Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents

Objective: To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to 'current practice'. Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analysis of randomised controlled trials. An assessment on second stage filter criteria ('equity'; 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are tracked for the duration of a new episode of MDD arising in eligible children (age 6-17 years) in the Australian population in the year 2000. Simulation-modelling techniques are used to present a 95% uncertainty interval (UI) around the cost-effectiveness ratios. Results: Compared to current practice, CBT by public psychologists is the most cost-effective intervention for MDD in children and adolescents at A$9000 per DALY saved (95% UI A$3900 to A$24 000). SSRIs and CBT by other providers are less cost-effective but likely to be less than A$50 000 per DALY saved (> 80% chance). CBT is more effective than SSRIs in children and adolescents, resulting in a greater total health benefit (DALYs saved) than could be achieved with SSRIs. Issues that require attention for the CBT intervention include equity concerns, ensuring an adequate workforce, funding arrangements and acceptability to various stakeholders. Conclusions: Cognitive behavioural therapy provided by a public psychologist is the most effective and cost-effective option for the first-line treatment of MDD in children and adolescents. However, this option is not currently accessible by all patients and will require change in policy to allow more widespread uptake. It will also require 'start-up' costs and attention to ensuring an adequate workforce.

Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder

Objective: To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice. Method: Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental cost-effectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted. Results: The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100-22 000). DEX is more costly than MPH for the government, but much less costly for the patient. Conclusions: MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.

Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

The new craft skills of engineering: The impact of innovation technology on engineering practices

This chapter explores the impact of innovation technologies such as simulation, modelling, and rapid prototyping on engineering practice. Innovation technologies help redefine the role of engineers in the innovation process, creating a new division of innovative labour both with and across organizations. This chapter also explores the boundaries of experimentation and inertia within particular domains of problem-solving to create new opportunities and value.

SPAnDX: a process-based population dynamics model to explore management and climate change impacts on an invasive alien plant, Acacia nilotica

This paper describes a process-based metapopulation dynamics and phenology model of prickly acacia, Acacia nilotica, an invasive alien species in Australia. The model, SPAnDX, describes the interactions between riparian and upland sub-populations of A. nilotica within livestock paddocks, including the effects of extrinsic factors such as temperature, soil moisture availability and atmospheric concentrations of carbon dioxide. The model includes the effects of management events such as changing the livestock species or stocking rate, applying fire, and herbicide application. The predicted population behaviour of A. nilotica was sensitive to climate. Using 35 years daily weather datasets for five representative sites spanning the range of conditions that A. nilotica is found in Australia, the model predicted biomass levels that closely accord with expected values at each site. SPAnDX can be used as a decision-support tool in integrated weed management, and to explore the sensitivity of cultural management practices to climate change throughout the range of A. nilotica. The cohort-based DYMEX modelling package used to build and run SPAnDX provided several advantages over more traditional population modelling approaches (e.g. an appropriate specific formalism (discrete time, cohort-based, process-oriented), user-friendly graphical environment, extensible library of reusable components, and useful and flexible input/output support framework). (C) 2003 Published by Elsevier Science B.V.

(Virtual) Agents for running electricity markets

This paper describes a multi-agent based simulation (MABS) framework to construct an artificial electric power market populated with learning agents. The artificial market, named TEMMAS (The Electricity Market Multi-Agent Simulator), explores the integration of two design constructs: (i) the specification of the environmental physical market properties and (ii) the specification of the decision-making (deliberative) and reactive agents. TEMMAS is materialized in an experimental setup involving distinct power generator companies that operate in the market and search for the trading strategies that best exploit their generating units' resources. The experimental results show a coherent market behavior that emerges from the overall simulated environment.

proxel-based method : formalisation, analysis and applications

Simulation, modelling, proxels, PDEs, Markov chains, Petri nets, stochastic, performability, transient analysis

Poverty, inequality and policy since 1997

This study examines the impact of policy on poverty and inequality in Britain since 1997This research shows what effect policies introduced since 1997 have had on reducing poverty and inequality. It offers a considered assessment of impacts over a decade:How did policies change, before 1997 and since then?What evidence is there of impacts on key outcomes?What gaps or problems remain or emerged?The study covers a range of subjects, including public attitudes to poverty and inequality, children and early years, education, health, employment, pensions, and migrants. It measures the extent of progress and also considers future direction and pressures, particularly in the light of recession and an ageing society.The research draws on extensive analysis of policy documents, analysis by government departments and research bodies, published statistics and evaluations, analysis of large-scale datasets, micro-simulation modelling and a long-running qualitative study with residents of low-income neighbourhoods.��

Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland

BACKGROUND: Various centralised mammography screening programmes have shown to reduce breast cancer mortality at reasonable costs. However, mammography screening is not necessarily cost-effective in every situation. Opportunistic screening, the predominant screening modality in several European countries, may under certain circumstances be a cost-effective alternative. In this study, we compared the cost-effectiveness of both screening modalities in Switzerland. METHODS: Using micro-simulation modelling, we predicted the effects and costs of biennial mammography screening for 50-69 years old women between 1999 and 2020, in the Swiss female population aged 30-70 in 1999. A sensitivity analysis on the test sensitivity of opportunistic screening was performed. RESULTS: Organised mammography screening with an 80% participation rate yielded a breast cancer mortality reduction of 13%. Twenty years after the start of screening, the predicted annual breast cancer mortality was 25% lower than in a situation without screening. The 3% discounted cost-effectiveness ratio of organised mammography screening was euro11,512 per life year gained. Opportunistic screening with a similar participation rate was comparably effective, but at twice the costs: euro22,671-24,707 per life year gained. This was mainly related to the high costs of opportunistic mammography and frequent use of imaging diagnostics in combination with an opportunistic mammogram. CONCLUSION: Although data on the performance of opportunistic screening are limited, both opportunistic and organised mammography screening seem effective in reducing breast cancer mortality in Switzerland. However, for opportunistic screening to become equally cost-effective as organised screening, costs and use of additional diagnostics should be reduced.

Stability Evaluation of a Paper Machine Wet End

Työssä analysoidaanprosessin vaikutusta paperikoneen stabiiliuteen. Kaksi modernia sanomalehtipaperikonetta analysoitiin ja sen perusteella molemmista prosesseista rakennettiin fysiikan lakeihin perustuvat simulointimallit APROS Paper simulointiohjelmistolla. Työn tavoitteena on selvittää, miten kyseisten koneiden prosessit eroavat toisistaan ja arvioida, miten havaitut erot vaikuttavat prosessien stabiiliuteen. Työssä tarkastellaan periodisten häiriöiden vaimenemista prosessissa. Simuloinnissa herätteenä käytettiin puhdasta valkoista kohinaa, jonka avulla eri taajuistenperiodisten häiriöiden vaimenemista analysoitiin. Prosessien häiriövasteet esitetään taajuuskoordinaatistossa. Suurimmat erot prosessien välillä löytyivät viirakaivosta ja sen sekoitusdynamiikasta. Perinteisen viirakaivon todettiin muistuttavan käyttäytymiseltään sarjaan kytkettyjä ideaalisekoittimia, kun taas pienempitilavuuksisen fluumin todettiin käyttäytyvän lähes kuin putkiviive. Vaikka erotprosessitilavuudessa sekä viirakaivon sekoitusdynamiikassa olivat hyvin selkeät, havaittiin vain marginaalinen ero prosessin välillä periodisten häiriöiden vaimenemisessa, koska erot viiraretentiotasoissa vaikuttivat eniten simulointituloksia. Matalammalla viiraretentiolla operoivan paperikoneen todettiin vaimentavan tehokkaammin prosessihäiriöitä. Samalla retentiotasolla pienempitilavuuksisen prosessin todettiin vaimentavan hitaita prosessihäiriöitä marginaalisesti paremmin. Tutkituista paperikoneista toisella simuloitiin viiraosan vedenpoistomuutoksenvaikutusta viiraretentioon ja paperin koostumukseen. Lisäksi arvioitiin viiraretention säädön toimivuutta. Viiraosan listakengän vedenpoiston todettiin aiheuttavan merkittäviä sakeus- ja retentiohäiriöitä, mikäli sen avulla poistettavan kiintoaineen virtaus tuplaantuisi. Viiraretention säädön todettiin estävän häiriöiden kierron prosessissa, mutta siirtävän ne suoraan rainaan. Retention säädön eikuitenkaan todettu olevan suoranainen häiriön lähde.

Differences in phasic development rate amongst wheat cultivars independent of responses to photoperiod and vernalization. A viewpoint of the intrinsic earliness hypothesis

Differences amongst wheat cultivars in the rate of reproductive development are largely dependent on differences in their sensitivity to photoperiod and vernalization. However, when these responses are accounted for, by growing vernalized seedlings under long photoperiods, cultivars can still differ markedly in time to ear emergence. Control of rate of development by this ‘third factor’ has been poorly understood and is variously referred to as intrinsic earliness, earliness in the narrow sense, basic vegetative period, earliness per se, and basic development rate. Certain assumptions are made in the concept of intrinsic earliness. They are that differences in intrinsic earliness (i) are independent of the responses of the cultivars to photoperiod and vernalization, (ii) apply only to the length of the vegetative period up to floral initiation (as suggested by several authors), (iii) are maintained under different temperatures, measured either in days or degree days. As a consequence of this, the ranking of cultivars (from intrinsically early to intrinsically late) must be maintained at different temperatures. This paper, by the re-analysis of published data, examines the extent to which these assumptions can be supported. Although it is shown that intrinsic earliness operates independently of photoperiod and vernalization responses, the other assumptions were not supported. The differences amongst genotypes in time to ear emergence, grown under above-optimum vernalization and photoperiod (that is when the response to these factors is saturated), were not exclusively due to parallel differences in the length of the vegetative phase, and the length of the reproductive phase was independent of that of the vegetative phase. Thus, it would be possible to change the relative allocation of time to vegetative and reproductive periods with no change in the full period to ear emergence. The differences in intrinsic earliness between cultivars were modified by the temperature regime under which they were grown, i.e. the difference between cultivars (both considering the full phase to ear emergence or some sub-phases) was not a constant amount of time or thermal time at different temperatures. In addition, in some instances genotypes changed their ranking for ‘intrinsic earliness’ depending on the temperature regime. This was interpreted to mean that while all genotypes are sensitive to temperature they differ amongst themselves in the extent of that sensitivity. Therefore, ‘intrinsic earliness’ should not be considered as a static genotypic characteristic, but the result of the interaction between the genotype and temperature. Intrinsic earliness is therefore likely to be related to temperature sensitivity. Some implications of these conclusions for plant breeding and crop simulation modelling are discussed.

TMP- laitoksen mallinnus ja simulointi

Diplomityössä tehtiin Balas- simulointimalli Stora Enso Publication Papers Oy Ltd Varkauden tehtaiden kuumahierrelaitoksesta, johon sovitettiin tehtaan lämpö-, kuitu- ja kiertovesivirtaukset sekä kiertovesissä olevien liuenneiden ja kolloidisten aineiden virtaukset. Kirjallisuusosassa perehdyttiin simulaattorimallin luontiin ja käyttötarkoituksiin. Siinä käsitellään Balas- simulaattorin ominaisuuksia ja laiteparametrointia. Tarkastellaan kuumahierreprosessin eri vaiheita, olosuhteita ja laitteiden toimintaa. Perehdytään prosessin energian kulutukseen ja talteenottoon sekä kiertovesien liuenneiden ja kolloidisten aineiden mittaussuureisiin ja vaikutuksiin prosessissa. Simulaattorimallin tekemiseen kuului tehtaan virtauskaavion ja simulaattorimallin tekeminen, mittauskoesuunnittelu, tehdasmittaukset, simulaattorin parametrointi, mittaus- ja simulaattoritulosten yhteensovittaminen sekä mallin kelpoistaminen. Tehtaan virtauskaavion piirtämisessä käytettiin apuna tehtaan prosessi- ja instrumentointikaavioita, joiden pohjalta mittauskoesuunnitelma ja simulaattorimalli tehtiin. Koesuunnitelman mittaussuureiksi valittiin virtaukset, sakeudet, lämpötilat sekä kiertovesien kiintoaineen-, kokonaisorgaanisen hiilen- ja liuenneen orgaanisen aineen pitoisuuksien määritykset. Mittauksilla saatiin tietoja prosessivirtausten taseista, joita käytettiin simulaattorimallin keskeisempien laiteparametriarvojen määrityksessä. Exceliä hyödynnettiin mittaus- ja simulaattoritulosten taulukoinnissa, laiteparametrien laskemisessa sekä arvojen syötössä ja vastaanotossa Excelin ja simulaattorin välillä. Sitä käytettiin myös graafisessa mittaus- ja simulaattoritulosten yhteensovittamisessa, jolla pystyttiin havainnollisesti näkemään eri syöttöparametrien muutoksien vaikutukset simulaattorin laskemissa virtaustuloksissa. Mallin antamien arvojen ja todellisten prosessimittausarvojen yhteensovittamisen ja mallista varmistumisen tuloksista voidaan todeta mallin korreloivan todellista prosessia melko hyvin.

Höyry- ja kaasuturbiinin mallintaminen prosessisimulointiohjelmaan

Tässä diplomityössä on mallinnettu höyry- ja kaasuturbiini Balas -prosessisimulointi-ohjelmaan. Balas on Valtion Teknillisen Tutkimuskeskuksen kehittämä simulointiohjelma, erityisesti paperi- ja selluteollisuuden prosessien staattiseen simulointiin. Työn tavoitteena on kehittää simulointimallit höyry- ja kaasuturbiinille, sekä tutkia niiden toimivuutta vertaamalla simulointeja mittaus- ja mitoitustietoihin. Työssä on muodostettu matemaattiset mallit höyryturbiinille, höyryturbiinin säätövyöhykkeelle sekä höyryturbiinin off-design laskennalle. Kaasuturbiinille muodostettiin toimintakäyrät, joiden avulla tarkastellaan sen toimintaa off-design tilanteessa. Komponentit mallinnettiin diplomityövaiheessa Matlab-ympäristöön, josta ne siirretään Balasiin erillisessä työvaiheessa. Malleissa on kiinnitetty huomiota erityisesti niiden helppokäyttöisyyteen ja monipuolisuuteen. Höyryturbiinimalleja testattiin simuloimalla erään paperitehtaan yhteydessä toimivan voimalaitoksen vastapaineturbiini säätövyöhykkeineen ja vertaamalla simulointituloksia tehtaan mittaustietoihin. Kaasuturbiinimallia testattiin vertaamalla GE Power MS 7001 kaasuturbiinin mitoitustietoja vastaavilla parametreilla simuloituun tapaukseen.

The role of collective intelligence in crowdsourcing innovation

Social insects are known for their ability to display swarm intelligence, where the cognitive capabilities of the collective surpass those of the individuals forming it by orders of magnitude. The rise of crowdsourcing in recent years has sparked speculation as to whether something similar might be taking place on crowdsourcing sites, where hundreds or thousands of people interact with each other. The phenomenon has been dubbed collective intelligence. This thesis focuses on exploring the role of collective intelligence in crowdsourcing innovations. The task is approached through three research questions: 1) what is collective intelligence; 2) how is collective intelligence manifested in websites involved in crowdsourcing innovation; and 3) how important is collective intelligence for the functioning of the crowdsourcing sites. After developing a theoretical framework for collective intelligence, a multiple case study is conducted using an ethnographic data collection approach for the most part. A variety of qualitative, quantitative and simulation modelling methods are used to analyse the complex phenomenon from several theoretical viewpoints or ‘lenses’. Two possible manifestations of collective intelligence are identified: discussion, typical of web forums; and the wisdom of crowds in evaluating crowd submissions to websites. However, neither of these appears to be specific to crowdsourcing or critical for the functioning of the sites. Collective intelligence appears to play only a minor role in the cases investigated here. In addition, this thesis shows that feedback loops, which are found in all the cases investigated, reduce the accuracy of the crowd’s evaluations when a count of votes is used for aggregation.

Performance of Supply Chain when using selected Coordination Mechanisms

Coordination among supply chain members is essential for better supply chain performance. An effective method to improve supply chain coordination is to implement proper coordination mechanisms. The primary objective of this research is to study the performance of a multi-level supply chain while using selected coordination mechanisms separately, and in combination, under lost sale and back order cases. The coordination mechanisms used in this study are price discount, delay in payment and different types of information sharing. Mathematical modelling and simulation modelling are used in this study to analyse the performance of the supply chain using these mechanisms. Initially, a three level supply chain consisting of a supplier, a manufacturer and a retailer has been used to study the combined effect of price discount and delay in payment on the performance (profit) of supply chain using mathematical modelling. This study showed that implementation of individual mechanisms improves the performance of the supply chain compared to ‘no coordination’. When more than one mechanism is used in combination, performance in most cases further improved. The three level supply chain considered in mathematical modelling was then extended to a three level network supply chain consisting of a four retailers, two wholesalers, and a manufacturer with an infinite part supplier. The performance of this network supply chain was analysed under both lost sale and backorder cases using simulation modelling with the same mechanisms: ‘price discount and delay in payment’ used in mathematical modelling. This study also showed that the performance of the supply chain is significantly improved while using combination of mechanisms as obtained earlier. In this study, it is found that the effect (increase in profit) of ‘delay in payment’ and combination of ‘price discount’ & ‘delay in payment’ on SC profit is relatively high in the case of lost sale. Sensitivity analysis showed that order cost of the retailer plays a major role in the performance of the supply chain as it decides the order quantity of the other players in the supply chain in this study. Sensitivity analysis also showed that there is a proportional change in supply chain profit with change in rate of return of any player. In the case of price discount, elasticity of demand is an important factor to improve the performance of the supply chain. It is also found that the change in permissible delay in payment given by the seller to the buyer affects the SC profit more than the delay in payment availed by the buyer from the seller. In continuation of the above, a study on the performance of a four level supply chain consisting of a manufacturer, a wholesaler, a distributor and a retailer with ‘information sharing’ as coordination mechanism, under lost sale and backorder cases, using a simulation game with live players has been conducted. In this study, best performance is obtained in the case of sharing ‘demand and supply chain performance’ compared to other seven types of information sharing including traditional method. This study also revealed that effect of information sharing on supply chain performance is relatively high in the case of lost sale than backorder. The in depth analysis in this part of the study showed that lack of information sharing need not always be resulting in bullwhip effect. Instead of bullwhip effect, lack of information sharing produced a huge hike in lost sales cost or backorder cost in this study which is also not favorable for the supply chain. Overall analysis provided the extent of improvement in supply chain performance under different cases. Sensitivity analysis revealed useful insights about the decision variables of supply chain and it will be useful for the supply chain management practitioners to take appropriate decisions.