Showing papers on "Cost effectiveness published in 1981"

Information in Organizations as Signal and Symbol.

Abstract: We are grateful for the comments of Kenneth Arrow, Kennette Benedict, Robert Biller, David Brereton, Louise Comfort, Jerry Feldman, Victor Fuchs, Anne Miner, J. Rounds, Alan Saltzstein, Guje Sevon, and J. Serge Taylor; for the assistance of Julia Ball; and for grants from the Spencer Foundation, Brookings Institution, Hoover Institution, and National Institute of Education. Formal theories of rational choice suggest that information about the possible consequences of alternative actions will be sought and used only if the precision, relevance, and reliability of the information are compatible with its cost. Empirical studies of information in organizations portray a pattern that is hard to rationalize in such terms. In particular, organizations systematically gather more information than they use, yet continue to ask for more. We suggest that this behavior is a consequence of some ways in which organizational settings for information use differ from those anticipated in a simple decision-theory vision. In particular, the use of information is embedded in social normsthat make it highly symbolic. Some of the implications of such a pattern of information use are discussed.

Fundamental limitations in antennas

Abstract: Four fundamental limitations in antennas have been identified in the areas of: electrically small antennas, superdirective antennas, superresolution antennas, and high-pin antennas. All exhibit roughly exponential increase in cost factors with performance increase beyond the robust range. This paper reviews these limitations. Electrically small antennas are analyzed via spherical mode theory, with the antenna enclosed in a virtual sphere. Minimum Q varies inversely as the cube of sphere radius in radian wavelengths when the radius is much less than the latter. This limits the achievable bandwidth. Superdirective apertures require a constraint; the optimization is generally intractable except for line sources. Superdirective arrays have spacing below half-wavelength, and for small spacings a constraint is desirable to limit Q, tolerances, efficiency, sidelobes, etc. This is accomplished by expressing constrained directivity as a ratio of two Hermilian quadratic forms, for which a solution exists. Array Q varies exponentially with directivity so only modest increases are practical. Superresolution arrays use maximum entropy processes to improve spatial frequency resolution for short samples (short arrays), analogous to spectral analysis processing. An amplitude-tapered autocorrelation function is extended by linear least square prediction and autoregression; the latter contributes filter poles. This extension is with minimum added information, hence maximum entropy. In contrast to superdirective arrays which are all zero functions, superresolution maximum entropy uses an all pole function. Results are dependent upon the sampling subarray size and upon signal/noise (S/N). Required S/N increases exponentially with inverse angular resolution. Achievable gain of high-gain reflector antennas is limited by cost of the structure. For random surface errors maximum gain is proportional to the mechanical tolerance ratio (antenna diameter/1σ tolerance) squared. Since cost increases rapidly with diameter and with tolerance ratio this comprises a gain limitation. Current best reflectors have maximum gain in the range of 90 to 100 dB.

Natural history of autoimmune thyroiditis.

Abstract: One hundred and sixty-three asymptomatic people with thyroid antibodies or raised serum thyrotrophin (TSH) concentrations, or both, and 209 age-matched and sex-matched controls without either marker of thyroid disorder were followed up for four years to determine the natural history of autoimmune thyroiditis. Mildly raised TSH concentrations alone and the presence of thyroid antibodies alone did not significantly increase the risk of developing overt hypothyroidism during the four years compared with the controls. Overt hypothyroidism developed at the rate of 5% a year in women who initially had both raised TSH concentrations and thyroid antibodies. Prophylactic treatment with thyroxine may be justified in women found to have both markers of impending thyroid failure. The cost effectiveness of screening the adult population remains to be evaluated.

Cost Effectiveness of Clinical Diagnosis, Venography, and Noninvasive Testing in Patients with Symptomatic Deep-Vein Thrombosis

Abstract: Until the past decade, physicians were content to base therapeutic decisions on the clinical diagnosis of deep-vein thrombosis. Subsequently, numerous studies demonstrated that clinical diagnosis of this condition is nonspecific. Although many now use objective methods to diagnose venous thrombosis, their relative cost and effectiveness have not been adequately studied. We performed a cost-effectiveness analysis of 516 patients with clinically suspected venous thrombosis who were evaluated by clinical diagnosis, venography, and the less invasive combination of impedance plethysmography and leg scanning. We used this analysis to rank these alternative approaches in terms of both cost and effectiveness. The results indicate that clinical diagnosis is cost ineffective. Venography is cost effective — more so when applied as an outpatient investigation. Impedance plethysmography plus leg scanning is a practical, less invasive alternative to outpatient venography. The cost of inpatient diagnosis is lik...

The urban transportation system : politics and policy innovation

Abstract: This book is presented in three parts: part 1, The Politics, reviews the postwar history of urban transport policy and advances some propositions for ranking potential innovations according to their political feasibility. Part 2, The Problems, examines the criteria for evaluating the transport system in terms of problems such as energy, air pollution, safety, equity, congestion and urban sprawl. Part 3, The Options, discusses eight broad policy categories in terms of political feasibility and cost effectiveness. The options examined include: highway capacity expansion, the extension of fixed-route services, demand responsive transport, car pooling, traffic priorities for high occupancy vehicles, performance standard regulation for car manufacturers, direct consumer regulation, and price disincentives intended to curtail car travel and/or fuel consumption. (TRRL)

Computer Architectures for Pictorial Information Systems

Abstract: In the international search for the optimal image processing computer architecture, image parallelism is the key to cost effectiveness.

Clinical behavior therapy with children

Abstract: 1. Foundations of Behavior Therapy.- Assumptions in Behavior Therapy.- Determinants of Behavior.- Behavior Therapy Models.- The Classical Conditioning Model.- The Instrumental Conditioning Model.- The Operant Conditioning Model.- The Drive Reduction Models.- The Two-Factor Model of Learning.- Social Learning Theory.- Summary.- 2. Behavioral Assessment.- Behavioral Interviews.- Checklists and Rating Forms.- Traditional Standardized Instruments.- Other Instruments.- Behavioral Observation.- Summary.- 3. Systematic Desensitization, Implosion, and Flooding.- Systematic Desensitization.- Background.- Clinical Application.- Clinical Application with Young Children...- Implosive Therapy and Flooding.- Background.- Clinical Application.- Summary.- 4. Modeling and Social Skills Training.- Modeling.- Background.- Clinical Application: Fears and Phobias.- Clinical Application: Social Withdrawal.- Social Skills Training.- Background.- Clinical Application: Social Withdrawal.- Clinical Application: Aggressive Behavior.- Summary.- 5. Basic Operant Procedures.- Shaping.- Background.- Clinical Application.- Chaining.- Background.- Discrimination, Stimulus Control, and Fading...- Background.- Clinical Application.- Prompting.- Background.- Clinical Application.- Summary.- 6. Other Operant Procedures.- Contingency Contracting.- Background.- Clinical Application.- Token Economy Programs.- Background.- Clinical Application.- Biofeedback Training.- Background.- Clinical Application.- Summary.- 7. Operant Reductive Procedures.- Extinction.- Background.- Clinical Application.- Differential Reinforcement.- Background.- Clinical Application.- Response Cost.- Background.- Clinical Application.- Timeout.- Background.- Clinical Application.- Overcorrection.- Background.- Clinical Application.- Physical Punishment.- Background.- Clinical Application.- Summary.- Chapters 7. Cognitive Procedures and Self-Management.- Cognitive Behavior Therapy.- Background.- Clinical Application.- Self-Management.- Background.- Clinical Application.- Summary.- 9. Parent Training Programs.- Models of Parent Training.- Characteristics of Clinic-Referred Children and Their Families.- Family Characteristics and Parent Training Outcome.- Parent Training Formats.- Content Issues in Parent Training.- Parent Training Procedures.- Cost Effectiveness of Parent Training.- Clinical Applications.- New Developments.- Summary.- 10. Integrative Issues.- Comprehensive Behavioral Programs.- Maintenance and Generalization.- Preventive Efforts.- Ethical Considerations.- Summary.

Forms of brief therapy

Abstract: With "accountability" fast becoming the byword of the age, psychotherapists are challenged to demonstrate both the therapeutic and cost effectiveness of their interventions. While traditionally these two goals have been considered mutually exclusive, new research on the briefer therapies appears to show that less can sometimes be more. Fewer sessions of a carefully planned, focused and well-executed short-term intervention may contribute more to positive change that protracted analysis. "Forms of Brief Therapy" is the first volume to comprehensively and critically address the issue of how the element of time can be used as a therapeutic tool in psychodynamic and behavioral systems, and across individual, couple, family and group interventions. The authors put to rest the pervasive myth that there is an ideal, specific duration for most therapy. Instead, they offer a variety of approaches that combine careful examination and integration of presenting problems and patient characteristics. At times, evaluation may indicate as many as fifty sessions. In other cases, as evidenced with special force in Bloom's provocative presentation, just a single focused session may suffice. As Weiss and Jacobson put it in their marital therapy contribution, the purpose of this book is to structure therapy that is brief by design rather than by default. The contributors to "Forms of Brief Therapy" are among the most renowned practitioners and thinkers in their respective fields. Their critical overviews of research, and pragmatic analyses of therapy design, will prove highly instructive to clinical researchers and teachers who wish to better understand the relationship of therapeutic structure to underlying mechanisms of change. Mental health practitioners will find this volume eminently useful in their daily work. It provides explicit recommendations for patient selection, evaluation, and choice of therapeutic techniques which are richly illustrated by case materials. Unexcelled as clinical guide and reference, "Forms of Brief Therapy" is also ideally suited as a textbook for psychotherapy courses.

Cost-effectiveness of a worksite hypertension treatment program.

Abstract: The cost-effectiveness of treating hypertension at the patient's place of work was compared in a randomized controlled trial with care delivered in a community. The average total cost per patient for worksite care in this 12-month study was not significantly different from that for regular care ($242.86 +/- 6.94 vs $211.34 +/- 18.66, mean +/- SEM). The worksite health system cost was significantly more expensive ($197.36 +/- 4.99 vs $129.33 +/- 13.34, p less than 0.001) but the patient cost was significantly less ($45.40 +/- 3.23 vs $82.00 +/- 6.20, p less than 0.01). The mean reduction in diastolic blood pressure (BP) at the year-end assessment was significantly greater in the worksite group (12.1 +/- 0.6 vs 6.5 +/- 0.6 mm Hg, p less than 0.001). The incremental cost-effectiveness ratio of $5.63 per mm Hg for worksite care was less than the base cost-effectiveness ratio of $32.51 per mm Hg for regular care, indicating that the worksite program was substantially more cost-effective. Our findings support health policies that favor allocating resources to work-based hypertension treatment programs for the target group identified in this study.

Multiobjective Optimization in Structural Design: The Model Choice Problem

Abstract: : Existing and potential applications of multi-optimization techniques to structural design are reviewed. Two approaches are available to formulate a multiobjective structural design problem. The first approach starts with a classical design, say minimize weight subject to cost, reliability, risk and other constraints; and then some of the quantities included in the constraints, in particular cost and reliability, are used to define additional objectives.

The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study.

Abstract: The cost-effectiveness of counseling by telephone and by clinic visit contacts were compared in 40 hypertensive patients each of whom received counseling and reinforcement every three weeks for six months regarding diet, exercise, smoking, and coping with stress Blood pressure declined significantly in both counseling groups (N: 10 each) but not in a control group (N: 20) The cost per patient under control was $82 for the clinic counseling and $39 for the telephone counseling strategy, suggesting that telephone counseling was a cost-effective technique

The cost-effectiveness of multiple sclerosis rehabilitation: a model.

Abstract: Many patients with multiple sclerosis (MS) who have fixed, chronic neurologic deficits are kept at home with the help of community support systems, which cannot improve the physical independence of the MS patients they serve. We have found that active, intensive, multidisciplinary rehabilitation effectively improves functional performance, even though it cannot alter the underlying disorder. Inpatient rehabilitation with follow-up home care may actually be less expensive than any other current health care alternative.

Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants

Abstract: The clinical contribution and cost effectiveness of pharmacist involvement in peripheral-vein total parenteral nutrition (TPN) in a neonatal intensive-care unit was studied. Fourteen neonates who received a standardized TPN solution without pharmacist monitoring (Group 1) were compared with 14 neonates who received an individualized TPN solution with pharmacist monitoring (Group 2). Infants were excluded from the study if they received oral feeding, or TPN for less than five days, or were fluid-restricted. No significant difference in mean gestational age, birth weight, gestational size, age at initiation of therapy, duration of therapy, or daily amount of fluid administered was found between the two groups. The mean weight gain in Group 1 (4.9 g/day) was significantly less than in Group 2 (11.8 g/day) (p less than 0.02). The amount of protein provided to Group 2 (2.2 g/kg/day) was significantly greater than to Group 1 (1.9 g/kg/day) (p less than 0.01). The number of calories provided per day was greater for Group 2 (63 kcal/kg/day) than for Group 1 (53 kcal/kg/day) (p less than 0.001). When only those infants who received lipids were analyzed, Group 2 received significantly more lipid (2.0 g/kg/day) than group 1 (1.5 g/kg/day) (p less than 0.001). The mean daily cost was greater for Group 2; however, when cost was related to efficacy, Group-2 cost per gram of weight gain was lower than Group-1 cost. Pharmacist monitoring of an individualized program of TPN in neonates provided a greater mean daily weight gain, allowed a greater amount of nutrients to be provided, and was cost effective compared with the use of a standardized solution without pharmacist monitoring.

Policy Formulation and Technology Assessment

Abstract: Describes technology assessment and its application to the health field; examines evaluation of efficacy safety and cost effectiveness; discusses the use of technology assessment in policy formulation especially by federal programs; suggests a system for assessment of medical technologies; and offers some observations about the future of technology assessment in policy making. Technology assessment began formally in 1965 in the Committee on Science and Astronautics of the House of Representatives as a process of examining technology and its impacts. Only a few attempts have been made since then to apply the concepts of technology assessment to health care. The amount of money currently devoted to assessing the efficacy and safety of medical technologies is small and many important technologies have not been assessed. Priorities for clinical trials should therefore be set. Cost effectiveness analysis is a useful tool in decision making but because of its inherent limitations it should not be the sole or even primary determinant of a decision. Technology assessment is apparently infrequently used as a decision-assisting tool by 3rd party payers federal government agencies funding biomedical research or the federal program which is designed to control physician utilization of certain technologies. Only the FDA regularly utilizes technology assessment. A systematic program of technology assessment would require identification of technologies needing testing setting of priorities for such tests synthesizing of information gained and its dessemination to decision makers.

The electronic library.

Abstract: ed in: Cambridge Scientific Abstracts, Inc., INSPEC, Libra y b Information Science Abstracts, and Public Affairs Information Service.

Is antimicrobial prophylaxis of urinary tract infections cost effective

Abstract: Antimicrobial prophylaxis prevents recurrent urinary tract infections in susceptible women, but its cost effectiveness has not been studied. In a recent placebo-controlled trial of urinary...

Cost and Benefit in Control of Nosocomial Infection: Methods for Analysis

Abstract: Because health care costs are rising at an alarming rate, the cost-benefit relationship of infection control measures has to be considered. This assessment involves measuring the real cost of implementing a procedure and determining whether or not an associated reduction has occurred in nosocomial infection and its economic consequences. If the cost is found to outweigh the benefit, the procedure should be eliminated. Conversely, when a procedure proves cost-effective, infection control personnel must work to ensure that it is implemented correctly. To do these things, we need improved methods for measuring cost and benefit objectively, for implementing the few procedures that have been shown to reduce nosocomial infection, and for developing effective systems of monitoring compliance with recommended procedures. Many steps have been taken to decrease the incidence or the adverse effects of nosocomial infections. These steps include implementation of

Accounting systems: the reliability approach to internal control evaluation

Abstract: Recent developments have increased the value to management of objective methodologies for the evaluation of accounting internal control systems (AICS). The Foreign Corrupt Practices Act requires management to assure the accuracy of these systems. The process of evaluation of AICS by both management and external auditors is judgmental in nature. The few attempts at modeling AICS have not been implemented by firms due to the lack of realism, difficulty of modeling behavioral systems, lack of cost effectiveness, and lack of understanding by practitioners. For these reasons, the role of the decision scientist has been limited. The research reported here attempts to demonstrate feasibility of a reliability model. A typical accounting system for raw material purchases is modeled via a simulation routine. The effects of internal control weaknesses on ending dollar balances is determined by performing sensitivity analysis. After summarizing these effects, the reliability model is formulated for the same control system, and the analysis is repeated and the results compared with those obtained in a simulation model.

The State Of Development Of Systems For Handling Natural Resources Inventory Data

Abstract: In early 1980, Tomlinson Associates examined nine computer-based systems to assess their ability to handle natural resources inventory data. Their client, the Saskatchewan Department of Tourism and Natural Resources, was considering the acquisition of such a system to handle their forest resource data. Cost effectiveness, reliability, ease of use, and ability to meet the volume and throughput requirements were considered, as well as technical capability. Five systems were selected for detailed standardized tests on a function-by-function basis. Except for a block adjustment procedure, the Forest Inventory Section required general-purpose spatial data handling software suitable for many users who process natural resources inventory data. The tests showed that the systems could not then meet the requirements for forest data processing in Saskatchewan. Much of the software was under development but was not yet reliable. Some packages worked well but others operated so slowly that they could put a heavy load ...

Selecting Traffic Signal Control at Individual Intersections

Abstract: To assist in the evaluation of the best type of traffic signal control to use at an intersection, this report describes (1) maintenance requirements, (2) vehicle delays on the major and minor streets, (3) overall traffic safety, (4) coordination adaptability, and (5) cost effectiveness. Controller performance was evaluated in terms of delay per vehicle (in seconds/vehicle) and percent stops per vehicle. These measures of effectiveness were selected because they are frequently used in traffic engineering studies and can be directly related to traffic flow at individual intersections. The approach used was to perform detailed analysis of controller effectiveness expressed in terms of stops and delays and then to develop additional relationships for vehicle emissions, fuel consumption, and accidents as a function of stops and delay. Three complementary approaches were used to evaluate controller effectiveness: (1) field data collection using observers to manually measure vehicle volumes and vehicle stops and delay; (2) simulation using the NETSIM model, developed under the sponsorship of FHWA, to evaluate control system performance; and (3) analytical techniques developed by the research team and other agencies. The research results demonstrated that the form of control which minimizes the vehicle stops and delays at an intersection also minimizes fuel consumption and emissions. Furthermore, the differences in the annualized costs for equipment acquisition, installation, operation, and maintenance between the control alternatives were significantly less than the differences between the benefits. For this reason, the control alternative that minimized stops and delays also proved to be the most cost-effective installation. Therefore, it is not considered necessary to develop individual estimates for all of the measures of system effectiveness and costs in order to select the best form of control. Graphs are used to define regions in which each type of control is most effective; the regions defined are for pretimed, semi-actuated and basic full-actuated control. The applicability of volume-density control and detectorization requirements are also defined. Although this report significantly advances the state of knowledge on this subject, the reader should understand that both the field data and simulation data used to develop the relationships were somewhat limited. Further refinement of these relationships through other research, as well as by traffic engineers for their specific situations, is desirable. Nonetheless, the comprehensive information presented herein should prove useful until the desired refinements are accomplished. (Author)

Factors Affecting the Use of Vaccines: Considerations for Immunization Program Planners

Abstract: A CONTINUAL CHALLENGE to those who plan and implement immunization programs is to improve the effectiveness of limited resources. One method of allocating resources wisely is targeting efforts to selected populations that can benefit most from vaccinations. It is seldom feasible and sometimes not desirable to vaccinate everyone in the general population. Benefits, risks, and cost effectiveness of vaccinations vary according to people's risk status for a given disease. Another consideration in improving resource allocation is assessing the factors that influence the use of selected vaccines for targeted populations. Research concerning the public's acceptance of vaccine was initiated more than 20 years ago, following the advent of polio vaccine. Recent findings validate, and in some cases embellish, the early observations of consumers' vaccineseeking behavior. The factors described here can affect consumers' and physicians' use of vaccines. Immunization program planners might improve' the effectiveness of their efforts by considering these factors before implementing their programs.

Deep space network software cost estimation model

Abstract: A parametric software cost estimation model prepared for Deep Space Network (DSN) Data Systems implementation tasks is presented The resource estimation model incorporates principles and data from a number of existing models The model calibrates task magnitude and difficulty, development environment, and software technology effects through prompted responses to a set of approximately 50 questions Parameters in the model are adjusted to fit DSN software life cycle statistics The estimation model output scales a standard DSN Work Breakdown Structure skeleton, which is then input into a PERT/CPM system, producing a detailed schedule and resource budget for the project being planned

Psychiatric day treatment as alternative to and transition from full-time hospitalization.

Abstract: A review of the comparative studies on day treatment as an alternative modality to traditional full-time hospitalization reveals impressive evidence of its superior effectiveness in facilitating the adjustment and re-integration of patients into the community. On other measures, such as cost effectiveness, family stress, symptom alleviation and relapse rate, day treatment proves to be on par with full-time hospitalization. The data base pertaining to the efficacy of day treatment as a transitional facility from hospital to community is promising, but much too incomplete to permit conclusive statements. Methodological and conceptual issues in the current research are discussed and recommendations for future studies are offered.

Wind Energy - A Utility Perspective

Abstract: Of all the renewable energy systems, wind turbine generators (WTG's) are likely to make the earliest significant cost-effective' contribution to the utility grid. In order to accelerate the commercial deployment of WTG's, several issues must be addressed in a timely manner. This paper presents some of the ' issues facing the utility industry as they relate to implementation of an effective wind energy program. In addition, the Southern California Edison Company's wind energy program is presented, which is designed to provide pertinent answers to the technical, economic and environmental issues concerning WTG installations and their commercial viability as a future generation resource

Planning and scheduling work zone traffic control

Abstract: Construction, maintenance and utility activities on highway facilities can lead to significant disruption of traffic. This study developed a planning process that highway agencies can use to objectively select the most effective work zone traffic control strategy for each project. Seventeen state and local agencies were reviewed for information concerning existing practices in work zone planning. It was found that work zone traffic control strategies were selected mostly on the basis of subjective judgment. Using existing and new data collected in this study, quantitative procedures were developed for estimating accidents, delays, stops, fuel consumption, operating costs, air pollution, and cost of traffic control. Case construction costs were presented. This Technical Report describes the research performed and the significant results of the study.