Showing papers on "Cost effectiveness published in 1979"

Selective primary health care. An interim strategy for disease control in developing countries.

Abstract: Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.

Processing facilitation in a lexical decision task.

Abstract: A cost/benefit and a speed/accuracy analysis of semantic priming in a lexical decision task provided information'relevant to the \\\ automatic/conscious' facilitation distinction made by Neely (1977 and Posner and Snyder (1975b).. Information is also provided about the opera\tion_of distriminability, criterion bias, and response bias in the facilitation. In both studies, half the cues were neutral and half were words.. Word-cues were instances from 30 semantic categories. : Word,targets were the category names, nonword targets were derived from those names. The cue-word was valid 80% ok the time and invalid 20% of the time. In Experiment 1, cue time, a between groups factor was either 200, 300, 400, 500, or 700 msec. Valid cues produced facilitation:in. RT at cue times as short as 400 msec. j Invalid cues produced inhibition at cue times as short as 200 msec. These results, while Similar in many respects to Neely's (1977), raise doubts about an "inhibitionless" kind of automatic facilitation in primed lexical decisions. Response bias and simple applications .of criterion bias models are also ruled -out as the sole explanation of the facilitation. Experiment 2 used a response-signal technique to collect information about the speed/accuracy trade-off-in a lexical decision task. Six college students ' participated in 10 sessions each. Cues were always presented for 800 msec, targets were variably presented-within subjects for either 100, 200, 300, 450,-or 600 msec. Results indicate that.: (a-) subjects are...capable of trading. accuracy for speed; (b) invalid cues can ,.lower discriminability; (c) response bias is an active component in-primingl_JAJ_previous studies

Mathematics and mallard management

Abstract: Waterfowl managers can effectively use simple population models to aid in making management decisions. We present a basic model of the change in population size as related to survival and recruitment. A management technique designed to increase survival of mallards (Anas platyrhynchos) by limiting harvest on the Chippewa National Forest, Minnesota, is used to illustrate the application of models in decision making. The analysis suggests that the management technique would be of limited effectiveness. In a 2nd example, the change in mallard population in central North Dakota is related to implementing programs to create dense nesting cover with or without supplementary predator control. The analysis suggests that large tracts of land would be required to achieve a hypothetical management objective of increasing harvest by 50% while maintaining a stable population. Less land would be required if predator reduction were used in combination with cover management, but questions about effectiveness and ecological implications of large scale predator reduction remain unresolved. The use of models as a guide to planning research responsive to the needs of management is illustrated. J. WILDL. MANAGE. 43(1):18-35 Management of a wildlife population is a complicated task that often requires decisions based on limited data. To make logical decisions we need (1) a management policy or objective defined in terms of some goal, (2) a relationship between that goal and parameters of the population to be managed, and (3) estimates of these parameters. Such a relationship is often termed a "model," and can be either quite rudimentary and qualitative or complicated and quantitative. Inadequate information often forces us to use models that grossly oversimplify the behavior of the real population and to employ estimates that are frequently little better than informed guesses. The manager cannot postpone a decision until the dynamics of the population are fully understood and precise estimates of all parameters are available. Inaction is in fact a decision by default. The development of simple models, imperfect though they may be, and the graphic representation of these models can facilitate logical and orderly development of management strategy. Because of the large quantity of pertinent banding and survey data available, the mallard has been the subject of several published models (Walters et al. 1974, Anderson 1975a,b, Brown et al. 1976). These models use estimates of production based on survey data for the continental population. In contrast, our model relates recruitment to various components that are frequently measured in local studies and that are subject to manipulation by the waterfowl manager. The exercise of presenting a model has a number of benefits: (1) inspection of the model may focus attention on critical parameters; (2) the model provides a frame of reference for evaluating policy and assessing the feasibility of objectives; (3) insight into possible alternatives for reaching an objective is gained; and (4) we are forced to face the reality of the management problem and to answer important questions such as cost effectiveness and political feasibility. The purpose of this paper is to demonstrate a simple model that can facilitate decisions concerning management of mallards in the north central

Virtual Machine Technology: A Bridge From Large Mainframes To Networks Of Small Computers

Abstract: The cost effectiveness of small computers (minis and micros) makes it desirable to use networks of such machines in a manner that provides the functionality available on large systems, but takes advantage of the potentially greater reliability of a distributed system. This paper explores how traditional virtual machine concepts can be extended to networks of cooperating virtual machines running on multiple processors. Some design approaches useful in building systems of cooperating virtual machines are then discussed.

Cost-Effectiveness of Computer-Based Instruction in Military Training

Abstract: : The cost and effectiveness of computer-based instruction for military training are evaluated on the basis of about 30 studies conducted since 1968. Four methods of instruction are distinguished and compared: Conventional Instruction: group-paced lectures, and discussions. Individualized Instruction: self-paced (without computer support). Computer-Assisted Instruction (CAI): computer stores and provides instructional materials to students individually via interactive terminals; computer tests and guides students; self-paced. Computer-Managed Instruction (CMI): instructional materials and tests provided away from computer; computer scores the tests and guides students; self-paced.

Performance testing: a rose among thorns?

Abstract: Data on 21 performance tests, entry level and promotional, motor and verbal, were evaluated for 263 applicants for city government jobs over a 17-month period. The heterogeneity in applicants was matched by a similar heterogeneity in raters. Thorough training of raters, clear performance standards, and content valid tests resulted in average inter-rater reliabilities of .93 (promotional), .87 (entry level), .91 (motor) and .89 (verbal) for the different types and levels of tests. There was no evidence of adverse impact, and turnover decreased from 40 percent to less than 3 percent in the 9-26 months following the introduction of performance testing. In comparison to paper and pencil tests, performance tests were more cost effective, more face valid, and more acceptable to applicants in this situation. Considering the growing problems in public sector management, performance testing may be viewed as a rose among thorns.

Refractory metal gate processes for VLSI applications

Abstract: The conventional n-channel silicon-gate MOS technology faces limitations due to poly-sheet resistance, patterning, and overall process compatibility as feature dimensions shrink and circuit sizes increase. This work describes an investigation of refractory metals as alternate gate material due to their potential advantages in terms of patternability, film sheet resistance that is 50 to 100 times lower comparable to polysilicon, and circuit layout options with improved performance and cost effectiveness. A process was developed for fabrication of NMOS devices using electron-beam direct writing, refractory metal gates and interconnects. Evaporated as well as sputtered molybdenum and tungsten show columnar crystalline structure allowing reproducible patterning of 1-µm lines with the conventional plasma etch techniques. Sheet resistivities of 0.25 Ω/□ and 0.4 Ω/□ were achieved for 3500-A Mo and W films, respectively. Basic parameters such as electronic work function, interface, and surface state charge densities and MOS transistor threshold voltages were determined from metal gate devices with 200-800-A oxides. Flat-band voltages of -0.2 V with mid 1010cm-2interface charges were achieved. Mo-Al-Si double-level metal structure with contacts as small as 2 µm2were fabricated. Considerable improvement in the speed of the LSI circuits fabricated with these high-conductivity gates was demonstrated through computer simulation. Improved circuit layouts of static and dynamic memory cells for speed, power, and density optimization can be achieved. A four-mask process with the simplicity of aluminum gate technology and the performance of current n-channel silicon gate MOS process is proposed.

Weighing the Risks.

Abstract: The nuclear industry's standstill over legal uncertainties and the lack of clear criteria on which to decide hazard management questions is typical of the frustrations in assessing new technologies to see if they are safe enough. Four techniques of risk assessment are described; (1) cost-benefit analysis, in which benefits outweighing costs can determine safety; (2) revealed preference, in which risks cannot exceed those of existing technologies having equal benefit; (3) expessed preferences, in which the people decide to accept the risks; and (4) natural standards, in which the risks do not exceed those normally associated with human development. The strengths and weaknesses of each approach are described and the conclusion reached that a combined approach that brings more scientific and lay perspectives to bear on the issue is more likely to be right, particularly in situations involving multiple hazards. 40 references.

Uses, Value, and Benefits of Knowledge

Abstract: In this article, the author argues that the use of knowledge refers not to the information, not to the process of transmitting messages, but to the contents the knowledge conveyed by it However the delivery system is often mistaken for the knowledge it delivers, resulting in misplaced values Intellectual knowledge can only be acquired by people willing to exert themselves for the sake of becoming more knowledgeable and better educated Expressing his frustrations with miscon ceptions among vanous producers of knowledge, the author reminds them that equitable availability and distribution of benefits must be considered in the developmental stages of systems that disseminate knowledge Only then will the wise use of knowledge be encouraged for societal good

A monolithic video A/D converter

Abstract: The design and measured performance of a fully parallel monolithic 8-bit A/D converter is reported. The required comparators and combining logic were designed and fabricated with a standard high-performance triple-diffused technology. A bipolar comparator circuit giving good performance with high input impedance is described. Circuit operation is reported at sample rates up to 30 megasamples per second (MS/s), with analog input signal power at frequencies up to 6 MHz. Full 8-bit linearity was achieved. An SNR of 42-44 dB was observed at input signal frequencies up to 5.3 MHz.

Pharmacist monitoring of parenteral nutrition: clinical and cost effectiveness.

Abstract: The effect of pharmacist involvement in total parenteral nutrient (TPN) therapy on patient outcome and cost of therapy was studied. Data from 26 patients who received standard TPN solutions without pharmacist monitoring (Group 1) were compared with those from 26 patients whose TPN therapy was individualized (by use of a minicomputer) and monitored by a pharmacist (Group 2). Six patients from each group who were 35 days of age or younger and who received TPN as the only caloric source for 8 to 20 days were compared for clinical response. Mean duration of TPN therapy increased form 12.3 +/- 9 days for Group 1 to 14.8 +/- 12 days for Group 2, and the TPN use rate for Group 2 was 31% above that for group 1. The mean daily charge for TPN was greater for Group 1 ($72.00) than for Group 2 ($50.18). The pharmacy's mean cost per course of TPN for Group 2 was $44.10 less than that for Group 1. The mean weight gain in Group 1 was significantly less (4 g/day) than that in Group 2 (17 g/day) (p less than 0.05) (for the six patients per group compared). Pharmacist monitoring of TPN reduced the pharmacy's costs and patient charges for TPN and improved the patients' clinical responses to TPN.

Rapid geomorphological assessments for engineering

Abstract: Summary Geomorphological mapping is being used increasingly in engineering projects (especially at the reconnaissance and site-investigation stages) as a rapid, highly cost-effective means of assessing both potential hazards and resources. This is normally achieved through a field mapping programme which is dependent on the availability of aerial photographs, and which involves the correct interpretation of landforms as to their origins, material composition, and associated present-day geomorphological processes. The results of such a survey need to be presented in a form which is of direct use to an engineering geologist and/or engineer. This is best achieved, in most cases, by the production of problem or site-orientated maps derived from the primary geomorphological survey. The case studies, drawn from several investigations in arid land environments, were made by a small team of (3-5) geomorphologists and geologists, working for short but concentrated periods of time in the field. A search for fine aggregates in Bahrain was closely associated with the identification and mapping of contributing drainage networks and source areas for alluvial fan deposits. Thelocation of trial pits and boreholes at a site in Dubai was rationalised in terms of a reconnaissance map of both landforms and their constituent materials; while at Suez, extrapolation between existing trial pit and borehole sites was made possible from the geomorphological mapping of landform boundaries. Hazards to engineering from flooding (at Suez) and dune migration (in Dubai) were identified, assessed, and mapped on the basis of a knowledge of their place in the overall geomorphological system.

Systems of Care and Treatment Outcomes for Alcoholic Patients

Abstract: • All admissions to the Singer Mental Health Center, Rockford, III, with a diagnosis of alcoholism in a one-year period (N = 466) were randomly assigned to one of two inpatient programs. One program, "intensive incare," had a high staffpatient ratio with the operating assumption that intensive staffpatient interaction is significant in patient outcome. The other, "peer-oriented incare," was of low staff density with the assumption that patient-patient interaction is critical in rehabilitation. In addition, the patients resided in communities with outpatient services classified as either "network" (an organized set of community services) or "no-network" (no special funding or deliberate outreach effort). Thus, each patient could be treated in one of four systems of care. Data on treatment outcomes were collected via semistructured interviews at 3, 6, 12, and 18 months after admission. The "peer-oriented incare" system showed superiority to the "intensive incare" treatment approach in improved drinking behavior. There were no other significant differences among the four systems on the outcome criteria for alcoholic patients. Along with other recent studies, these findings have implications for policy planning, particularly with today's emphasis on cost effectiveness.

Home health care cost effectiveness: an overview of the literature.

Abstract: services has sparked a number of studies comparing the costs of home care relative to the costs of hospitalization and to care in skilled nursing and intermediate care facilities. These comparisons have led several authors to conclude that if greater emphasis were placed on providing health services to patients in their homes in lieu of institutions, significant cost savings would be realized from lowered admissions, earlier discharges, and reduced capital construction costs for inpatient facilities. Others counter that such generalizations fail to account for a number of important qualifying details. They point out, for example, that home health care may be less costly than institutional care for patients with lower levels of impairment but that cost savings tend to disappear when more severely impaired persons are cared for at home. Moreover, increased availability of home health care may inctease the total costs of health care by increasing overall utilization. These caveats open to question whether in-home care is in fact a potential means of cost savings for health care programs.

Preoperative electrocardiography: its cost-effectiveness in detecting abnormalities when a previous tracing exists

Abstract: In 812 patients who underwent routine preoperative electrocardiography a mean of 24.6 months after undergoing electrocardiography at the same institution, the frequency of new abnormalities was estimated to evaluate the cost-effectiveness of this procedure prior to an operation. New abnormalities were judged to be either relevant or irrelevant to the assessment of operative risk, depending upon their previously demonstrated correlation with operative and postoperative morbidity and mortality. Since new abnormalities, especially new relevant abnormalities, were found to be relatively infrequent, the cost-effectiveness of routine preoperative electrocardiography was considered to be low. The evidence suggested that when a previous tracing exists preoperative electrocardiography is most clearly indicated for patients who are 60 years of age or older or whose previous tracing exhibited abnormalities. However, further research is required to develop more sensitive and specific protocols, and to evaluate the role of repeat electrocardiography in clinical decision-making.

Thermal and other tests of photovoltaic modules performed in natural sunlight

Abstract: The bulk of the testing was the characterization of twenty-nine modules according to their nominal operating cell temperature (NOCT) and the effect on NOCT of changes in module design, various residential roof mounting configurations, and dirt accumulation. Other tests, often performed parallel with the NOCT measurements, evaluated the improvement in electrical performance by cooling the modules with water and by channeling the waste heat into a phase change material (wax). Electrical degradation resulting from the natural marriage of photovoltaic and solar water heating modules was also demonstrated. Cost effectiveness of each of these techniques are evaluated in light of the LSA cost goal of $0.50 per watt.

Cost-effectiveness of operative cholangiography.

Abstract: (1) Three hundred seventy-seven of 1,616 patients undergoing cholecystectomy between January 1, 1971 and December 31, 1975 had intraoperative cholangiograms and form the basis for this study. (2) The cholangiograms of thirty-seven patients were interpreted as positive for ductal disease, but only twenty-three had confirmed disease on common bile duct exploration. The average false-positive rate was 38 per cent per year. (3) One hundred nine patients had cholangiograms because of small stones in the gallbladder, and only one study was true-positive. (4) One hundred nineteen patients had cholangiograms without any clinical indication for the study. Only one was true-positive for intraductal disease. (5) Operative cholangiograms done routinely or for multiple small stones rarely reveal intraductal disease (2 of 228, or 0.9 per cent). (6) Of 149 cholangiograms in patients with clinical indications other than multiple small stones, twenty-one of twenty-six positive cholangiograms were true-positive, for an 81 per cent accuracy. (7) Operative time was prolonged an average of 31 minutes when cholangiography was performed. (8) The 377 cholangiograms cost $21,866. Of the 228 studies done routinely or for only multiple small stones, two were positive, for a cost of $6,612 per positive examination. (9) Therefore, to be cost-effective, the use of intraoperative cholangiography is indicated only when standard criteria for ductal exploration, with the exception of the presence of small calculi, are present.

Clinical interdisciplinary health team care: an educational experiment.

Abstract: With increasing concern for teamwork in clinical practice in health care settings, the need to identify the concepts, methods, and learning processes for improving interdisciplinary team skills is apparent. This paper describes patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting. The teams were involved in the theory and practice of team-building, including weekly sessions on leadership styles, communication, group decision-making, and team effectiveness assessment. Objective and subjective measurements were administered throughout the program. The results indicate that task-oriented patient care favors the learning of team skills, especially when all levels of administration support and participate in the processes. Question are raised concerning the effect of clinical teams on the quality of patient care, their cost-effectiveness, and the low priority given to teaching interdisciplinary team skills in professional education.

Educational Planning as Political Process: Two Case Studies from Latin America

Abstract: Undeterred by mounting evidence of the limitations and failures of educational plans as levers for institutional change, the international donor agencies (eg, World Bank, United States Agency for International Development [USAID], Interamerican Development Bank [IDB], Organization of American States [OAS] in Latin America) persist in their demands for a plan as a prerequisite to receiving credit or grants The generation of this plan requires, in their perspective, a "rational" approach to problems of education and development based on extensive quantitative description and analysis and free from "irrational" considerations such as those imposed by politicians It is difficult enough if a country feels pressured to accept international assistance either as grant or loan; but, in addition, the donors often specify how the gift is to be spent It is this second problem that concerns us here Recent working documents of the World Bank and USAID indicate the type of information considered essential in deciding whether or not to fund educational development projects' While USAID focuses more on the social significance of the project (loan or proposed change) in terms of how it meets the agency's congressional mandate, the bank's emphasis is on cost effectiveness The bank asks more for information dealing with internal efficiency; USAID is more concerned with external effectiveness In both cases, the criteria for assessment come from the agencies themselves rather than from the recipient countries There is little or no consideration of development objectives that are not related to goals of economic growth or distribution, and there is no consideration of dissent within the country on values for development Both lists implicitly

Fire Loss Reduction: Fire Detectors vs. Fire Stations

Abstract: This paper develops a method for comparing the cost effectiveness of two ways of improving the fire protection in a community: the installation of detection-alarm systems DAS in dwellings and the addition of fire companies. The method is developed from a number of relatively simple models and assumptions. One is a relationship that predicts average travel time from the number of “covered” fire stations and the size of the area being served. A second is a set of regressions of the percentage of the property value destroyed vs. response time for five classes of fires in one-and two-family homes. And a third is the effect of installing detection-alarm systems on the distribution of fires among the five classes at the time of detection. Adding fire companies increases the number of covered stations, thus reducing response time, and thence expected loss. Installing detectors increases the proportion of fires in the less serious classes, thus reducing expected loss. The method was applied to data from Calgary, Canada. The results for this case show that, from a base case with no DAS and 16 fire stations, adding detectors would be more cost effective than adding fire stations to reduce fire losses if a DAS for a one-or two-family home costs less than $2500 to install and $1700 a year to maintain or the equivalent cost mix using present values. The methodology can be extended to other types of occupancies e.g., high-rise buildings and commercial properties, and to other types of losses e.g., indirect and life. It could then become a useful tool in helping to choose fire protection levels for a community, as well as determining how to allocate a given amount of resources among different means of fire protection.

Induced groundwater recharge in the Ganges Basin

Abstract: The Ganges basin in India has a serious problem of water availability. The basin area, which is only one twelfth that of the United States, has a population greater than the total U.S. population, and it is increasing at a rate of 2.5% per annum. About 77% of the population is engaged in agriculture which is totally dependent on irrigation, as almost 85% of rainfall takes places in 2–3 monsoon months. Surface storage possibility is extremely limited, but groundwater recharge appears feasible, since sedimentary alluvial formations extend to depths of thousands of meters. Three alternative schemes of groundwater recharge have been proposed. One involves pumping heavily along perennial rivers prior to monsoons so as to lower groundwaters to promote induced groundwater recharge. The second proposes a similar approach along nonperennial rivers. The third involves irrigation during monsoons with groundwater lowered adequately in the nonmonsoon period so that enough induced groundwater recharge takes place to provide adequate supplies for nonmonsoon months. A simulation-optimization model has been developed to study the surface flow-groundwater interaction and has been applied to study comparative cost effectiveness of the three alternate approaches. Sensitivity analysis has also been carried out. It is shown that the third scheme is the most attractive.

Perinatal care and cost effectiveness: changes in health expenditures and birth outcome following the establishment of a nurse-midwife program.

Abstract: Estimates of infant health status and expenditures for perinatal care are presented for periods of time before and after implementation of a nurse-midwife program in rural Georgia. As the program developed, the infant mortality rate of the four counties served by the program showed a decrease. Similarly, the target population (pregnant women of low to moderate income who had no private physician) experienced decreases in the rate of neonatal mortality, low birthweight, and short gestational age. Estimated expenditures for perinatal care in the four counties decreased as well. These results are examined from the perspective of the National Health Planning and Resources Development Act of 1974 and the utility of using an epidemiologic approach for estimating the output of health services in terms of health status is emphasized.