, this quasi-modal control method produces a control effect close to an ideal modal control.

Trajectory of cost overtime after psychotherapy for depression in older Veterans via telemedicine.

PubMed

Egede, Leonard E; Gebregziabher, Mulugeta; Walker, Rebekah J; Payne, Elizabeth H; Acierno, Ron; Frueh, B Christopher

2017-01-01

Little evidence exists regarding the costs of telemedicine, especially considering changes over time. This analysis aimed to analyze trajectory of healthcare cost before, during, and after a behavioral activation intervention delivered via telepsychology and same-room delivery to elderly Veterans with depression. 241 participants were randomly assigned into one of two study groups: behavioral activation for depression via telemedicine or via same-room treatment. Patients received 8 weeks of weekly 60-min individual sessions of behavioral activation for depression. Primary outcomes were collected at 12-months. Inpatient, outpatient, pharmacy, and total costs were collected from VA Health Economics Resource Center (HERC) datasets for FY 1998-2014 and compared between the two treatment groups. Generalized mixed models were used to investigate the trajectories over time. Overall cost, as well as, outpatient and pharmacy cost show increasing trend over time. Unadjusted and adjusted trajectories over time for any cost were not different between the two treatment groups. There was a significant overall increasing trend over time for outpatient (p<0.001) and total cost (p<0.001) but not for inpatient (p=0.543) or pharmacy cost (p=0.084). Generalizability to younger, healthier populations may be limited due to inclusion criteria for study participants. Healthcare costs before, during, and after intervention did not differ between the telemedicine and in-person delivery methods. Outpatient costs accounted for most of the increasing trend of cost over time. These results support policies to use both telehealth and in-person treatment modalities to effectively and efficiently provide high quality care. Copyright © 2016 Elsevier B.V. All rights reserved.

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

PubMed

Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K

2013-01-01

Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

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

Strauss, Jonathan B.; Chen, Sea S.; Shah, Anand P.

Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgerymore » for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered.« less

Examining the use of comparative and cost-effectiveness analyses in radiology.

PubMed

Goehler, Alexander; Gazelle, G Scott

2014-11-01

This article explores key principles of comparative effectiveness analysis--in particular, how radiologic comparative and cost-effectiveness studies differ from other clinical trials. Exemplary studies are reviewed to show how comparative effectiveness has been implemented in radiology and how future studies might be conducted. Finally, the article closes with a discussion of several additional key themes relevant to quality and value in clinical radiology going forward. Comparative effectiveness is likely to require a paradigm shift in thinking within the discipline. For new radiologic applications to be accepted, we will need to show at least a significant change in treatment planning and at best a meaningful change in patient outcomes. This shift will require a forward-thinking approach to robust evidence generation for new imaging modalities or indications and the inclusion of other modes of value demonstration such as clinical decision support and intelligent data mining.

Structural Design Optimization of Doubly-Fed Induction Generators Using GeneratorSE

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

Sethuraman, Latha; Fingersh, Lee J; Dykes, Katherine L

2017-11-13

A wind turbine with a larger rotor swept area can generate more electricity, however, this increases costs disproportionately for manufacturing, transportation, and installation. This poster presents analytical models for optimizing doubly-fed induction generators (DFIGs), with the objective of reducing the costs and mass of wind turbine drivetrains. The structural design for the induction machine includes models for the casing, stator, rotor, and high-speed shaft developed within the DFIG module in the National Renewable Energy Laboratory's wind turbine sizing tool, GeneratorSE. The mechanical integrity of the machine is verified by examining stresses, structural deflections, and modal properties. The optimization results aremore » then validated using finite element analysis (FEA). The results suggest that our analytical model correlates with the FEA in some areas, such as radial deflection, differing by less than 20 percent. But the analytical model requires further development for axial deflections, torsional deflections, and stress calculations.« less

The electrophotonic silicon biosensor

NASA Astrophysics Data System (ADS)

Juan-Colás, José; Parkin, Alison; Dunn, Katherine E.; Scullion, Mark G.; Krauss, Thomas F.; Johnson, Steven D.

2016-09-01

The emergence of personalized and stratified medicine requires label-free, low-cost diagnostic technology capable of monitoring multiple disease biomarkers in parallel. Silicon photonic biosensors combine high-sensitivity analysis with scalable, low-cost manufacturing, but they tend to measure only a single biomarker and provide no information about their (bio)chemical activity. Here we introduce an electrochemical silicon photonic sensor capable of highly sensitive and multiparameter profiling of biomarkers. Our electrophotonic technology consists of microring resonators optimally n-doped to support high Q resonances alongside electrochemical processes in situ. The inclusion of electrochemical control enables site-selective immobilization of different biomolecules on individual microrings within a sensor array. The combination of photonic and electrochemical characterization also provides additional quantitative information and unique insight into chemical reactivity that is unavailable with photonic detection alone. By exploiting both the photonic and the electrical properties of silicon, the sensor opens new modalities for sensing on the microscale.

Endoscopic resection is cost-effective compared with laparoscopic resection in the management of complex colon polyps: an economic analysis.

PubMed

Law, Ryan; Das, Ananya; Gregory, Dyanna; Komanduri, Srinadh; Muthusamy, Raman; Rastogi, Amit; Vargo, John; Wallace, Michael B; Raju, G S; Mounzer, Rawad; Klapman, Jason; Shah, Janak; Watson, Rabindra; Wilson, Robert; Edmundowicz, Steven A; Wani, Sachin

2016-06-01

Endoscopic resection (ER) is an efficacious treatment for complex colon polyps (CCPs). Many patients are referred for surgical resection because of concerns over procedural safety, incomplete polyp resection, and adenoma recurrence after ER. Efficacy data for both resection strategies are widely available, but a paucity of data exist on the cost-effectiveness of each modality. The aim of this study was to perform an economic analysis comparing ER and laparoscopic resection (LR) strategies in patients with CCP. A decision analysis tree was constructed using decision analysis software. The 2 strategies (ER vs LR) were evaluated in a hypothetical cohort of patients with CCPs. A hybrid Markov model with a 10-year time horizon was used. Patients entered the model after colonoscopic diagnosis at age 50. Under Strategy I, patients underwent ER followed by surveillance colonoscopy at 3 to 6 months and 12 months. Patients with failed ER and residual adenoma at 12 months were referred for LR. Under Strategy II, patients underwent LR as primary treatment. Patients with invasive cancer were excluded. Estimates regarding ER performance characteristics were obtained from a systematic review of published literature. The Centers for Medicare & Medicaid Services (2012-2013) and the 2012 Healthcare Cost and Utilization Project databases were used to determine the costs and loss of utility. We assumed that all procedures were performed with anesthesia support, and patients with adverse events in both strategies required inpatient hospitalization. Baseline estimates and costs were varied by using a sensitivity analysis through the ranges. LR was found to be more costly and yielded fewer quality-adjusted life-years (QALYs) compared with ER. The cost of ER of a CCP was $5570 per patient and yielded 9.640 QALYs. LR of a CCP cost $18,717 per patient and yielded fewer QALYs (9.577). For LR to be more cost-effective, the thresholds of 1-way sensitivity analyses were (1) technical success of ER for complete resection in <75.8% of cases, (2) adverse event rates for ER > 12%, and (3) LR cost of <$14,000. Our data suggest that ER is a cost-effective strategy for removal of CCPs. The effectiveness is driven by high technical success and low adverse event rates associated with ER, in addition to the increased cost of LR. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Correlation Results for a Mass Loaded Vehicle Panel Test Article Finite Element Models and Modal Survey Tests

NASA Technical Reports Server (NTRS)

Maasha, Rumaasha; Towner, Robert L.

2012-01-01

High-fidelity Finite Element Models (FEMs) were developed to support a recent test program at Marshall Space Flight Center (MSFC). The FEMs correspond to test articles used for a series of acoustic tests. Modal survey tests were used to validate the FEMs for five acoustic tests (a bare panel and four different mass-loaded panel configurations). An additional modal survey test was performed on the empty test fixture (orthogrid panel mounting fixture, between the reverb and anechoic chambers). Modal survey tests were used to test-validate the dynamic characteristics of FEMs used for acoustic test excitation. Modal survey testing and subsequent model correlation has validated the natural frequencies and mode shapes of the FEMs. The modal survey test results provide a basis for the analysis models used for acoustic loading response test and analysis comparisons

Modal Auxiliaries and Their Semantic Functions Used by Advanced EFL Learners

ERIC Educational Resources Information Center

Torabiardakani, Najmeh; Khojasteh, Laleh; Shokrpour, Nasrin

2015-01-01

Since modal auxiliary verbs have been proved to be one of the most troublesome grammatical structures in English, the researchers of this study decided to do an analysis on the ways in which advanced EFL Iranian students use modal auxiliaries focusing specially on nine modals' semantic functions. Consequently, was conducted based on the following…

A generalized modal shock spectra method for spacecraft loads analysis

NASA Technical Reports Server (NTRS)

Trubert, M.; Salama, M.

1979-01-01

Unlike the traditional shock spectra approach, the generalization presented in this paper permits elastic interaction between the spacecraft and launch vehicle in order to obtain accurate bounds on the spacecraft response and structural loads. In addition, the modal response from a previous launch vehicle transient analysis - with or without a dummy spacecraft - is exploited in order to define a modal impulse as a simple idealization of the actual forcing function. The idealized modal forcing function is then used to derive explicit expressions for an estimate of the bound on the spacecraft structural response and forces.

Numerical Investigation on Detection of Prestress Losses in a Prestressed Concrete Slab by Modal Analysis

NASA Astrophysics Data System (ADS)

Kovalovs, A.; Rucevskis, S.; Akishin, P.; Kolupajevs, J.

2017-10-01

The paper presents numerical results of loss of prestress in the reinforced prestressed precast hollow core slabs by modal analysis. Loss of prestress is investigated by the 3D finite element method, using ANSYS software. In the numerical examples, variables initial stresses were introduced into seven-wire stress-relieved strands of the concrete slabs. The effects of span and material properties of concrete on the modal frequencies of the concrete structure under initial stress were studied. Modal parameters computed from the finite element models were compared. Applicability and effectiveness of the proposed method was investigated.

Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003.

PubMed

Cipriano, Lauren E; Romanus, Dorothy; Earle, Craig C; Neville, Bridget A; Halpern, Elkan F; Gazelle, G Scott; McMahon, Pamela M

2011-01-01

The objective of this analysis was to estimate costs for lung cancer care and evaluate trends in the share of treatment costs that are the responsibility of Medicare beneficiaries. The Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1991-2003 for 60,231 patients with lung cancer were used to estimate monthly and patient-liability costs for clinical phases of lung cancer (prediagnosis, staging, initial, continuing, and terminal), stratified by treatment, stage, and non-small- versus small-cell lung cancer. Lung cancer-attributable costs were estimated by subtracting each patient's own prediagnosis costs. Costs were estimated as the sum of Medicare reimbursements (payments from Medicare to the service provider), co-insurance reimbursements, and patient-liability costs (deductibles and "co-payments" that are the patient's responsibility). Costs and patient-liability costs were fit with regression models to compare trends by calendar year, adjusting for age at diagnosis. The monthly treatment costs for a 72-year-old patient, diagnosed with lung cancer in 2000, in the first 6 months ranged from $2687 (no active treatment) to $9360 (chemo-radiotherapy); costs varied by stage at diagnosis and histologic type. Patient liability represented up to 21.6% of care costs and increased over the period 1992-2003 for most stage and treatment categories, even when care costs decreased or remained unchanged. The greatest monthly patient liability was incurred by chemo-radiotherapy patients, which ranged from $1617 to $2004 per month across cancer stages. Costs for lung cancer care are substantial, and Medicare is paying a smaller proportion of the total cost over time. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A generalized modal shock spectra method for spacecraft loads analysis. [internal loads in a spacecraft structure subjected to a dynamic launch environment

NASA Technical Reports Server (NTRS)

Trubert, M.; Salama, M.

1979-01-01

Unlike an earlier shock spectra approach, generalization permits an accurate elastic interaction between the spacecraft and launch vehicle to obtain accurate bounds on the spacecraft response and structural loads. In addition, the modal response from a previous launch vehicle transient analysis with or without a dummy spacecraft - is exploited to define a modal impulse as a simple idealization of the actual forcing function. The idealized modal forcing function is then used to derive explicit expressions for an estimate of the bound on the spacecraft structural response and forces. Greater accuracy is achieved with the present method over the earlier shock spectra, while saving much computational effort over the transient analysis.

A modal analysis of lamellar diffraction gratings in conical mountings

NASA Technical Reports Server (NTRS)

Li, Lifeng

1992-01-01

A rigorous modal analysis of lamellar grating, i.e., gratings having rectangular grooves, in conical mountings is presented. It is an extension of the analysis of Botten et al. which considered non-conical mountings. A key step in the extension is a decomposition of the electromagnetic field in the grating region into two orthogonal components. A computer program implementing this extended modal analysis is capable of dealing with plane wave diffraction by dielectric and metallic gratings with deep grooves, at arbitrary angles of incidence, and having arbitrary incident polarizations. Some numerical examples are included.

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

PubMed Central

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

2017-01-01

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

Newborn Sequencing in Genomic Medicine and Public Health

PubMed Central

Agrawal, Pankaj B.; Bailey, Donald B.; Beggs, Alan H.; Brenner, Steven E.; Brower, Amy M.; Cakici, Julie A.; Ceyhan-Birsoy, Ozge; Chan, Kee; Chen, Flavia; Currier, Robert J.; Dukhovny, Dmitry; Green, Robert C.; Harris-Wai, Julie; Holm, Ingrid A.; Iglesias, Brenda; Joseph, Galen; Kingsmore, Stephen F.; Koenig, Barbara A.; Kwok, Pui-Yan; Lantos, John; Leeder, Steven J.; Lewis, Megan A.; McGuire, Amy L.; Milko, Laura V.; Mooney, Sean D.; Parad, Richard B.; Pereira, Stacey; Petrikin, Joshua; Powell, Bradford C.; Powell, Cynthia M.; Puck, Jennifer M.; Rehm, Heidi L.; Risch, Neil; Roche, Myra; Shieh, Joseph T.; Veeraraghavan, Narayanan; Watson, Michael S.; Willig, Laurel; Yu, Timothy W.; Urv, Tiina; Wise, Anastasia L.

2017-01-01

The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing in newborns for both diagnosis and screening. PMID:28096516

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.

PubMed

Emery, D W

1997-01-01

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.

Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.

PubMed

Deen, Shaun A; Wilson, Jennifer L; Wilshire, Candice L; Vallières, Eric; Farivar, Alexander S; Aye, Ralph W; Ely, Robson E; Louie, Brian E

2014-03-01

Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures. A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis. In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases. VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness analysis of mammography and clinical breast examination strategies

PubMed Central

Ahern, Charlotte Hsieh; Shen, Yu

2009-01-01

Purpose Breast cancer screening by mammography and clinical breast exam are commonly used for early tumor detection. Previous cost-effectiveness studies considered mammography alone or did not account for all relevant costs. In this study, we assessed the cost-effectiveness of screening schedules recommended by three major cancer organizations and compared them with alternative strategies. We considered costs of screening examinations, subsequent work-up, biopsy, and treatment interventions after diagnosis. Methods We used a microsimulation model to generate women’s life histories, and assessed screening and treatment impacts on survival. Using statistical models, we accounted for age-specific incidence, preclinical disease duration, and age-specific sensitivity and specificity for each screening modality. The outcomes of interest were quality-adjusted life years (QALYs) saved and total costs with a 3% annual discount rate. Incremental cost-effectiveness ratios were used to compare strategies. Sensitivity analyses were performed by varying some of the assumptions. Results Compared to guidelines from the National Cancer Institute and the U.S. Preventive Services Task Force, alternative strategies were more efficient. Mammography and clinical breast exam in alternating years from ages 40 to 79 was a cost-effective alternative compared to the guidelines, costing $35,500 per QALY saved compared with no screening. The American Cancer Society guideline was the most effective and the most expensive, costing over $680,000 for an added QALY compared to the above alternative. Conclusion Screening strategies with lower costs and benefits comparable to those currently recommended should be considered for implementation in practice and for future guidelines. PMID:19258473

An audit of the outcome of amblyopia treatment: a retrospective analysis of 322 children.

PubMed

Awan, M; Proudlock, F A; Grosvenor, D; Choudhuri, I; Sarvanananthan, N; Gottlob, I

2010-08-01

Little is known about the effectiveness of occlusion therapy in hospital settings. A retrospective analysis was conducted to assess modalities, outcome and hospital costs of children treated for amblyopia with patching in a UK clinic. Notes of 322 children with amblyopia discharged after occlusion treatment were selected consecutively and reviewed. Data collated included age at presentation, amblyopia type, visual acuity (VA; before/after occlusion and at discharge), number of prescribed hours of occlusion, duration of patching treatment, number of glasses prescribed and number of visits attended or failed to attend. Hospital treatment costs were estimated. Mixed amblyopes were prescribed the longest amount of patching (mean 2815 h over 23 months) followed by strabismic (1984 h) and anisometropic (1238 h) amblyopes. 319 amblyopes received glasses and five atropine treatment. The percentage of patients reaching VA of 6/12 was best in the anisometropic and strabismic groups (>75%) and worse in mixed amblyopia (64%). Average hospital costs were estimated at pound1365. Although the mean duration of treatment was long, involving many hospital visits, the visual outcome was variable, unsatisfactory (<6/9) and more expensive than necessary. As compliance has been identified as a major problem methods to improve amblyopia treatment are needed, possibly by using educational/motivational intervention.

Modal analysis using a Fourier analyzer, curve-fitting, and modal tuning

NASA Technical Reports Server (NTRS)

Craig, R. R., Jr.; Chung, Y. T.

1981-01-01

The proposed modal test program differs from single-input methods in that preliminary data may be acquired using multiple inputs, and modal tuning procedures may be employed to define closely spaced frquency modes more accurately or to make use of frequency response functions (FRF's) which are based on several input locations. In some respects the proposed modal test proram resembles earlier sine-sweep and sine-dwell testing in that broadband FRF's are acquired using several input locations, and tuning is employed to refine the modal parameter estimates. The major tasks performed in the proposed modal test program are outlined. Data acquisition and FFT processing, curve fitting, and modal tuning phases are described and examples are given to illustrate and evaluate them.

Newborns with suspected occult spinal dysraphism: a cost-effectiveness analysis of diagnostic strategies.

PubMed

Medina, L S; Crone, K; Kuntz, K M

2001-12-01

To assess the clinical and economic consequences of different diagnostic strategies in newborns with suspected occult spinal dysraphism. A decision-analytic model was constructed to project the cost and health outcomes of magnetic resonance imaging (MRI), ultrasound (US), plain radiographs, and no imaging in newborns with suspected occult spinal dysraphism. Morbidity and mortality rates of early versus late diagnosis of dysraphism and the sensitivity and specificity of MRI, US, and plain radiographs were obtained from the literature. Cost estimates were obtained from a hospital cost accounting database and from the Medicaid fee schedule. We found that the choice of imaging strategy depends on the underlying risk of occult spinal dysraphism. In low-risk children with intergluteal dimple or newborns of diabetic mothers (pretest probability: 0.3%-0.34%), US was the most effective strategy with an incremental cost-effectiveness ratio of $55 100 per quality-adjusted life year gained. For children with lumbosacral dimples, who have a higher pretest probability of 3.8%, US was less costly and more effective than the other 3 strategies considered. In intermediate-risk newborns with low anorectal malformation (pretest probability: 27%), US was more effective and less costly than radiographs and no imaging. However, MRI was more effective than US at an incremental cost-effectiveness of $1000 per quality-adjusted life year gained. In the high-risk group that included high anorectal malformation, cloacal malformation, and exstrophy (pretest probability: 44%-46%), MRI was actually cost-saving when compared with the other diagnostic strategies. For the intermediate-risk group, we found our analysis to be sensitive to the costs and diagnostic performances (sensitivity and specificity) of MRI and US. Lower MRI cost or greater MRI diagnostic performance improved the cost-effectiveness of the MRI strategy, whereas lower US cost or greater US diagnostic performance worsened the cost-effectiveness of the MRI strategy. Therefore, individual or institutional expertise with a specific diagnostic modality (MRI versus US) may influence the optimal diagnostic strategy. In newborns with suspected occult dysraphism, appropriate selection of patients and diagnostic strategy may increase quality-adjusted life expectancy and decrease cost of medical work-up.

Magnetic Field Sensing Based on Bi-Tapered Optical Fibers Using Spectral Phase Analysis.

PubMed

Herrera-Piad, Luis A; Haus, Joseph W; Jauregui-Vazquez, Daniel; Sierra-Hernandez, Juan M; Estudillo-Ayala, Julian M; Lopez-Dieguez, Yanelis; Rojas-Laguna, Roberto

2017-10-20

A compact, magnetic field sensor system based on a short, bi-tapered optical fiber (BTOF) span lying on a magnetic tape was designed, fabricated, and characterized. We monitored the transmission spectrum from a broadband light source, which displayed a strong interference signal. After data collection, we applied a phase analysis of the interference optical spectrum. We here report the results on two fabricated, BTOFs with different interference spectrum characteristics; we analyzed the signal based on the interference between a high-order modal component and the core fiber mode. The sensor exhibited a linear response for magnetic field increments, and we achieved a phase sensitivity of around 0.28 rad/mT. The sensing setup presented remote sensing operation and low-cost transducer magnetic material.

Magnetic Field Sensing Based on Bi-Tapered Optical Fibers Using Spectral Phase Analysis

PubMed Central

Herrera-Piad, Luis A.; Jauregui-Vazquez, Daniel; Sierra-Hernandez, Juan M.; Lopez-Dieguez, Yanelis

2017-01-01

A compact, magnetic field sensor system based on a short, bi-tapered optical fiber (BTOF) span lying on a magnetic tape was designed, fabricated, and characterized. We monitored the transmission spectrum from a broadband light source, which displayed a strong interference signal. After data collection, we applied a phase analysis of the interference optical spectrum. We here report the results on two fabricated, BTOFs with different interference spectrum characteristics; we analyzed the signal based on the interference between a high-order modal component and the core fiber mode. The sensor exhibited a linear response for magnetic field increments, and we achieved a phase sensitivity of around 0.28 rad/mT. The sensing setup presented remote sensing operation and low-cost transducer magnetic material. PMID:29053570

Utility of MRCP in clinical decision making of suspected choledocholithiasis: An institutional analysis and literature review.

PubMed

Badger, Wesley R; Borgert, Andrew J; Kallies, Kara J; Kothari, Shanu N

2017-08-01

The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalities can also be therapeutic. Each of these modalities for diagnosis and treatment carries its own set of risks, benefits, and institutional costs. We hypothesized that there would be a significant difference between the biochemical profiles and characteristics of patients who undergo ERCP vs. MRCP vs. operative intervention as the initial choice of treatment/imaging modality. We performed a retrospective review of the electronic medical records for all patients with a coded diagnosis of choledocholithiasis from 2011 to 2014. The initial diagnostic modality was assessed for each hospital encounter. The statistical characteristics of MRCP as compared to fluoroscopic imaging of the biliary tree (ERCP, IOC) were analyzed. Overall, 527 hospital encounters were identified. Initial intervention included ERCP in 63%, MRCP in 12%, and cholecystectomy in 25% of patients. Patients undergoing cholecystectomy first, compared to MRCP or ERCP, tended to have lower values for alkaline phosphatase (P < 0.001) and AST (P = 0.002) as well as be of younger age (P < 0.0001). Of the patients that underwent MRCP as their initial procedure, 82% subsequently underwent either ERCP or laparoscopic cholecystectomy. In patients who underwent an initial MRCP followed by either ERCP or IOC, the predictive performance of MRCP was as follows: sensitivity = 0.90, specificity = 0.86, positive predictive value = 0.97, negative predictive value = 0.60, agreement (Cohen's Kappa) = 0.64. There is a significant difference in the laboratory evaluation and demographics of patients undergoing ERCP, MRCP, and laparoscopic cholecystectomy. MRCP was followed with a more invasive test a majority of the time. Since MRCP did not change the management of patients with suspected choledocholithiasis, its utility in this patient population should be questioned. Further research is needed to better define the pretest characteristics which would predict which patients do not need further intervention after MRCP as well as defining the most cost-effective strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

International Space Station Modal Correction Analysis

NASA Technical Reports Server (NTRS)

Fotz[atrocl. Lrostom; Grugoer. < ocjae; Laible, Michael; Sugavanam, Sujatha

2012-01-01

This paper summarizes the on-orbit modal test and the related modal analysis, model validation and correlation performed for the ISS Stage ULF4, DTF S4-1A, October 11,2010, GMT 284/06:13:00.00. The objective of this analysis is to validate and correlate analytical models with the intent to verify the ISS critical interface dynamic loads and improve fatigue life prediction. For the ISS configurations under consideration, on-orbit dynamic responses were collected with Russian vehicles attached and without the Orbiter attached to the ISS. ISS instrumentation systems that were used to collect the dynamic responses during the DTF S4-1A included the Internal Wireless Instrumentation System (IWIS), External Wireless Instrumentation System (EWIS), Structural Dynamic Measurement System (SDMS), Space Acceleration Measurement System (SAMS), Inertial Measurement Unit (IMU) and ISS External Cameras. Experimental modal analyses were performed on the measured data to extract modal parameters including frequency, damping and mode shape information. Correlation and comparisons between test and analytical modal parameters were performed to assess the accuracy of models for the ISS configuration under consideration. Based on the frequency comparisons, the accuracy of the mathematical models is assessed and model refinement recommendations are given. Section 2.0 of this report presents the math model used in the analysis. This section also describes the ISS configuration under consideration and summarizes the associated primary modes of interest along with the fundamental appendage modes. Section 3.0 discusses the details of the ISS Stage ULF4 DTF S4-1A test. Section 4.0 discusses the on-orbit instrumentation systems that were used in the collection of the data analyzed in this paper. The modal analysis approach and results used in the analysis of the collected data are summarized in Section 5.0. The model correlation and validation effort is reported in Section 6.0. Conclusions and recommendations drawn from this analysis are included in Section 7.0.

Anatomical and metabolic small-animal whole-body imaging using ring-shaped confocal photoacoustic computed tomography

NASA Astrophysics Data System (ADS)

Xia, Jun; Chatni, Muhammad; Maslov, Konstantin; Wang, Lihong V.

2013-03-01

Due to the wide use of animals for human disease studies, small animal whole-body imaging plays an increasingly important role in biomedical research. Currently, none of the existing imaging modalities can provide both anatomical and glucose metabolic information, leading to higher costs of building dual-modality systems. Even with image coregistration, the spatial resolution of the metabolic imaging modality is not improved. We present a ring-shaped confocal photoacoustic computed tomography (RC-PACT) system that can provide both assessments in a single modality. Utilizing the novel design of confocal full-ring light delivery and ultrasound transducer array detection, RC-PACT provides full-view cross-sectional imaging with high spatial resolution. Scanning along the orthogonal direction provides three-dimensional imaging. While the mouse anatomy was imaged with endogenous hemoglobin contrast, the glucose metabolism was imaged with a near-infrared dye-labeled 2-deoxyglucose. Through mouse tumor models, we demonstrate that RC-PACT may be a paradigm shifting imaging method for preclinical research.

Dynamic modal characterization of musical instruments using digital holography

NASA Astrophysics Data System (ADS)

Demoli, Nazif; Demoli, Ivan

2005-06-01

This study shows that a dynamic modal characterization of musical instruments with membrane can be carried out using a low-cost device and that the obtained very informative results can be presented as a movie. The proposed device is based on a digital holography technique using the quasi-Fourier configuration and time-average principle. Its practical realization with a commercial digital camera and large plane mirrors allows relatively simple analyzing of big vibration surfaces. The experimental measurements given for a percussion instrument are supported by the mathematical formulation of the problem.

Circularly-symmetric complex normal ratio distribution for scalar transmissibility functions. Part III: Application to statistical modal analysis

NASA Astrophysics Data System (ADS)

Yan, Wang-Ji; Ren, Wei-Xin

2018-01-01

This study applies the theoretical findings of circularly-symmetric complex normal ratio distribution Yan and Ren (2016) [1,2] to transmissibility-based modal analysis from a statistical viewpoint. A probabilistic model of transmissibility function in the vicinity of the resonant frequency is formulated in modal domain, while some insightful comments are offered. It theoretically reveals that the statistics of transmissibility function around the resonant frequency is solely dependent on 'noise-to-signal' ratio and mode shapes. As a sequel to the development of the probabilistic model of transmissibility function in modal domain, this study poses the process of modal identification in the context of Bayesian framework by borrowing a novel paradigm. Implementation issues unique to the proposed approach are resolved by Lagrange multiplier approach. Also, this study explores the possibility of applying Bayesian analysis in distinguishing harmonic components and structural ones. The approaches are verified through simulated data and experimentally testing data. The uncertainty behavior due to variation of different factors is also discussed in detail.

Galileo spacecraft modal test and evaluation of testing techniques

NASA Technical Reports Server (NTRS)

Chen, J.-C.

1984-01-01

The structural configuration, modal test requirements and pre-test activities involved in modeling the expected dynamic environment and responses of the Galileo spacecraft are discussed. The probe will be Shuttle-launched in 1986 and will gather data on the Jupiter system. Loads analysis for the 5300 lb spacecraft were performed with the NASTRAN code, and covered 10,000 static degrees of freedom and 1600 mass degrees of freedom. A modal analysis will be used to verify the predictions for natural frequencies, mode shapes, orthogonality checks, residual mass, modal damping and forces, and generalized forces. Verification of the validity of considering only 70 natural modes in the numerical simulation is being performed by examining the forcing functions of the analysis. The analysis led to requirements that 162 channels of accelerometer data and 118 channels of strain gage data be recorded during shaker tests to reveal areas where design changes will be needed to eliminate vibration peaks.

Multimodal Diffuse Optical Imaging

NASA Astrophysics Data System (ADS)

Intes, Xavier; Venugopal, Vivek; Chen, Jin; Azar, Fred S.

Diffuse optical imaging, particularly diffuse optical tomography (DOT), is an emerging clinical modality capable of providing unique functional information, at a relatively low cost, and with nonionizing radiation. Multimodal diffuse optical imaging has enabled a synergistic combination of functional and anatomical information: the quality of DOT reconstructions has been significantly improved by incorporating the structural information derived by the combined anatomical modality. In this chapter, we will review the basic principles of diffuse optical imaging, including instrumentation and reconstruction algorithm design. We will also discuss the approaches for multimodal imaging strategies that integrate DOI with clinically established modalities. The merit of the multimodal imaging approaches is demonstrated in the context of optical mammography, but the techniques described herein can be translated to other clinical scenarios such as brain functional imaging or muscle functional imaging.

Viewpoint in the Visual-Spatial Modality: The Coordination of Spatial Perspective

PubMed Central

Pyers, Jennie E.; Perniss, Pamela; Emmorey, Karen

2015-01-01

Sign languages express viewpoint-dependent spatial relations (e.g., left, right) iconically but must conventionalize from whose viewpoint the spatial relation is being described, the signer's or the perceiver's. In Experiment 1, ASL signers and sign-naïve gesturers expressed viewpoint-dependent relations egocentrically, but only signers successfully interpreted the descriptions non-egocentrically, suggesting that viewpoint convergence in the visual modality emerges with language conventionalization. In Experiment 2, we observed that the cost of adopting a non-egocentric viewpoint was greater for producers than for perceivers, suggesting that sign languages have converged on the most cognitively efficient means of expressing left-right spatial relations. We suggest that non-linguistic cognitive factors such as visual perspective-taking and motor embodiment may constrain viewpoint convergence in the visual-spatial modality. PMID:26981027

Viewpoint in the Visual-Spatial Modality: The Coordination of Spatial Perspective.

PubMed

Pyers, Jennie E; Perniss, Pamela; Emmorey, Karen

2015-06-01

Sign languages express viewpoint-dependent spatial relations (e.g., left, right) iconically but must conventionalize from whose viewpoint the spatial relation is being described, the signer's or the perceiver's. In Experiment 1, ASL signers and sign-naïve gesturers expressed viewpoint-dependent relations egocentrically, but only signers successfully interpreted the descriptions non-egocentrically, suggesting that viewpoint convergence in the visual modality emerges with language conventionalization. In Experiment 2, we observed that the cost of adopting a non-egocentric viewpoint was greater for producers than for perceivers, suggesting that sign languages have converged on the most cognitively efficient means of expressing left-right spatial relations. We suggest that non-linguistic cognitive factors such as visual perspective-taking and motor embodiment may constrain viewpoint convergence in the visual-spatial modality.

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

PubMed

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

2015-05-01

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

Charles River Crossing

DTIC Science & Technology

2012-04-06

48 MODAL ANALYSIS...2. Lateral Loads 3. Non-uniform Loads 4. Modal Analysis 5. Seismic Analysis 6. Moving Load Analysis All of these analyses were conducted with...Tandem c onsisting of a t wo a xle ve hicle with 25 kips on each axle spaced by 4 ft Self-Weight Dead Load: Steel density of 0.49 kips per cubic foot

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

PubMed

Babbush, Charles A; Kanawati, Ali; Kotsakis, Georgios A; Hinrichs, James E

2014-04-01

Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

Multi-Modal Intelligent Traffic Signal Systems (MMITSS) impacts assessment.

DOT National Transportation Integrated Search

2015-08-01

The study evaluates the potential network-wide impacts of the Multi-Modal Intelligent Transportation Signal System (MMITSS) based on a field data analysis utilizing data collected from a MMITSS prototype and a simulation analysis. The Intelligent Tra...

Cost-Effectiveness Analysis of Radiation Therapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma.

PubMed

Rodin, Danielle; Caulley, Lisa; Burger, Emily; Kim, Jane; Johnson-Obaseki, Stephanie; Palma, David; Louie, Alexander V; Hansen, Aaron; O'Sullivan, Brian

2017-03-15

The objective of this study was to compare the cost-effectiveness of transoral robotic surgery (TORS) versus the standard treatment modality for oropharyngeal squamous cell carcinoma (OPSCC), radiation therapy (RT), in a subset of patients with early-stage OPSCC. We developed a microsimulation state-transition model associated with RT and TORS for patients with clinically staged T1N0M0 to T2N1M0 OPSCC. Transition probabilities, utilities, and costs for each health state were estimated from recently published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs (in 2014 US dollars), health benefits (quality-adjusted life-years [QALYs]), and cost-effectiveness ratios from a societal perspective. Under base-case assumptions, TORS was associated with modest gains in QALYs. RT yielded 10.43 QALYs at a cost of $123,410 per patient, whereas TORS yielded 11.10 QALYs at a cost of $178,480. This resulted in an incremental cost-effectiveness ratio of $82,190/QALY gained. The incremental cost-effectiveness ratio was most sensitive to the need for adjuvant therapy, cost of late toxicity, age at diagnosis, disease state utilities, and discount rate. Accounting for joint parameter uncertainty, RT had a higher probability of demonstrating a cost-effective profile compared with TORS, at 54% compared with 46%. By use of standard benchmarks for cost-effectiveness in the United States, TORS may be a cost-effective alternative for the subset of patients with early-stage OPSCC but demonstrates considerable sensitivity to assumptions around quality of life. Copyright © 2016. Published by Elsevier Inc.

Erbium-doped fiber ring laser with SMS modal interferometer for hydrogen sensing

NASA Astrophysics Data System (ADS)

Zhang, Ya-nan; Zhang, Lebin; Han, Bo; Peng, Huijie; Zhou, Tianmin; Lv, Ri-qing

2018-06-01

A hydrogen sensor based on erbium-doped fiber ring laser with modal interferometer is proposed. A single mode-multimode-single mode (SMS) modal interferometer structure coated with Pd/WO3 film is used as the sensing head, due to that it is easy to be fabricated and low cost. The sensing structure is inserted into an erbium-doped fiber ring laser in order to solve the problem of spectral confusion and improve the detection limit of the hydrogen sensor based on the SMS modal interferometer. The SMS sensing structure is acted as a fiber band-pass filter. When hydrogen concentration around the sensor is changed, it will induce the refractive index and strain variations of the Pd/WO3 film, and then shift the resonant spectrum of the SMS modal interferometer as well as the laser wavelength of the fiber ring laser. Therefore, the hydrogen concentration can be measured by monitoring the wavelength shift of the laser, which has high intensity and narrow full width half maximum. Experimental results demonstrate that the sensor has high sensitivity of 1.23 nm/%, low detection limit of 0.017%, good stability and excellent repeatability.

Experimental study of microwave-induced thermoacoustic imaging

NASA Astrophysics Data System (ADS)

Jacobs, Ryan T.

Microwave-Induced Thermoacoustic Imaging (TAI) is a noninvasive hybrid modality which improves contrast by using thermoelastic wave generation induced by microwave absorption. Ultrasonography is widely used in medical practice as a low-cost alternative and supplement to magnetic resonance imaging (MRI). Although ultrasonography has relatively high image resolution (depending on the ultrasonic wavelength at diagnostic frequencies), it suffers from low image contrast of soft tissues. In this work samples are irradiated with sub-microsecond electromagnetic pulses inducing acoustic waves in the sample that are then detected with an unfocused transducer. The advantage of this hybrid modality is the ability to take advantage of the microwave absorption coefficients which provide high contrast in tissue samples. This in combination with the superior spatial resolution of ultrasound waves is important to providing a low-cost alternative to MRI and early breast cancer detection methods. This work describes the implementation of a thermoacoustic experiment using a 5 kW peak power microwave source.

Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD

PubMed Central

Page, Timothy F.; Fabiano, Gregory A.; Greiner, Andrew R.; Gnagy, Elizabeth M.; Pelham, William E.; Hart, Katie; Coxe, Stefany; Waxmonsky, James G.; Pelham, William E.

2016-01-01

Objective We conducted a cost-analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment randomized, and adaptive trial investigating the sequencing and enhancement of treatment for ADHD children (Pelham et al., under review; N=152, 76% male, 80% Caucasian). Methods The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Results Beginning treatment with a low-intensity regimen of behavior modification (group parent training) was less costly for a school-year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1689), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Conclusions Outcome data from the parent study (Pelham et al., under review) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings document that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD. PMID:26808137

Why home hemodialysis? A systematic "marketing" analysis.

PubMed

Piccoli, Giorgina Barbara; Ferraresi, Martina; Consiglio, Valentina; Scognamiglio, Stefania; Deagostini, Maria Chiara; Randone, Olga; Vigotti, Federica Neve; Calderale, Pasquale Mario

2012-01-01

Home hemodialysis (HHD) has met with alternating fortunes. The present revival of interest is due to lower costs and more frequent/efficient treatments. HHD is underdeveloped, and a marketing approach may help in defining development strategies. The aim of this study was to systematically review the recent literature (2000-2010) according to a marketing approach, defining the potential of HHD according to the classical marketing items: market size, growth rate, profitability, trends, keys for success, needs for structures and distribution channels. A Medline search was conducted for 2000-2010. The analysis took into account the recent trends in publication as a measure of interest, size and trends, while survival and costs were analyzed as keys for success. The issues of structures and distribution channels were arbitrarily considered as equivalent to the overall hemodialysis market. Interest in HHD is growing, as shown by the increasing number of published papers (9 in 2000, 52 in 2010); yet, clinical studies accounted for less than half of the papers. In the 138 clinical studies, quality of life (33 papers) and metabolism (16 papers) were the most studied topics. Survival and cost analyses were highly heterogeneous (the broad inclusion of nocturnal or quotidian dialysis has to be mentioned). Overall, survival was equal to, or better than, that for other modalities, including transplantation and peritoneal dialysis; costs compared favorably with hospital dialysis and were equivalent to those of peritoneal dialysis. The small "market" of HHD is increasing, with potential for further growth, the keys for success being equivalence or superiority of survival at equivalent or lower costs.

Experimental and Theoretical Modal Analysis of Full-Sized Wood Composite Panels Supported on Four Nodes

PubMed Central

Guan, Cheng; Zhang, Houjiang; Wang, Xiping; Miao, Hu; Zhou, Lujing; Liu, Fenglu

2017-01-01

Key elastic properties of full-sized wood composite panels (WCPs) must be accurately determined not only for safety, but also serviceability demands. In this study, the modal parameters of full-sized WCPs supported on four nodes were analyzed for determining the modulus of elasticity (E) in both major and minor axes, as well as the in-plane shear modulus of panels by using a vibration testing method. The experimental modal analysis was conducted on three full-sized medium-density fiberboard (MDF) and three full-sized particleboard (PB) panels of three different thicknesses (12, 15, and 18 mm). The natural frequencies and mode shapes of the first nine modes of vibration were determined. Results from experimental modal testing were compared with the results of a theoretical modal analysis. A sensitivity analysis was performed to identify the sensitive modes for calculating E (major axis: Ex and minor axis: Ey) and the in-plane shear modulus (Gxy) of the panels. Mode shapes of the MDF and PB panels obtained from modal testing are in a good agreement with those from theoretical modal analyses. A strong linear relationship exists between the measured natural frequencies and the calculated frequencies. The frequencies of modes (2, 0), (0, 2), and (2, 1) under the four-node support condition were determined as the characteristic frequencies for calculation of Ex, Ey, and Gxy of full-sized WCPs. The results of this study indicate that the four-node support can be used in free vibration test to determine the elastic properties of full-sized WCPs. PMID:28773043

Does the modality effect exist? And if so, which modality effect?

PubMed

Reinwein, Joachim

2012-02-01

The modality effect is a central issue in multimedia learning [see Mayer (Cambridge University Press, 2005a), for a review]. Sweller's Cognitive Load Theory (CLT), for example, presumes that an illustrated text is better understood when presented visually rather than orally. The predictive power of CLT lies in how it links in to Baddeley's (1986) model of working memory and Penney's (Mem Cognit 17:398-442, 1989) Separate-Streams Hypothesis. Ginns's (Learn Instr 4:313-331, 2005) recent meta-analysis also supports the modality effect (d = 0.72, based on 43 independent effects). This article replicates the meta-analysis of the modality effect based on 86 independent effects (with within-study subgroups as the unit of analysis and with mean of the outcomes as the dependent measure), with results showing a reduction of the overall effect size by almost half (d = 0.38), and even more when Duval and Tweedie's Trim and Fill method is used to correct publication bias (d = 0.20). This article also widens the scope of the analysis of moderator variables (e.g. Pace of presentation, Type of visualization, Research group) as well as their potentially confounded effects. Finally, it is argued that, for theoretical reasons, the so-called modality effect cannot be based on Penney's or Baddeley's theories and must be explained in a different way.

TACT: A Set of MSC/PATRAN- and MSC/NASTRAN- based Modal Correlation Tools

NASA Technical Reports Server (NTRS)

Marlowe, Jill M.; Dixon, Genevieve D.

1998-01-01

This paper describes the functionality and demonstrates the utility of the Test Analysis Correlation Tools (TACT), a suite of MSC/PATRAN Command Language (PCL) tools which automate the process of correlating finite element models to modal survey test data. The initial release of TACT provides a basic yet complete set of tools for performing correlation totally inside the PATRAN/NASTRAN environment. Features include a step-by-step menu structure, pre-test accelerometer set evaluation and selection, analysis and test result export/import in Universal File Format, calculation of frequency percent difference and cross-orthogonality correlation results using NASTRAN, creation and manipulation of mode pairs, and five different ways of viewing synchronized animations of analysis and test modal results. For the PATRAN-based analyst, TACT eliminates the repetitive, time-consuming and error-prone steps associated with transferring finite element data to a third-party modal correlation package, which allows the analyst to spend more time on the more challenging task of model updating. The usefulness of this software is presented using a case history, the correlation for a NASA Langley Research Center (LaRC) low aspect ratio research wind tunnel model. To demonstrate the improvements that TACT offers the MSC/PATRAN- and MSC/DIASTRAN- based structural analysis community, a comparison of the modal correlation process using TACT within PATRAN versus external third-party modal correlation packages is presented.

Modal Identification in an Automotive Multi-Component System Using HS 3D-DIC

PubMed Central

López-Alba, Elías; Felipe-Sesé, Luis; Díaz, Francisco A.

2018-01-01

The modal characterization of automotive lighting systems becomes difficult using sensors due to the light weight of the elements which compose the component as well as the intricate access to allocate them. In experimental modal analysis, high speed 3D digital image correlation (HS 3D-DIC) is attracting the attention since it provides full-field contactless measurements of 3D displacements as main advantage over other techniques. Different methodologies have been published that perform modal identification, i.e., natural frequencies, damping ratios, and mode shapes using the full-field information. In this work, experimental modal analysis has been performed in a multi-component automotive lighting system using HS 3D-DIC. Base motion excitation was applied to simulate operating conditions. A recently validated methodology has been employed for modal identification using transmissibility functions, i.e., the transfer functions from base motion tests. Results make it possible to identify local and global behavior of the different elements of injected polymeric and metallic materials. PMID:29401725

Modal density of rectangular structures in a wide frequency range

NASA Astrophysics Data System (ADS)

Parrinello, A.; Ghiringhelli, G. L.

2018-04-01

A novel approach to investigate the modal density of a rectangular structure in a wide frequency range is presented. First, the modal density is derived, in the whole frequency range of interest, on the basis of sound transmission through the infinite counterpart of the structure; then, it is corrected by means of the low-frequency modal behavior of the structure, taking into account actual size and boundary conditions. A statistical analysis reveals the connection between the modal density of the structure and the transmission of sound through its thickness. A transfer matrix approach is used to compute the required acoustic parameters, making it possible to deal with structures having arbitrary stratifications of different layers. A finite element method is applied on coarse grids to derive the first few eigenfrequencies required to correct the modal density. Both the transfer matrix approach and the coarse grids involved in the finite element analysis grant high efficiency. Comparison with alternative formulations demonstrates the effectiveness of the proposed methodology.

Constrained maximum likelihood modal parameter identification applied to structural dynamics

NASA Astrophysics Data System (ADS)

El-Kafafy, Mahmoud; Peeters, Bart; Guillaume, Patrick; De Troyer, Tim

2016-05-01

A new modal parameter estimation method to directly establish modal models of structural dynamic systems satisfying two physically motivated constraints will be presented. The constraints imposed in the identified modal model are the reciprocity of the frequency response functions (FRFs) and the estimation of normal (real) modes. The motivation behind the first constraint (i.e. reciprocity) comes from the fact that modal analysis theory shows that the FRF matrix and therefore the residue matrices are symmetric for non-gyroscopic, non-circulatory, and passive mechanical systems. In other words, such types of systems are expected to obey Maxwell-Betti's reciprocity principle. The second constraint (i.e. real mode shapes) is motivated by the fact that analytical models of structures are assumed to either be undamped or proportional damped. Therefore, normal (real) modes are needed for comparison with these analytical models. The work done in this paper is a further development of a recently introduced modal parameter identification method called ML-MM that enables us to establish modal model that satisfies such motivated constraints. The proposed constrained ML-MM method is applied to two real experimental datasets measured on fully trimmed cars. This type of data is still considered as a significant challenge in modal analysis. The results clearly demonstrate the applicability of the method to real structures with significant non-proportional damping and high modal densities.

An investigation into NVC characteristics of vehicle behaviour using modal analysis

NASA Astrophysics Data System (ADS)

Hanouf, Zahir; Faris, Waleed F.; Ahmad, Kartini

2017-03-01

NVC characterizations of vehicle behavior is one essential part of the development targets in automotive industries. Therefore understanding dynamic behavior of each structural part of the vehicle is a major requirement in improving the NVC characteristics of a vehicle. The main focus of this research is to investigate structural dynamic behavior of a passenger car using modal analysis part by part technique and apply this method to derive the interior noise sources. In the first part of this work computational modal analysis part by part tests were carried out to identify the dynamic parameters of the passenger car. Finite elements models of the different parts of the car are constructed using VPG 3.2 software. Ls-Dyna pre and post processing was used to identify and analyze the dynamic behavior of each car components panels. These tests had successfully produced natural frequencies and their associated mode shapes of such panels like trunk, hood, roof and door panels. In the second part of this research, experimental modal analysis part by part is performed on the selected car panels to extract modal parameters namely frequencies and mode shapes. The study establishes the step-by-step procedures to carry out experimental modal analysis on the car structures, using single input excitation and multi-output responses (SIMO) technique. To ensure the validity of the results obtained by the previous method an inverse method was done by fixing the response and moving the excitation and the results found were absolutely the same. Finally, comparison between results obtained from both analyses showed good similarity in both frequencies and mode shapes. Conclusion drawn from this part of study was that modal analysis part-by-part can be strongly used to establish the dynamic characteristics of the whole car. Furthermore, the developed method is also can be used to show the relationship between structural vibration of the car panels and the passengers’ noise comfort inside the cabin.

[Forecast of costs of ecodependent cancer treatment for the development of management decisions].

PubMed

Krasovskiy, V O

2014-01-01

The methodical approach for probabilistic forecasting and differentiation of treatment of costs of ecodependent cancer cases has been elaborated. The modality is useful in the organization of medical aid to cancer patients, in developing management decisions for the reduction the occupational load on the population, as well as in solutions problems in compensation to the population economic and social loss from industrial plants.

Modal sound transmission loss of a single leaf panel: Asymptotic solutions.

PubMed

Wang, Chong

2015-12-01

In a previously published paper [C. Wang, J. Acoust. Soc. Am. 137(6), 3514-3522 (2015)], the modal sound transmission coefficients of a single leaf panel were discussed with regard to the inter-modal coupling effects. By incorporating such effect into the equivalent modal radiation impedance, which is directly related to the modal sound transmission coefficient of each mode, the overall sound transmission loss for both normal and randomized sound incidences was computed through a simple modal superposition. Benefiting from the analytical expressions of the equivalent modal impedance and modal transmission coefficients, in this paper, behaviors of modal sound transmission coefficients in several typical frequency ranges are discussed in detail. Asymptotic solutions are also given for the panels with relatively low bending stiffnesses, for which the sound transmission loss has been assumed to follow the mass law of a limp panel. Results are also compared to numerical analysis and the renowned mass law theories.

Linked independent component analysis for multimodal data fusion.

PubMed

Groves, Adrian R; Beckmann, Christian F; Smith, Steve M; Woolrich, Mark W

2011-02-01

In recent years, neuroimaging studies have increasingly been acquiring multiple modalities of data and searching for task- or disease-related changes in each modality separately. A major challenge in analysis is to find systematic approaches for fusing these differing data types together to automatically find patterns of related changes across multiple modalities, when they exist. Independent Component Analysis (ICA) is a popular unsupervised learning method that can be used to find the modes of variation in neuroimaging data across a group of subjects. When multimodal data is acquired for the subjects, ICA is typically performed separately on each modality, leading to incompatible decompositions across modalities. Using a modular Bayesian framework, we develop a novel "Linked ICA" model for simultaneously modelling and discovering common features across multiple modalities, which can potentially have completely different units, signal- and contrast-to-noise ratios, voxel counts, spatial smoothnesses and intensity distributions. Furthermore, this general model can be configured to allow tensor ICA or spatially-concatenated ICA decompositions, or a combination of both at the same time. Linked ICA automatically determines the optimal weighting of each modality, and also can detect single-modality structured components when present. This is a fully probabilistic approach, implemented using Variational Bayes. We evaluate the method on simulated multimodal data sets, as well as on a real data set of Alzheimer's patients and age-matched controls that combines two very different types of structural MRI data: morphological data (grey matter density) and diffusion data (fractional anisotropy, mean diffusivity, and tensor mode). Copyright © 2010 Elsevier Inc. All rights reserved.

Computer-Aided Surgical Simulation in Head and Neck Reconstruction: A Cost Comparison among Traditional, In-House, and Commercial Options.

PubMed

Li, Sean S; Copeland-Halperin, Libby R; Kaminsky, Alexander J; Li, Jihui; Lodhi, Fahad K; Miraliakbari, Reza

2018-06-01

 Computer-aided surgical simulation (CASS) has redefined surgery, improved precision and reduced the reliance on intraoperative trial-and-error manipulations. CASS is provided by third-party services; however, it may be cost-effective for some hospitals to develop in-house programs. This study provides the first cost analysis comparison among traditional (no CASS), commercial CASS, and in-house CASS for head and neck reconstruction.  The costs of three-dimensional (3D) pre-operative planning for mandibular and maxillary reconstructions were obtained from an in-house CASS program at our large tertiary care hospital in Northern Virginia, as well as a commercial provider (Synthes, Paoli, PA). A cost comparison was performed among these modalities and extrapolated in-house CASS costs were derived. The calculations were based on estimated CASS use with cost structures similar to our institution and sunk costs were amortized over 10 years.  Average operating room time was estimated at 10 hours, with an average of 2 hours saved with CASS. The hourly cost to the hospital for the operating room (including anesthesia and other ancillary costs) was estimated at $4,614/hour. Per case, traditional cases were $46,140, commercial CASS cases were $40,951, and in-house CASS cases were $38,212. Annual in-house CASS costs were $39,590.  CASS reduced operating room time, likely due to improved efficiency and accuracy. Our data demonstrate that hospitals with similar cost structure as ours, performing greater than 27 cases of 3D head and neck reconstructions per year can see a financial benefit from developing an in-house CASS program. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vibration signature analysis of multistage gear transmission

NASA Technical Reports Server (NTRS)

Choy, F. K.; Tu, Y. K.; Savage, M.; Townsend, D. P.

1989-01-01

An analysis is presented for multistage multimesh gear transmission systems. The analysis predicts the overall system dynamics and the transmissibility to the gear box or the enclosed structure. The modal synthesis approach of the analysis treats the uncoupled lateral/torsional model characteristics of each stage or component independently. The vibration signature analysis evaluates the global dynamics coupling in the system. The method synthesizes the interaction of each modal component or stage with the nonlinear gear mesh dynamics and the modal support geometry characteristics. The analysis simulates transient and steady state vibration events to determine the resulting torque variations, speeds, changes, rotor imbalances, and support gear box motion excitations. A vibration signature analysis examines the overall dynamic characteristics of the system, and the individual model component responses. The gear box vibration analysis also examines the spectral characteristics of the support system.

Multi-body Dynamic Contact Analysis Tool for Transmission Design

DTIC Science & Technology

2003-04-01

frequencies were computed in COSMIC NASTRAN, and were validated against the published experimental modal analysis [17]. • Using assumed time domain... modal superposition. • Results from the structural analysis (mode shapes or forced response) were converted into IDEAS universal format (dataset 55...ARMY RESEARCH LABORATORY Multi-body Dynamic Contact Analysis Tool for Transmission Design SBIR Phase II Final Report by

Contribucion al estudio de la semantica de los verbos modales en espanol (con ejemplos del habla de Madrid). The Contribution of Spanish Modal Verbs to the Study of Semantics (with Evidence from Madrid Speech).

ERIC Educational Resources Information Center

Sirbu-Dumitrescu, Domnita

1988-01-01

Spanish modal verbs may express necessity, obligation, probability, and possibility, in either their personal or impersonal modes. Analysis is based on examples of contemporary Madrid speech. Four modals, "poder,""deber (de)," tener que," and "haber que," are placed within a tripartite structure defined by…

An automatic data system for vibration modal tuning and evaluation

NASA Technical Reports Server (NTRS)

Salyer, R. A.; Jung, E. J., Jr.; Huggins, S. L.; Stephens, B. L.

1975-01-01

A digitally based automatic modal tuning and analysis system developed to provide an operational capability beginning at 0.1 hertz is described. The elements of the system, which provides unique control features, maximum operator visibility, and rapid data reduction and documentation, are briefly described; and the operational flow is discussed to illustrate the full range of capabilities and the flexibility of application. The successful application of the system to a modal survey of the Skylab payload is described. Information about the Skylab test article, coincident-quadrature analysis of modal response data, orthogonality, and damping calculations is included in the appendixes. Recommendations for future application of the system are also made.

Diagnostic imaging and interventional therapy of hepatocellular carcinoma.

PubMed

Palma, L D

1998-08-01

Diagnostic imaging has many important roles in the management of patients with hepatocellular carcinoma (HCC). In diagnosis, lipiodol CT (LCT) has been shown to be the most sensitive imaging modality (90-97%) for all sizes of lesions; all other modalities have high sensitivities for lesions 1-3 cm but low sensitivities for lesions < 1 cm (ultrasound 33-37%, conventional CT 20-42% and digital subtraction angiography 40-55%). All imaging modalities understage HCC. Once again LCT is the most accurate method of evaluating the extent of tumour, but even this method does not identify all satellite nodules. Ultrasound has been proposed as a screening method, but this cannot be justified on the basis of its results or cost benefit analysis. Both CT and dynamic MRI play useful roles in evaluating the efficacy and follow-up of patients undergoing chemoembolization (TACE) and percutaneous ethanol injection (PEI). Although surgery remains the best treatment of HCC, it is unsuitable in most of the cases which would be better treated with interventional therapy. This article presents a review of the literature regarding the use of TACE, PEI or a combination of both procedures in the treatment of HCC. A multicentric study has shown that patients with monofocal lesions less than 5 cm in diameter are better treated with PEI, which is therefore a good alternative to the surgical treatment; patients with multifocal lesions (maximum of three lesions) show a better survival with TACE. Combined treatment with TACE and PEI proves to be effective in patients with large HCC.

IMAGES: A digital computer program for interactive modal analysis and gain estimation for eigensystem synthesis

NASA Technical Reports Server (NTRS)

Jones, R. L.

1984-01-01

An interactive digital computer program for modal analysis and gain estimation for eigensystem synthesis was written. Both mathematical and operation considerations are described; however, the mathematical presentation is limited to those concepts essential to the operational capability of the program. The program is capable of both modal and spectral synthesis of multi-input control systems. It is user friendly, has scratchpad capability and dynamic memory, and can be used to design either state or output feedback systems.

Multi-disciplinary optimization of aeroservoelastic systems

NASA Technical Reports Server (NTRS)

Karpel, Mordechay

1991-01-01

New methods were developed for efficient aeroservoelastic analysis and optimization. The main target was to develop a method for investigating large structural variations using a single set of modal coordinates. This task was accomplished by basing the structural modal coordinates on normal modes calculated with a set of fictitious masses loading the locations of anticipated structural changes. The following subject areas are covered: (1) modal coordinates for aeroelastic analysis with large local structural variations; and (2) time simulation of flutter with large stiffness changes.

To increase controllability of a large flexible antenna by modal optimization

NASA Astrophysics Data System (ADS)

Wang, Feng; Wang, Pengpeng; Jiang, Wenjian

2017-12-01

Large deployable antennas are widely used in aerospace engineering to meet the envelop limit of rocket fairing. The high flexibility and low damping of antenna has proposed critical requirement not only for stability control of the antenna itself, but also for attitude control of the satellite. This paper aims to increase controllability of a large flexible antenna by modal optimization. Firstly, Sensitivity analysis of antenna modal frequencies to stiffness of support structure and stiffness of scanning mechanism are conducted respectively. Secondly, Modal simulation results of antenna frequencies are given, influences of scanning angles on moment of inertia and modal frequencies are evaluated, and modal test is carried out to validate the simulation results. All the simulation and test results show that, after modal optimization the modal characteristic of the large deployable antenna meets the controllability requirement well.

Lossless compression of grayscale medical images: effectiveness of traditional and state-of-the-art approaches

NASA Astrophysics Data System (ADS)

Clunie, David A.

2000-05-01

Proprietary compression schemes have a cost and risk associated with their support, end of life and interoperability. Standards reduce this cost and risk. The new JPEG-LS process (ISO/IEC 14495-1), and the lossless mode of the proposed JPEG 2000 scheme (ISO/IEC CD15444-1), new standard schemes that may be incorporated into DICOM, are evaluated here. Three thousand, six hundred and seventy-nine (3,679) single frame grayscale images from multiple anatomical regions, modalities and vendors, were tested. For all images combined JPEG-LS and JPEG 2000 performed equally well (3.81), almost as well as CALIC (3.91), a complex predictive scheme used only as a benchmark. Both out-performed existing JPEG (3.04 with optimum predictor choice per image, 2.79 for previous pixel prediction as most commonly used in DICOM). Text dictionary schemes performed poorly (gzip 2.38), as did image dictionary schemes without statistical modeling (PNG 2.76). Proprietary transform based schemes did not perform as well as JPEG-LS or JPEG 2000 (S+P Arithmetic 3.4, CREW 3.56). Stratified by modality, JPEG-LS compressed CT images (4.00), MR (3.59), NM (5.98), US (3.4), IO (2.66), CR (3.64), DX (2.43), and MG (2.62). CALIC always achieved the highest compression except for one modality for which JPEG-LS did better (MG digital vendor A JPEG-LS 4.02, CALIC 4.01). JPEG-LS outperformed existing JPEG for all modalities. The use of standard schemes can achieve state of the art performance, regardless of modality, JPEG-LS is simple, easy to implement, consumes less memory, and is faster than JPEG 2000, though JPEG 2000 will offer lossy and progressive transmission. It is recommended that DICOM add transfer syntaxes for both JPEG-LS and JPEG 2000.

New modeling method and mechanism analyses for active control of interior noise in an irregular enclosure using piezoelectric actuators.

PubMed

Geng, Hou C; Rao, Zhu S; Han, Zu S

2003-03-01

A new modeling method is developed in this paper for the active minimization of noise within a three-dimensional irregular enclosure using distributed lead zirconate titanate piezoelectric (PZT) actuators, and the control mechanisms for irregular enclosure are analyzed. The irregular enclosure is modeled with four rigid walls and two simply supported flexible panels, and PZT actuators are bound to one of the flexible panels. The process of the new modeling method is as follows. First, the modal coupling method is used to establish the motion equations, which contain important coefficients such as modal masses and modal coupling coefficients, etc., of acoustic-structural-piezoelectric coupling system. Then, the acoustic modes and the modal masses of irregular enclosure are calculated by numerical methods. Last, the modal coupling coefficients in motion equations are calculated according to the numerical results of the acoustic modes of irregular enclosure and the modes of two panels. The validity of this modeling method is verified by a regular hexahedron enclosure. Two cost functions are applied to this model. With the two cost functions, good results are obtained in minimizing the sound-pressure level (SPL) within irregular enclosure according to numerical investigations. By comparing the results obtained under controlled and uncontrolled states, the control mechanisms of the system are discussed. It is found that the control mechanisms vary with disturbance frequencies. At most disturbance frequencies, the SPL within enclosure is reduced by restructuring the modes of two panels simultaneously. When the disturbance frequency comes close to one of the natural frequencies of panel a, the dominant mode of panel a is suppressed, while the modes of panel b are reconstructed. While the disturbance frequency is near one of the natural frequencies of panel b, the modes of two panels are restructured at the same time.

Modality and Causation in Serbian Dative Anticausatives: A Crosslinguistic Perspective

ERIC Educational Resources Information Center

Ilic, Tatjana

2013-01-01

In this dissertation I provide a principled, unified account of modality and causation in Serbian dative anticausatives using a typological, cognitive approach. This analysis is set within a larger claim that the causative and modal meanings crosslinguistically arise in the same morphosyntactic environments, indicating a shared conceptual base…

Investigation of a dual modal method for bone pathologies using quantitative ultrasound and photoacoustics

NASA Astrophysics Data System (ADS)

Steinberg, Idan; Gannot, Israel; Eyal, Avishay

2015-03-01

Osteoporosis is a widespread disease that has a catastrophic impact on patient's lives and overwhelming related healthcare costs. In recent works, we have developed a multi-spectral, frequency domain photoacoustic method for the evaluation of bone pathologies. This method has great advantages over pure ultrasonic or optical methods as it provides both molecular information from the bone absorption spectrum and bone mechanical status from the characteristics of the ultrasound propagation. These characteristics include both the Speed of Sound (SOS) and Broadband Ultrasonic Attenuation (BUA). To test the method's quantitative predictions, we have constructed a combined ultrasound and photoacoustic setup. Here, we experimentally present a dual modality system, and compares between the methods on bone samples in-vitro. The differences between the two modalities are shown to provide valuable insight into the bone structure and functional status.

Self-referred whole-body CT imaging: current implications for health care consumers.

PubMed

Illes, Judy; Fan, Ellen; Koenig, Barbara A; Raffin, Thomas A; Kann, Dylan; Atlas, Scott W

2003-08-01

To conduct an empirical analysis of self-referred whole-body computed tomography (CT) and develop a profile of the geographic and demographic distribution of centers, types of services and modalities, costs, and procedures for reporting results. An analysis was conducted of Web sites for imaging centers accepting self-referred patients identified by two widely used Internet search engines with large indexes. These Web sites were analyzed for geographic location, type of screening center, services, costs, and procedures for managing imaging results. Demographic data were extrapolated for analysis on the basis of center location. Descriptive statistics, such as frequencies, means, SDs, ranges, and CIs, were generated to describe the characteristics of the samples. Data were compared with national norms by using a distribution-free method for calculating a 95% CI (P <.05) for the median. Eighty-eight centers identified with the search methods were widely distributed across the United States, with a concentration on both coasts. Demographic analysis further situated them in areas of the country characterized by a population that consisted largely of European Americans (P <.05) and individuals of higher education (P <.05) and socioeconomic status (P <.05). Forty-seven centers offered whole-body screening; heart and lung examinations were most frequently offered. Procedures for reporting results were highly variable. The geographic distribution of the centers suggests target populations of educated health-conscious consumers who can assume high out-of-pocket costs. Guidelines developed from within the profession and further research are needed to ensure that benefits of these services outweigh risks to individuals and the health care system. Copyright RSNA, 2003.

Systematic review, critical appraisal, and analysis of the quality of economic evaluations in stroke imaging.

PubMed

Burton, Kirsteen R; Perlis, Nathan; Aviv, Richard I; Moody, Alan R; Kapral, Moira K; Krahn, Murray D; Laupacis, Andreas

2014-03-01

This study reviews the quality of economic evaluations of imaging after acute stroke and identifies areas for improvement. We performed full-text searches of electronic databases that included Medline, Econlit, the National Health Service Economic Evaluation Database, and the Tufts Cost Effectiveness Analysis Registry through July 2012. Search strategy terms included the following: stroke*; cost*; or cost-benefit analysis*; and imag*. Inclusion criteria were empirical studies published in any language that reported the results of economic evaluations of imaging interventions for patients with stroke symptoms. Study quality was assessed by a commonly used checklist (with a score range of 0% to 100%). Of 568 unique potential articles identified, 5 were included in the review. Four of 5 articles were explicit in their analysis perspectives, which included healthcare system payers, hospitals, and stroke services. Two studies reported results during a 5-year time horizon, and 3 studies reported lifetime results. All included the modified Rankin Scale score as an outcome measure. The median quality score was 84.4% (range=71.9%-93.5%). Most studies did not consider the possibility that patients could not tolerate contrast media or could incur contrast-induced nephropathy. Three studies compared perfusion computed tomography with unenhanced computed tomography but assumed that outcomes guided by the results of perfusion computed tomography were equivalent to outcomes guided by the results of magnetic resonance imaging or noncontrast computed tomography. Economic evaluations of imaging modalities after acute ischemic stroke were generally of high methodological quality. However, important radiology-specific clinical components were missing from all of these analyses.

Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan: a combined survey and retrospective cohort analysis.

PubMed

Tang, Chao-Hsiun; Wu, Yu-Ting; Huang, Siao-Yuan; Chen, Hsi-Hsien; Wu, Ming-Ju; Hsu, Bang-Gee; Tsai, Jer-Chia; Chen, Tso-Hsiao; Sue, Yuh-Mou

2017-03-21

Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A tri-modality image fusion method for target delineation of brain tumors in radiotherapy.

PubMed

Guo, Lu; Shen, Shuming; Harris, Eleanor; Wang, Zheng; Jiang, Wei; Guo, Yu; Feng, Yuanming

2014-01-01

To develop a tri-modality image fusion method for better target delineation in image-guided radiotherapy for patients with brain tumors. A new method of tri-modality image fusion was developed, which can fuse and display all image sets in one panel and one operation. And a feasibility study in gross tumor volume (GTV) delineation using data from three patients with brain tumors was conducted, which included images of simulation CT, MRI, and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) examinations before radiotherapy. Tri-modality image fusion was implemented after image registrations of CT+PET and CT+MRI, and the transparency weight of each modality could be adjusted and set by users. Three radiation oncologists delineated GTVs for all patients using dual-modality (MRI/CT) and tri-modality (MRI/CT/PET) image fusion respectively. Inter-observer variation was assessed by the coefficient of variation (COV), the average distance between surface and centroid (ADSC), and the local standard deviation (SDlocal). Analysis of COV was also performed to evaluate intra-observer volume variation. The inter-observer variation analysis showed that, the mean COV was 0.14(± 0.09) and 0.07(± 0.01) for dual-modality and tri-modality respectively; the standard deviation of ADSC was significantly reduced (p<0.05) with tri-modality; SDlocal averaged over median GTV surface was reduced in patient 2 (from 0.57 cm to 0.39 cm) and patient 3 (from 0.42 cm to 0.36 cm) with the new method. The intra-observer volume variation was also significantly reduced (p = 0.00) with the tri-modality method as compared with using the dual-modality method. With the new tri-modality image fusion method smaller inter- and intra-observer variation in GTV definition for the brain tumors can be achieved, which improves the consistency and accuracy for target delineation in individualized radiotherapy.

Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing.

PubMed

Thaker, Nikhil G; Pugh, Thomas J; Mahmood, Usama; Choi, Seungtaek; Spinks, Tracy E; Martin, Neil E; Sio, Terence T; Kudchadker, Rajat J; Kaplan, Robert S; Kuban, Deborah A; Swanson, David A; Orio, Peter F; Zelefsky, Michael J; Cox, Brett W; Potters, Louis; Buchholz, Thomas A; Feeley, Thomas W; Frank, Steven J

2016-01-01

Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. Patients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes. Patient-level costs to 1 year after PBT were collected using TDABC. Process mapping and radar chart analyses were conducted to visualize this value framework. A total of 238 men were eligible for analysis. Median age was 64 (range, 46-81). Median followup was 5 years (0.5-12.1). There were no acute Grade 3-5 complications. Expanded Prostate Cancer Index Composite 50 scores were favorable, with no clinically significant changes from baseline to last followup at 48 months for urinary incontinence/bother, bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource utilization for PBT, with 41% and 10% of costs occurring in the operating room and with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes and costs. We successfully created a visual framework to define the value of PBT using the International Consortium for Health Outcomes Measurement standard set and TDABC costs. PBT is associated with excellent outcomes and low costs. Widespread adoption of this methodology will enable value comparisons across providers, institutions, and treatment modalities. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

PubMed Central

Sprague, Brian L.; Stout, Natasha K.; Schechter, Clyde; van Ravesteyn, Nicolien T.; Cevik, Mucahit; Alagoz, Oguzhan; Lee, Christoph I.; van den Broek, Jeroen J.; Miglioretti, Diana L.; Mandelblatt, Jeanne S.; de Koning, Harry J.; Kerlikowske, Karla; Lehman, Constance D.; Tosteson, Anna N. A.

2014-01-01

Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing screening mammography would substantially increase costs while producing relatively small benefits in breast cancer deaths averted and QALYs gained. Primary Funding Source National Institutes of Health PMID:25486550

Data dependent systems approach to modal analysis Part 1: Theory

NASA Astrophysics Data System (ADS)

Pandit, S. M.; Mehta, N. P.

1988-05-01

The concept of Data Dependent Systems (DDS) and its applicability in the context of modal vibration analysis is presented. The ability of the DDS difference equation models to provide a complete representation of a linear dynamic system from its sampled response data forms the basis of the approach. The models are decomposed into deterministic and stochastic components so that system characteristics are isolated from noise effects. The modelling strategy is outlined, and the method of analysis associated with modal parameter identification is described in detail. Advantages and special features of the DDS methodology are discussed. Since the correlated noise is appropriately and automatically modelled by the DDS, the modal parameters are shown to be estimated very accurately and hence no preprocessing of the data is needed. Complex mode shapes and non-classical damping are as easily analyzed as the classical normal mode analysis. These features are illustrated by using simulated data in this Part I and real data on a disc-brake rotor in Part II.

Modal analysis on resonant excitation of two-dimensional waveguide grating filters

NASA Astrophysics Data System (ADS)

Zhou, Jianyu; Sang, Tian; Li, Junlang; Wang, Rui; Wang, La; Wang, Benxin; Wang, Yueke

2017-12-01

Modal analysis on resonant excitation of two-dimensional (2-D) waveguide grating filters (WGFs) is proposed. It is shown that the 2-D WGFs can support the excitation of a resonant pair, and the locations of the resonant pair arising from the TE and TM guided-mode resonances (GMRs) can be estimated accurately based on the modal analysis. Multichannel filtering using the resonant pair is investigated, and the antireflection (AR) design of the 2-D WGFs is also studied. It is shown that the reflection sideband can be reduced by placing an AR layer on the bottom of the homogeneous layer, and the well-shaped reflection spectrum with near-zero sideband reflection can be achieved by using the double-faced AR design. By merely increasing the thickness of the homogeneous layer with other parameters maintained, the spectrally dense comb-like filters with good unpolarized filtering features can be achieved. The proposed modal analysis can be extended to study the resonant excitation of 2-D periodic nanoarrays with diverse surface profiles.

Multi-Body Dynamic Contact Analysis. Tool for Transmission Design SBIR Phase II Final Report

DTIC Science & Technology

2003-04-01

shapes and natural frequencies were computed in COSMIC NASTRAN, and were validated against the published experimental modal analysis [17]. • Using...COSMIC NASTRAN via modal superposition. • Results from the structural analysis (mode shapes or forced response) were converted into IDEAS universal...ARMY RESEARCH LABORATORY Multi-body Dynamic Contact Analysis Tool for Transmission Design SBIR Phase II Final Report by

Transient Elastography and Controlled Attenuation Parameter for Diagnosing Liver Fibrosis and Steatosis in Ontario: An Economic Analysis

PubMed Central

Thavorn, K; Coyle, D

2015-01-01

Background Liver fibrosis is characterized by a buildup of connective tissue due to chronic liver damage. Steatosis is the collection of excessive amounts of fat inside liver cells. Liver biopsy remains the gold standard for the diagnosis of liver fibrosis and steatosis, but its use as a diagnostic tool is limited by its invasive nature and high cost. Objectives To evaluate the cost-effectiveness and budget impact of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease, and nonalcoholic fatty liver disease. Data Sources An economic literature search was performed using computerized databases. For primary economic and budget impact analyses, we obtained data from various sources, such as the Health Quality Ontario evidence-based analysis, published literature, and the Institute for Clinical Evaluative Sciences. Review Methods A systematic review of existing TE cost-effectiveness studies was conducted, and a primary economic evaluation was undertaken from the perspective of the Ontario Ministry of Health and Long-Term Care. Decision analytic models were used to compare short-term costs and outcomes of TE compared to liver biopsy. Outcomes were expressed as incremental cost per correctly diagnosed cases gained. A budget impact analysis was also conducted. Results We included 10 relevant studies that evaluated the cost-effectiveness of TE compared to other noninvasive tests and to liver biopsy; no cost-effectiveness studies of TE with CAP were identified. All studies showed that TE was less expensive but associated with a decrease in the number of correctly diagnosed cases. TE also improved quality-adjusted life-years in patients with hepatitis B and hepatitis C. Our primary economic analysis suggested that TE led to cost savings but was less effective than liver biopsy in the diagnosis of liver fibrosis. TE became more economically attractive with a higher degree of liver fibrosis. TE with CAP was also less expensive and less accurate than liver biopsy. Limitations The model did not take into account long-term costs and consequences associated with TE and liver biopsy and did not include costs to patients and their families, or patient preferences related to diagnostic information. Conclusions TE showed potential cost savings compared to liver biopsy. Further investigation is needed to determine the long-term impacts of TE on morbidity and mortality in Canada and the optimal diagnostic modality for liver fibrosis and steatosis. PMID:26664666

Using Response Surface Methods to Correlate the Modal Test of an Inflatable Test Article

NASA Technical Reports Server (NTRS)

Gupta, Anju

2013-01-01

This paper presents a practical application of response surface methods (RSM) to correlate a finite element model of a structural modal test. The test article is a quasi-cylindrical inflatable structure which primarily consists of a fabric weave, with an internal bladder and metallic bulkheads on either end. To mitigate model size, the fabric weave was simplified by representing it with shell elements. The task at hand is to represent the material behavior of the weave. The success of the model correlation is measured by comparing the four major modal frequencies of the analysis model to the four major modal frequencies of the test article. Given that only individual strap material properties were provided and material properties of the overall weave were not available, defining the material properties of the finite element model became very complex. First it was necessary to determine which material properties (modulus of elasticity in the hoop and longitudinal directions, shear modulus, Poisson's ratio, etc.) affected the modal frequencies. Then a Latin Hypercube of the parameter space was created to form an efficiently distributed finite case set. Each case was then analyzed with the results input into RSM. In the resulting response surface it was possible to see how each material parameter affected the modal frequencies of the analysis model. If the modal frequencies of the analysis model and its corresponding parameters match the test with acceptable accuracy, it can be said that the model correlation is successful.

[Assessment of the right ventricular anatomy and function by advanced echocardiography: pathological and physiological insights].

PubMed

Lakatos, Bálint; Kovács, Attila; Tokodi, Márton; Doronina, Alexandra; Merkely, Béla

2016-07-01

Accurate assessment of right ventricular geometry and function is of high clinical importance. However, several limitations have to be taken into consideration if using conventional echocardiographic parameters. Advanced echocardiographic techniques, such as speckle-tracking analysis or 3D echocardiography are reliable and simple tools providing a cost-effective and non-invasive alternative of current modalities used to characterize the right ventricle. There is a growing interest in the diagnostic and prognostic value of these methods regarding pathological (right ventricular infarction, pulmonary hypertension, arrhythmogenic right ventricular dysplasia, follow-up of heart transplantation) and even physiological (athlete's heart) alterations of the right ventricle. Orv. Hetil., 2016, 157(29), 1139-1146.

Newborn Sequencing in Genomic Medicine and Public Health.

PubMed

Berg, Jonathan S; Agrawal, Pankaj B; Bailey, Donald B; Beggs, Alan H; Brenner, Steven E; Brower, Amy M; Cakici, Julie A; Ceyhan-Birsoy, Ozge; Chan, Kee; Chen, Flavia; Currier, Robert J; Dukhovny, Dmitry; Green, Robert C; Harris-Wai, Julie; Holm, Ingrid A; Iglesias, Brenda; Joseph, Galen; Kingsmore, Stephen F; Koenig, Barbara A; Kwok, Pui-Yan; Lantos, John; Leeder, Steven J; Lewis, Megan A; McGuire, Amy L; Milko, Laura V; Mooney, Sean D; Parad, Richard B; Pereira, Stacey; Petrikin, Joshua; Powell, Bradford C; Powell, Cynthia M; Puck, Jennifer M; Rehm, Heidi L; Risch, Neil; Roche, Myra; Shieh, Joseph T; Veeraraghavan, Narayanan; Watson, Michael S; Willig, Laurel; Yu, Timothy W; Urv, Tiina; Wise, Anastasia L

2017-02-01

The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing in newborns for both diagnosis and screening. Copyright © 2017 by the American Academy of Pediatrics.

Estimating pharmacy level prescription drug acquisition costs for third-party reimbursement.

PubMed

Kreling, D H; Kirk, K W

1986-07-01

Accurate payment for the acquisition costs of drug products dispensed is an important consideration in a third-party prescription drug program. Two alternative methods of estimating these costs among pharmacies were derived and compared. First, pharmacists were surveyed to determine the purchase discounts offered to them by wholesalers. A 10.00% modal and 11.35% mean discount resulted for 73 responding pharmacists. Second, cost-plus percents derived from gross profit margins of wholesalers were calculated and applied to wholesaler product costs to estimate pharmacy level acquisition costs. Cost-plus percents derived from National Median and Southwestern Region wholesaler figures were 9.27% and 10.10%, respectively. A comparison showed the two methods of estimating acquisition costs would result in similar acquisition cost estimates. Adopting a cost-plus estimating approach is recommended because it avoids potential pricing manipulations by wholesalers and manufacturers that would negate improvements in drug product reimbursement accuracy.

Bayesian operational modal analysis of Jiangyin Yangtze River Bridge

NASA Astrophysics Data System (ADS)

Brownjohn, James Mark William; Au, Siu-Kui; Zhu, Yichen; Sun, Zhen; Li, Binbin; Bassitt, James; Hudson, Emma; Sun, Hongbin

2018-09-01

Vibration testing of long span bridges is becoming a commissioning requirement, yet such exercises represent the extreme of experimental capability, with challenges for instrumentation (due to frequency range, resolution and km-order separation of sensor) and system identification (because of the extreme low frequencies). The challenge with instrumentation for modal analysis is managing synchronous data acquisition from sensors distributed widely apart inside and outside the structure. The ideal solution is precisely synchronised autonomous recorders that do not need cables, GPS or wireless communication. The challenge with system identification is to maximise the reliability of modal parameters through experimental design and subsequently to identify the parameters in terms of mean values and standard errors. The challenge is particularly severe for modes with low frequency and damping typical of long span bridges. One solution is to apply 'third generation' operational modal analysis procedures using Bayesian approaches in both the planning and analysis stages. The paper presents an exercise on the Jiangyin Yangtze River Bridge, a suspension bridge with a 1385 m main span. The exercise comprised planning of a test campaign to optimise the reliability of operational modal analysis, the deployment of a set of independent data acquisition units synchronised using precision oven controlled crystal oscillators and the subsequent identification of a set of modal parameters in terms of mean and variance errors. Although the bridge has had structural health monitoring technology installed since it was completed, this was the first full modal survey, aimed at identifying important features of the modal behaviour rather than providing fine resolution of mode shapes through the whole structure. Therefore, measurements were made in only the (south) tower, while torsional behaviour was identified by a single measurement using a pair of recorders across the carriageway. The modal survey revealed a first lateral symmetric mode with natural frequency 0.0536 Hz with standard error ±3.6% and damping ratio 4.4% with standard error ±88%. First vertical mode is antisymmetric with frequency 0.11 Hz ± 1.2% and damping ratio 4.9% ± 41%. A significant and novel element of the exercise was planning of the measurement setups and their necessary duration linked to prior estimation of the precision of the frequency and damping estimates. The second novelty is the use of the multi-sensor precision synchronised acquisition without external time reference on a structure of this scale. The challenges of ambient vibration testing and modal identification in a complex environment are addressed leveraging on advances in practical implementation and scientific understanding of the problem.

Sensory Load Incurs Conceptual Processing Costs

ERIC Educational Resources Information Center

Vermeulen, Nicolas; Corneille, Olivier; Niedenthal, Paula M.

2008-01-01

Theories of grounded cognition propose that modal simulations underlie cognitive representation of concepts [Barsalou, L. W. (1999). "Perceptual symbol systems." "Behavioral and Brain Sciences, 22"(4), 577-660; Barsalou, L. W. (2008). "Grounded cognition." "Annual Review of Psychology, 59", 617-645]. Based…

Joint modality fusion and temporal context exploitation for semantic video analysis

NASA Astrophysics Data System (ADS)

Papadopoulos, Georgios Th; Mezaris, Vasileios; Kompatsiaris, Ioannis; Strintzis, Michael G.

2011-12-01

In this paper, a multi-modal context-aware approach to semantic video analysis is presented. Overall, the examined video sequence is initially segmented into shots and for every resulting shot appropriate color, motion and audio features are extracted. Then, Hidden Markov Models (HMMs) are employed for performing an initial association of each shot with the semantic classes that are of interest separately for each modality. Subsequently, a graphical modeling-based approach is proposed for jointly performing modality fusion and temporal context exploitation. Novelties of this work include the combined use of contextual information and multi-modal fusion, and the development of a new representation for providing motion distribution information to HMMs. Specifically, an integrated Bayesian Network is introduced for simultaneously performing information fusion of the individual modality analysis results and exploitation of temporal context, contrary to the usual practice of performing each task separately. Contextual information is in the form of temporal relations among the supported classes. Additionally, a new computationally efficient method for providing motion energy distribution-related information to HMMs, which supports the incorporation of motion characteristics from previous frames to the currently examined one, is presented. The final outcome of this overall video analysis framework is the association of a semantic class with every shot. Experimental results as well as comparative evaluation from the application of the proposed approach to four datasets belonging to the domains of tennis, news and volleyball broadcast video are presented.

Amodal processing in human prefrontal cortex.

PubMed

Tamber-Rosenau, Benjamin J; Dux, Paul E; Tombu, Michael N; Asplund, Christopher L; Marois, René

2013-07-10

Information enters the cortex via modality-specific sensory regions, whereas actions are produced by modality-specific motor regions. Intervening central stages of information processing map sensation to behavior. Humans perform this central processing in a flexible, abstract manner such that sensory information in any modality can lead to response via any motor system. Cognitive theories account for such flexible behavior by positing amodal central information processing (e.g., "central executive," Baddeley and Hitch, 1974; "supervisory attentional system," Norman and Shallice, 1986; "response selection bottleneck," Pashler, 1994). However, the extent to which brain regions embodying central mechanisms of information processing are amodal remains unclear. Here we apply multivariate pattern analysis to functional magnetic resonance imaging (fMRI) data to compare response selection, a cognitive process widely believed to recruit an amodal central resource across sensory and motor modalities. We show that most frontal and parietal cortical areas known to activate across a wide variety of tasks code modality, casting doubt on the notion that these regions embody a central processor devoid of modality representation. Importantly, regions of anterior insula and dorsolateral prefrontal cortex consistently failed to code modality across four experiments. However, these areas code at least one other task dimension, process (instantiated as response selection vs response execution), ensuring that failure to find coding of modality is not driven by insensitivity of multivariate pattern analysis in these regions. We conclude that abstract encoding of information modality is primarily a property of subregions of the prefrontal cortex.

Statistical analysis of modal parameters of a suspension bridge based on Bayesian spectral density approach and SHM data

NASA Astrophysics Data System (ADS)

Li, Zhijun; Feng, Maria Q.; Luo, Longxi; Feng, Dongming; Xu, Xiuli

2018-01-01

Uncertainty of modal parameters estimation appear in structural health monitoring (SHM) practice of civil engineering to quite some significant extent due to environmental influences and modeling errors. Reasonable methodologies are needed for processing the uncertainty. Bayesian inference can provide a promising and feasible identification solution for the purpose of SHM. However, there are relatively few researches on the application of Bayesian spectral method in the modal identification using SHM data sets. To extract modal parameters from large data sets collected by SHM system, the Bayesian spectral density algorithm was applied to address the uncertainty of mode extraction from output-only response of a long-span suspension bridge. The posterior most possible values of modal parameters and their uncertainties were estimated through Bayesian inference. A long-term variation and statistical analysis was performed using the sensor data sets collected from the SHM system of the suspension bridge over a one-year period. The t location-scale distribution was shown to be a better candidate function for frequencies of lower modes. On the other hand, the burr distribution provided the best fitting to the higher modes which are sensitive to the temperature. In addition, wind-induced variation of modal parameters was also investigated. It was observed that both the damping ratios and modal forces increased during the period of typhoon excitations. Meanwhile, the modal damping ratios exhibit significant correlation with the spectral intensities of the corresponding modal forces.

Comparison of NASTRAN analysis with ground vibration results of UH-60A NASA/AEFA test configuration

NASA Technical Reports Server (NTRS)

Idosor, Florentino; Seible, Frieder

1990-01-01

Preceding program flight tests, a ground vibration test and modal test analysis of a UH-60A Black Hawk helicopter was conducted by Sikorsky Aircraft to complement the UH-60A test plan and NASA/ARMY Modern Technology Rotor Airloads Program. The 'NASA/AEFA' shake test configuration was tested for modal frequencies and shapes and compared with its NASTRAN finite element model counterpart to give correlative results. Based upon previous findings, significant differences in modal data existed and were attributed to assumptions regarding the influence of secondary structure contributions in the preliminary NASTRAN modeling. An analysis of an updated finite element model including several secondary structural additions has confirmed that the inclusion of specific secondary components produces a significant effect on modal frequency and free-response shapes and improves correlations at lower frequencies with shake test data.

Effects of auditory and visual modalities in recall of words.

PubMed

Gadzella, B M; Whitehead, D A

1975-02-01

Ten experimental conditions were used to study the effects of auditory and visual (printed words, uncolored and colored pictures) modalities and their various combinations with college students. A recall paradigm was employed in which subjects responded in a written test. Analysis of data showed the auditory modality was superior to visual (pictures) ones but was not significantly different from visual (printed words) modality. In visual modalities, printed words were superior to colored pictures. Generally, conditions with multiple modes of representation of stimuli were significantly higher than for conditions with single modes. Multiple modalities, consisting of two or three modes, did not differ significantly from each other. It was concluded that any two modalities of the stimuli presented simultaneously were just as effective as three in recall of stimulus words.

Modal vector estimation for closely spaced frequency modes

NASA Technical Reports Server (NTRS)

Craig, R. R., Jr.; Chung, Y. T.; Blair, M.

1982-01-01

Techniques for obtaining improved modal vector estimates for systems with closely spaced frequency modes are discussed. In describing the dynamical behavior of a complex structure modal parameters are often analyzed: undamped natural frequency, mode shape, modal mass, modal stiffness and modal damping. From both an analytical standpoint and an experimental standpoint, identification of modal parameters is more difficult if the system has repeated frequencies or even closely spaced frequencies. The more complex the structure, the more likely it is to have closely spaced frequencies. This makes it difficult to determine valid mode shapes using single shaker test methods. By employing band selectable analysis (zoom) techniques and by employing Kennedy-Pancu circle fitting or some multiple degree of freedom (MDOF) curve fit procedure, the usefulness of the single shaker approach can be extended.

[Economic evaluation on breast cancer screening in mainland China: a systematic review].

PubMed

Wang, L; Shi, J F; Huang, H Y; Zhu, J; Li, J; Fang, Y; Dai, M

2016-12-10

Objective: To gather available evidence related to the economic evaluation on breast cancer screening in mainland China and to provide reference for further research. Methods: A systematic review was conducted to identify articles in PubMed and three Chinese databases (CNKI, Wanfang and VIP) during 1995-2015. Data related to descriptive characteristics, rates on participation and detection for population-based studies, methods for model-based studies, types of economic evaluation and results, were extracted. A Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the reporting quality of included studies. Results: Of the 356 records searched in the databases, 13 studies (all published between 2012 and 2015) were included in the current paper involving 11 population-based studies and 3 model-based evaluations (1 study using both methods). Age of the participants who started to be engaged in the screening program ranged from 18 to 45 years old, but terminated at the age of 59 years or older. The screening modalities included single-used clinical breast examination, mammography and ultrasound or combined applications. Study persepectives were described in 7 studies, with 5 from the healthcare providers, and 2 from societal angles. Only 5 studies discounted cost or effectiveness. Out of 11 papers, 9 showed the results on cost-effectiveness analysis (CEA) that reporting the cost per breast cancer detection, with median as 145.0 thousand Chinese Yuan (CNY), ranging from 49.7 thousand to 2 293.0 thousand CNY. From 4 papers with results of cost-utility analysis (CUA), the cost per quality adjusted life year (QALY) gained or cost per disability adjusted life year (DALY) averted, were evaluated. The incremental cost-effectiveness ratio (ICER) was from 2.9 thousand to 270.7 thousand CNY (GDP per capita of China was CNY 49.3 thousand in 2015). In 13 studies, the quality of reporting varied, with an average score of 14.5 (range: 9.5-21.0). In the domains of study perspective, discounting, ICER and uncertainty, all the scores of equalities were relatively levels. Conclusions: Currently, evidence on economic evaluation of breast cancer screening in mainland China remained limited and weakly comparable, particularly model-based studies. Comprehensive analysis from societal perspective and QALY or DALY related cost-utility analysis should be implemented.

A three-way parallel ICA approach to analyze links among genetics, brain structure and brain function.

PubMed

Vergara, Victor M; Ulloa, Alvaro; Calhoun, Vince D; Boutte, David; Chen, Jiayu; Liu, Jingyu

2014-09-01

Multi-modal data analysis techniques, such as the Parallel Independent Component Analysis (pICA), are essential in neuroscience, medical imaging and genetic studies. The pICA algorithm allows the simultaneous decomposition of up to two data modalities achieving better performance than separate ICA decompositions and enabling the discovery of links between modalities. However, advances in data acquisition techniques facilitate the collection of more than two data modalities from each subject. Examples of commonly measured modalities include genetic information, structural magnetic resonance imaging (MRI) and functional MRI. In order to take full advantage of the available data, this work extends the pICA approach to incorporate three modalities in one comprehensive analysis. Simulations demonstrate the three-way pICA performance in identifying pairwise links between modalities and estimating independent components which more closely resemble the true sources than components found by pICA or separate ICA analyses. In addition, the three-way pICA algorithm is applied to real experimental data obtained from a study that investigate genetic effects on alcohol dependence. Considered data modalities include functional MRI (contrast images during alcohol exposure paradigm), gray matter concentration images from structural MRI and genetic single nucleotide polymorphism (SNP). The three-way pICA approach identified links between a SNP component (pointing to brain function and mental disorder associated genes, including BDNF, GRIN2B and NRG1), a functional component related to increased activation in the precuneus area, and a gray matter component comprising part of the default mode network and the caudate. Although such findings need further verification, the simulation and in-vivo results validate the three-way pICA algorithm presented here as a useful tool in biomedical data fusion applications. Copyright © 2014 Elsevier Inc. All rights reserved.

Full-field modal analysis during base motion excitation using high-speed 3D digital image correlation

NASA Astrophysics Data System (ADS)

Molina-Viedma, Ángel J.; López-Alba, Elías; Felipe-Sesé, Luis; Díaz, Francisco A.

2017-10-01

In recent years, many efforts have been made to exploit full-field measurement optical techniques for modal identification. Three-dimensional digital image correlation using high-speed cameras has been extensively employed for this purpose. Modal identification algorithms are applied to process the frequency response functions (FRF), which relate the displacement response of the structure to the excitation force. However, one of the most common tests for modal analysis involves the base motion excitation of a structural element instead of force excitation. In this case, the relationship between response and excitation is typically based on displacements, which are known as transmissibility functions. In this study, a methodology for experimental modal analysis using high-speed 3D digital image correlation and base motion excitation tests is proposed. In particular, a cantilever beam was excited from its base with a random signal, using a clamped edge join. Full-field transmissibility functions were obtained through the beam and converted into FRF for proper identification, considering a single degree-of-freedom theoretical conversion. Subsequently, modal identification was performed using a circle-fit approach. The proposed methodology facilitates the management of the typically large amounts of data points involved in the DIC measurement during modal identification. Moreover, it was possible to determine the natural frequencies, damping ratios and full-field mode shapes without requiring any additional tests. Finally, the results were experimentally validated by comparing them with those obtained by employing traditional accelerometers, analytical models and finite element method analyses. The comparison was performed by using the quantitative indicator modal assurance criterion. The results showed a high level of correspondence, consolidating the proposed experimental methodology.

A Frequency Domain Approach to Pretest Analysis Model Correlation and Model Updating for the Mid-Frequency Range

DTIC Science & Technology

2009-02-01

range of modal analysis and the high frequency region of statistical energy analysis , is referred to as the mid-frequency range. The corresponding...frequency range of modal analysis and the high frequency region of statistical energy analysis , is referred to as the mid-frequency range. The...predictions. The averaging process is consistent with the averaging done in statistical energy analysis for stochastic systems. The FEM will always

The economic considerations of patients and caregivers in choice of dialysis modality

PubMed Central

Howard, Kirsten; Tong, Allison; Palmer, Suetonia C.; Marshall, Mark R.; Morton, Rachael L.

2016-01-01

Abstract Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers. PMID:27196634

Modal Representations and Their Role in the Learning Process: A Theoretical and Pragmatic Analysis

ERIC Educational Resources Information Center

Gunel, Murat; Yesildag-Hasancebi, Funda

2016-01-01

In the construction and sharing of scientific knowledge, modal representations such as text, graphics, pictures, and mathematical expressions are commonly used. Due to the increasing importance of their role in the production and communication of science, modal representations have become a topic of growing interest in science education research…

Output-only modal parameter estimator of linear time-varying structural systems based on vector TAR model and least squares support vector machine

NASA Astrophysics Data System (ADS)

Zhou, Si-Da; Ma, Yuan-Chen; Liu, Li; Kang, Jie; Ma, Zhi-Sai; Yu, Lei

2018-01-01

Identification of time-varying modal parameters contributes to the structural health monitoring, fault detection, vibration control, etc. of the operational time-varying structural systems. However, it is a challenging task because there is not more information for the identification of the time-varying systems than that of the time-invariant systems. This paper presents a vector time-dependent autoregressive model and least squares support vector machine based modal parameter estimator for linear time-varying structural systems in case of output-only measurements. To reduce the computational cost, a Wendland's compactly supported radial basis function is used to achieve the sparsity of the Gram matrix. A Gamma-test-based non-parametric approach of selecting the regularization factor is adapted for the proposed estimator to replace the time-consuming n-fold cross validation. A series of numerical examples have illustrated the advantages of the proposed modal parameter estimator on the suppression of the overestimate and the short data. A laboratory experiment has further validated the proposed estimator.

Combining optimization methods with response spectra curve-fitting toward improved damping ratio estimation

NASA Astrophysics Data System (ADS)

Brewick, Patrick T.; Smyth, Andrew W.

2016-12-01

The authors have previously shown that many traditional approaches to operational modal analysis (OMA) struggle to properly identify the modal damping ratios for bridges under traffic loading due to the interference caused by the driving frequencies of the traffic loads. This paper presents a novel methodology for modal parameter estimation in OMA that overcomes the problems presented by driving frequencies and significantly improves the damping estimates. This methodology is based on finding the power spectral density (PSD) of a given modal coordinate, and then dividing the modal PSD into separate regions, left- and right-side spectra. The modal coordinates were found using a blind source separation (BSS) algorithm and a curve-fitting technique was developed that uses optimization to find the modal parameters that best fit each side spectra of the PSD. Specifically, a pattern-search optimization method was combined with a clustering analysis algorithm and together they were employed in a series of stages in order to improve the estimates of the modal damping ratios. This method was used to estimate the damping ratios from a simulated bridge model subjected to moving traffic loads. The results of this method were compared to other established OMA methods, such as Frequency Domain Decomposition (FDD) and BSS methods, and they were found to be more accurate and more reliable, even for modes that had their PSDs distorted or altered by driving frequencies.

Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial

PubMed Central

Warren, Daniel; Andres, Tate; Hoelscher, Christian; Ricart-Hoffiz, Pedro; Bendo, John; Goldstein, Jeffrey

2013-01-01

Background Patients with cervical disc herniations resulting in radiculopathy or myelopathy from single level disease have traditionally been treated with Anterior Cervical Discectomy and Fusion (ACDF), yet Cervical Disc Arthroplasty (CDA) is a new alternative. Expert suggestion of reduced adjacent segment degeneration is a promising future result of CDA. A cost-utility analysis of these procedures with long-term follow-up has not been previously reported. Methods We reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Both Medicare reimbursement schedules and actual hospital cost data for peri-operative care were separately reviewed and analyzed to estimate the cost of treatment of each patient. QALYs were calculated at 1 and 2 years based on NDI and SF-36 outcome scores, and incremental cost effectiveness ratio (ICER) analysis was performed to determine relative cost-effectiveness. Results Patients of both groups showed improvement in NDI and SF-36 outcome scores. Medicare reimbursement rates to the hospital were $11,747 and $10,015 for ACDF and CDA, respectively; these figures rose to $16,162 and $13,171 when including physician and anesthesiologist reimbursement. The estimated actual cost to the hospital of ACDF averaged $16,108, while CDA averaged $16,004 (p = 0.97); when including estimated physicians fees, total hospital costs came to $19,811 and $18,440, respectively. The cost/QALY analyses therefore varied widely with these discrepancies in cost values. The ICERs of ACDF vs CDA with Medicare reimbursements were $18,593 (NDI) and $19,940 (SF-36), while ICERs based on actual total hospital cost were $13,710 (NDI) and $9,140 (SF-36). Conclusions We confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease, as our results suggest similar clinical outcomes at one and two year follow-up. The ICER suggests that the non-significant added benefit via ACDF comes at a reasonable cost, whether we use actual hospital costs or Medicare reimbursement values, though the actual ICER values vary widely depending upon the CUA modality used. Long term follow-up may illustrate a different profile for CDA due to reduced cost and greater long-term utility scores. It is crucial to note that financial modeling plays an important role in how economic treatment dominance is portrayed. PMID:25694905

Integration of Multi-Modal Biomedical Data to Predict Cancer Grade and Patient Survival.

PubMed

Phan, John H; Hoffman, Ryan; Kothari, Sonal; Wu, Po-Yen; Wang, May D

2016-02-01

The Big Data era in Biomedical research has resulted in large-cohort data repositories such as The Cancer Genome Atlas (TCGA). These repositories routinely contain hundreds of matched patient samples for genomic, proteomic, imaging, and clinical data modalities, enabling holistic and multi-modal integrative analysis of human disease. Using TCGA renal and ovarian cancer data, we conducted a novel investigation of multi-modal data integration by combining histopathological image and RNA-seq data. We compared the performances of two integrative prediction methods: majority vote and stacked generalization. Results indicate that integration of multiple data modalities improves prediction of cancer grade and outcome. Specifically, stacked generalization, a method that integrates multiple data modalities to produce a single prediction result, outperforms both single-data-modality prediction and majority vote. Moreover, stacked generalization reveals the contribution of each data modality (and specific features within each data modality) to the final prediction result and may provide biological insights to explain prediction performance.

Time-driven activity-based costing of low-dose-rate and high-dose-rate brachytherapy for low-risk prostate cancer.

PubMed

Ilg, Annette M; Laviana, Aaron A; Kamrava, Mitchell; Veruttipong, Darlene; Steinberg, Michael; Park, Sang-June; Burke, Michael A; Niedzwiecki, Douglas; Kupelian, Patrick A; Saigal, Christopher

Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care. The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%). With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Health economic controversy and cost-effectiveness of proton therapy.

PubMed

Lievens, Yolande; Pijls-Johannesma, Madelon

2013-04-01

Owing to increasing healthcare costs, there is a need to examine whether the benefits of new technologies are worth the extra cost. In proton therapy, where the evidence in favor is limited, it is heavily debated whether the expected benefit justifies the higher capital and operating costs. The aim of this article was to explore the existing methodologies of economic evaluations (EEs) of particle therapy and recommend an approach for future data collection and analysis. We reviewed the published literature on health economics of proton therapy using accepted guidelines on performing EE. Different cost strategies were assessed and comparisons with other treatment modalities were made in terms of cost-effectiveness. Potential bias in the existing studies was identified and new methodologies proposed. The principal cause of bias in EEs of proton therapy is the lack of valid data on effects as well as costs. The introduction of proton therapy may be seriously hampered by the lack of outcome and cost data and the situation is likely to continue not only in terms of justifying the capital investment but also covering the operational costs. We identified an urgent need to collect appropriate data to allow for reimbursement of such novel technology. In the absence of level 1 evidence, well-performed modeling studies taking into account the available cost and outcome parameters, including the current uncertainties, can help to address the problem of limited outcome and health economic data. The approach of coverage with evidence development, in which evidence is collected in an ongoing manner in population-based registries along with dedicated financing, may allow technological advances with limited initial evidence of benefit and value, such as protons, to become available to patients in an early phase of their technology life cycle. Copyright © 2013 Elsevier Inc. All rights reserved.

A graph theory approach to identify resonant and non-resonant transmission paths in statistical modal energy distribution analysis

NASA Astrophysics Data System (ADS)

Aragonès, Àngels; Maxit, Laurent; Guasch, Oriol

2015-08-01

Statistical modal energy distribution analysis (SmEdA) extends classical statistical energy analysis (SEA) to the mid frequency range by establishing power balance equations between modes in different subsystems. This circumvents the SEA requirement of modal energy equipartition and enables applying SmEdA to the cases of low modal overlap, locally excited subsystems and to deal with complex heterogeneous subsystems as well. Yet, widening the range of application of SEA is done at a price with large models because the number of modes per subsystem can become considerable when the frequency increases. Therefore, it would be worthwhile to have at one's disposal tools for a quick identification and ranking of the resonant and non-resonant paths involved in modal energy transmission between subsystems. It will be shown that previously developed graph theory algorithms for transmission path analysis (TPA) in SEA can be adapted to SmEdA and prove useful for that purpose. The case of airborne transmission between two cavities separated apart by homogeneous and ribbed plates will be first addressed to illustrate the potential of the graph approach. A more complex case representing transmission between non-contiguous cavities in a shipbuilding structure will be also presented.

Modal energy analysis for mechanical systems excited by spatially correlated loads

NASA Astrophysics Data System (ADS)

Zhang, Peng; Fei, Qingguo; Li, Yanbin; Wu, Shaoqing; Chen, Qiang

2018-10-01

MODal ENergy Analysis (MODENA) is an energy-based method, which is proposed to deal with vibroacoustic problems. The performance of MODENA on the energy analysis of a mechanical system under spatially correlated excitation is investigated. A plate/cavity coupling system excited by a pressure field is studied in a numerical example, in which four kinds of pressure fields are involved, which include the purely random pressure field, the perfectly correlated pressure field, the incident diffuse field, and the turbulent boundary layer pressure fluctuation. The total energies of subsystems differ to reference solution only in the case of purely random pressure field and only for the non-excited subsystem (the cavity). A deeper analysis on the scale of modal energy is further conducted via another numerical example, in which two structural modes excited by correlated forces are coupled with one acoustic mode. A dimensionless correlation strength factor is proposed to determine the correlation strength between modal forces. Results show that the error on modal energy increases with the increment of the correlation strength factor. A criterion is proposed to establish a link between the error and the correlation strength factor. According to the criterion, the error is negligible when the correlation strength is weak, in this situation the correlation strength factor is less than a critical value.

The impact of the use of intraoperative radiotherapy on costs, travel time and distance for women with breast cancer in the Mexico City Metropolitan Area.

PubMed

Bargallo-Rocha, Juan Enrique; Soto-Perez-de-Celis, Enrique; Picó-Guzmán, Francisco Javier; Quintero-Rodríguez, Carlos Eduardo; Almog, David; Santiago-Concha, Gabriel; Flores-Balcazar, Christian Haydee; Corona, Jaime; Vazquez-Romo, Rafael; Villarreal-Garza, Cynthia; Mohar, Alejandro

2017-11-01

The low availability and poor access to external beam radiotherapy (EBRT) in developing countries makes it hard for women with breast cancer to receive breast conservation. We studied the effect of providing intraoperative radiotherapy (IORT) on the travel time, distance, and costs of in the Mexico City Metropolitan Area (MCMA). Sixty-nine patients treated between January 2013 and September 2014 were analyzed. Travel distance and transit time was calculated using Google Maps. The time and distance patients living in the MCMA treated with IORT would have spent if they had received EBRT was calculated. Cost analysis for each modality was performed. 71% (n = 49) lived in the MCMA. Sixteen (33%) received additional EBRT and 33 (66%) received IORT only. Mean driving distance and transit time of those 33 women was 132.6 km (SD 25.7) and 66 min (SD 32.9). Patients from the MCMA receiving IORT alone avoided 990 visits, 43 700 km and 65 400 min in transit. IORT led to a 12% reduction in costs per patient. By reducing costs and time needed for patients to receive radiotherapy, IORT could potentially enhance access to breast conservation in resource-limited developing countries. © 2017 Wiley Periodicals, Inc.

Modal analysis applied to circular, rectangular, and coaxial waveguides

NASA Technical Reports Server (NTRS)

Hoppe, D. J.

1988-01-01

Recent developments in the analysis of various waveguide components and feedhorns using Modal Analysis (Mode Matching Method) are summarized. A brief description of the theory is presented, and the important features of the method are pointed out. Specific examples in circular, rectangular, and coaxial waveguides are included, with comparisons between the theory and experimental measurements. Extensions to the methods are described.

[Guidelines for wise utilization of knee imaging].

PubMed

Finestone, Aharon S; Eshed, Iris; Freedman, Yehuda; Beer, Yiftah; Bar-Sever, Zvi; Kots, Yavvgeni; Adar, Eliyahu; Mann, Gideon

2012-02-01

The knee is a complex structure afflicted with diverse pathologies. Correct management of knee complaints demands wise utilization of imaging modalities, considering their accuracy in the specific clinical situation, the patient's safety and availability and financial issues. Some of these considerations are universal, while others are local, depending on medical and insurance systems. There is controversy and unclearness regarding the best imaging modality in different clinical situations. To develop clinical guidelines for utilizing knee imaging. Leading physicians in specialties associated with knee disease and imaging were invited to participate in a panel on the guidelines. Controversies were settled in the main panel or in sub-panels. The panel agreed on the principles in choosing from the various modalities, primarily medical accuracy, followed by patient safety, availability and cost. There was agreement that the physician is responsible to choose the most appropriate diagnostic tool, consulting, when necessary, on the advantages, limitations and risks of the various imaging modalities. A comprehensive table was compiled with the importance of the different imaging modalities in various clinical situations. For the first time, Israeli guidelines on wise utilization of knee imaging are presented. They take into consideration the clinical situations and also availability and financial issues specific to Israel. These guidelines will serve physicians of several disciplines and medical insurers to improve patient management efficiently.

A modal approach to the prediction of the sound reduction index

NASA Astrophysics Data System (ADS)

Tisseyre, Alain; Courné, Cécile; Buzzy, Thomas; Moulinier, André

2003-04-01

The calculation of the sound reduction index in modal analysis is presented in a general way; different possible approaches are described. These calculations are done in two steps: a vibratory study to determine the transverse displacement of the plate and a study of radiation. The specificity of orthotropic plates is presented. This study led to programming a calculation algorithm. Initial hypotheses are indicated, as well as results obtained for various plates or partitions. Modal analysis calculation results are then compared to the Cremer-Sewell approach results.

NASTRAN documentation for flutter analysis of advanced turbopropellers

NASA Technical Reports Server (NTRS)

Elchuri, V.; Gallo, A. M.; Skalski, S. C.

1982-01-01

An existing capability developed to conduct modal flutter analysis of tuned bladed-shrouded discs was modified to facilitate investigation of the subsonic unstalled flutter characteristics of advanced turbopropellers. The modifications pertain to the inclusion of oscillatory modal aerodynamic loads of blades with large (backward and forward) varying sweep.

Long Island Transportation Plan to Manage Congestion: Framework for Developing and Evaluating Improvement Strategies

DOT National Transportation Integrated Search

2002-04-20

The Long Island Transportation Plan to Manage Congestion (LITP 2000) will establish an integrated, multi-modal transportation program of cost-effective strategies to manage congestion and improve the movement of people and goods in Nassau and Suffolk...

Accuracy, risk and the intrinsic value of diagnostic imaging: a review of the cost-utility literature.

PubMed

Otero, Hansel J; Fang, Chi H; Sekar, Meera; Ward, Robert J; Neumann, Peter J

2012-05-01

The aim of this study was to systematically review the reporting of the value of imaging unrelated to treatment consequences and test characteristics in all imaging-related published cost-utility analyses (CUAs) in the medical literature. All CUAs published between 1976 and 2008 evaluating diagnostic imaging technologies contained in the CEA Registry, a publicly available comprehensive database of health related CUAs, were screened. Publication characteristics, imaging modality, and the inclusion of test characteristics including accuracy, costs, risks, and the potential value unrelated to treatment consequences (eg, reassurance or anxiety) were assessed. Ninety-six published CUAs evaluating 155 different imaging technologies were included in the final sample; 27 studies were published in imaging-specialized journals. Fifty-two studies (54%) evaluated the performance of a single imaging modality, while 44 studies (46%) compared two or more different imaging modalities. The most common areas of interest were cardiovascular (45%) and neuroradiology (17%). Forty-two technologies (27%) concerned ultrasound, while 34 (22%) concerned magnetic resonance. Seventy-nine (51%) technologies used ionizing radiation. Test accuracy was reported or calculated for 90% (n = 133 and n = 5, respectively) and assumed perfect (reference test or gold-standard test without alternative testing strategy to capture false-negatives and false-positives) for 8% (n = 12) of technologies. Only 22 studies (23%) assessing 40 imaging technologies (26%) considered inconclusive or indeterminate results. The risk of testing was reported for 32 imaging technologies (21%). Fifteen studies (16%) considered the value of diagnostic imaging unrelated to treatment. Four studies incorporated it as quality-of-life adjustments, while 10 studies mentioned it only in their discussions or as a limitation. The intrinsic value of imaging (the value of imaging unrelated to treatment) has not been appropriately defined or incorporated in the existing cost-utility literature, which could be due to a lack of evidence on the issue. Thus, more research is needed on metrics for a more comprehensive evaluation of diagnostic imaging. Similarly, the incorporation of variations in imaging tests accuracy, inconclusive results and associated risks has lacked uniformity in the cost-utility literature. Acknowledgment of these characteristics in future cost-utility publications will enhance their value and provide results that more closely resemble routine clinical practice. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

Microsoft kinect-based artificial perception system for control of functional electrical stimulation assisted grasping.

PubMed

Strbac, Matija; Kočović, Slobodan; Marković, Marko; Popović, Dejan B

2014-01-01

We present a computer vision algorithm that incorporates a heuristic model which mimics a biological control system for the estimation of control signals used in functional electrical stimulation (FES) assisted grasping. The developed processing software acquires the data from Microsoft Kinect camera and implements real-time hand tracking and object analysis. This information can be used to identify temporal synchrony and spatial synergies modalities for FES control. Therefore, the algorithm acts as artificial perception which mimics human visual perception by identifying the position and shape of the object with respect to the position of the hand in real time during the planning phase of the grasp. This artificial perception used within the heuristically developed model allows selection of the appropriate grasp and prehension. The experiments demonstrate that correct grasp modality was selected in more than 90% of tested scenarios/objects. The system is portable, and the components are low in cost and robust; hence, it can be used for the FES in clinical or even home environment. The main application of the system is envisioned for functional electrical therapy, that is, intensive exercise assisted with FES.

Microsoft Kinect-Based Artificial Perception System for Control of Functional Electrical Stimulation Assisted Grasping

PubMed Central

Kočović, Slobodan; Popović, Dejan B.

2014-01-01

We present a computer vision algorithm that incorporates a heuristic model which mimics a biological control system for the estimation of control signals used in functional electrical stimulation (FES) assisted grasping. The developed processing software acquires the data from Microsoft Kinect camera and implements real-time hand tracking and object analysis. This information can be used to identify temporal synchrony and spatial synergies modalities for FES control. Therefore, the algorithm acts as artificial perception which mimics human visual perception by identifying the position and shape of the object with respect to the position of the hand in real time during the planning phase of the grasp. This artificial perception used within the heuristically developed model allows selection of the appropriate grasp and prehension. The experiments demonstrate that correct grasp modality was selected in more than 90% of tested scenarios/objects. The system is portable, and the components are low in cost and robust; hence, it can be used for the FES in clinical or even home environment. The main application of the system is envisioned for functional electrical therapy, that is, intensive exercise assisted with FES. PMID:25202707

Development of Reduced-Order Models for Aeroelastic and Flutter Prediction Using the CFL3Dv6.0 Code

NASA Technical Reports Server (NTRS)

Silva, Walter A.; Bartels, Robert E.

2002-01-01

A reduced-order model (ROM) is developed for aeroelastic analysis using the CFL3D version 6.0 computational fluid dynamics (CFD) code, recently developed at the NASA Langley Research Center. This latest version of the flow solver includes a deforming mesh capability, a modal structural definition for nonlinear aeroelastic analyses, and a parallelization capability that provides a significant increase in computational efficiency. Flutter results for the AGARD 445.6 Wing computed using CFL3D v6.0 are presented, including discussion of associated computational costs. Modal impulse responses of the unsteady aerodynamic system are then computed using the CFL3Dv6 code and transformed into state-space form. Important numerical issues associated with the computation of the impulse responses are presented. The unsteady aerodynamic state-space ROM is then combined with a state-space model of the structure to create an aeroelastic simulation using the MATLAB/SIMULINK environment. The MATLAB/SIMULINK ROM is used to rapidly compute aeroelastic transients including flutter. The ROM shows excellent agreement with the aeroelastic analyses computed using the CFL3Dv6.0 code directly.

Hybrid Residual Flexibility/Mass-Additive Method for Structural Dynamic Testing

NASA Technical Reports Server (NTRS)

Tinker, M. L.

2003-01-01

A large fixture was designed and constructed for modal vibration testing of International Space Station elements. This fixed-base test fixture, which weighs thousands of pounds and is anchored to a massive concrete floor, initially utilized spherical bearings and pendulum mechanisms to simulate Shuttle orbiter boundary constraints for launch of the hardware. Many difficulties were encountered during a checkout test of the common module prototype structure, mainly due to undesirable friction and excessive clearances in the test-article-to-fixture interface bearings. Measured mode shapes and frequencies were not representative of orbiter-constrained modes due to the friction and clearance effects in the bearings. As a result, a major redesign effort for the interface mechanisms was undertaken. The total cost of the fixture design, construction and checkout, and redesign was over $2 million. Because of the problems experienced with fixed-base testing, alternative free-suspension methods were studied, including the residual flexibility and mass-additive approaches. Free-suspension structural dynamics test methods utilize soft elastic bungee cords and overhead frame suspension systems that are less complex and much less expensive than fixed-base systems. The cost of free-suspension fixturing is on the order of tens of thousands of dollars as opposed to millions, for large fixed-base fixturing. In addition, free-suspension test configurations are portable, allowing modal tests to be done at sites without modal test facilities. For example, a mass-additive modal test of the ASTRO-1 Shuttle payload was done at the Kennedy Space Center launch site. In this Technical Memorandum, the mass-additive and residual flexibility test methods are described in detail. A discussion of a hybrid approach that combines the best characteristics of each method follows and is the focus of the study.

Treatment trends and Medicare reimbursements for localized prostate cancer in elderly patients.

PubMed

Dell'oglio, Paolo; Valiquette, Anne Sophie; Leyh-Bannurah, Sami-Ramzi; Tian, Zhe; Trudeau, Vincent; Larcher, Alessandro; Shariat, Shahrokh F; Capitanio, Umberto; Briganti, Alberto; Graefen, Markus; Montorsi, Francesco; Karakiewicz, Pierre I

2018-03-19

The absolute and proportional numbers of elderly patients diagnosed with localized prostate cancer (PCa) are on the rise. We examined treatment trends and reimbursement figures in localized PCa patients aged ≥80 years. Between 2000 and 2008, we identified 30 217 localized PCa patients aged ≥80 years in Surveillance, Epidemiology and End Results (SEER)-Medicare-linked database. Alternative treatment modalities consisted of conservative management (CM), radiation therapy (RT), radical prostatectomy (RP), and primary androgen-deprivation therapy (PADT). For all four modalities, utilization and reimbursements were examined. PADT was the most frequently used treatment modality between 2000 and 2005. CM became the dominant treatment modality from 2006-2008. RP rates were marginal and RT ranked third and its annual rate increased from 20.77% in 2000 to 29.13% in 2008. Median individual reimbursement of RT was highest and ranged from $29 343 in 2000 to $31 090 in 2008, followed by RP (from $20 560 in 2000 to $19 580 in 2008), PADT (from $18 901 in 2000 to $8000 in 2008) and CM (from $1824 in 2000 to $1938 in 2008). RT contributed to most of the cumulative annual reimbursements from 2003 (49.24%) to 2008 (72.97%). PADT ranked first from 2000 (54.56%) to 2002 (50.49%), but decreased by 19.40% in 2008. CM's contribution increased from 4.42% in 2000 to 6.96% in 2008. RP share of reimbursements was stable during the study period. Our results, focusing on localized PCa treatment in patients aged ≥80 years, showed an important increase in rates, median cost, and proportion of cumulative cost related to RT.

Projections of Demand for Waterborne Transportation, Ohio River Basin, 1980, 1990, 2000, 2020, 2040. Volume 1. Study Summary.

DTIC Science & Technology

1980-12-01

NOTES 3 19. KEY WORDS (Continue on revere side If n.cessary d Identify by block number) Bulk cargo Market demand analysis Commodity resource inventory...The study included a Commodity Resource Inventory, a Modal Split Analysis and a Market Demand Analysis. The work included investigation and analyses...inventory, a modal split analysis and a market demand analysis. The work included investigation and analyses of the production, transportation, and

Comparison of the levonorgestrel-releasing intrauterine system, hysterectomy, and endometrial ablation for heavy menstrual bleeding in a decision analysis model.

PubMed

Louie, Michelle; Spencer, Jennifer; Wheeler, Stephanie; Ellis, Victoria; Toubia, Tarek; Schiff, Lauren D; Siedhoff, Matthew T; Moulder, Janelle K

2017-11-01

A better understanding of the relative risks and benefits of common treatment options for abnormal uterine bleeding (AUB) can help providers and patients to make balanced, evidence-based decisions. To provide comparative estimates of clinical outcomes after placement of levonorgestrel-releasing intrauterine system (LNG-IUS), ablation, or hysterectomy for AUB. A PubMED search was done using combinations of search terms related to abnormal uterine bleeding, LNG-IUS, hysterectomy, endometrial ablation, cost-benefit analysis, cost-effectiveness, and quality-adjusted life years. Full articles published in 2006-2016 available in English comparing at least two treatment modalities of interest among women of reproductive age with AUB were included. A decision tree was generated to compare clinical outcomes in a hypothetical cohort of 100 000 premenopausal women with nonmalignant AUB. We evaluated complications, mortality, and treatment outcomes over a 5-year period, calculated cumulative quality-adjusted life years (QALYs), and conducted probabilistic sensitivity analysis. Levonorgestrel-releasing intrauterine system had the highest number of QALYs (406 920), followed by hysterectomy (403 466), non-resectoscopic ablation (399 244), and resectoscopic ablation (395 827). Ablation had more treatment failures and complications than LNG-IUS and hysterectomy. Findings were robust in probabilistic sensitivity analysis. Levonorgestrel-releasing intrauterine system and hysterectomy outperformed endometrial ablation for treatment of AUB. © 2017 International Federation of Gynecology and Obstetrics.

Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

NASA Astrophysics Data System (ADS)

Gosse, Conrad A.; Clarens, Andres F.

2013-03-01

Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users.

Simultaneous photoacoustic and optically mediated ultrasound microscopy: an in vivo study

PubMed Central

Orlova, Anna; Shirmanova, Marina; Postnikova, Anna; Turchin, Ilya

2015-01-01

We propose the use of thermoelastic (TE) excitation of an ultrasonic (US) detector by backscattered laser radiation as a means of upgrading a single-modality photoacoustic (PA) microscope to dual-modality PA/US imaging at minimal cost. The upgraded scanning head of our dual-modality microscope consists of a fiber bundle with 14 output arms and a 32MHz polyvinylidene difluoride (PVDF) detector with a 34 MHz bandwidth (−6 dB level), 12.7 mm focal length, and a 0.25 numerical aperture. A single optical pulse delivered through the fiber bundle to the biotissue being investigated, in combination with a metalized surface on the PVDF detector allows us to obtain both PA and US A-scans. To demonstrate the in vivo capabilities of the proposed method we present the results of bimodal imaging of the brain of a newborn rat, a mouse tail and a mouse tumor. PMID:25780752

The effects of speech controls on performance in advanced helicopters in a double stimulation paradigm

NASA Technical Reports Server (NTRS)

Bortolussi, Michael R.; Vidulich, Michael A.

1991-01-01

The potential benefit of speech as a control modality has been investigated with mixed results. Earlier studies suggests that speech controls can reduce the potential of manual control overloads and improve time-sharing performance. However, these benefits were not without costs. Pilots reported higher workload levels associated with the use of speech controls. To further investigate these previous findings, an experiment was conducted in a simulation of an advanced single-pilot, scout/attack helicopter at NASA-Ames' ICAB (interchangeable cab) facility. Objective performance data suggested that speech control modality was effective in reducing interference of discrete, time-shared responses during continuous flight control activity. Subjective ratings, however, indicated that the speech control modality increased workload. Post-flight debriefing indicated that these results were mainly due to the increased effort to speak precisely to a less than perfect voice recognition system.

Highly sensitive force sensor based on balloon-like interferometer

NASA Astrophysics Data System (ADS)

Wu, Yue; Xiao, Shiying; Xu, Yao; Shen, Ya; Jiang, Youchao; Jin, Wenxing; Yang, Yuguang; Jian, Shuisheng

2018-07-01

An all-fiber highly sensitive force sensor based on modal interferometer has been presented and demonstrated. The single-mode fiber (SMF) with coating stripped is designed into a balloon-like shape to form a modal interferometer. Due to the bent SMF, the interference occurs between the core mode and cladding modes. With variation of the force applied to the balloon-like interferometer, the bending diameter changes, which caused the wavelength shift of the modal interference. Thus the measurement of the force variation can be achieved by monitoring the wavelength shift. The performances of the interferometer with different bending diameter are experimentally investigated, and the maximum force sensitivity of 24.9 pm/ μ N can be achieved with the bending diameter 14 mm ranging from 0 μ N to 1464.12 μ N. Furthermore, the proposed fiber sensor exhibits the advantages of easy fabrication and low cost, making it a suitable candidate in the optical fiber sensing field.

Antibiofouling polymer coated gold nanoparticles as a dual modal contrast agent for X-ray and photoacoustic imaging

NASA Astrophysics Data System (ADS)

Huang, Guojia; Yuan, Yi; Xing, Da

2011-01-01

X-ray is one of the most useful diagnostic tools in hospitals in terms of frequency of use and cost, while photoacoustic (PA) imaging is a rapidly emerging non-invasive imaging technology that integrates the merits of high optical contrast with high ultrasound resolution. In this study, for the first time, we used gold nanoparticles (GNPs) as a dual modal contrast agent for X-ray and PA imaging. Soft gelatin phantoms with embedded tumor simulators of GNPs in various concentrations are clearly shown in both X-ray and PA imaging. With GNPs as a dual modal contrast agent, X-ray can fast detect the position of tumor and provide morphological information, whereas PA imaging has important potential applications in the image guided therapy of superficial tumors such as breast cancer, melanoma and Merkel cell carcinoma.

Achieving a high mode count in the exact electromagnetic simulation of diffractive optical elements.

PubMed

Junker, André; Brenner, Karl-Heinz

2018-03-01

The application of rigorous optical simulation algorithms, both in the modal as well as in the time domain, is known to be limited to the nano-optical scale due to severe computing time and memory constraints. This is true even for today's high-performance computers. To address this problem, we develop the fast rigorous iterative method (FRIM), an algorithm based on an iterative approach, which, under certain conditions, allows solving also large-size problems approximation free. We achieve this in the case of a modal representation by avoiding the computationally complex eigenmode decomposition. Thereby, the numerical cost is reduced from O(N 3 ) to O(N log N), enabling a simulation of structures like certain diffractive optical elements with a significantly higher mode count than presently possible. Apart from speed, another major advantage of the iterative FRIM over standard modal methods is the possibility to trade runtime against accuracy.

Telephone, print, and Web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review.

PubMed

Goode, Ana D; Lawler, Sheleigh P; Brakenridge, Charlotte L; Reeves, Marina M; Eakin, Elizabeth G

2015-12-01

Broad-reach (non-face-to-face) modalities offer an accessible and cost-effective means to provide behavior change programs in diverse and growing cancer survivor populations. The purpose of this systematic review is to evaluate the efficacy of physical activity, dietary, and/or weight control interventions for cancer survivors in which telephone, short-message service, print, and/or Web is the primary method of delivery. A structured search of PubMed, Embase, Web of Science, CINAHL, and CENTRAL (May 2013) was conducted. Included studies focused and reported on physical activity (PA) and dietary change and/or weight control in adult cancer survivors, delivered at least 50% of intervention contacts by broad-reach modality and included a control group. Study design, intervention features, and behavioral/weight outcomes were extracted, tabulated, and summarized. Twenty-seven studies were included; 22 telephone, three Web, and two print. Sixteen studies targeted PA, two diet, and nine targeted multiple behaviors. Most studies (18/27) targeted a single survivor group, namely breast cancer (n = 12). Nineteen of 27 studies found evidence for initiation of behavior change, with only eight reporting on maintenance and one on cost-effectiveness. This review provides support for broad-reach modalities, particularly the telephone, in the delivery of lifestyle interventions to cancer survivors. Future research should evaluate (1) newer technologies (i.e., SMS and mobile phone applications), (2) interventions for diverse cancer survivors and those targeting multiple behaviors, (3) long-term outcomes, and 4) cost-effectiveness. Broad-reach lifestyle interventions are effective, with further research needed to evaluate their generalizability and integration into cancer care.

An Investigation of New Snow Water Equivalence Sensing Modalities

NASA Astrophysics Data System (ADS)

Frolik, J.; Skalka, C.; Wemple, B.

2008-12-01

It is well known that snowpack is highly variable and influenced by a range of factors, including topography and vegetation cover. As such, single point measurements may be viewed as being inadequate to characterize snowpack in a given area. Thus motivated by the desire for distributed sensing, this work presents results of a proof-of-concept investigation for new, low-cost, snow water equivalence (SWE) sensors based on the attenuation of microwave and gamma radiation. First, our work considers the attenuation of microwave signals at 2.4 GHz and 5 GHz due to an accumulating snowpack. These frequencies coincide with those used for common wireless networks and thus our proposed sensor can leverage existing hardware designs which are low-cost and power efficient. Second, we present attenuation data for radiation energy occurring between 500 keV and 1 MeV. These results were obtained utilizing a radiation detector based on Cadmium Zinc Telluride (CZT) technology. The proposed sensor will leverage recent investments such CZT based designs for homeland security applications. We contend that sensors based on these modalities will be low-cost and low-energy and thus readily integrated with wireless sensor network hardware for distributed monitoring. In addition, these sensors will be compact and thus can be placed in locations not feasible for current SWE sensor designs (e.g., snow pillows) or in locations too dangerous for snow course measurements (e.g., areas prone to avalanche). Since neither sensing methods requires contact with the snowpack, these modalities are also immune to snow bridging effects which plague existing designs. We also present preliminary findings of work conducted in a mountainous forested setting in northern New England which examines the influence of forest vegetation on snowpack.

Conceptual Structure within and between Modalities

PubMed Central

Dilkina, Katia; Lambon Ralph, Matthew A.

2012-01-01

Current views of semantic memory share the assumption that conceptual representations are based on multimodal experience, which activates distinct modality-specific brain regions. This proposition is widely accepted, yet little is known about how each modality contributes to conceptual knowledge and how the structure of this contribution varies across these multiple information sources. We used verbal feature lists, features from drawings, and verbal co-occurrence statistics from latent semantic analysis to examine the informational structure in four domains of knowledge: perceptual, functional, encyclopedic, and verbal. The goals of the analysis were three-fold: (1) to assess the structure within individual modalities; (2) to compare structures between modalities; and (3) to assess the degree to which concepts organize categorically or randomly. Our results indicated significant and unique structure in all four modalities: perceptually, concepts organize based on prominent features such as shape, size, color, and parts; functionally, they group based on use and interaction; encyclopedically, they arrange based on commonality in location or behavior; and verbally, they group associatively or relationally. Visual/perceptual knowledge gives rise to the strongest hierarchical organization and is closest to classic taxonomic structure. Information is organized somewhat similarly in the perceptual and encyclopedic domains, which differs significantly from the structure in the functional and verbal domains. Notably, the verbal modality has the most unique organization, which is not at all categorical but also not random. The idiosyncrasy and complexity of conceptual structure across modalities raise the question of how all of these modality-specific experiences are fused together into coherent, multifaceted yet unified concepts. Accordingly, both methodological and theoretical implications of the present findings are discussed. PMID:23293593

Diagnoses-based cost groups in the Dutch risk-equalization model: the effects of including outpatient diagnoses.

PubMed

van Kleef, R C; van Vliet, R C J A; van Rooijen, E M

2014-03-01

The Dutch basic health-insurance scheme for curative care includes a risk equalization model (RE-model) to compensate competing health insurers for the predictable high costs of people in poor health. Since 2004, this RE-model includes the so-called Diagnoses-based Cost Groups (DCGs) as a risk adjuster. Until 2013, these DCGs have been mainly based on diagnoses from inpatient hospital treatment. This paper examines (1) to what extent the Dutch RE-model can be improved by extending the inpatient DCGs with diagnoses from outpatient hospital treatment and (2) how to treat outpatient diagnoses relative to their corresponding inpatient diagnoses. Based on individual-level administrative costs we estimate the Dutch RE-model with three different DCG modalities. Using individual-level survey information from a prior year we examine the outcomes of these modalities for different groups of people in poor health. We find that extending DCGs with outpatient diagnoses has hardly any effect on the R-squared of the RE-model, but reduces the undercompensation for people with a chronic condition by about 8%. With respect to incentives, it may be preferable to make no distinction between corresponding inpatient and outpatient diagnoses in the DCG-classification, although this will be at the expense of the predictive accuracy of the RE-model. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

An efficient high-frequency analysis of modal reflection and transmission coefficients for a class of waveguide discontinuities

NASA Technical Reports Server (NTRS)

Pathak, P. H.; Altintas, A.

1988-01-01

A high-frequency analysis of electromagnetic modal reflection and transmission coefficients is presented for waveguide discontinuities formed by joining different waveguide sections. The analysis uses an extended version of the concept of geometrical theory of diffraction based equivalent edge currents in conjunction with the reciprocity theorem to describe interior scattering effects. If the waveguide modes and their associated modal rays can be found explicitly, general two- and three-dimensional waveguide geometries can be analyzed. Expressions are developed for two-dimensional reflection and transmission coefficients. Numerical results are given for a flanged, semi-infinite parallel plate waveguide and for the junction between two linearly tapered waveguides.

Modal simulation analysis of novel 3D elliptical ultrasonic transducer

NASA Astrophysics Data System (ADS)

Kurniawan, R.; Ali, S.; Ko, T. J.

2018-03-01

This paper aims to present the modal simulation analysis results of a novel 3D elliptical ultrasonic transducer. This research aims to develop a novel elliptical transducer that works in ultrasonic and is able to generate a three dimensional motion in Cartesian space. The concept of the transducer design is basically to find a coupling frequency of the longitudinal-bending-bending mode. To achieve that purpose, the modal simulation analysis was performed to find a proper dimension of the transducer, thus the natural frequency of the 1st longitudinal mode is much closed with the two of natural frequency of the 3rd bending mode. The finite element modelling (FEM) was used to perform this work.

Completely automated modal analysis procedure based on the combination of different OMA methods

NASA Astrophysics Data System (ADS)

Ripamonti, Francesco; Bussini, Alberto; Resta, Ferruccio

2018-03-01

In this work a completely automated output-only Modal Analysis procedure is presented and all its benefits are listed. Based on the merging of different Operational Modal Analysis methods and a statistical approach, the identification process has been improved becoming more robust and giving as results only the real natural frequencies, damping ratios and mode shapes of the system. The effect of the temperature can be taken into account as well, leading to the creation of a better tool for automated Structural Health Monitoring. The algorithm has been developed and tested on a numerical model of a scaled three-story steel building present in the laboratories of Politecnico di Milano.

Finite-Element Vibration Analysis and Modal Testing of Graphite Epoxy Tubes and Correlation Between the Data

NASA Technical Reports Server (NTRS)

Taleghani, Barmac K.; Pappa, Richard S.

1996-01-01

Structural materials in the form of graphite epoxy composites with embedded rubber layers are being used to reduce vibrations in rocket motor tubes. Four filament-wound, graphite epoxy tubes were studied to evaluate the effects of the rubber layer on the modal parameters (natural vibration frequencies, damping, and mode shapes). Tube 1 contained six alternating layers of 30-degree helical wraps and 90-degree hoop wraps. Tube 2 was identical to tube 1 with the addition of an embedded 0.030-inch-thick rubber layer. Tubes 3 and 4 were identical to tubes 1 and 2, respectively, with the addition of a Textron Kelpoxy elastomer. This report compares experimental modal parameters obtained by impact testing with analytical modal parameters obtained by NASTRAN finite-element analysis. Four test modes of tube 1 and five test modes of tube 3 correlate highly with corresponding analytical predictions. Unsatisfactory correlation of test and analysis results occurred for tubes 2 and 4 and these comparisons are not shown. Work is underway to improve the analytical models of these tubes. Test results clearly show that the embedded rubber layers significantly increase structural modal damping as well as decrease natural vibration frequencies.

Identification of Historical Veziragasi Aqueduct Using the Operational Modal Analysis

PubMed Central

Ercan, E.; Nuhoglu, A.

2014-01-01

This paper describes the results of a model updating study conducted on a historical aqueduct, called Veziragasi, in Turkey. The output-only modal identification results obtained from ambient vibration measurements of the structure were used to update a finite element model of the structure. For the purposes of developing a solid model of the structure, the dimensions of the structure, defects, and material degradations in the structure were determined in detail by making a measurement survey. For evaluation of the material properties of the structure, nondestructive and destructive testing methods were applied. The modal analysis of the structure was calculated by FEM. Then, a nondestructive dynamic test as well as operational modal analysis was carried out and dynamic properties were extracted. The natural frequencies and corresponding mode shapes were determined from both theoretical and experimental modal analyses and compared with each other. A good harmony was attained between mode shapes, but there were some differences between natural frequencies. The sources of the differences were introduced and the FEM model was updated by changing material parameters and boundary conditions. Finally, the real analytical model of the aqueduct was put forward and the results were discussed. PMID:24511287

Modal response of a computational vocal fold model with a substrate layer of adipose tissue.

PubMed

Jones, Cameron L; Achuthan, Ajit; Erath, Byron D

2015-02-01

This study demonstrates the effect of a substrate layer of adipose tissue on the modal response of the vocal folds, and hence, on the mechanics of voice production. Modal analysis is performed on the vocal fold structure with a lateral layer of adipose tissue. A finite element model is employed, and the first six mode shapes and modal frequencies are studied. The results show significant changes in modal frequencies and substantial variation in mode shapes depending on the strain rate of the adipose tissue. These findings highlight the importance of considering adipose tissue in computational vocal fold modeling.

Community financing of local ivermectin distribution in Nigeria: potential payment and cost-recovery outlook.

PubMed

Onwujekwe, O E; Shu, E N; Okonkwo, P O

2000-04-01

The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.

Surface-emitting circular DFB, disk- and ring- Bragg resonator lasers with chirped gratings: a unified theory and comparative study.

PubMed

Sun, Xiankai; Yariv, Amnon

2008-06-09

We have developed a theory that unifies the analysis of the modal properties of surface-emitting chirped circular grating lasers. This theory is based on solving the resonance conditions which involve two types of reflectivities of chirped circular gratings. This approach is shown to be in agreement with previous derivations which use the characteristic equations. Utilizing this unified analysis, we obtain the modal properties of circular DFB, disk-, and ring- Bragg resonator lasers. We also compare the threshold gain, single mode range, quality factor, emission efficiency, and modal area of these types of circular grating lasers. It is demonstrated that, under similar conditions, disk Bragg resonator lasers have the highest quality factor, the highest emission efficiency, and the smallest modal area, indicating their suitability in low-threshold, high-efficiency, ultracompact laser design, while ring Bragg resonator lasers have a large single mode range, high emission efficiency, and large modal area, indicating their suitability for high-efficiency, large-area, high-power applications.

The influence of patients' decisions on treatment planning in restorative dentistry.

PubMed

Kalsi, Jagdip S; Hemmings, Kenneth

2013-11-01

As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected. This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out. Many psychological and social determinants influence patients'values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.

Negligence claims following non-union and malunion of long bone fractures: An analysis of 15 years of data.

PubMed

Metcalfe, C W; Harrison, W D; Nayagam, S; Narayan, B

2016-10-01

Non-unions and malunions are recognised to be complications of the treatment of long bone fractures. No previous work has looked at the implications of these complications from a medicolegal perspective. A complete database of litigation claims in Trauma and Orthopaedic Surgery was obtained from the NHS Litigation Authority. Two separate modalities of the treatment of long bone fractures were examined i) non-union and ii) acquired deformity. The type of complaint, whether defended or not, and costs were analysed. There were claims of which 97 related to non-union and 32 related to postoperative limb deformity. The total cost was £8.2 million over a 15-year period in England and Wales. Femoral and tibial non-unions were more expensive particularly if they resulted in amputation. Rotational deformity cost nearly twice as much as angulation deformities. The cosmetic appearances of rotational malalignment and amputation results in higher compensation; this reinforces an outward perception of outcome as being more important than harmful effects. Notwithstanding the limitations of this database, there are clinical lessons to be gained from these litigation claims. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Response format, magnitude of laterality effects, and sex differences in laterality.

PubMed

Voyer, Daniel; Doyle, Randi A

2012-01-01

The present study examined the evidence for the claim that response format might affect the magnitude of laterality effects by means of a meta-analysis. The analysis included the 396 effect sizes drawn from 266 studies retrieved by Voyer (1996) and relevant to the main effect of laterality and sex differences in laterality for verbal and non-verbal tasks in the auditory, tactile, and visual sensory modality. The response format used in specific studies was the only moderator variable of interest in the present analysis, resulting in four broad response categories (oral, written, computer, and pointing). A meta-analysis analogue to ANOVA showed no significant influence of response format on either the main effect of laterality or sex differences in laterality when all sensory modalities were combined. However, when modalities were considered separately, response format affected the main effect of laterality in the visual modality, with a clear advantage for written responses. Further pointed analyses revealed some specific differences among response formats. Results are discussed in terms of their implications for the measurement of laterality.

Comparison of modal analysis results of laser vibrometry and nearfield acoustical holography measurements of an aluminum plate

NASA Astrophysics Data System (ADS)

Potter, Jennifer L.

2011-12-01

Noise and vibration has long been sought to be reduced in major industries: automotive, aerospace and marine to name a few. Products must be tested and pass certain levels of federally regulated standards before entering the market. Vibration measurements are commonly acquired using accelerometers; however limitations of this method create a need for alternative solutions. Two methods for non-contact vibration measurements are compared: Laser Vibrometry, which directly measures the surface velocity of the aluminum plate, and Nearfield Acoustic Holography (NAH), which measures sound pressure in the nearfield, and using Green's Functions, reconstructs the surface velocity at the plate. The surface velocity from each method is then used in modal analysis to determine the comparability of frequency, damping and mode shapes. Frequency and mode shapes are also compared to an FEA model. Laser Vibrometry is a proven, direct method for determining surface velocity and subsequently calculating modal analysis results. NAH is an effective method in locating noise sources, especially those that are not well separated spatially. Little work has been done in incorporating NAH into modal analysis.

Joint analysis of multiple high-dimensional data types using sparse matrix approximations of rank-1 with applications to ovarian and liver cancer.

PubMed

Okimoto, Gordon; Zeinalzadeh, Ashkan; Wenska, Tom; Loomis, Michael; Nation, James B; Fabre, Tiphaine; Tiirikainen, Maarit; Hernandez, Brenda; Chan, Owen; Wong, Linda; Kwee, Sandi

2016-01-01

Technological advances enable the cost-effective acquisition of Multi-Modal Data Sets (MMDS) composed of measurements for multiple, high-dimensional data types obtained from a common set of bio-samples. The joint analysis of the data matrices associated with the different data types of a MMDS should provide a more focused view of the biology underlying complex diseases such as cancer that would not be apparent from the analysis of a single data type alone. As multi-modal data rapidly accumulate in research laboratories and public databases such as The Cancer Genome Atlas (TCGA), the translation of such data into clinically actionable knowledge has been slowed by the lack of computational tools capable of analyzing MMDSs. Here, we describe the Joint Analysis of Many Matrices by ITeration (JAMMIT) algorithm that jointly analyzes the data matrices of a MMDS using sparse matrix approximations of rank-1. The JAMMIT algorithm jointly approximates an arbitrary number of data matrices by rank-1 outer-products composed of "sparse" left-singular vectors (eigen-arrays) that are unique to each matrix and a right-singular vector (eigen-signal) that is common to all the matrices. The non-zero coefficients of the eigen-arrays identify small subsets of variables for each data type (i.e., signatures) that in aggregate, or individually, best explain a dominant eigen-signal defined on the columns of the data matrices. The approximation is specified by a single "sparsity" parameter that is selected based on false discovery rate estimated by permutation testing. Multiple signals of interest in a given MDDS are sequentially detected and modeled by iterating JAMMIT on "residual" data matrices that result from a given sparse approximation. We show that JAMMIT outperforms other joint analysis algorithms in the detection of multiple signatures embedded in simulated MDDS. On real multimodal data for ovarian and liver cancer we show that JAMMIT identified multi-modal signatures that were clinically informative and enriched for cancer-related biology. Sparse matrix approximations of rank-1 provide a simple yet effective means of jointly reducing multiple, big data types to a small subset of variables that characterize important clinical and/or biological attributes of the bio-samples from which the data were acquired.

A cost-utility analysis of ablative therapy for Barrett’s esophagus

PubMed Central

Inadomi, John M.; Somsouk, Ma; Madanick, Ryan D.; Thomas, Jennifer P.; Shaheen, Nicholas J.

2009-01-01

Background & Aims Recommendations for patients with Barrett’s esophagus (BE) include endoscopic surveillance with esophagectomy for early-stage cancer, although new technologies to ablate dysplasia and metaplasia are available. This study compares the cost-utility of ablation with that of endoscopic surveillance strategies. Methods A decision analysis model was created to examine a population of patients with BE (mean age 50), with separate analyses for patients with no dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). Strategies compared were: no endoscopic surveillance; endoscopic surveillance with ablation for incident dysplasia; immediate ablation followed by endoscopic surveillance in all patients or limited to patients in whom metaplasia persisted, and esophagectomy. Ablation modalities modeled included radiofrequency, argon plasma coagulation, multipolar electrocoagulation and photodynamic therapy. Results Endoscopic ablation for patients with HGD could increase life expectancy by 3 quality-adjusted years at an incremental cost of < $6,000, compared with no intervention. Patients with LGD or no dysplasia can also be optimally managed with ablation, but continued surveillance after eradication of metaplasia is expensive. If ablation permanently eradicates at least 28% of LGD or 40% of non-dysplastic metaplasias, ablation would be preferred to surveillance. Conclusions Endoscopic ablation could be the preferred strategy for managing patients with BE with HGD. Ablation might also be preferred in subjects with LGD or no dysplasia, but the cost-effectiveness depends on the long-term effectiveness of ablation and whether surveillance endoscopy can be discontinued following successful ablation. As further post-ablation data become available, the optimal management strategy will be clarified. PMID:19272389

Projections of Demand for Waterborne Transportation, Ohio River Basin, 1980, 1990, 2000, 2020, 2040. Volume 10. Group VIII. Iron Ore, Steel and Iron.

DTIC Science & Technology

1980-12-01

SUPPLEMENTARY NOTES 19. KEY WORDS (Continue on reverse aide if neceeary aod identify by block number) Bulk cargo Market demand analysis Iron Commodity resource...shown below. The study included a Commodity Resource Inventory, a Modal Split Analysis and a Market Demand Analysis. The work included investigation...resource inventory, a modal split analysis and a market demand analysis. The work included investigation and analyses of the production

Dynamic Facial Expressions Prime the Processing of Emotional Prosody.

PubMed

Garrido-Vásquez, Patricia; Pell, Marc D; Paulmann, Silke; Kotz, Sonja A

2018-01-01

Evidence suggests that emotion is represented supramodally in the human brain. Emotional facial expressions, which often precede vocally expressed emotion in real life, can modulate event-related potentials (N100 and P200) during emotional prosody processing. To investigate these cross-modal emotional interactions, two lines of research have been put forward: cross-modal integration and cross-modal priming. In cross-modal integration studies, visual and auditory channels are temporally aligned, while in priming studies they are presented consecutively. Here we used cross-modal emotional priming to study the interaction of dynamic visual and auditory emotional information. Specifically, we presented dynamic facial expressions (angry, happy, neutral) as primes and emotionally-intoned pseudo-speech sentences (angry, happy) as targets. We were interested in how prime-target congruency would affect early auditory event-related potentials, i.e., N100 and P200, in order to shed more light on how dynamic facial information is used in cross-modal emotional prediction. Results showed enhanced N100 amplitudes for incongruently primed compared to congruently and neutrally primed emotional prosody, while the latter two conditions did not significantly differ. However, N100 peak latency was significantly delayed in the neutral condition compared to the other two conditions. Source reconstruction revealed that the right parahippocampal gyrus was activated in incongruent compared to congruent trials in the N100 time window. No significant ERP effects were observed in the P200 range. Our results indicate that dynamic facial expressions influence vocal emotion processing at an early point in time, and that an emotional mismatch between a facial expression and its ensuing vocal emotional signal induces additional processing costs in the brain, potentially because the cross-modal emotional prediction mechanism is violated in case of emotional prime-target incongruency.

Multi-modal spectroscopic imaging with synchrotron light to study mechanisms of brain disease

NASA Astrophysics Data System (ADS)

Summers, Kelly L.; Fimognari, Nicholas; Hollings, Ashley; Kiernan, Mitchell; Lam, Virginie; Tidy, Rebecca J.; Takechi, Ryu; George, Graham N.; Pickering, Ingrid J.; Mamo, John C.; Harris, Hugh H.; Hackett, Mark J.

2017-04-01

The international health care costs associated with Alzheimer's disease (AD) and dementia have been predicted to reach $2 trillion USD by 2030. As such, there is urgent need to develop new treatments and diagnostic methods to stem an international health crisis. A major limitation to therapy and diagnostic development is the lack of complete understanding about the disease mechanisms. Spectroscopic methods at synchrotron light sources, such as FTIR, XRF, and XAS, offer a "multi-modal imaging platform" to reveal a wealth of important biochemical information in situ within ex vivo tissue sections, to increase our understanding of disease mechanisms.

Should Nitrous Oxide Be Used for Laboring Patients?

PubMed

Richardson, Michael G; Lopez, Brandon M; Baysinger, Curtis L

2017-03-01

Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Analgesic effectiveness is highly variable, yet maternal satisfaction is often high among the women who choose to use it. Despite being less effective in treating labor pain than neuraxial analgesic modalities, nitrous oxide serves the needs and preferences of a subset of laboring parturients. Nitrous oxide should, therefore, be considered for inclusion in the repertoire of modalities used to alleviate pain and facilitate effective coping during labor. Copyright © 2016 Elsevier Inc. All rights reserved.

Chronic musculoskeletal pain: ultrasound guided pain control.

PubMed

Chiou, Hong-Jen; Chou, Yi-Hong; Wang, Hsin-Kai; Lai, Yi-Chen

2014-09-01

The review demonstrates the unique advantages of ultrasonography in pain control. Several imaging modalities can be used to guide pain control, such as computed tomography, magnetic resonance imaging, and radiography. Ultrasonography has unique advantages over these other modalities in terms of its non-ionizing radiation, real-time imaging, portability, and cost-effectiveness. Ultrasonography with color Doppler and elastography can provide safer guidance to avoid blood vessels and the nerve trunk when using steroid or xylocaine infusions to encase the nerve trunk. This review focuses on the control of chronic pain in the upper limbs, lower limbs, and trunk. Copyright © 2014. Published by Elsevier B.V.

A dual modality optical fiber sensor

NASA Astrophysics Data System (ADS)

Herrera-Piad, Luis A.; Haus, Joseph W.; Jauregui-Vazquez, Daniel; Lopez-Dieguez, Yanelis; Estudillo-Ayala, Julian M.; Sierra-Hernandez, Juan M.; Hernandez-Garcia, Juan C.; Rojas-Laguna, Roberto

2018-02-01

We propose and demonstrate a fibre optic system based on bi-tapered silica fibre that can simultaneously measure strain and fibre curvature. Both modalities on the signal can be extracted with no measurable crosstalk between them. The experimental signal has a pure phase modulation when strain is applied to the tapered fibre optic section of the sensor and the signal shows only intensity modulation when an un-tapered fibre section is bent. High sensitivity is achieved from the experimental results for strain and bending losses and the estimation of measurement errors is 0.2 and 0.1%, respectively. This system offers low-cost, compactness and it can be adapted for structural health monitoring.

Polynomial modal analysis of lamellar diffraction gratings in conical mounting.

PubMed

Randriamihaja, Manjakavola Honore; Granet, Gérard; Edee, Kofi; Raniriharinosy, Karyl

2016-09-01

An efficient numerical modal method for modeling a lamellar grating in conical mounting is presented. Within each region of the grating, the electromagnetic field is expanded onto Legendre polynomials, which allows us to enforce in an exact manner the boundary conditions that determine the eigensolutions. Our code is successfully validated by comparison with results obtained with the analytical modal method.

Deontic Modals in RP-US Visiting Forces Agreement (VFA): A Corpus-Based Analysis

ERIC Educational Resources Information Center

Dela Rosa, John Paul Obillos

2017-01-01

The marriage between language and the law is apparent in any legal document of whatever purpose. Hence, at present, studies on the language of the law are definitely in vogue. Grounded on Quirk et al. (1985) and Matulewska's (2010) description of deontic modality, this corpus-based linguistic study aimed at analyzing the use of deontic modals in…

Modality distribution of sensory neurons in the feline caudate nucleus and the substantia nigra.

PubMed

Márkus, Zita; Eördegh, Gabriella; Paróczy, Zsuzsanna; Benedek, G; Nagy, A

2008-09-01

Despite extensive analysis of the motor functions of the basal ganglia and the fact that multisensory information processing appears critical for the execution of their behavioral action, little is known concerning the sensory functions of the caudate nucleus (CN) and the substantia nigra (SN). In the present study, we set out to describe the sensory modality distribution and to determine the proportions of multisensory units within the CN and the SN. The separate single sensory modality tests demonstrated that a majority of the neurons responded to only one modality, so that they seemed to be unimodal. In contrast with these findings, a large proportion of these neurons exhibited significant multisensory cross-modal interactions. Thus, these neurons should also be classified as multisensory. Our results suggest that a surprisingly high proportion of sensory neurons in the basal ganglia are multisensory, and demonstrate that an analysis without a consideration of multisensory cross-modal interactions may strongly underrepresent the number of multisensory units. We conclude that a majority of the sensory neurons in the CN and SN process multisensory information and only a minority of these units are clearly unimodal.

Fiducial marker for correlating images

DOEpatents

Miller, Lisa Marie [Rocky Point, NY; Smith, Randy J [Wading River, NY; Warren, John B [Port Jefferson, NY; Elliott, Donald [Hampton Bays, NY

2011-06-21

The invention relates to a fiducial marker having a marking grid that is used to correlate and view images produced by different imaging modalities or different imaging and viewing modalities. More specifically, the invention relates to the fiducial marking grid that has a grid pattern for producing either a viewing image and/or a first analytical image that can be overlaid with at least one other second analytical image in order to view a light path or to image different imaging modalities. Depending on the analysis, the grid pattern has a single layer of a certain thickness or at least two layers of certain thicknesses. In either case, the grid pattern is imageable by each imaging or viewing modality used in the analysis. Further, when viewing a light path, the light path of the analytical modality cannot be visualized by viewing modality (e.g., a light microscope objective). By correlating these images, the ability to analyze a thin sample that is, for example, biological in nature but yet contains trace metal ions is enhanced. Specifically, it is desired to analyze both the organic matter of the biological sample and the trace metal ions contained within the biological sample without adding or using extrinsic labels or stains.

Direct system parameter identification of mechanical structures with application to modal analysis

NASA Technical Reports Server (NTRS)

Leuridan, J. M.; Brown, D. L.; Allemang, R. J.

1982-01-01

In this paper a method is described to estimate mechanical structure characteristics in terms of mass, stiffness and damping matrices using measured force input and response data. The estimated matrices can be used to calculate a consistent set of damped natural frequencies and damping values, mode shapes and modal scale factors for the structure. The proposed technique is attractive as an experimental modal analysis method since the estimation of the matrices does not require previous estimation of frequency responses and since the method can be used, without any additional complications, for multiple force input structure testing.

Complementary and alternative exercise for fibromyalgia: a meta-analysis.

PubMed

Mist, Scott David; Firestone, Kari A; Jones, Kim Dupree

2013-01-01

Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management.

Experimental modal analysis of the fuselage panels of an Aero Commander aircraft

NASA Technical Reports Server (NTRS)

Geisler, D.

1981-01-01

The reduction of interior noise in light aircraft was investigated with emphasis the thin fuselage sidewall. The approach used is theoretical and involves modeling of the sidewall panels and stiffeners. Experimental data obtained from tests investigating the effects of mass and stiffness treatments to the sidewalls are presented. The dynamic characteristics of treated panels are contrasted with the untreated sidewall panels using experimental modal analysis techniques. The results include the natural frequencies, modal dampling, and mode shapes of selected panels. Frequency response functions, data relating to the global fuselage response, and acoustic response are also presented.

Modality-specific spectral dynamics in response to visual and tactile sequential shape information processing tasks: An MEG study using multivariate pattern classification analysis.

PubMed

Gohel, Bakul; Lee, Peter; Jeong, Yong

2016-08-01

Brain regions that respond to more than one sensory modality are characterized as multisensory regions. Studies on the processing of shape or object information have revealed recruitment of the lateral occipital cortex, posterior parietal cortex, and other regions regardless of input sensory modalities. However, it remains unknown whether such regions show similar (modality-invariant) or different (modality-specific) neural oscillatory dynamics, as recorded using magnetoencephalography (MEG), in response to identical shape information processing tasks delivered to different sensory modalities. Modality-invariant or modality-specific neural oscillatory dynamics indirectly suggest modality-independent or modality-dependent participation of particular brain regions, respectively. Therefore, this study investigated the modality-specificity of neural oscillatory dynamics in the form of spectral power modulation patterns in response to visual and tactile sequential shape-processing tasks that are well-matched in terms of speed and content between the sensory modalities. Task-related changes in spectral power modulation and differences in spectral power modulation between sensory modalities were investigated at source-space (voxel) level, using a multivariate pattern classification (MVPC) approach. Additionally, whole analyses were extended from the voxel level to the independent-component level to take account of signal leakage effects caused by inverse solution. The modality-specific spectral dynamics in multisensory and higher-order brain regions, such as the lateral occipital cortex, posterior parietal cortex, inferior temporal cortex, and other brain regions, showed task-related modulation in response to both sensory modalities. This suggests modality-dependency of such brain regions on the input sensory modality for sequential shape-information processing. Copyright © 2016 Elsevier B.V. All rights reserved.

Advanced Gun System (AGS) Dynamic Characterization: Modal Test and Analysis, High-Frequency Analysis.

DTIC Science & Technology

1999-12-01

frequency data (to 10 kHz) in the AGS test. 3.2 High-Frequency Damping Determination by Wavelet Transform. The continuous wavelet transform (CWT...ARMY RESEARCH LABORATORY MmOSm Hi Advanced Gun System ( AGS ) Dynamic Characterization: Modal Test and Analysis, High-Frequency Analysis by Morris...this report when it is no longer needed. Do not return it to the originator. ERRATA SHEET re: ARL-TR-2138 "Advanced Gun System ( AGS ) Dynamic

The Inception of OMA in the Development of Modal Testing Technology for Wind Turbines

NASA Technical Reports Server (NTRS)

James, George H., III; Carne. Thomas G.

2008-01-01

Wind turbines are immense, flexible structures with aerodynamic forces acting on the rotating blades at harmonics of the turbine rotational frequency, which are comparable to the modal frequencies of the structure. Predicting and experimentally measuring the modal frequencies of wind turbines has been important to their successful design and operation. Performing modal tests on wind turbine structures over 100 meters tall is a substantial challenge, which has inspired innovative developments in modal test technology. For wind turbines, a further complication is that the modal frequencies are dependent on the turbine rotation speed. The history and development of a new technique for acquiring the modal parameters using output-only response data, called the Natural Excitation Technique (NExT), will be reviewed, showing historical tests and techniques. The initial attempts at output-only modal testing began in the late 1980's with the development of NExT in the 1990's. NExT was a predecessor to OMA, developed to overcome these challenges of testing immense structures excited with environmental inputs. We will trace the difficulties and successes of wind turbine modal testing from 1982 to the present. Keywords: OMA, Modal Analysis, NExT, Wind Turbines, Wind Excitation

Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi.

PubMed

Maheswaran, Hendramoorthy; Petrou, Stavros; MacPherson, Peter; Choko, Augustine T; Kumwenda, Felistas; Lalloo, David G; Clarke, Aileen; Corbett, Elizabeth L

2016-02-19

HIV self-testing (HIVST) has been found to be highly effective, but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies. Consecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-randomised trial ( ISRCTN02004005 ) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling (HTC). Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population. Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing, and additionally their health-related quality of life was measured using the EuroQol EQ-5D. A total of 1,241 participants underwent either HIVST (n = 775) or facility-based HTC (n = 446). The mean societal cost per participant tested through HIVST (US$9.23; 95 % CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95 % CI: US$10.81-12.86). Although the mean health provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health provider cost per HIV positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV positive individual assessed for anti-retroviral treatment (ART) eligibility and the mean cost per HIV positive individual initiated onto ART. In comparison to the facility-testing group, the adjusted mean EQ-5D utility score was 0.046 (95 % CI: 0.022-0.070) higher in the HIVST group. HIVST reduces the economic burden on clients, but is a costlier strategy for the health provider aiming to identify HIV positive individuals for treatment. The provider cost of HIVST could be substantially lower under less restrictive distribution models, or if costs of oral fluid HIV test kits become comparable to finger-prick kits used in health facilities.

Economic and Environmental Impacts of the Columbia-Snake River Extended Lock Outage

DOT National Transportation Integrated Search

2012-03-01

This reports main objective is to analyze the change in rates and modal costs for shippers, commodity industries and ports prior to, during and after the fifteen week lock outage and to determine the impacts on the environment in the form of energ...

Feasibility of wall stress analysis of abdominal aortic aneurysms using three-dimensional ultrasound.

PubMed

Kok, Annette M; Nguyen, V Lai; Speelman, Lambert; Brands, Peter J; Schurink, Geert-Willem H; van de Vosse, Frans N; Lopata, Richard G P

2015-05-01

Abdominal aortic aneurysms (AAAs) are local dilations that can lead to a fatal hemorrhage when ruptured. Wall stress analysis of AAAs is a novel tool that has proven high potential to improve risk stratification. Currently, wall stress analysis of AAAs is based on computed tomography (CT) and magnetic resonance imaging; however, three-dimensional (3D) ultrasound (US) has great advantages over CT and magnetic resonance imaging in terms of costs, speed, and lack of radiation. In this study, the feasibility of 3D US as input for wall stress analysis is investigated. Second, 3D US-based wall stress analysis was compared with CT-based results. The 3D US and CT data were acquired in 12 patients (diameter, 35-90 mm). US data were segmented manually and compared with automatically acquired CT geometries by calculating the similarity index and Hausdorff distance. Wall stresses were simulated at P = 140 mm Hg and compared between both modalities. The similarity index of US vs CT was 0.75 to 0.91 (n = 12), with a median Hausdorff distance ranging from 4.8 to 13.9 mm, with the higher values found at the proximal and distal sides of the AAA. Wall stresses were in accordance with literature, and a good agreement was found between US- and CT-based median stresses and interquartile stresses, which was confirmed by Bland-Altman and regression analysis (n = 8). Wall stresses based on US were typically higher (+23%), caused by geometric irregularities due to the registration of several 3D volumes and manual segmentation. In future work, an automated US registration and segmentation approach is the essential point of improvement before pursuing large-scale patient studies. This study is a first step toward US-based wall stress analysis, which would be the modality of choice to monitor wall stress development over time because no ionizing radiation and contrast material are involved. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Cost-Consequence Analysis Alongside a Randomised Controlled Trial of Hospital Versus Telephone Follow-Up after Treatment for Endometrial Cancer.

PubMed

Dixon, Padraig; Beaver, Kinta; Williamson, Susan; Sutton, Chris; Martin-Hirsch, Pierre; Hollingworth, William

2018-06-01

Regular outpatient follow-up programmes are usually offered to patients following treatment for gynaecological and other cancers. Despite the substantial resources involved in providing these programmes, there is evidence that routine follow-up programmes do not affect survival or the likelihood of detecting recurrence and may not meet patient needs. Alternative follow-up modalities may offer the same outcomes at lower cost. We examined the costs of using telephone-based routine follow-up of women treated for endometrial cancer undertaken by specialist gynaecology oncology nurses in comparison to routine hospital-based follow-up. The ENDCAT trial randomised 259 women at five centres in the north west of England with a known diagnosis of Stage I endometrial cancer who had completed primary treatment on a 1:1 basis to receive either standard hospital outpatient follow-up or a telephone follow-up intervention administered by specialist nurses. A cost-consequence analysis was undertaken in which we compared costs to the health system and to individuals with the trial's co-primary outcomes of psychological morbidity and participant satisfaction with information received. Psychological morbidity, psychosocial needs, patient satisfaction and quality of life did not differ between arms. Patients randomised to telephone follow-up underwent more and longer consultations. There was no difference in total health service mean per patient costs at 6 months (mean difference £8, 95% percentile confidence interval: - £147 to £141) or 12 months (mean difference: - £77, 95% percentile confidence interval: - £334 to £154). Estimated return journey costs per patient for hospital consultations were £11.47. Productivity costs were approximately twice as high under hospital follow-up. Telephone follow-up was estimated to be cost-neutral for the NHS and may free up clinic time for other patients. There was some evidence that telephone follow-up may be more efficient for patients and wider society, and is not associated with additional psychological morbidity, lower patient satisfaction or reduced quality of life. ISRCTN: 75220876, prospectively registered 28 October 2011.

The Economics of Organ Transplantation.

PubMed

Altınörs, Nur; Haberal, Mehmet

2018-03-01

To determine the cost effectiveness of transplantation, we analyzed the financial economics of the organ and tissue transplant process. We compared the cost of this process with traditional modalities for treating endstage liver and kidney disease. Medical, surgical, legal, social, ethical, and religious issues are important in organ transplant procedures. Government, health insurance companies, and uninsured individuals are affected by the financial economics of organ transplantation. The distribution of financial burden differs among countries and is dependent on the unique circumstances of each country.

Time domain modal identification/estimation of the mini-mast testbed

NASA Technical Reports Server (NTRS)

Roemer, Michael J.; Mook, D. Joseph

1991-01-01

The Mini-Mast is a 20 meter long 3-dimensional, deployable/retractable truss structure designed to imitate future trusses in space. Presented here are results from a robust (with respect to measurement noise sensitivity), time domain, modal identification technique for identifying the modal properties of the Mini-Mast structure even in the face of noisy environments. Three testing/analysis procedures are considered: sinusoidal excitation near resonant frequencies of the Mini-Mast, frequency response function averaging of several modal tests, and random input excitation with a free response period.

Fluid mass and thermal loading effects on the modal characteristics of space shuttle main engine liquid oxygen inlet splitter vanes

NASA Technical Reports Server (NTRS)

Panossian, H. V.; Boehnlein, J. J.

1987-01-01

An analysis and evaluation of experimental modal survey test data on the variations of modal characteristics induced by pressure and thermal loading events are presented. Extensive modal survey tests were carried out on a Space Shuttle Main Engine (SSME) test article using liquid nitrogen under cryogenic temperatures and high pressures. The results suggest that an increase of pressure under constant cryogenic temperature or a decrease of temperature under high pressure induces an upward shift of frequencies of various modes of the structures.

Modal Filtering for Control of Flexible Aircraft

NASA Technical Reports Server (NTRS)

Suh, Peter M.; Mavris, Dimitri N.

2013-01-01

Modal regulators and deformation trackers are designed for an open-loop fluttering wing model. The regulators are designed with modal coordinate and accelerometer inputs respectively. The modal coordinates are estimated with simulated fiber optics. The robust stability of the closed-loop systems is compared in a structured singular-value vector analysis. Performance is evaluated and compared in a gust alleviation and flutter suppression simulation. For the same wing and flight condition two wing-shape-tracking control architectures are presented, which achieve deformation control at any point on the wing.

Bayesian operational modal analysis with asynchronous data, Part II: Posterior uncertainty

NASA Astrophysics Data System (ADS)

Zhu, Yi-Chen; Au, Siu-Kui

2018-01-01

A Bayesian modal identification method has been proposed in the companion paper that allows the most probable values of modal parameters to be determined using asynchronous ambient vibration data. This paper investigates the identification uncertainty of modal parameters in terms of their posterior covariance matrix. Computational issues are addressed. Analytical expressions are derived to allow the posterior covariance matrix to be evaluated accurately and efficiently. Synthetic, laboratory and field data examples are presented to verify the consistency, investigate potential modelling error and demonstrate practical applications.

Comparative study of 2-DOF micromirrors for precision light manipulation

NASA Astrophysics Data System (ADS)

Young, Johanna I.; Shkel, Andrei M.

2001-08-01

Many industry experts predict that the future of fiber optic telecommunications depends on the development of all-optical components for switching of photonic signals from fiber to fiber throughout the networks. MEMS is a promising technology for providing all-optical switching at high speeds with significant cost reductions. This paper reports on the the analysis of two designs for 2-DOF electrostatically actuated MEMS micromirrors for precision controllable large optical switching arrays. The behavior of the micromirror designs is predicted by coupled-field electrostatic and modal analysis using a finite element analysis (FEA) multi-physics modeling software. The analysis indicates that the commonly used gimbal type mirror design experiences electrostatic interference and would therefore be difficult to precisely control for 2-DOF motion. We propose a new design approach which preserves 2-DOF actuation while minimizing electrostatic interference between the drive electrodes and the mirror. Instead of using two torsional axes, we use one actuator which combines torsional and flexural DOFs. A comparative analysis of the conventional gimbal design and the one proposed in this paper is performed.

Vibroacoustics of the piano soundboard: (Non)linearity and modal properties in the low- and mid-frequency ranges

NASA Astrophysics Data System (ADS)

Ege, Kerem; Boutillon, Xavier; Rébillat, Marc

2013-03-01

The piano soundboard transforms the string vibration into sound and therefore, its vibrations are of primary importance for the sound characteristics of the instrument. An original vibro-acoustical method is presented to isolate the soundboard nonlinearity from that of the exciting device (here: a loudspeaker) and to measure it. The nonlinear part of the soundboard response to an external excitation is quantitatively estimated for the first time, at ≈-40 dB below the linear part at the ff nuance. Given this essentially linear response, a modal identification is performed up to 3 kHz by means of a novel high resolution modal analysis technique [K. Ege, X. Boutillon, B. David, High-resolution modal analysis, Journal of Sound and Vibration 325 (4-5) (2009) 852-869]. Modal dampings (which, so far, were unknown for the piano in this frequency range) are determined in the mid-frequency domain where FFT-based methods fail to evaluate them with an acceptable precision. They turn out to be close to those imposed by wood. A finite-element modelling of the soundboard is also presented. The low-order modal shapes and the comparison between the corresponding experimental and numerical modal frequencies suggest that the boundary conditions can be considered as blocked, except at very low frequencies. The frequency-dependency of the estimated modal densities and the observation of modal shapes reveal two well-separated regimes. Below ≈1 kHz, the soundboard vibrates more or less like a homogeneous plate. Above that limit, the structural waves are confined by ribs, as already noticed by several authors, and localised in restricted areas (one or a few inter-rib spaces), presumably due to a slightly irregular spacing of the ribs across the soundboard.

Three-way parallel independent component analysis for imaging genetics using multi-objective optimization.

PubMed

Ulloa, Alvaro; Jingyu Liu; Vergara, Victor; Jiayu Chen; Calhoun, Vince; Pattichis, Marios

2014-01-01

In the biomedical field, current technology allows for the collection of multiple data modalities from the same subject. In consequence, there is an increasing interest for methods to analyze multi-modal data sets. Methods based on independent component analysis have proven to be effective in jointly analyzing multiple modalities, including brain imaging and genetic data. This paper describes a new algorithm, three-way parallel independent component analysis (3pICA), for jointly identifying genomic loci associated with brain function and structure. The proposed algorithm relies on the use of multi-objective optimization methods to identify correlations among the modalities and maximally independent sources within modality. We test the robustness of the proposed approach by varying the effect size, cross-modality correlation, noise level, and dimensionality of the data. Simulation results suggest that 3p-ICA is robust to data with SNR levels from 0 to 10 dB and effect-sizes from 0 to 3, while presenting its best performance with high cross-modality correlations, and more than one subject per 1,000 variables. In an experimental study with 112 human subjects, the method identified links between a genetic component (pointing to brain function and mental disorder associated genes, including PPP3CC, KCNQ5, and CYP7B1), a functional component related to signal decreases in the default mode network during the task, and a brain structure component indicating increases of gray matter in brain regions of the default mode region. Although such findings need further replication, the simulation and in-vivo results validate the three-way parallel ICA algorithm presented here as a useful tool in biomedical data decomposition applications.

Meaning Making through Multiple Modalities in a Biology Classroom: A Multimodal Semiotics Discourse Analysis

ERIC Educational Resources Information Center

Jaipal, Kamini

2010-01-01

The teaching of science is a complex process, involving the use of multiple modalities. This paper illustrates the potential of a multimodal semiotics discourse analysis framework to illuminate meaning-making possibilities during the teaching of a science concept. A multimodal semiotics analytical framework is developed and used to (1) analyze the…

ANALYSIS OF RESPIRATORY DEPOSITION OF INHALED PARTICLES FOR DIFFERENT DOSE METRICS: COMPARISON OF NUMBER, SURFACE AREA AND MASS DOSE OF TYPICAL AMBIENT BI-MODAL AEROSOLS

EPA Science Inventory

ANALYSIS OF RESPIRATORY DEPOSITION OF INHALED PARTICLES FOR DIFFERENT DOSE METRICS: COMPARISON OF NUMBER, SURFACE AREA AND MASS DOSE OF TYPICAL AMBIENT BI-MODAL AEROSOLS.
Chong S. Kim, SC. Hu*, PA Jaques*, US EPA, National Health and Environmental Effects Research Laboratory, ...

Coupled vibration analysis of Maglev vehicle-guideway while standing still or moving at low speeds

NASA Astrophysics Data System (ADS)

Kim, Ki-Jung; Han, Jong-Boo; Han, Hyung-Suk; Yang, Seok-Jo

2015-04-01

Dynamic instability, that is, resonance, may occur on an electromagnetic suspension-type Maglev that runs over the elevated guideway, particularly at very low speeds, due to the flexibility of the guideway. An analysis of the dynamic interaction between the vehicle and guideway is required at the design stage to investigate such instability, setting slender guideway in design direction for reducing construction costs. In addition, it is essential to design an effective control algorithm to solve the problem of instability. In this article, a more detailed model for the dynamic interaction of vehicle/guideway is proposed. The proposed model incorporates a 3D full vehicle model based on virtual prototyping, flexible guideway by a modal superposition method and levitation electromagnets including feedback controller into an integrated model. By applying the proposed model to an urban Maglev vehicle newly developed for commercial application, an analysis of the instability phenomenon and an investigation of air gap control performance are carried out through a simulation.

Dynamic assessment of reinforced concrete beams repaired with externally bonded FRP sheets

NASA Astrophysics Data System (ADS)

Bonfiglioli, B.; Pascale, G.

2006-01-01

This research deals with RC beams strengthened with FRP. An experimental research is presented which is aimed at evaluating the capability of an experimental modal analysis to assess the stiffness decrease due to damage, as well as the stiffness recovery due to strengthening. Ten beams were tested. All of them were subjected to loading cycles with increasing load levels in order to induce cracking of different severity in them. The beams were then retrofitted by externally bonded FRP sheets. Three types of composites were used. The number of layers was varied, too. Modal tests were carried out after each loading-unloading cycle. The modal frequencies and damping ratios were determined for the first four vibration modes. The results obtained indicate that an experimental modal analysis can give useful information on the severity of damage and the effectiveness of strengthening.

Alternative Modal Basis Selection Procedures For Reduced-Order Nonlinear Random Response Simulation

NASA Technical Reports Server (NTRS)

Przekop, Adam; Guo, Xinyun; Rizi, Stephen A.

2012-01-01

Three procedures to guide selection of an efficient modal basis in a nonlinear random response analysis are examined. One method is based only on proper orthogonal decomposition, while the other two additionally involve smooth orthogonal decomposition. Acoustic random response problems are employed to assess the performance of the three modal basis selection approaches. A thermally post-buckled beam exhibiting snap-through behavior, a shallowly curved arch in the auto-parametric response regime and a plate structure are used as numerical test articles. The results of a computationally taxing full-order analysis in physical degrees of freedom are taken as the benchmark for comparison with the results from the three reduced-order analyses. For the cases considered, all three methods are shown to produce modal bases resulting in accurate and computationally efficient reduced-order nonlinear simulations.

Retrospective Analysis of Communication Events - Understanding the Dynamics of Collaborative Multi-Party Discourse

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

Cowell, Andrew J.; Haack, Jereme N.; McColgin, Dave W.

2006-06-08

This research is aimed at understanding the dynamics of collaborative multi-party discourse across multiple communication modalities. Before we can truly make sig-nificant strides in devising collaborative communication systems, there is a need to understand how typical users utilize com-putationally supported communications mechanisms such as email, instant mes-saging, video conferencing, chat rooms, etc., both singularly and in conjunction with traditional means of communication such as face-to-face meetings, telephone calls and postal mail. Attempting to un-derstand an individual’s communications profile with access to only a single modal-ity is challenging at best and often futile. Here, we discuss the development of RACE –more » Retrospective Analysis of Com-munications Events – a test-bed prototype to investigate issues relating to multi-modal multi-party discourse.« less

High-Temperature Modal Survey of a Hot-Structure Control Surface

NASA Technical Reports Server (NTRS)

Spivey, Natalie Dawn

2010-01-01

Ground vibration tests or modal surveys are routinely conducted for supporting flutter analysis for subsonic and supersonic vehicles; however, for hypersonic vehicle applications, thermoelastic vibration testing techniques are not well established and are not routinely performed for supporting hypersonic flutter analysis. New high-temperature material systems, fabrication technologies and high-temperature sensors expand the opportunities to develop advanced techniques for performing ground vibration tests at elevated temperatures. High-temperature materials have the unique property of increasing in stiffness when heated. When these materials are incorporated into a hot-structure, which includes metallic components that decrease in stiffness with increasing temperature, the interaction between the two materials systems needs to be understood because that interaction could ultimately affect the hypersonic flutter analysis. Performing a high-temperature modal survey will expand the research database for hypersonics and will help build upon the understanding of the dual material interaction. This paper will discuss the vibration testing of the Carbon-Silicon Carbide Ruddervator Subcomponent Test Article which is a truncated version of the full-scale X-37 hot-structure control surface. In order to define the modal characteristics of the test article during the elevated-temperature modal survey, two series of room-temperature modal test configurations had to be performed. The room-temperature test series included one with the test article suspended from a bungee cord (free-free) and the second with it mounted on the strongback (fixed boundary condition) in NASA Dryden's Flight Loads Lab large nitrogen test chamber.

A Benchmark Problem for Development of Autonomous Structural Modal Identification

NASA Technical Reports Server (NTRS)

Pappa, Richard S.; Woodard, Stanley E.; Juang, Jer-Nan

1996-01-01

This paper summarizes modal identification results obtained using an autonomous version of the Eigensystem Realization Algorithm on a dynamically complex, laboratory structure. The benchmark problem uses 48 of 768 free-decay responses measured in a complete modal survey test. The true modal parameters of the structure are well known from two previous, independent investigations. Without user involvement, the autonomous data analysis identified 24 to 33 structural modes with good to excellent accuracy in 62 seconds of CPU time (on a DEC Alpha 4000 computer). The modal identification technique described in the paper is the baseline algorithm for NASA's Autonomous Dynamics Determination (ADD) experiment scheduled to fly on International Space Station assembly flights in 1997-1999.

Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations.

PubMed

Rottenkolber, Dominik; Schmiedl, Sven; Rottenkolber, Marietta; Farker, Katrin; Saljé, Karen; Mueller, Silke; Hippius, Marion; Thuermann, Petra A; Hasford, Joerg

2011-06-01

German hospital reimbursement modalities changed as a result of the introduction of Diagnosis Related Groups (DRG) in 2004. Therefore, no data on the direct costs of adverse drug reactions (ADRs) resulting in admissions to departments of internal medicine are available. The objective was to quantify the ADR-related economic burden (direct costs) of hospitalizations in internal medicine wards in Germany. Record-based study analyzing the patient records of about 57,000 hospitalizations between 2006 and 2007 of the Net of Regional Pharmacovigilance Centers (Germany). All ADRs were evaluated by a team of experts in pharmacovigilance for severity, causality, and preventability. The calculation of accurate person-related costs for ADRs relied on the German DRG system (G-DRG 2009). Descriptive and bootstrap statistical methods were applied for data analysis. The incidence of hospitalization due to at least 'possible' serious outpatient ADRs was estimated to be approximately 3.25%. Mean age of the 1834 patients was 71.0 years (SD 14.7). Most frequent ADRs were gastrointestinal hemorrhage (n = 336) and drug-induced hypoglycemia (n = 270). Average inpatient length-of-stay was 9.3 days (SD 7.1). Average treatment costs of a single ADR were estimated to be approximately €2250. The total costs sum to €434 million per year for Germany. Considering the proportion of preventable cases (20.1%), this equals a saving potential of €87 million per year. Preventing ADRs is advisable in order to realize significant nationwide savings potential. Our cost estimates provide a reliable benchmark as they were calculated based on an intensified ADR surveillance and an accurate person-related cost application. Copyright © 2011 John Wiley & Sons, Ltd.

Cost analysis of debridement and retention for management of prosthetic joint infection.

PubMed

Peel, T N; Dowsey, M M; Buising, K L; Liew, D; Choong, P F M

2013-02-01

Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p <0.001), more additional surgery (3.3 vs. 0.07; p <0.001) and longer total bed days (31.6 vs. 7.9 days; p <0.001). In addition they had more inpatient, outpatient and emergency department visits (p <0.001, respectively). For patients with prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69,414 (±29,869) compared with $22,085 (±8147) (p <0.001). The demand for arthroplasty continues to grow and with that, the number of prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

Optimal Co-segmentation of Tumor in PET-CT Images with Context Information

PubMed Central

Song, Qi; Bai, Junjie; Han, Dongfeng; Bhatia, Sudershan; Sun, Wenqing; Rockey, William; Bayouth, John E.; Buatti, John M.

2014-01-01

PET-CT images have been widely used in clinical practice for radiotherapy treatment planning of the radiotherapy. Many existing segmentation approaches only work for a single imaging modality, which suffer from the low spatial resolution in PET or low contrast in CT. In this work we propose a novel method for the co-segmentation of the tumor in both PET and CT images, which makes use of advantages from each modality: the functionality information from PET and the anatomical structure information from CT. The approach formulates the segmentation problem as a minimization problem of a Markov Random Field (MRF) model, which encodes the information from both modalities. The optimization is solved using a graph-cut based method. Two sub-graphs are constructed for the segmentation of the PET and the CT images, respectively. To achieve consistent results in two modalities, an adaptive context cost is enforced by adding context arcs between the two subgraphs. An optimal solution can be obtained by solving a single maximum flow problem, which leads to simultaneous segmentation of the tumor volumes in both modalities. The proposed algorithm was validated in robust delineation of lung tumors on 23 PET-CT datasets and two head-and-neck cancer subjects. Both qualitative and quantitative results show significant improvement compared to the graph cut methods solely using PET or CT. PMID:23693127

Short-term memory stores organized by information domain.

PubMed

Noyce, Abigail L; Cestero, Nishmar; Shinn-Cunningham, Barbara G; Somers, David C

2016-04-01

Vision and audition have complementary affinities, with vision excelling in spatial resolution and audition excelling in temporal resolution. Here, we investigated the relationships among the visual and auditory modalities and spatial and temporal short-term memory (STM) using change detection tasks. We created short sequences of visual or auditory items, such that each item within a sequence arose at a unique spatial location at a unique time. On each trial, two successive sequences were presented; subjects attended to either space (the sequence of locations) or time (the sequence of inter item intervals) and reported whether the patterns of locations or intervals were identical. Each subject completed blocks of unimodal trials (both sequences presented in the same modality) and crossmodal trials (Sequence 1 visual, Sequence 2 auditory, or vice versa) for both spatial and temporal tasks. We found a strong interaction between modality and task: Spatial performance was best on unimodal visual trials, whereas temporal performance was best on unimodal auditory trials. The order of modalities on crossmodal trials also mattered, suggesting that perceptual fidelity at encoding is critical to STM. Critically, no cost was attributable to crossmodal comparison: In both tasks, performance on crossmodal trials was as good as or better than on the weaker unimodal trials. STM representations of space and time can guide change detection in either the visual or the auditory modality, suggesting that the temporal or spatial organization of STM may supersede sensory-specific organization.

Unstalled flutter stability predictions and comparisons to test data for a composite prop-fan model

NASA Technical Reports Server (NTRS)

Turnberg, J. E.

1986-01-01

The aeroelastic stability analyses for three graphite/epoxy composite Prop-Fan designs and post-test stability analysis for one of the designs, the SR-3C-X2 are presented. It was shown that Prop-Fan stability can be effectively analyzed using the F203 modal aeroelastic stability analysis developed at Hamilton Standard and that first mode torsion-bending coupling has a direct effect on blade stability. Positive first mode torsion-bending coupling is a destabilizing factor and the minimization of this parameter will increase Prop-Fan stability. It was also shown that Prop-Fan stability analysis using F203 is sensitive to the blade modal data used as input. Calculated blade modal properties varied significantly with the structural analysis used, and these variations are reflected in the F203 calculations.

Dynamic analysis using superelements for a large helicopter model

NASA Technical Reports Server (NTRS)

Patel, M. P.; Shah, L. C.

1978-01-01

Using superelements (substructures), modal and frequency response analysis was performed for a large model of the Advanced Attack Helicopter developed for the U.S. Army. Whiffletree concept was employed so that the residual structure along with the various superelements could be represented as beam-like structures for economical and accurate dynamic analysis. A very large DMAP alter to the rigid format was developed so that the modal analysis, the frequency response, and the strain energy in each component could be computed in the same run.

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma.

PubMed

Song, Do Seon; Nam, Soon Woo; Bae, Si Hyun; Kim, Jin Dong; Jang, Jeong Won; Song, Myeong Jun; Lee, Sung Won; Kim, Hee Yeon; Lee, Young Joon; Chun, Ho Jong; You, Young Kyoung; Choi, Jong Young; Yoon, Seung Kew

2015-02-28

To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC). A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively. In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P<0.001) and objective tumor response (P=0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P=0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P<0.001). Multivariate analysis identified tumor stage (P<0.001) and tumor type (P=0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P<0.001), surgical treatment (P=0.009), and multi-modal treatment (P=0.002) were identified as independent post-treatment prognostic factors. TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC.

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma

PubMed Central

Song, Do Seon; Nam, Soon Woo; Bae, Si Hyun; Kim, Jin Dong; Jang, Jeong Won; Song, Myeong Jun; Lee, Sung Won; Kim, Hee Yeon; Lee, Young Joon; Chun, Ho Jong; You, Young Kyoung; Choi, Jong Young; Yoon, Seung Kew

2015-01-01

AIM: To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC). METHODS: A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively. RESULTS: In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P < 0.001) and objective tumor response (P = 0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P = 0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P < 0.001). Multivariate analysis identified tumor stage (P < 0.001) and tumor type (P = 0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P < 0.001), surgical treatment (P = 0.009), and multi-modal treatment (P = 0.002) were identified as independent post-treatment prognostic factors. CONCLUSION: TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC. PMID:25741147

Model validity and frequency band selection in operational modal analysis

NASA Astrophysics Data System (ADS)

Au, Siu-Kui

2016-12-01

Experimental modal analysis aims at identifying the modal properties (e.g., natural frequencies, damping ratios, mode shapes) of a structure using vibration measurements. Two basic questions are encountered when operating in the frequency domain: Is there a mode near a particular frequency? If so, how much spectral data near the frequency can be included for modal identification without incurring significant modeling error? For data with high signal-to-noise (s/n) ratios these questions can be addressed using empirical tools such as singular value spectrum. Otherwise they are generally open and can be challenging, e.g., for modes with low s/n ratios or close modes. In this work these questions are addressed using a Bayesian approach. The focus is on operational modal analysis, i.e., with 'output-only' ambient data, where identification uncertainty and modeling error can be significant and their control is most demanding. The approach leads to 'evidence ratios' quantifying the relative plausibility of competing sets of modeling assumptions. The latter involves modeling the 'what-if-not' situation, which is non-trivial but is resolved by systematic consideration of alternative models and using maximum entropy principle. Synthetic and field data are considered to investigate the behavior of evidence ratios and how they should be interpreted in practical applications.

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid

PubMed Central

2012-01-01

Background Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated. Methods A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients. Results Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population. Conclusions In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality. PMID:22537712

Treating Cancer with Amplitude-Modulated Electromagnetic Fields: A Potential Paradigm Shift, Again?

EPA Science Inventory

The Zimmerman et al. (2011) study published here, coupled with the group's two preceding papers (Barbault et al. (2009), Costa et al. (2011)), identify a potential modality for treating tumors at a dramatic reduction in trauma and cost. This set of clinical and explanatory labora...

Mobile, Multi-modal, Label-Free Imaging Probe Analysis of Choroidal Oximetry and Retinal Hypoxia

DTIC Science & Technology

2015-10-01

eyes and image choroidal vessels/capillaries using CARS intravital microscopy Subtask 3: Measure oxy-hemoglobin levels in PBI test and control eyes...AWARD NUMBER: W81XWH-14-1-0537 TITLE: Mobile, Multi-modal, Label-Free Imaging Probe Analysis of Choroidal Oximetry and Retinal Hypoxia...4. TITLE AND SUBTITLE Mobile, Multimodal, Label-Free Imaging Probe Analysis of Choroidal Oximetry and Retinal Hypoxia 5a. CONTRACT NUMBER W81XWH

Simulating flight boundary conditions for orbiter payload modal survey

NASA Technical Reports Server (NTRS)

Chung, Y. T.; Sernaker, M. L.; Peebles, J. H.

1993-01-01

An approach to simulate the characteristics of the payload/orbiter interfaces for the payload modal survey was developed. The flexure designed for this approach is required to provide adequate stiffness separation in the free and constrained interface degrees of freedom to closely resemble the flight boundary condition. Payloads will behave linearly and demonstrate similar modal effective mass distribution and load path as the flight if the flexure fixture is used for the payload modal survey. The potential non-linearities caused by the trunnion slippage during the conventional fixed base modal survey may be eliminated. Consequently, the effort to correlate the test and analysis models can be significantly reduced. An example is given to illustrate the selection and the sensitivity of the flexure stiffness. The advantages of using flexure fixtures for the modal survey and for the analytical model verification are also demonstrated.

Cross-modal representation of spoken and written word meaning in left pars triangularis.

PubMed

Liuzzi, Antonietta Gabriella; Bruffaerts, Rose; Peeters, Ronald; Adamczuk, Katarzyna; Keuleers, Emmanuel; De Deyne, Simon; Storms, Gerrit; Dupont, Patrick; Vandenberghe, Rik

2017-04-15

The correspondence in meaning extracted from written versus spoken input remains to be fully understood neurobiologically. Here, in a total of 38 subjects, the functional anatomy of cross-modal semantic similarity for concrete words was determined based on a dual criterion: First, a voxelwise univariate analysis had to show significant activation during a semantic task (property verification) performed with written and spoken concrete words compared to the perceptually matched control condition. Second, in an independent dataset, in these clusters, the similarity in fMRI response pattern to two distinct entities, one presented as a written and the other as a spoken word, had to correlate with the similarity in meaning between these entities. The left ventral occipitotemporal transition zone and ventromedial temporal cortex, retrosplenial cortex, pars orbitalis bilaterally, and the left pars triangularis were all activated in the univariate contrast. Only the left pars triangularis showed a cross-modal semantic similarity effect. There was no effect of phonological nor orthographic similarity in this region. The cross-modal semantic similarity effect was confirmed by a secondary analysis in the cytoarchitectonically defined BA45. A semantic similarity effect was also present in the ventral occipital regions but only within the visual modality, and in the anterior superior temporal cortex only within the auditory modality. This study provides direct evidence for the coding of word meaning in BA45 and positions its contribution to semantic processing at the confluence of input-modality specific pathways that code for meaning within the respective input modalities. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparative analysis of success of psoriasis treatment with standard therapeutic modalities and balneotherapy.

PubMed

Baros, Duka Ninković; Gajanin, Vesna S; Gajanin, Radoslav B; Zrnić, Bogdan

2014-01-01

Psoriasis is a chronic, inflammatory, immune-mediated skin disease. In addition to standard therapeutic modalities (antibiotics, cytostatics, phototherapy, photochemotherapy and retinoids), nonstandard methods can be used in the treatment of psoriasis. This includes balneotherapy which is most commonly used in combination with therapeutic resources. The aim of this research was to determine the length of remission of psoriasis in patients treated with standard therapeutic modalities, balneotherapy, and combined treatment (standard therapeutic modalities and balneotherapy). The study analyzed 60 adult patients, of both sexes, with different clinical forms of psoriasis, who were divided into three groups according to the applied therapeutic modalities: the first group (treated with standard therapeutic modalities), the second group (treated with balneotherapy) and the third group (treated with combined therapy-standard methods therapy and balneotherapy). The Psoriasis Area and Severity Index was determined in first, third and sixth week of treatment for all patients. The following laboratory analysis were performed and monitored: C reactive protein, iron with total iron binding capacity, unsaturated iron binding capacity and ferritin, uric acid, rheumatoid factors and antibodies to streptolysin O in the first and sixth week of treatment. The average length of remission in patients treated with standard therapeutic modalities and in those treated with balneotherapy was 1.77 +/- 0.951 months and 1.79 +/- 0.918 months, respectively. There was a statistically significant difference in the duration of remission between the patients treated with combination therapy and patients treated with standard therapeutic modalities (p = 0.019) and balneotherapy (p = 0.032). The best results have been achieved when the combination therapy was administered.

Malaria burden and costs of intensified control in Bhutan, 2006-14: an observational study and situation analysis.

PubMed

Wangdi, Kinley; Banwell, Cathy; Gatton, Michelle L; Kelly, Gerard C; Namgay, Rinzin; Clements, Archie C A

2016-05-01

The number of malaria cases has fallen in Bhutan in the past two decades, and the country has a goal of complete elimination of malaria by 2016. The aims of this study are to ascertain the trends and burden of malaria, the costs of intensified control activities, the main donors of funding for the control activities, and the costs of different preventive measures in the pre-elimination phase (2006-14) in Bhutan. We undertook a descriptive analysis of malaria surveillance data from 2006 to 2014, using data from the Vector-borne Disease Control Programme (VDCP) run by the Department of Public Health of Bhutan's Ministry of Health. Malaria morbidity and mortality in local Bhutanese people and foreign nationals were analysed. The cost of different control and preventive measures were calculated, and the average numbers of long-lasting insecticidal nests per person were estimated. A total of 5491 confirmed malaria cases occurred in Bhutan between 2006 and 2014. By 2013, there was an average of one long-lasting insecticidal net for every 1·51 individuals. The cost of procuring long-lasting insecticidal nets accounted for more than 90% of the total cost of prevention measures. The Global Fund to Fight AIDS, Tuberculosis and Malaria was the main international donor, accounting for more than 80% of the total funds. The malaria burden in Bhutan decreased significantly during the study period with high coverage of long-lasting insecticidal nets. The foreseeable challenges that require national attention to maintain a malaria-free status after elimination are importation of malaria, especially from India; continued protection of the population in endemic districts through complete coverage with long-lasting insecticidal nets and indoor residual spraying; and exploration of local funding modalities post-elimination in the event of a reduction in international funding. None. Copyright © 2016 Wangdi et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Spatial Analysis of Case-Mix and Dialysis Modality Associations.

PubMed

Phirtskhalaishvili, Tamar; Bayer, Florian; Edet, Stephane; Bongiovanni, Isabelle; Hogan, Julien; Couchoud, Cécile

2016-01-01

♦ Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency. Copyright © 2016 International Society for Peritoneal Dialysis.

Spatial Analysis of Case-Mix and Dialysis Modality Associations

PubMed Central

Phirtskhalaishvili, Tamar; Bayer, Florian; Edet, Stephane; Bongiovanni, Isabelle; Hogan, Julien; Couchoud, Cécile

2016-01-01

♦ Background: Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ Methods: The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ Result: The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ Conclusions: The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency. PMID:26475843

Salmon fishing by bears and the dawn of cooperative predation.

PubMed

Stringham, Stephen F

2012-11-01

Although bears are an epitome of solitary predation, black (Ursus americanus) and brown bears (U. arctos) occasionally act in pairs to capture salmon (Onchorynchous spp.). I sought to identify conditions that promote pairing and how this relates to optimal foraging. This study on Alaskan black bears assessed whether each mode of fishing (solo vs. paired) occurs mainly where it is most efficient at harvesting salmon--that is, whether modal group size (1 vs. 2) is also optimal size. Not in this case. Pairing increased captures per attempt (benefit/cost ratio = profitability) by up to 47% and captures per minute by up to 5.2-fold. Yet, the ratio of paired versus solo fishing was significantly lower than either profitability or chance explains. Modal group size was 1, optimal size was 2. This discrepancy did not result from intervention by other current benefits and costs, but from unnecessary defensiveness toward any rapidly approaching conspecific, even though it was chasing salmon, not threatening. For bears to regularly hunt cooperatively, they would have to more readily habituate to agonistic-like predatory actions, communicate intentions from > 10 m apart, and assess situational variations in benefit/cost ratios for solo versus paired hunting. It would be revealing to discover how social carnivores overcame these challenges.

The Economics of Skin Cancer: An Analysis of Medicare Payment Data.

PubMed

Chen, Jenny T; Kempton, Steven J; Rao, Venkat K

2016-09-01

The incidence and cost of nonmelanoma skin cancers are skyrocketing. Five million cases cost $8.1 billion in 2011. The average cost of treatment per patient increased from $1000 in 2006 to $1600 in 2011. We present a study of the economics and costs of skin cancer management in Medicare patients. We studied data released by the Centers for Medicare and Medicaid Services in 2014. Treatment modalities for the management of skin cancer were reviewed, and costs of treatment were quantified for a sample of 880,000 providers. Review of Medicare payment records related to the management of skin cancer yielded data from over 880,000 health care providers who received $77 billion in Medicare payments in 2012. From 1992 to 2009, the rate of Mohs micrographic surgery (MMS) has increased by 700%, and these procedures typically have Medicare payments 120% to 370% more than surgical excision, even when including pathology fees. From 1992 to 2009, MMS increased by 700%, whereas surgical excisions increased by only 20%. In 2009, 1800 providers billed Medicare for MMS; in 2012, that number increased to 3209. On average, 1 in 4 cases of skin cancer is treated with MMS. Mohs excision is more expensive than surgical excision in an office setting. Procedures requiring the operating room are much more expensive than office procedures. In an era of high deductible health plans, patients' financial burden is much less with simple excisions of skin cancers done in a clinic when compared with Mohs surgery or operative interventions.

Examining evidence based resistance plus balance training in community-dwelling older adults with complex health care needs: Trial protocol for the Muscling Up Against Disability project.

PubMed

Keogh, Justin W L; Henwood, Tim; Gardiner, Paul; Tuckett, Anthony; Hodgkinson, Brent; Rouse, Kevin

Progressive resistance plus balance training (PRBT) has been demonstrated as effective in reducing later life physical disability, falls risk and poor health, even among those with complex health care needs. However, few studies have examined the influence of PRBT on health service utilisation, cognitive wellbeing and training modality acceptance or undertaken a cost benefit analysis. This project will investigate the broad scope benefits of PRBT participation among community-dwelling older Australians receiving Government supported aged care packages for their complex health care needs. Using a modified stepped-wedge design, 248 community-dwelling adults 65 years and older with some level of government support aged care have been randomised into the study. Those randomised to exercise undertake six months of twice weekly machine-based, moderate to high intensity, supervised PRBT, followed by a six month unsupervised, unsupported follow-up. Controls spend six months undertaking usual activities, before entering the PRBT and follow-up phases. Data are collected at baseline and after each of the six month phases. Measures include level of and change in health and care needs, body composition, muscle capacity, falls, sleep, quality of life, nutritional and mental health status. In addition, acceptance and engagement is determined through telephone and focus group interviews complementing a multi-model health cost benefit evaluation. It is hypothesised this study will demonstrate the feasibility and efficacy of PRBT in improving primary and secondary health outcomes for older adults with aged care needs, and will support the value of this modality of exercise as an integral evidence-based service model of care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Complementary and alternative exercise for fibromyalgia: a meta-analysis

PubMed Central

Mist, Scott David; Firestone, Kari A; Jones, Kim Dupree

2013-01-01

Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management. PMID:23569397

A Deeper Look at How Teachers Say What They Say: A Quantitative Modality Analysis of Teacher-to-Teacher Talk

ERIC Educational Resources Information Center

Kosko, Karl W.; Herbst, Patricio

2012-01-01

Analysis of teacher-to-teacher talk provides researchers with useful information regarding the teaching profession and teachers' perspectives. This article provides a description of a method, with accompanying example, examining teacher-to-teacher talk by incorporating semantic modality and examining trends of its usage in a quantitative manner.…

Analysis of Modal Growth on the Leeward Centerplane of the X-51 Vehicle

DTIC Science & Technology

2009-09-01

Research Center ( CUBRC ) 4455 Genesee Street Buffalo, NY 14225 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) Air Force Research...8 Figure 9. Disturbance N-factor Growth and CUBRC Data Showing Transition...for CUBRC Run 4 9 LIST OF TABLES Table Page Table 1. Freestream Conditions for Ground Test Cases Selected for Modal Analysis Study

A Review of Multivariate Methods for Multimodal Fusion of Brain Imaging Data

PubMed Central

Adali, Tülay; Yu, Qingbao; Calhoun, Vince D.

2011-01-01

The development of various neuroimaging techniques is rapidly improving the measurements of brain function/structure. However, despite improvements in individual modalities, it is becoming increasingly clear that the most effective research approaches will utilize multi-modal fusion, which takes advantage of the fact that each modality provides a limited view of the brain. The goal of multimodal fusion is to capitalize on the strength of each modality in a joint analysis, rather than a separate analysis of each. This is a more complicated endeavor that must be approached more carefully and efficient methods should be developed to draw generalized and valid conclusions from high dimensional data with a limited number of subjects. Numerous research efforts have been reported in the field based on various statistical approaches, e.g. independent component analysis (ICA), canonical correlation analysis (CCA) and partial least squares (PLS). In this review paper, we survey a number of multivariate methods appearing in previous reports, which are performed with or without prior information and may have utility for identifying potential brain illness biomarkers. We also discuss the possible strengths and limitations of each method, and review their applications to brain imaging data. PMID:22108139

Restricted Modal Analysis Applied to Internal Annular Combustor Autospectra and Cross-Spectra Measurements

NASA Technical Reports Server (NTRS)

Miles, Jeffrey Hilton

2007-01-01

A treatment of the modal decomposition of the pressure field in a combustor as determined by two pressure time history measurements is developed herein. It is applied to a Pratt and Whitney PW4098 engine combustor over a range of operating conditions. For modes other than the plane wave the assumption is made that there are distinct frequency bands in which the individual modes, including the plane wave mode, overlap such that if circumferential mode m and circumferential mode m-1 are present then circumferential mode m-2 is not. In the analysis used herein at frequencies above the first cutoff mode frequency, only pairs of circumferential modes are individually present at each frequency. Consequently, this is a restricted modal analysis. As part of the analysis one specifies mode cut-on frequencies. This creates a set of frequencies that each mode spans. One finding was the successful use of the same modal span frequencies over a range of operating conditions for this particular engine. This suggests that for this case the cut-on frequencies are in proximity at each operating condition. Consequently, the combustion noise spectrum related to the circumferential modes might not change much with operating condition.

Determination of orthotropic material properties by modal analysis

NASA Astrophysics Data System (ADS)

Lai, Junpeng

The methodology for determination of orthotropic material properties in plane stress condition will be presented. It is applied to orthotropic laminated plates like printed wiring boards. The first part of the thesis will focus on theories and methodologies. The static beam model and vibratory plate model is presented. The methods are validated by operating a series of test on aluminum. In the static tests, deflection and two directions of strain are measured, thus four of the properties will be identified: Ex, Ey, nuxy, nuyx. Moving on to dynamic test, the first ten modes' resonance frequencies are obtained. The technique of modal analysis is adopted. The measured data is processed by FFT and analyzed by curve fitting to extract natural frequencies and mode shapes. With the last material property to be determined, a finite element method using ANSYS is applied. Along with the identified material properties in static tests, and proper initial guess of the unknown shear modulus, an iterative process creates finite element model and conducts modal analysis with the updating model. When the modal analysis result produced by ANSYS matches the natural frequencies acquired by dynamic test, the process will halt. Then we obtained the last material property in plane stress condition.

Fiber facet gratings for high power fiber lasers

NASA Astrophysics Data System (ADS)

Vanek, Martin; Vanis, Jan; Baravets, Yauhen; Todorov, Filip; Ctyroky, Jiri; Honzatko, Pavel

2017-12-01

We numerically investigated the properties of diffraction gratings designated for fabrication on the facet of an optical fiber. The gratings are intended to be used in high-power fiber lasers as mirrors either with a low or high reflectivity. The modal reflectance of low reflectivity polarizing grating has a value close to 3% for TE mode while it is significantly suppressed for TM mode. Such a grating can be fabricated on laser output fiber facet. The polarizing grating with high modal reflectance is designed as a leaky-mode resonant diffraction grating. The grating can be etched in a thin layer of high index dielectric which is sputtered on fiber facet. We used refractive index of Ta2O5 for such a layer. We found that modal reflectance can be close to 0.95 for TE polarization and polarization extinction ratio achieves 18 dB. Rigorous coupled wave analysis was used for fast optimization of grating parameters while aperiodic rigorous coupled wave analysis, Fourier modal method and finite difference time domain method were compared and used to compute modal reflectance of designed gratings.

Dynamic characteristics of the rotor in a magnetically suspended control moment gyroscope with active magnetic bearing and passive magnetic bearing.

PubMed

Tang, Jiqiang; Xiang, Biao; Zhang, Yongbin

2014-07-01

For a magnetically suspended control moment gyroscope, stiffness and damping of magnetic bearing will influence modal frequency of a rotor. In this paper the relationship between modal frequency and stiffness and damping has been investigated. The mathematic calculation model of axial passive magnetic bearing (PMB) stiffness is developed. And PID control based on internal model control is introduced into control of radial active magnetic bearing (AMB), considering the radial coupling of axial PMB, a mathematic calculation model of stiffness and damping of radial AMB is established. According to modal analysis, the relationship between modal frequency and modal shapes is achieved. Radial vibration frequency is mainly influenced by stiffness of radial AMB; however, when stiffness increases, radial vibration will disappear and a high frequency bending modal will appear. Stiffness of axial PMB mainly affects the axial vibration mode, which will turn into high-order bending modal. Axial PMB causes bigger influence on torsion modal of the rotor. Copyright © 2014 ISA. Published by Elsevier Ltd. All rights reserved.

An uncertainty analysis of air pollution externalities from road transport in Belgium in 2010.

PubMed

Int Panis, L; De Nocker, L; Cornelis, E; Torfs, R

2004-12-01

Although stricter standards for vehicles will reduce emissions to air significantly by 2010, a number of problems will remain, especially related to particulate concentrations in cities, ground-level ozone, and CO(2). To evaluate the impacts of new policy measures, tools need to be available that assess the potential benefits of these measures in terms of the vehicle fleet, fuel choice, modal choice, kilometers driven, emissions, and the impacts on public health and related external costs. The ExternE accounting framework offers the most up to date and comprehensive methodology to assess marginal external costs of energy-related pollutants. It combines emission models, air dispersion models at local and regional scales with dose-response functions and valuation rules. Vito has extended this accounting framework with data and models related to the future composition of the vehicle fleet and transportation demand to evaluate the impact of new policy proposals on air quality and aggregated (total) external costs by 2010. Special attention was given to uncertainty analysis. The uncertainty for more than 100 different parameters was combined in Monte Carlo simulations to assess the range of possible outcomes and the main drivers of these results. Although the impacts from emission standards and total fleet mileage look dominant at first, a number of other factors were found to be important as well. This includes the number of diesel vehicles, inspection and maintenance (high-emitter cars), use of air conditioning, and heavy duty transit traffic.

Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil War.

PubMed

Duramaz, Altuğ; Bilgili, Mustafa Gökhan; Bayram, Berhan; Ziroğlu, Nezih; Bayrak, Alkan; Avkan, Mustafa Cevdet

2017-05-01

The aim of this study was to evaluate the musculoskeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees. Totally 158 patients (67 female, 91 male) treated in our clinic in 34 months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3 years (range: 18-82 years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, injury severity score, surgical technique, complications, mortality/morbidity and treatment cost. The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity injuries compared with the other types of injuries (p = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity fractures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6 days and the mean treatment cost was 3844 Turkish Liras (TL). In this study, it was shown that there was a statistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with fractures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospitalization periods.

Analysis of strategies to increase external fixator stiffness: is double stacking worth the cost?

PubMed

Strebe, Sara; Kim, Hyunchul; Russell, Joseph P; Hsieh, Adam H; Nascone, Jason; O'Toole, Robert V

2014-07-01

We compared the mechanical benefits and costs of 3 strategies that are commonly used to increase knee-spanning external fixator stiffness (resistance to deformation): double stacking, cross-linking, and use of an oblique pin. At our academic trauma centre and biomechanical testing laboratory, we used ultra-high-molecular-weight polyethylene bone models and commercially available external fixator components to simulate knee-spanning external fixation. The models were tested in anterior-posterior bending, medial-lateral bending, axial compression, and torsion. We recorded the construct stiffness for each strategy in all loading modes and assessed a secondary outcome of cost per 10% increase in stiffness. Double stacking significantly increased construct stiffness under anterior-posterior bending (109%), medial-lateral bending (22%), axial compression (150%), and torsion (41%) (p<0.05). Use of an oblique pin significantly increased stiffness under torsion (25%) (p<0.006). Cross-linking significantly increased stiffness only under torsion (29%) (p<0.002). Double stacking increased costs by 84%, cross-linking by 28%, and use of an oblique pin by 15% relative to a standard fixator. All 3 strategies increased stiffness under torsion to varying degrees, but only double stacking increased stiffness in all 4 testing modalities (p<0.05). Double stacking is most effective in increasing resistance to bending, particularly under anterior-posterior bending and axial compression, but requires a relatively high cost increase. Clinicians can use these data to help guide the most cost-effective strategy to increase construct stiffness based on the plane in which stiffness is needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mutual information-based template matching scheme for detection of breast masses: from mammography to digital breast tomosynthesis

PubMed Central

Mazurowski, Maciej A; Lo, Joseph Y; Harrawood, Brian P; Tourassi, Georgia D

2011-01-01

Development of a computational decision aid for a new medical imaging modality typically is a long and complicated process. It consists of collecting data in the form of images and annotations, development of image processing and pattern recognition algorithms for analysis of the new images and finally testing of the resulting system. Since new imaging modalities are developed more rapidly than ever before, any effort for decreasing the time and cost of this development process could result in maximizing the benefit of the new imaging modality to patients by making the computer aids quickly available to radiologists that interpret the images. In this paper, we make a step in this direction and investigate the possibility of translating the knowledge about the detection problem from one imaging modality to another. Specifically, we present a computer-aided detection (CAD) system for mammographic masses that uses a mutual information-based template matching scheme with intelligently selected templates. We presented principles of template matching with mutual information for mammography before. In this paper, we present an implementation of those principles in a complete computer-aided detection system. The proposed system, through an automatic optimization process, chooses the most useful templates (mammographic regions of interest) using a large database of previously collected and annotated mammograms. Through this process, the knowledge about the task of detecting masses in mammograms is incorporated in the system. Then we evaluate whether our system developed for screen-film mammograms can be successfully applied not only to other mammograms but also to digital breast tomosynthesis (DBT) reconstructed slices without adding any DBT cases for training. Our rationale is that since mutual information is known to be a robust intermodality image similarity measure, it has high potential of transferring knowledge between modalities in the context of the mass detection task. Experimental evaluation of the system on mammograms showed competitive performance compared to other mammography CAD systems recently published in the literature. When the system was applied “as-is” to DBT, its performance was notably worse than that for mammograms. However, with a simple additional preprocessing step, the performance of the system reached levels similar to that obtained for mammograms. In conclusion, the presented CAD system not only performed competitively on screen-film mammograms but it also performed robustly on DBT showing that direct transfer of knowledge across breast imaging modalities for mass detection is in fact possible. PMID:21554985

ON-Q infusion pump linked to increased hospital stay after total knee arthroplasty.

PubMed

O'Neil, Stephen; Danielson, Kristopher; Johnson, Kory; Matelic, Thomas

2018-06-01

The purpose of this study was to evaluate immediate postoperative pain control modalities after total knee arthroplasty at the author's specific institution and compare those modalities with patient satisfaction, rehabilitation status, and length of hospital stay. A retrospective chart review of 101 patients who underwent total knee arthroplasty from 2013 to 2016 was performed. Data was collected including the pain control modality, total pain medication consumption, physical therapy progress, length of hospital stay and Visual Analog Scores. Analysis was then performed using SAS proprietary software. Results were reported as statistically significant if p value was less than 0.05. Multiple variables proved to be statistically significant (p value <0.05) in this particular study. Patients who received Valium required more morphine equivalents on average and reported higher Visual Analog Scores (VAS). For those patients who received a lower extremity nerve block pre operatively, there was a decrease in morphine equivalents on postoperative day one and lower VAS. For those patients who received the continuous pain pump, ON-Q postoperatively, there was an average increase in length of hospital stay by one day and a decrease in ambulation on postoperative day one. Also, females required less overall pain medication on postoperative days two and three compared to their male counterparts. Finally, there was no statistically significant difference for those patients who received Lyrica (pregabalin) or NSAIDS for the parameters that were measured in this study. Postoperative pain control modalities after total knee arthroplasty are highly variable among physicians. This variability has allowed researchers to review each modality and compare and contrast the benefits with the potential adverse effects of these medications on total knee replacement outcomes. The data in this study suggests that the use of Valium is correlated with increased pain medication consumption and decreased patient satisfaction. Data from this study also reveals that patients who underwent preoperative nerve blocks experienced decreased pain on postoperative day one and greater patient satisfaction. The most notable contribution of this study was the discovery of the adverse effects of the continuous pain pump, ON-Q. Patients treated with this modality had decreased ambulation on postoperative day one and on average remained in the hospital one extra day, a variable that significantly increases the cost of a total knee arthroplasty for the hospital, the surgeon and the patient. Even though this data is significant, further studies should be performed to enhance our knowledge of postoperative pain control for these patients.

Estimating multivariate similarity between neuroimaging datasets with sparse canonical correlation analysis: an application to perfusion imaging.

PubMed

Rosa, Maria J; Mehta, Mitul A; Pich, Emilio M; Risterucci, Celine; Zelaya, Fernando; Reinders, Antje A T S; Williams, Steve C R; Dazzan, Paola; Doyle, Orla M; Marquand, Andre F

2015-01-01

An increasing number of neuroimaging studies are based on either combining more than one data modality (inter-modal) or combining more than one measurement from the same modality (intra-modal). To date, most intra-modal studies using multivariate statistics have focused on differences between datasets, for instance relying on classifiers to differentiate between effects in the data. However, to fully characterize these effects, multivariate methods able to measure similarities between datasets are needed. One classical technique for estimating the relationship between two datasets is canonical correlation analysis (CCA). However, in the context of high-dimensional data the application of CCA is extremely challenging. A recent extension of CCA, sparse CCA (SCCA), overcomes this limitation, by regularizing the model parameters while yielding a sparse solution. In this work, we modify SCCA with the aim of facilitating its application to high-dimensional neuroimaging data and finding meaningful multivariate image-to-image correspondences in intra-modal studies. In particular, we show how the optimal subset of variables can be estimated independently and we look at the information encoded in more than one set of SCCA transformations. We illustrate our framework using Arterial Spin Labeling data to investigate multivariate similarities between the effects of two antipsychotic drugs on cerebral blood flow.

Acceptability and feasibility of a low-cost, theory-based and co-produced intervention to reduce workplace sitting time in desk-based university employees.

PubMed

Mackenzie, Kelly; Goyder, Elizabeth; Eves, Francis

2015-12-24

Prolonged sedentary time is linked with poor health, independent of physical activity levels. Workplace sitting significantly contributes to sedentary time, but there is limited research evaluating low-cost interventions targeting reductions in workplace sitting. Current evidence supports the use of multi-modal interventions developed using participative approaches. This study aimed to explore the acceptability and feasibility of a low-cost, co-produced, multi-modal intervention to reduce workplace sitting. The intervention was developed with eleven volunteers from a large university department in the UK using participative approaches and "brainstorming" techniques. Main components of the intervention included: emails suggesting ways to "sit less" e.g. walking and standing meetings; free reminder software to install onto computers; social media to increase awareness; workplace champions; management support; and point-of-decision prompts e.g. by lifts encouraging stair use. All staff (n = 317) were invited to take part. Seventeen participated in all aspects of the evaluation, completing pre- and post-intervention sitting logs and questionnaires. The intervention was delivered over four weeks from 7th July to 3rd August 2014. Pre- and post-intervention difference in daily workplace sitting time was presented as a mean ± standard deviation. Questionnaires were used to establish awareness of the intervention and its various elements, and to collect qualitative data regarding intervention acceptability and feasibility. Mean baseline sitting time of 440 min/workday was reported with a mean reduction of 26 ± 54 min/workday post-intervention (n = 17, 95 % CI = -2 to 53). All participants were aware of the intervention as a whole, although there was a range of awareness for individual elements of the intervention. The intervention was generally felt to be both acceptable and feasible. Management support was perceived to be a strength, whilst specific strategies that were encouraged, including walking and standing meetings, received mixed feedback. This small-scale pilot provides encouragement for the acceptability and feasibility of low-cost, multi-modal interventions to reduce workplace sitting in UK settings. Evaluation of this intervention provides useful information to support participatory approaches during intervention development and the potential for more sustainable low-cost interventions. Findings may be limited in terms of generalisability as this pilot was carried out within a health-related academic setting.

Dynamic analysis of flexible rotor-bearing systems using a modal approach

NASA Technical Reports Server (NTRS)

Choy, K. C.; Gunter, E. J.; Barrett, L. E.

1978-01-01

The generalized dynamic equations of motion were obtained by the direct stiffness method for multimass flexible rotor-bearing systems. The direct solution of the equations of motion is illustrated on a simple 3-mass system. For complex rotor-bearing systems, the direct solution of the equations becomes very difficult. The transformation of the equations of motion into modal coordinates can greatly simplify the computation for the solution. The use of undamped and damped system mode shapes in the transformation are discussed. A set of undamped critical speed modes is used to transform the equations of motion into a set of coupled modal equations of motion. A rapid procedure for computing stability, steady state unbalance response, and transient response of the rotor-bearing system is presented. Examples of the application of this modal approach are presented. The dynamics of the system is further investigated with frequency spectrum analysis of the transient response.

Ares I-X Flight Test Vehicle: Stack 5 Modal Test

NASA Technical Reports Server (NTRS)

Buehrle, Ralph D.; Templeton, Justin D.; Reaves, Mercedes C.; Horta, Lucas G.; Gaspar, James L.; Bartolotta, Paul A.; Parks, Russel A.; Lazor, Danel R.

2010-01-01

Ares I-X was the first flight test vehicle used in the development of NASA's Ares I crew launch vehicle. The Ares I-X used a 4-segment reusable solid rocket booster from the Space Shuttle heritage with mass simulators for the 5th segment, upper stage, crew module and launch abort system. Three modal tests were defined to verify the dynamic finite element model of the Ares I-X flight test vehicle. Test configurations included two partial stacks and the full Ares I-X flight test vehicle on the Mobile Launcher Platform. This report focuses on the first modal test that was performed on the top section of the vehicle referred to as Stack 5, which consisted of the spacecraft adapter, service module, crew module and launch abort system simulators. This report describes the test requirements, constraints, pre-test analysis, test operations and data analysis for the Ares I-X Stack 5 modal test.

Ares I-X Flight Test Vehicle:Stack 1 Modal Test

NASA Technical Reports Server (NTRS)

Buehrle, Ralph D.; Templeton, Justin D.; Reaves, Mercedes C.; Horta, Lucas G.; Gaspar, James L.; Bartolotta, Paul A.; Parks, Russel A.; Lazor, Daniel R.

2010-01-01

Ares I-X was the first flight test vehicle used in the development of NASA s Ares I crew launch vehicle. The Ares I-X used a 4-segment reusable solid rocket booster from the Space Shuttle heritage with mass simulators for the 5th segment, upper stage, crew module and launch abort system. Three modal tests were defined to verify the dynamic finite element model of the Ares I-X flight test vehicle. Test configurations included two partial stacks and the full Ares I-X flight test vehicle on the Mobile Launcher Platform. This report focuses on the second modal test that was performed on the middle section of the vehicle referred to as Stack 1, which consisted of the subassembly from the 5th segment simulator through the interstage. This report describes the test requirements, constraints, pre-test analysis, test operations and data analysis for the Ares I-X Stack 1 modal test.

Finite-element analysis and modal testing of a rotating wind turbine

NASA Astrophysics Data System (ADS)

Carne, T. G.; Lobitz, D. W.; Nord, A. R.; Watson, R. A.

1982-10-01

A finite element procedure, which includes geometric stiffening, and centrifugal and Coriolis terms resulting from the use of a rotating coordinate system, was developed to compute the mode shapes and frequencies of rotating structures. Special applications of this capability was made to Darrieus, vertical axis wind turbines. In a parallel development effort, a technique for the modal testing of a rotating vertical axis wind turbine is established to measure modal parameters directly. Results from the predictive and experimental techniques for the modal frequencies and mode shapes are compared over a wide range of rotational speeds.

Finite element analysis and modal testing of a rotating wind turbine

NASA Astrophysics Data System (ADS)

Carne, T. G.; Lobitz, D. W.; Nord, A. R.; Watson, R. A.

A finite element procedure, which includes geometric stiffening, and centrifugal and Coriolis terms resulting from the use of a rotating coordinate system, has been developed to compute the mode shapes and frequencies of rotating structures. Special application of this capability has been made to Darrieus, vertical axis wind turbines. In a parallel development effort, a technique for the modal testing of a rotating vertical axis wind turbine has been established to measure modal parameters directly. Results from the predictive and experimental techniques for the modal frequencies and mode shapes are compared over a wide range of rotational speeds.

Model mismatch analysis and compensation for modal phase measuring deflectometry

DOE PAGES

Huang, Lei; Xue, Junpeng; Gao, Bo; ...

2017-01-11

The correspondence residuals due to the discrepancy between the reality and the shape model in use are analyzed for the modal phase measuring deflectometry. Slope residuals are calculated from these discrepancies between the modal estimation and practical acquisition. Since the shape mismatch mainly occurs locally, zonal integration methods which are good at dealing with local variations are used to reconstruct the height residual for compensation. Finally, results of both simulation and experiment indicate the proposed height compensation method is effective, which can be used as a post-complement for the modal phase measuring deflectometry.

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma.

PubMed

Naghavi, Arash O; Gonzalez, Ricardo J; Scott, Jacob G; Kim, Youngchul; Abuodeh, Yazan A; Strom, Tobin J; Echevarria, Michelle; Mullinax, John E; Ahmed, Kamran A; Harrison, Louis B; Fernandez, Daniel C

2017-02-01

Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective. A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months. Median follow-up was 31 months. Staged reconstruction ( n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR ( n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR ( p = 0.005) and $58K higher with LF ( p = 0.02). In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

PubMed Central

Naghavi, Arash O.; Gonzalez, Ricardo J.; Scott, Jacob G.; Kim, Youngchul; Abuodeh, Yazan A.; Strom, Tobin J.; Echevarria, Michelle; Mullinax, John E.; Ahmed, Kamran A.; Harrison, Louis B.

2017-01-01

Purpose Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective. Material and methods A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months. Results Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02). Conclusions In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine. PMID:28344600

Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

PubMed Central

Pak, Jae; Kim, Jino

2017-01-01

Two relatively new modalities, follicular unit extraction (FUE) and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5%) and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination. PMID:29263945

Operational Modal Analysis of the Cablestayed Footbridge

NASA Astrophysics Data System (ADS)

Kortiš, Ján; Daniel, Ľuboš; Farbák, Matúš; Maliar, Lukáš; Škarupa, Milan

2017-12-01

Modern architecture leads to design subtle bridge structures that are more sensitive to increased dynamic loading than the massive ones. This phenomenon can be especially observed on lightweight steel structures such as suspended footbridges. As a result, it is necessary to know precisely its dynamic characteristics, such as natural frequencies, natural shapes and damping of construction. This information can be used for further analysis such as damage detection, system identification, health monitoring, etc. or also for the design of new types of construction. For this purpose, classical modal analysis using trigger load or harmonic vibration exciter in combination with acceleration sensors is used in practice. However, there are many situations where it is not possible to stop the traffic or operation of the bridge. The article presents an experimental measurement of the dynamic parameters of the structure at the operating load using the operational modal analysis.

Restricted Acoustic Modal Analysis Applied to Internal Combustor Spectra and Cross-Spectra Measurements

NASA Technical Reports Server (NTRS)

Miles, Jeffrey Hilton

2006-01-01

A treatment of the modal decomposition of the pressure field in a combustor as determined by two Kulite pressure measurements is developed herein. It is applied to a Pratt & Whitney PW4098 engine combustor over a range of operating conditions. For modes other than the plane wave the new part of the treatment is the assumption that there are distinct frequency bands in which the individual modes, including the plane wave mode, overlap such that if circumferential mode m and circumferential mode m-1 are present than circumferential mode m 2 is not. Consequently, in the analysis used herein at frequencies above the first cut-off mode frequency, only pairs of circumferential modes are individually present at each frequency. Consequently, this is a restricted modal analysis. A new result is that the successful use of the same modal span frequencies over a range of operating conditions for this particular engine suggests that the temperature, T, and the velocity, v, of the flow at each operating condition are related by c(sup 2)-v(sup 2) = a constant where c is the speed of sound.

A versatile clearing agent for multi-modal brain imaging

PubMed Central

Costantini, Irene; Ghobril, Jean-Pierre; Di Giovanna, Antonino Paolo; Mascaro, Anna Letizia Allegra; Silvestri, Ludovico; Müllenbroich, Marie Caroline; Onofri, Leonardo; Conti, Valerio; Vanzi, Francesco; Sacconi, Leonardo; Guerrini, Renzo; Markram, Henry; Iannello, Giulio; Pavone, Francesco Saverio

2015-01-01

Extensive mapping of neuronal connections in the central nervous system requires high-throughput µm-scale imaging of large volumes. In recent years, different approaches have been developed to overcome the limitations due to tissue light scattering. These methods are generally developed to improve the performance of a specific imaging modality, thus limiting comprehensive neuroanatomical exploration by multi-modal optical techniques. Here, we introduce a versatile brain clearing agent (2,2′-thiodiethanol; TDE) suitable for various applications and imaging techniques. TDE is cost-efficient, water-soluble and low-viscous and, more importantly, it preserves fluorescence, is compatible with immunostaining and does not cause deformations at sub-cellular level. We demonstrate the effectiveness of this method in different applications: in fixed samples by imaging a whole mouse hippocampus with serial two-photon tomography; in combination with CLARITY by reconstructing an entire mouse brain with light sheet microscopy and in translational research by imaging immunostained human dysplastic brain tissue. PMID:25950610

Representational similarity analysis reveals commonalities and differences in the semantic processing of words and objects.

PubMed

Devereux, Barry J; Clarke, Alex; Marouchos, Andreas; Tyler, Lorraine K

2013-11-27

Understanding the meanings of words and objects requires the activation of underlying conceptual representations. Semantic representations are often assumed to be coded such that meaning is evoked regardless of the input modality. However, the extent to which meaning is coded in modality-independent or amodal systems remains controversial. We address this issue in a human fMRI study investigating the neural processing of concepts, presented separately as written words and pictures. Activation maps for each individual word and picture were used as input for searchlight-based multivoxel pattern analyses. Representational similarity analysis was used to identify regions correlating with low-level visual models of the words and objects and the semantic category structure common to both. Common semantic category effects for both modalities were found in a left-lateralized network, including left posterior middle temporal gyrus (LpMTG), left angular gyrus, and left intraparietal sulcus (LIPS), in addition to object- and word-specific semantic processing in ventral temporal cortex and more anterior MTG, respectively. To explore differences in representational content across regions and modalities, we developed novel data-driven analyses, based on k-means clustering of searchlight dissimilarity matrices and seeded correlation analysis. These revealed subtle differences in the representations in semantic-sensitive regions, with representations in LIPS being relatively invariant to stimulus modality and representations in LpMTG being uncorrelated across modality. These results suggest that, although both LpMTG and LIPS are involved in semantic processing, only the functional role of LIPS is the same regardless of the visual input, whereas the functional role of LpMTG differs for words and objects.

Cost-effectiveness of routine imaging of suspected appendicitis.

PubMed

D'Souza, N; Marsden, M; Bottomley, S; Nagarajah, N; Scutt, F; Toh, S

2018-01-01

Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

Computer-Assisted Traffic Engineering Using Assignment, Optimal Signal Setting, and Modal Split

DOT National Transportation Integrated Search

1978-05-01

Methods of traffic assignment, traffic signal setting, and modal split analysis are combined in a set of computer-assisted traffic engineering programs. The system optimization and user optimization traffic assignments are described. Travel time func...

Modal analysis of untransposed bilateral three-phase lines -- a perturbation approach

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

Faria, J.A.B.; Mendes, J.H.B.

1997-01-01

Model analysis of three-phase power lines exhibiting bilateral symmetry leads to modal transformation matrices that closely resemble Clarke`s transformation. The authors develop a perturbation theory approach to justify, interpret, and gain understanding of this well known fact. Further, the authors show how to find new frequency dependent correction terms that once added to Clarke`s transformation lead to improved accuracy.

Design and Analysis of Wind Turbine Rotors Using Hinged Structures and Rods

NASA Astrophysics Data System (ADS)

Lu, Hongya; Zeng, Pan; Lei, Liping

2018-03-01

Light weight and high stiffness are key design factors in ensuring cost effectiveness and reliability of wind turbines, especially for the inboard region of the rotor blades. In this study, several novel designs were developed to improve the mechanical performance of the rotor. Experiments were performed on an isolated blade incorporating the new features of a hinged structure and rods. The results validated the effectiveness of these features at alleviating the root-bending moment of the blade under varying wind loads and enhancing the stiffness of the blade. A numerical investigation was carried out to further examine the bending moment distribution, shear and axial force, and rod tension of these novel rotor designs under uniform loads. Longitudinal geometrical variations of the blade were considered in the model. Results showed that two designs realized a favorable bending moment distribution and improved the modal frequencies of the edgewise modes: bisymmetrical rods on a single-hinged structure and interveined symmetrical rods on a cantilevered structure. However, these designs have different deformation mechanisms. In addition, the first group of edgewise modal frequencies of these two designs were improved compared with the traditional rotor design. Their potential values in the application to the design of a lightweight, high-stiffness, and reliable wind turbine rotor were discussed.

A portable microscopy system for fluorescence, polarized, and brightfield imaging

NASA Astrophysics Data System (ADS)

Gordon, Paul; Wattinger, Rolla; Lewis, Cody; Venancio, Vinicius Paula; Mertens-Talcott, Susanne U.; Coté, Gerard

2018-02-01

The use of mobile phones to conduct diagnostic microscopy at the point-of-care presents intriguing possibilities for the advancement of high-quality medical care in remote settings. However, it is challenging to create a single device that can adapt to the ever-varying camera technologies in phones or that can image with the customization that multiple modalities require for applications such as malaria diagnosis. A portable multi-modal microscope system is presented that utilizes a Raspberry Pi to collect and transmit data wirelessly to a myriad of electronic devices for image analysis. The microscopy system is capable of providing to the user correlated brightfield, polarized, and fluorescent images of samples fixed on traditional microscopy slides. The multimodal diagnostic capabilities of the microscope were assessed by measuring parasitemia of Plasmodium falciparum-infected thin blood smears. The device is capable of detecting fluorescently-labeled DNA using FITC excitation (490 nm) and emission (525 nm), the birefringent P. falciparum byproduct hemozoin, and detecting brightfield absorption with a resolution of 0.78 micrometers (element 9-3 of a 1951 Air Force Target). This microscopy system is a novel portable imaging tool that may be a viable candidate for field implementation if challenges of system durability, cost considerations, and full automation can be overcome.

Effective Connectivity of Cortical Sensorimotor Networks During Finger Movement Tasks: A Simultaneous fNIRS, fMRI, EEG Study.

PubMed

Anwar, A R; Muthalib, M; Perrey, S; Galka, A; Granert, O; Wolff, S; Heute, U; Deuschl, G; Raethjen, J; Muthuraman, Muthuraman

2016-09-01

Recently, interest has been growing to understand the underlying dynamic directional relationship between simultaneously activated regions of the brain during motor task performance. Such directionality analysis (or effective connectivity analysis), based on non-invasive electrophysiological (electroencephalography-EEG) and hemodynamic (functional near infrared spectroscopy-fNIRS; and functional magnetic resonance imaging-fMRI) neuroimaging modalities can provide an estimate of the motor task-related information flow from one brain region to another. Since EEG, fNIRS and fMRI modalities achieve different spatial and temporal resolutions of motor-task related activation in the brain, the aim of this study was to determine the effective connectivity of cortico-cortical sensorimotor networks during finger movement tasks measured by each neuroimaging modality. Nine healthy subjects performed right hand finger movement tasks of different complexity (simple finger tapping-FT, simple finger sequence-SFS, and complex finger sequence-CFS). We focused our observations on three cortical regions of interest (ROIs), namely the contralateral sensorimotor cortex (SMC), the contralateral premotor cortex (PMC) and the contralateral dorsolateral prefrontal cortex (DLPFC). We estimated the effective connectivity between these ROIs using conditional Granger causality (GC) analysis determined from the time series signals measured by fMRI (blood oxygenation level-dependent-BOLD), fNIRS (oxygenated-O2Hb and deoxygenated-HHb hemoglobin), and EEG (scalp and source level analysis) neuroimaging modalities. The effective connectivity analysis showed significant bi-directional information flow between the SMC, PMC, and DLPFC as determined by the EEG (scalp and source), fMRI (BOLD) and fNIRS (O2Hb and HHb) modalities for all three motor tasks. However the source level EEG GC values were significantly greater than the other modalities. In addition, only the source level EEG showed a significantly greater forward than backward information flow between the ROIs. This simultaneous fMRI, fNIRS and EEG study has shown through independent GC analysis of the respective time series that a bi-directional effective connectivity occurs within a cortico-cortical sensorimotor network (SMC, PMC and DLPFC) during finger movement tasks.

Modal parameter identification based on combining transmissibility functions and blind source separation techniques

NASA Astrophysics Data System (ADS)

Araújo, Iván Gómez; Sánchez, Jesús Antonio García; Andersen, Palle

2018-05-01

Transmissibility-based operational modal analysis is a recent and alternative approach used to identify the modal parameters of structures under operational conditions. This approach is advantageous compared with traditional operational modal analysis because it does not make any assumptions about the excitation spectrum (i.e., white noise with a flat spectrum). However, common methodologies do not include a procedure to extract closely spaced modes with low signal-to-noise ratios. This issue is relevant when considering that engineering structures generally have closely spaced modes and that their measured responses present high levels of noise. Therefore, to overcome these problems, a new combined method for modal parameter identification is proposed in this work. The proposed method combines blind source separation (BSS) techniques and transmissibility-based methods. Here, BSS techniques were used to recover source signals, and transmissibility-based methods were applied to estimate modal information from the recovered source signals. To achieve this combination, a new method to define a transmissibility function was proposed. The suggested transmissibility function is based on the relationship between the power spectral density (PSD) of mixed signals and the PSD of signals from a single source. The numerical responses of a truss structure with high levels of added noise and very closely spaced modes were processed using the proposed combined method to evaluate its ability to identify modal parameters in these conditions. Colored and white noise excitations were used for the numerical example. The proposed combined method was also used to evaluate the modal parameters of an experimental test on a structure containing closely spaced modes. The results showed that the proposed combined method is capable of identifying very closely spaced modes in the presence of noise and, thus, may be potentially applied to improve the identification of damping ratios.

Four novel prosthodontic methods for managing upper airway resistance syndrome: an investigative analysis revealing the efficacy of the new nasopharyngeal aperture guard appliance.

PubMed

Venkat, R; Gopichander, N; Vasantakumar, M

2010-01-01

Obstructive sleep apnea is the most frequent cause for insomnia in the populace. Snoring is mulled over as the potential factor that can lead the sequel to obstructive sleep apnea. Although the etiology and deterrence measures for snoring are yet to be undoubtedly clarified by our scientific sorority, various means of surgical corrections have been affirmed and put into practice, with a substantial degree of success. Despite this, it is implicit that a noninvasive method of managing obstructive sleep apnea is more relevant for overcoming this condition. This manuscript intends to establish how snoring can be controlled prosthodontically by different modalities of scientifically defensible approaches. The most effective among the modalities was affirmed as the investigative analyses of the treatment outcomes with each modality. NOVEL METHODS: Four new methods of managing obstructive sleep apnea--uvula lift appliance, uvula and velopharynx lift appliance, nasopharyngeal aperture guard, and soft palate lift appliance were demonstrated through this article. The four new modalities stated and one conventional modality of mandibular advancement appliance for managing obstructive sleep apnea, a total of five types of appliance therapies, were described with case reports for each. Five individuals undergoing the appliance therapy were chosen for each modality. The treatment outcome with each modality was examined by analysis of clinical predictors and also by means of standard investigation, with nasal and oral endoscopic analyses. Among the five types of appliance therapies, the nasopharyngeal aperture guard provided the best treatment outcome in terms of clinical predictors and endoscopic analyses. Nasopharyngeal aperture guard, the novel method stated in this article is the better modality for managing obstructive sleep apnea, among the five different appliance therapies.