Mitä hyötyä tehohoidosta? : Tehohoitoa sisältäneiden hoitojaksojen vaikuttavuuden arviointi

Intensive care is to be provided to patients benefiting from it, in an ethical, efficient, effective and cost-effective manner. This implies a long-term qualitative and quantitative analysis of intensive care procedures and related resources. The study population consists of 2709 patients treated in the general intensive care unit (ICU) of Helsinki University Hospital. Study sectors investigate intensive care patients mortality, quality of life (QOL), Quality-Adjusted Life-Years (QALY units) and factors related to severity of illness, length of stay (LOS), patient s age, evaluation period as well as experiences and memories connected with the ICU episode. In addition, the study examines the qualities of two QOL measures, the RAND 36 Item Health Survey 1.0 (RAND-36) and the 5 Item EuroQol-5D (EQ-5D) and assesses the correlation of the test results. Patients treated in 1995 responded to the RAND-36 questionnaire in 1996. All patients, treated from 1995-2000, received a QOL questionnaires in 2001, when 1 7 years had lapsed from the intensive treatment. Response rate was 79.5 %. Main Results 1) Of the patients who died within the first year (n = 1047) 66 % died during the intensive care period or within the following month. The non-survivors were more aged than the surviving patients, had generally a higher than average APACHE II and SOFA score depicting the severity of illness, their ICU LOS was longer and hospital stay shorter than of the surviving patients (p < 0.001). Mortality of patients receiving conservative treatment was higher than of those receiving surgical treatment. Patients replying to the QOL survey in 2001 (n = 1099) had recovered well: 97 % of those lived at home. More than half considered their QOL as good or extremely good, 40 % as satisfactory and 7 % as bad. All QOL indexes of those of working-age were considerably lower (p < 0.001) than comparable figures of the age- and gender-adjusted Finnish population. The 5-year monitoring period made evident that mental recovery was slower than physical recovery. 2) The results of RAND-36 and EQ-5D correlated well (p < 0.01). The RAND-36 profile measure distinguished more clearly between the different categories of QOL and their levels. EQ-5D measured well the patient groups general QOL and the sum index was used to calculate QALY units. 3) QALY units were calculated by multiplying the time the patient survived after ICU stay or expected life-years by the EQ-5D sum index. Aging automatically lowers the number of QALY units. Patients under the age of 65 receiving conservative treatment benefited from treatment to a greater extent measured in QALY units than their peers receiving surgical treatment, but in the age group 65 and over patients with surgical treatment received higher QALY ratings than recipients of conservative treatment. 4) The intensive care experience and QOL ratings were connected. The QOL indices were statistically highest for those recipients with memories of intensive care as a positive experience, albeit their illness requiring intensive care treatment was less serious than average. No statistically significant differences were found in the QOL indices of those with negative memories, no memories or those who did not express the quality of their experiences.

Cooperative game play with avatars and agents: Differences in brain activity and the experience of play

The current study sought to identify the impact of whether teammates in a cooperative videogame were controlled by other humans (avatars) or by the game (agents). The impact on player experience was explored through both subjective questionnaire measures and brain wave activity measurement (electroencephalography). Play with human teammates was associated with a greater sense of relatedness, but less competence and flow than play with other computer-controlled teammates. In terms of brain activity, play with human teammates was associated with greater activity in the alpha, theta and beta power bands than play with computer-controlled teammates. Overall, the results suggest that play with human teammates involves greater cognitive activity in terms of 'mentalising' than play with computer-controlled teammates. Additionally, the associations between subjective measures of player experience and brain activity are described. Limitations of the current study are identified and key directions for future research are discussed.

Grand Push Auto: A car based exertion game

Grand Push Auto is an exertion game in which players aim to push a full sized car to ever increasing speeds. The re-appropriation of a car as essentially a large weight allows us to create a highly portable and distributable exertion game in which the main game element has a weight of over 1000 kilograms. In this paper we discuss initial experiences with GPA, and present 3 questions for ongoing study which have been identified from our early testing: How might we appropriate existing objects in exertion game design, and does appropriation change how we think about these objects in different contexts, for example environmental awareness? How does this relate to more traditional sled based weight training? How can we create exertion games that allow truly brutal levels of force?

A cooperative game theoretic approach to prototype selection

In this paper we consider the task of prototype selection whose primary goal is to reduce the storage and computational requirements of the Nearest Neighbor classifier while achieving better classification accuracies. We propose a solution to the prototype selection problem using techniques from cooperative game theory and show its efficacy experimentally.

Experimental implementation of a three qubit quantum game with corrupt source using nuclear magnetic resonance quantum information processor

In a three player quantum `Dilemma' game each player takes independent decisions to maximize his/her individual gain. The optimal strategy in the quantum version of this game has a higher payoff compared to its classical counterpart. However, this advantage is lost if the initial qubits provided to the players are from a noisy source. We have experimentally implemented the three player quantum version of the `Dilemma' game as described by Johnson, [N.F. Johnson, Phys. Rev. A 63 (2001) 020302(R)] using nuclear magnetic resonance quantum information processor and have experimentally verified that the payoff of the quantum game for various levels of corruption matches the theoretical payoff. (c) 2007 Elsevier Inc. All rights reserved.

Urban growth dilemmas and solutions in China: Looking forward to 2030

China’s urbanization and industrialization are occupying farmland in large amounts, which is strongly driven by land finance regime. This is due to the intensified regional/local competition for manufacturing investment opportunities that push local governments to expropriate farmland at low prices while lease land at high market value to property developers. The additional revenue obtained in this way, termed financial increment in land values, can drive local economic growth, and provide associated infrastructure and other public services. At the same time, however, a floating population of large numbers of inadequately compensated land-lost farmers, although unable to become citizens, have to migrate into the urban areas for work, causing overheated employment and housing markets, with rocketing unaffordable housing prices. This, together with various micro factors relating to the party/state’s promotion/evaluation system play an essential role leading to some serious economic, environment and social consequences, e.g., on migrant welfare, the displacement of peasants and the loss of land resources that requires immediate attention. Our question is: whether such type of urbanization is sustainable? What are the mechanisms behind such a phenomenal urbanization process? From the perspective of institutionalism, this paper aims to investigate the institutional background of the urban growth dilemma and solutions in urban China and to introduce further an inter-regional game theoretical framework to indicate why the present urbanization pattern is unsustainable. Looking forward to 2030, paradigm policy changes are made from the triple consideration of floating population, social security and urban environmental pressures. This involves: (1) changing land increment based finance regime into land stock finance system; (2) the citizenization of migrant workers with affordable housing, and; (3) creating a more enlightened local government officer appraisal system to better take into account societal issues such as welfare and beyond.

Two-agent cooperative search using game models with endurance-time constraints

In this article, the problem of two Unmanned Aerial Vehicles (UAVs) cooperatively searching an unknown region is addressed. The search region is discretized into hexagonal cells and each cell is assumed to possess an uncertainty value. The UAVs have to cooperatively search these cells taking limited endurance, sensor and communication range constraints into account. Due to limited endurance, the UAVs need to return to the base station for refuelling and also need to select a base station when multiple base stations are present. This article proposes a route planning algorithm that takes endurance time constraints into account and uses game theoretical strategies to reduce the uncertainty. The route planning algorithm selects only those cells that ensure the agent will return to any one of the available bases. A set of paths are formed using these cells which the game theoretical strategies use to select a path that yields maximum uncertainty reduction. We explore non-cooperative Nash, cooperative and security strategies from game theory to enhance the search effectiveness. Monte-Carlo simulations are carried out which show the superiority of the game theoretical strategies over greedy strategy for different look ahead step length paths. Within the game theoretical strategies, non-cooperative Nash and cooperative strategy perform similarly in an ideal case, but Nash strategy performs better than the cooperative strategy when the perceived information is different. We also propose a heuristic based on partitioning of the search space into sectors to reduce computational overhead without performance degradation.

Design of incentive compatible protocols for wireless networks: A game theoretic approach

In this thesis work, we design rigorous and efficient protocols/mechanisms for different types of wireless networks using a mechanism design [1] and game theoretic approach [2]. Our work can broadly be viewed in two parts. In the first part, we concentrate on ad hoc wireless networks [3] and [4]. In particular, we consider broadcast in these networks where each node is owned by independent and selfish users. Being selfish, these nodes do not forward the broadcast packets. All existing protocols for broadcast assume that nodes forward the transit packets. So, there is need for developing new broadcast protocols to overcome node selfishness. In our paper [5], we develop a strategy proof pricing mechanism which we call immediate predecessor node pricing mechanism (IPNPM) and an efficient new broadcast protocol based on IPNPM. We show the efficacy of our proposed broadcast protocol using simulation results.

A non-cooperative game-theoretic approach to channel assignment in multi-channel multi-radio wireless networks

Channel assignment in multi-channel multi-radio wireless networks poses a significant challenge due to scarcity of number of channels available in the wireless spectrum. Further, additional care has to be taken to consider the interference characteristics of the nodes in the network especially when nodes are in different collision domains. This work views the problem of channel assignment in multi-channel multi-radio networks with multiple collision domains as a non-cooperative game where the objective of the players is to maximize their individual utility by minimizing its interference. Necessary and sufficient conditions are derived for the channel assignment to be a Nash Equilibrium (NE) and efficiency of the NE is analyzed by deriving the lower bound of the price of anarchy of this game. A new fairness measure in multiple collision domain context is proposed and necessary and sufficient conditions for NE outcomes to be fair are derived. The equilibrium conditions are then applied to solve the channel assignment problem by proposing three algorithms, based on perfect/imperfect information, which rely on explicit communication between the players for arriving at an NE. A no-regret learning algorithm known as Freund and Schapire Informed algorithm, which has an additional advantage of low overhead in terms of information exchange, is proposed and its convergence to the stabilizing outcomes is studied. New performance metrics are proposed and extensive simulations are done using Matlab to obtain a thorough understanding of the performance of these algorithms on various topologies with respect to these metrics. It was observed that the algorithms proposed were able to achieve good convergence to NE resulting in efficient channel assignment strategies.

A game theoretical multiple resource interaction approach to resource allocation in an air campaign

In this paper we propose a multiple resource interaction model in a game-theoretical framework to solve resource allocation problems in theater level military campaigns. An air raid campaign using SEAD aircraft and bombers against an enemy target defended by air defense units is considered as the basic platform. Conditions for the existence of saddle point in pure strategies is proved and explicit feedback strategies are obtained for a simplified model with linear attrition function limited by resource availability. An illustrative example demonstrates the key features.

A Coalitional Game Framework for Cooperative Secondary Spectrum Access

We consider a framework in which several service providers offer downlink wireless data access service in a certain area. Each provider serves its end-users through opportunistic secondary spectrum access of licensed spectrum, and needs to pay primary license holders of the spectrum usage based and membership based charges for such secondary spectrum access. In these circumstances, if providers pool their resources and allow end-users to be served by any of the cooperating providers, the total user satisfaction as well as the aggregate revenue earned by providers may increase. We use coalitional game theory to investigate such cooperation among providers, and show that the optimal cooperation schemes can be obtained as solutions of convex optimizations. We next show that under usage based charging scheme, if all providers cooperate, there always exists an operating point that maximizes the aggregate revenue of providers, while presenting each provider a share of the revenue such that no subset of providers has an incentive to leave the coalition. Furthermore, such an operating point can be computed in polynomial time. Finally, we show that when the charging scheme involves membership based charges, the above result holds in important special cases.

A Coalition game model for spectrum pooling in wireless data access networks

We consider a setting in which several operators offer downlink wireless data access services in a certain geographical region. Each operator deploys several base stations or access points, and registers some subscribers. In such a situation, if operators pool their infrastructure, and permit the possibility of subscribers being served by any of the cooperating operators, then there can be overall better user satisfaction, and increased operator revenue. We use coalitional game theory to investigate such resource pooling and cooperation between operators.We use utility functions to model user satisfaction, and show that the resulting coalitional game has the property that if all operators cooperate (i.e., form a grand coalition) then there is an operating point that maximizes the sum utility over the operators while providing the operators revenues such that no subset of operators has an incentive to break away from the coalition. We investigate whether such operating points can result in utility unfairness between users of the various operators. We also study other revenue sharing concepts, namely, the nucleolus and the Shapely value. Such investigations throw light on criteria for operators to accept or reject subscribers, based on the service level agreements proposed by them. We also investigate the situation in which only certain subsets of operators may be willing to cooperate.