Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson's disease with severe motor fluctuations: a 2-year follow-up review.

OBJECT: The aim of this study was to evaluate the long-term safety and efficacy of bilateral contemporaneous deep brain stimulation (DBS) in patients who have levodopa-responsive parkinsonism with untreatable motor fluctuations. Bilateral pallidotomy carries a high risk of corticobulbar and cognitive dysfunction. Deep brain stimulation offers new alternatives with major advantages such as reversibility of effects, minimal permanent lesions, and adaptability to individual needs, changes in medication, side effects, and evolution of the disease. METHODS: Patients in whom levodopa-responsive parkinsonism with untreatable severe motor fluctuations has been clinically diagnosed underwent bilateral pallidal magnetic resonance image-guided electrode implantation while receiving a local anesthetic. Pre- and postoperative evaluations at 3-month intervals included Unified Parkinson's Disease Rating Scale (UPDRS) scoring, Hoehn and Yahr staging, 24-hour self-assessments, and neuropsychological examinations. Six patients with a mean age of 55 years (mean 42-67 years), a mean duration of disease of 15.5 years (range 12-21 years), a mean "on/off' Hoehn and Yahr stage score of 3/4.2 (range 3-5), and a mean "off' time of 40% (range 20-50%) underwent bilateral contemporaneous pallidal DBS, with a minimum follow-up period lasting 24 months (range 24-30 months). The mean dose of levodopa in these patients could not be changed significantly after the procedure and pergolide was added after 12 months in five patients because of recurring fluctuations despite adjustments in stimulation parameters. All but two patients had no fluctuations until 9 months. Two of the patients reported barely perceptible fluctuations at 12 months and two at 15 months; however, two patients remain without fluctuations at 2 years. The mean improvements in the UPDRS motor score in the off time and the activities of daily living (ADL) score were more than 50%; the mean off time decreased from 40 to 10%, and the mean dyskinesia and complication of treatment scores were reduced to one-third until pergolide was introduced at 12 months. No significant improvement in "on" scores was observed. A slight worsening after 1 year was observed and three patients developed levodopa- and stimulation-resistant gait ignition failure and minimal fluctuations at 1 year. Side effects, which were controlled by modulation of stimulation, included dysarthria, dystonia, and confusion. CONCLUSIONS: Bilateral pallidal DBS is safe and efficient in patients who have levodopa-responsive parkinsonism with severe fluctuations. Major improvements in motor score, ADL score, and off time persisted beyond 2 years after the operation, but signs of decreased efficacy started to be seen after 12 months.

Iowa Efficiency Review Report to Governor Chet Culver and Lieutenant Governor Patty Judge, December 18,2009

Public Works is pleased to present the following Iowa Efficiency Review Report to Governor Chet Culver and Lieutenant Governor Patty Judge. This report is the product of a collaboration between our consulting team and very dedicated Iowa state employees who worked with us to share ideas and cost‐saving proposals under very difficult circumstances caused by the national financial crisis that is affecting state budgets throughout the country. For example, during the course of this review, Iowa departments were also asked to develop across‐the‐board cuts to achieve immediate reductions in state spending. It is a credit to Iowa state government that departmental staff continued to work on this Efficiency Review Report despite these challenges of also having to develop across‐the‐board budget cuts to achieve a balanced budget. We hope that these ideas will set the stage for further future budget improvements from achieving efficiencies, eliminating outdated practices, increasing the use of information technology solutions and finding new sources of non‐tax funding. The Efficiency Review Team faced a second challenge. Statewide Efficiency Reviews usually take from nine to 12 months to complete. In Iowa, we worked with dedicated department staff to complete our work in less than 4 months. The Governor challenged all of us to work intensely and to give him our best thinking on efficiency proposals so that he could act as quickly as possible to position state government for success over the next several years.

Final Report Energy Efficiency Plans and Programs Study Committee, February 2009

The Legislative Council created the Energy Efficiency Plans and Programs Study Committee for the 2008 Legislative Interim pursuant to the passage of S.F. 2386 during the 2008 Legislative Session, which provided, in Section 8: The Legislative Council is requested to establish an interim study committee to examine the existence and effectiveness of energy efficiency plans and programs implemented by gas and electric public utilities, with an emphasis on results achieved by current plans and programs from the demand, or customer, perspective, and to make recommendations for additional requirements applicable to energy efficiency plans and programs that would improve such results. In conducting the study and developing recommendations, the Committee shall consider testimony from the Iowa Utilities Board, rate and nonrate-regulated gas and electric utilities, the Consumer Advocate, state agencies involved with energy efficiency program administration, environmental groups and associations, and consumers.

On the efficiency of recursive evaluations with applications to risk theory

On the efficiency of recursive evaluations with applications to risk theoryCette thèse est composée de trois essais qui portent sur l'efficacité des évaluations récursives de la distribution du montant total des sinistres d'un portefeuille de polices d'assurance au cours d'un période donnée. Le calcul de sa fonction de probabilité ou de quantités liées à cette distribution apparaît fréquemment dans la plupart des domaines de la pratique actuarielle.C'est le cas notamment pour le calcul du capital de solvabilité en Suisse ou pour modéliser la perte d'une assurance vie au cours d'une année. Le principal problème des évaluations récursives est que la propagation des erreurs provenant de la représentation des nombres réels par l'ordinateur peut être désastreuse. Mais, le gain de temps qu'elles procurent en réduisant le nombre d'opérations arithmétiques est substantiel par rapport à d'autres méthodes.Dans le premier essai, nous utilisons certaines propriétés d'un outil informatique performant afin d'optimiser le temps de calcul tout en garantissant une certaine qualité dans les résultats par rapport à la propagation de ces erreurs au cours de l'évaluation.Dans le second essai, nous dérivons des expressions exactes et des bornes pour les erreurs qui se produisent dans les fonctions de distribution cumulatives d'un ordre donné lorsque celles-ci sont évaluées récursivement à partir d'une approximation de la transformée de De Pril associée. Ces fonctions cumulatives permettent de calculer directement certaines quantités essentielles comme les primes stop-loss.Finalement, dans le troisième essai, nous étudions la stabilité des évaluations récursives de ces fonctions cumulatives par rapport à la propagation des erreurs citées ci-dessus et déterminons la précision nécessaire dans la représentation des nombres réels afin de garantir des résultats satisfaisants. Cette précision dépend en grande partie de la transformée de De Pril associée.

Citizens' control and the efficiency of local public services

Està àmpliament acceptat que la descentralització fiscal incrementa el control dels ciutadans sobre els polítics, fomenta el rendiment de comptes i augmenta l¿eficiència. Aquest treball té per objectiu identificar les característiques socio-econòmiques dels ciutadans (votants potencials) que generen un major control sobre els responsables polítics locals provocant, així, un major nivell d'eficiència en un context descentralitzat.També s'analitzen les característiques fiscals dels governs locals que fomenten aquest control i eficiència. L'estudi s'ha aplicat a una mostra de municipis catalans seguint la metodologia convencional basada en l'estimació en dues etapes. A la primera etapa s'estima l'eficiència en que operen els municipis mitjançant la tècnica DEA. La novetat rau en el càlcul d'una nova versió d'indicador global d¿output municipal. En la segona etapa, a través d¿una estimació tipus Tobit (models censurats) i de mètodes bootstrap, es mostra com els factors abans comentats poden influir sobre l¿eficiència. Els resultats suggereixen que la forta presencia de comerciants, jubilats i persones amb dret a vot afavoreixen el control dels ciutadans, el rendiment de comptes i l¿eficiència. Un factor que facilita aquest control, i per tant una major eficiència, és la presència de baixos costos d'oportunitat d'obtenir informació sobre la gestió local dels serveis públics.

Measuring the efficiency in Spanish municipal refuse collection services

The objective of this study is to analyse the technical or productive efficiency ofthe refuse collection services in 75 municipalities located in the Spanish regionof Catalonia. The analysis has been carried out using various techniques. Firstly we have calculated a deterministic parametric frontier, then a stochastic parametric frontier, and finally, various non-parametric approaches (DEA and FDH). Concerning the results, these naturally differ according to the technique used to approach the frontier. Nevertheless, they have an appearance of solidity, at least with regard to the ordinal concordance among the indices of efficiency obtained by the different approaches, as is demonstrated by the statistical tests used. Finally, we have attempted to search for any relation existing between efficiency and the method (public or private) of managing the services. No significant relation was found between the type of management and efficiencyindices

Citizens' control and the efficiency of local public services

Està àmpliament acceptat que la descentralització fiscal incrementa el control dels ciutadans sobre els polítics, fomenta el rendiment de comptes i augmenta l¿eficiència. Aquest treball té per objectiu identificar les característiques socio-econòmiques dels ciutadans (votants potencials) que generen un major control sobre els responsables polítics locals provocant, així, un major nivell d'eficiència en un context descentralitzat.També s'analitzen les característiques fiscals dels governs locals que fomenten aquest control i eficiència. L'estudi s'ha aplicat a una mostra de municipis catalans seguint la metodologia convencional basada en l'estimació en dues etapes. A la primera etapa s'estima l'eficiència en que operen els municipis mitjançant la tècnica DEA. La novetat rau en el càlcul d'una nova versió d'indicador global d¿output municipal. En la segona etapa, a través d¿una estimació tipus Tobit (models censurats) i de mètodes bootstrap, es mostra com els factors abans comentats poden influir sobre l¿eficiència. Els resultats suggereixen que la forta presencia de comerciants, jubilats i persones amb dret a vot afavoreixen el control dels ciutadans, el rendiment de comptes i l¿eficiència. Un factor que facilita aquest control, i per tant una major eficiència, és la presència de baixos costos d'oportunitat d'obtenir informació sobre la gestió local dels serveis públics.

Measuring the efficiency in Spanish municipal refuse collection services

The objective of this study is to analyse the technical or productive efficiency ofthe refuse collection services in 75 municipalities located in the Spanish regionof Catalonia. The analysis has been carried out using various techniques. Firstly we have calculated a deterministic parametric frontier, then a stochastic parametric frontier, and finally, various non-parametric approaches (DEA and FDH). Concerning the results, these naturally differ according to the technique used to approach the frontier. Nevertheless, they have an appearance of solidity, at least with regard to the ordinal concordance among the indices of efficiency obtained by the different approaches, as is demonstrated by the statistical tests used. Finally, we have attempted to search for any relation existing between efficiency and the method (public or private) of managing the services. No significant relation was found between the type of management and efficiencyindices

Diversity and efficiency of bradyrhizobium strains isolated from soil samples collected from around sesbania virgata roots using cowpea as trap species

The genetic diversity of ten Bradyrhizobium strains was evaluated for tolerance to high temperatures, to different salinity levels and for the efficiency of symbiosis with cowpea plants (Vigna unguiculata (L.) Walp.). Eight of these strains were isolated from nodules that appeared on cowpea after inoculation with suspensions of soil sampled from around the root system of Sesbania virgata (wand riverhemp) in ecosystems of South Minas Gerais. The other two strains used in our analyses as references, were from the Amazon and are currently recommended as cowpea inoculants. Genetic diversity was analyzed by amplifying repetitive DNA elements with the BOX primer, revealing high genetic diversity with each strain presenting a unique band profile. Leonard jar assays showed that the strains UFLA 03-30 and UFLA 03-38 had the highest N2-fixing potentials in symbiosis with cowpea. These strains had more shoot and nodule dry matter, more shoot N accumulation, and a higher relative efficiency than the strains recommended as inoculants. All strains grew in media of pH levels ranging from 4.0 to 9.0. The strains with the highest N2-fixing efficiencies in symbiosis with cowpea were also tolerant to the greatest number of antibiotics. However, these strains also had the lowest tolerance to high salt concentrations. All strains, with the exceptions of UFLA 03-84 and UFLA 03-37, tolerated temperatures of up to 40 ºC. The genetic and phenotypic characteristics of the eight strains isolated from soils of the same region were highly variable, as well as their symbiotic efficiencies, despite their common origin. This variability highlights the importance of including these tests in the selection of cowpea inoculant strains.

Rhizosphere properties of maize genotypes with contrasting phosphorus efficiency

An experiment was conducted in a growth chamber to evaluate characteristics of the rhizosphere of maize genotypes contrasting in P-use efficiency, by determining length and density of root hairs, the rhizosphere pH and the functional diversity of rhizosphere bacteria. A sample of a Red Oxisol was limed and fertilized with N, K and micronutrients. In the treatment with the highest P level, 174 mg kg-1 P was added. Each experimental unit corresponded to a PVC rhizobox filled with 2.2 dm-3 soil. The experiment was completely randomized with three replications in a 5 x 2 factorial design, corresponding to five genotypes (H1, H2 and H3 = P-efficient hybrids, H4 and H5 = P-inefficient hybrids) and two P levels (low = 3 mg dm-3, high = 29 mg dm-3). It was found that 18 days after transplanting, the nodal roots of the hybrids H3 and H2 had the longest root hairs. In general, the pH in the rhizosphere of the different genotypes was higher than in non-rhizosphere soil, irrespective of the P level. The pH was higher in the rhizosphere of lateral than of nodal roots. At low P levels, the pH variation of the hybrids H2, H4 and H5 was greater in rhizospheric than in non-rhizospheric soil. The functional microbial activity in the rhizosphere of the hybrids H3 and H5 was highest. At low soil P levels, the indices of microbial functional diversity were also higher. The microbial metabolic profile in the rhizosphere of hybrids H1, H2, H3, and H5 remained unaltered when the plants were grown at low P. The variations in the rhizosphere properties could not be related to patterns of P-use efficiency in the tested genotypes.

Nitrogen fertilizer use efficiency, recovery and leaching of an alexandergrass pasture

Nitrogen usually determines the productive potential of forage crops, although it is highly unstable in the environment. Studies on recovery rates and use efficiency are important for more reliable fertilizer recommendations to reduce costs and avoid environmental pollution. The purpose of this study was to evaluate N use efficiency and recovery rate of Alexandergrass pasture (Brachiaria - Syn. Urochloa plantaginea) as well as N-NO3- and N-NH4+ soil concentrations using different levels of N fertilization under two grazing intensities. The experiment was arranged in a randomized block design in a factorial scheme with three replications. Treatments consisted of three N rates (0, 200 and 400 kg ha-1 N) and two grazing intensities termed low mass (LM; forage mass of 2,000 kg ha-1 of DM) and high mass (HM; forage mass of 3,600 kg ha-1 of DM) under continuous stocking and variable stocking rates. Results of N fertilization with 200 kg ha-1 were better than with 400 kg ha-1 N. There was a significant effect of N rates on soil N-NO3-concentration with higher levels in the first layer of the soil profile in the treatment with 400 kg ha-1 N. Grazing intensity also affected soil N-NO3- concentration, by increasing the levels under the higher stocking rate (lower forage mass).

Essays on the measurement of school efficiency

Measuring school efficiency is a challenging task. First, a performance measurement technique has to be selected. Within Data Envelopment Analysis (DEA), one such technique, alternative models have been developed in order to deal with environmental variables. The majority of these models lead to diverging results. Second, the choice of input and output variables to be included in the efficiency analysis is often dictated by data availability. The choice of the variables remains an issue even when data is available. As a result, the choice of technique, model and variables is probably, and ultimately, a political judgement. Multi-criteria decision analysis methods can help the decision makers to select the most suitable model. The number of selection criteria should remain parsimonious and not be oriented towards the results of the models in order to avoid opportunistic behaviour. The selection criteria should also be backed by the literature or by an expert group. Once the most suitable model is identified, the principle of permanence of methods should be applied in order to avoid a change of practices over time. Within DEA, the two-stage model developed by Ray (1991) is the most convincing model which allows for an environmental adjustment. In this model, an efficiency analysis is conducted with DEA followed by an econometric analysis to explain the efficiency scores. An environmental variable of particular interest, tested in this thesis, consists of the fact that operations are held, for certain schools, on multiple sites. Results show that the fact of being located on more than one site has a negative influence on efficiency. A likely way to solve this negative influence would consist of improving the use of ICT in school management and teaching. Planning new schools should also consider the advantages of being located on a unique site, which allows reaching a critical size in terms of pupils and teachers. The fact that underprivileged pupils perform worse than privileged pupils has been public knowledge since Coleman et al. (1966). As a result, underprivileged pupils have a negative influence on school efficiency. This is confirmed by this thesis for the first time in Switzerland. Several countries have developed priority education policies in order to compensate for the negative impact of disadvantaged socioeconomic status on school performance. These policies have failed. As a result, other actions need to be taken. In order to define these actions, one has to identify the social-class differences which explain why disadvantaged children underperform. Childrearing and literary practices, health characteristics, housing stability and economic security influence pupil achievement. Rather than allocating more resources to schools, policymakers should therefore focus on related social policies. For instance, they could define pre-school, family, health, housing and benefits policies in order to improve the conditions for disadvantaged children.

Roadway Lighting and Safety: Phase II – Monitoring Quality, Durability and Efficiency, November 2011

This Phase II project follows a previous project titled Strategies to Address Nighttime Crashes at Rural, Unsignalized Intersections. Based on the results of the previous study, the Iowa Highway Research Board (IHRB) indicated interest in pursuing further research to address the quality of lighting, rather than just the presence of light, with respect to safety. The research team supplemented the literature review from the previous study, specifically addressing lighting level in terms of measurement, the relationship between light levels and safety, and lamp durability and efficiency. The Center for Transportation Research and Education (CTRE) teamed with a national research leader in roadway lighting, Virginia Tech Transportation Institute (VTTI) to collect the data. An integral instrument to the data collection efforts was the creation of the Roadway Monitoring System (RMS). The RMS allowed the research team to collect lighting data and approach information for each rural intersection identified in the previous phase. After data cleanup, the final data set contained illuminance data for 101 lighted intersections (of 137 lighted intersections in the first study). Data analysis included a robust statistical analysis based on Bayesian techniques. Average illuminance, average glare, and average uniformity ratio values were used to classify quality of lighting at the intersections.

Road Use Tax Fund Efficiency Report, January 2012

In the November 2011 report issued by the Governor’s Transportation 2020 Citizen Advisory Commission (CAC), the commission recommended the Iowa Department of Transportation (DOT), at least annually, convene meetings with the cities and counties to review the operation, maintenance and improvement of Iowa’s public roadway system to identify ways to jointly increase efficiency. In response to this recommendation, Gov. Branstad directed the Iowa DOT to begin this effort immediately with a target of identifying $50 million of efficiency savings that can be captured from the $1.2 billion of Road Use Tax Funds (RUTF) provided to the Iowa DOT, cities and counties to administer, maintain and improve the public roadway system. This would build upon past joint and individual actions that have reduced administrative costs and resulted in increased funding for system improvements. Efficiency actions should be quantified, measured and reported to the public on a regular basis. Beyond the discussion of identifying funding solutions to our road and bridge needs, it is critical that all jurisdictions that own, maintain and improve the nation’s road and bridge systems demonstrate to the public these funds are utilized in the most efficient and effective manner. This requires continual innovation in all aspects of transportation planning, design, construction and maintenance - done in a transparent manner to clearly demonstrate to the public how their funds are being utilized. The Iowa DOT has identified 13 efficiency measures separated into two distinct categories – Program Efficiencies and Partnership Efficiencies. The total value of the efficiency measures is $50 million. Many of the efficiency items will need input, refinement and partnership from cities, counties, other local jurisdictions, and stakeholder interest groups. The Iowa DOT has begun meetings with many of these groups to help identify potential efficiency measures and strategies for moving forward. These partnerships and discussions will continue through implementation of the efficiency measures. Dependent on the measures identified, additional action may be required by the legislature, Iowa Transportation Commission, and/or other bodies to implement the action. In addition, a formal process will be developed to quantify, measure and report the results of actions taken on a regular basis.