Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.

Un model per a la gestió cultural municipal : Les arts visuals locals en revisió

El treball desenvolupa en cinc capítols la recerca, l'estudi de dades i les conclusions de la hipòtesi de treball inicial: es possible implementar un nou programa d'arts visuals de qualitat a Rubí? A través de l'estudi detallat, l'anàlisi de dates quantitatives i qualitatives, les entrevistes a responsables de centres d'arts visuals de tota Catalunya i amb la realitat de gestió de les arts visuals del municipi de Rubí, es tracta d'arribar a unes conclusions que condueixen al plantejament d'un nou model de gestió per a l'Ajuntament de Rubí.

Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost-effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy. METHODS: ERAS for pancreaticoduodenectomy was implemented in October 2012. All consecutive patients who underwent pancreaticoduodenectomy until October 2014 were recorded. This group was compared in terms of costs with a cohort of consecutive patients who underwent pancreaticoduodenectomy between January 2010 and October 2012, before ERAS implementation. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration. A bootstrap independent t test was used for comparison. ERAS-specific costs were integrated into the model. RESULTS: The groups were well matched in terms of demographic and surgical details. The overall complication rate was 68 per cent (50 of 74 patients) and 82 per cent (71 of 87 patients) in the ERAS and pre-ERAS groups respectively (P = 0·046). Median hospital stay was lower in the ERAS group (15 versus 19 days; P = 0·029). ERAS-specific costs were euro922 per patient. Mean total costs were euro56 083 per patient in the ERAS group and euro63 821 per patient in the pre-ERAS group (P = 0·273). The mean intensive care unit (ICU) and intermediate care costs were euro9139 and euro13 793 per patient for the ERAS and pre-ERAS groups respectively (P = 0·151). CONCLUSION: ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.

Cost-effectiveness analysis of cardiac resynchronization therapy in patients with NYHA I and NYHA II heart failure in Spain

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain. Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient"s management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum. Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were 18,431 per LYG and 21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years. Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.

Capçal extrusor per a un sistema de tecnologia additiva

El departament de GREP de la UdG disposa d’un sistema de tecnologia additiva, laFab@home model 1, una impressora 3D o també anomenada de prototipat ràpid. Ésuna màquina de dimensions reduïdes, versàtil i de cost reduït, que a partir d’un modelgenerat a CAD, es capaç de fabricar objectes sòlids tridimensionals mitjançant lasuperposició de capes horitzontals.Les impressores 3D neixen de la necessitat de realitzar, en un temps relativament curt,proves de geometries complexes, que executades en un procés de manofacturaciónormal pot ser llarg i d’elevat cost.Gran part de les màquines de característiques similars a la Fab@home, tenen modelspreparats fabricar / extrudir peces a partir de silicones, aliments o polímers. Ara bé, laconformació per extrusió de plàstic és a partir de polímer verge en forma de fil.El present projecte té l’objectiu de dissenyar un sistema de conformació que permetimanufacturar polímer en forma de gra i s’adapti al funcionament de la Fab@home, amb l’argot corresponent, es tracta d’adaptar la Fab@home al fused depositionmodeling (FDM)

Projecte de definició d'un model de gestió de documents electrònics per a l'e-Administració de Catalunya

TFG sobre un projecte de definició d'un model de gestió de documents electrònics, el qual pot ajudar a definir una guia bàsica per a la definició, planificació i execució d'un projecte d'aquestes característiques en el marc de la e-Administració, considerant la dificultat que pot suposar per a determinades administracions, en especial les de menor volum i capacitat, i amb menys infraestructura, adequar un nombre tan elevat de requeriments a la seva realitat de negoci (cultura i processos) i a la seva infraestructura tecnològica, sense oblidar la necessitat de contenir al màxim la despesa.

Model per a la creació d'un itinerari cultural : seguint els passos de Mossé Ben Nahman

El present estudi analitza una part de la bibliografia existent sobre els itineraris culturals, recollint les aportacions de major rellevància i elaborant un model propi per a la elaboració d’aquests. Fer notori el fet que s’afegeixen també nocions que orienten a la seva gestió i control. Tanmateix, es fa una proposta d’itinerari basada en un personatge històric, Mossé Ben Nahman, i el seu lligam amb les ciutats de Girona i Barcelona. Destacar la rellevància de les temàtiques tractades, ja que ambdues es troben presents en estudis i projectes en curs, esdevenint subjectes en període d’expansió i anàlisi

Els moviments en transició : model participatiu per treballar el sector alimentació : ciutat d'estudi, Granollers

Entenent el context global en el que estem amb les pertorbacions com són el pic del petroli o el canvi climàtic, el projecte ha treballa el vector alimentació de Granollers des de la perspectiva de les ciutats en Transició. Primer per entendre les iniciatives en Transició i com s'implementen s'ha elaborat unes entrevistes semiestrucutrades a 4 iniciatives en Transició. S'ha observat que totes les iniciatives depenen dels contextos objectius en que estant tot i que busquen la resiliència. Per treballar el vector alimentació s'ha portat a terme un model participatiu on s'han extret un conjunt de propostes i preocupacions per part d'actors relacionats amb el sistema alimentari de Granollers. Aquest treball serveix com una eina per entendre més bé les iniciatives en Transició i per començar a treballar el vector alimentació a partir de les conclusions extretes del model participatiu.

Proposta de model per mesurar el valor percebut, la satisfacció i la lleialtat a les destinacions turístiques transfrontereres

L’objectiu d’aquesta treball és proposar un model de relacions causals i unes hipòtesis de treball sobre la lleialtat dels turistes a les destinacions transfrontereres en el context de la Unió Europea

Anàlisi d'un spot televisiu segons el model proposat per Frederic Chaume : Estudi d'un cas: Beauty is nothing without brains

L’estudi de les situacions comunicatives sempre m’ha atret de manera significativa. El món de la publicitat, també. L’assignatura de Semiòtica audiovisual ha estat el vincle que ha inspirat el tema d’aquest treball. L’idea inicial era la d’analitzar des d’una perspectiva semiòtica un document audiovisual, concretament, Beauty is nothing without brains, un espot televisiu de Mercedes-Benz emès als Estats Units l’any 2007. Es pretenia identificar i analitzar cadascun dels elements que configuren la comunicació audiovisual i presentar possibles versions traductològiques del mateix. La dificultat de crear un esquema d’anàlisi que em permetés estructurar-ne l’estudi va conduir-me a Frederic Chaume. És llavors quan aconsegueixo concretar el tema del treball: es pretén analitzar aquest document audiovisual seguint el model proposat per Chaume, responent a un hipotètic encàrrec de traducció el qual demana la seva adaptació al mercat català.

Generic Life Cycle Cost Model and Cost-effective Solutions

Life cycle costing (LCC) practices are spreading from military and construction sectors to wider area of industries. Suppliers as well as customers are demanding comprehensive cost knowledge that includes all relevant cost elements through the life cycle of products. The problem of total cost visibility is being acknowledged and the performance of suppliers is evaluated not just by low acquisition costs of their products, but by total value provided through the life time of their offerings. The main purpose of this thesis is to provide better understanding of product cost structure to the case company. Moreover, comprehensive theoretical body serves as a guideline or methodology for further LCC process. Research includes the constructive analysis of LCC related concepts and features as well as overview of life cycle support services in manufacturing industry. The case study aims to review the existing LCC practices within the case company and provide suggestions for improvements. It includes identification of most relevant life cycle cost elements, development of cost breakdown structure and generic cost model for data collection. Moreover, certain cost-effective suggestions are provided as well. This research should support decision making processes, assessment of economic viability of products, financial planning, sales and other processes within the case company.

Teaching project: a low-cost swine model for chest tube insertion training

Objective: to describe and evaluate the acceptance of a low-cost chest tube insertion porcine model in a medical education project in the southwest of Paraná, Brazil. Methods: we developed a low-cost and low technology porcine model for teaching chest tube insertion and used it in a teaching project. Medical trainees - students and residents - received theoretical instructions about the procedure and performed thoracic drainage in this porcine model. After performing the procedure, the participants filled a feedback questionnaire about the proposed experimental model. This study presents the model and analyzes the questionnaire responses. Results: seventy-nine medical trainees used and evaluated the model. The anatomical correlation between the porcine model and human anatomy was considered high and averaged 8.1±1.0 among trainees. All study participants approved the low-cost porcine model for chest tube insertion. Conclusion: the presented low-cost porcine model for chest tube insertion training was feasible and had good acceptability among trainees. This model has potential use as a teaching tool in medical education.

Cost-efficient virtual machine management : provisioning, admission control, and consolidation

One of the main challenges in Software Engineering is to cope with the transition from an industry based on software as a product to software as a service. The field of Software Engineering should provide the necessary methods and tools to develop and deploy new cost-efficient and scalable digital services. In this thesis, we focus on deployment platforms to ensure cost-efficient scalability of multi-tier web applications and on-demand video transcoding service for different types of load conditions. Infrastructure as a Service (IaaS) clouds provide Virtual Machines (VMs) under the pay-per-use business model. Dynamically provisioning VMs on demand allows service providers to cope with fluctuations on the number of service users. However, VM provisioning must be done carefully, because over-provisioning results in an increased operational cost, while underprovisioning leads to a subpar service. Therefore, our main focus in this thesis is on cost-efficient VM provisioning for multi-tier web applications and on-demand video transcoding. Moreover, to prevent provisioned VMs from becoming overloaded, we augment VM provisioning with an admission control mechanism. Similarly, to ensure efficient use of provisioned VMs, web applications on the under-utilized VMs are consolidated periodically. Thus, the main problem that we address is cost-efficient VM provisioning augmented with server consolidation and admission control on the provisioned VMs. We seek solutions for two types of applications: multi-tier web applications that follow the request-response paradigm and on-demand video transcoding that is based on video streams with soft realtime constraints. Our first contribution is a cost-efficient VM provisioning approach for multi-tier web applications. The proposed approach comprises two subapproaches: a reactive VM provisioning approach called ARVUE and a hybrid reactive-proactive VM provisioning approach called Cost-efficient Resource Allocation for Multiple web applications with Proactive scaling. Our second contribution is a prediction-based VM provisioning approach for on-demand video transcoding in the cloud. Moreover, to prevent virtualized servers from becoming overloaded, the proposed VM provisioning approaches are augmented with admission control approaches. Therefore, our third contribution is a session-based admission control approach for multi-tier web applications called adaptive Admission Control for Virtualized Application Servers. Similarly, the fourth contribution in this thesis is a stream-based admission control and scheduling approach for on-demand video transcoding called Stream-Based Admission Control and Scheduling. Our fifth contribution is a computation and storage trade-o strategy for cost-efficient video transcoding in cloud computing. Finally, the sixth and the last contribution is a web application consolidation approach, which uses Ant Colony System to minimize the under-utilization of the virtualized application servers.

Model-based testing of software systems : functionality and performance

Software is a key component in many of our devices and products that we use every day. Most customers demand not only that their devices should function as expected but also that the software should be of high quality, reliable, fault tolerant, efficient, etc. In short, it is not enough that a calculator gives the correct result of a calculation, we want the result instantly, in the right form, with minimal use of battery, etc. One of the key aspects for succeeding in today's industry is delivering high quality. In most software development projects, high-quality software is achieved by rigorous testing and good quality assurance practices. However, today, customers are asking for these high quality software products at an ever-increasing pace. This leaves the companies with less time for development. Software testing is an expensive activity, because it requires much manual work. Testing, debugging, and verification are estimated to consume 50 to 75 per cent of the total development cost of complex software projects. Further, the most expensive software defects are those which have to be fixed after the product is released. One of the main challenges in software development is reducing the associated cost and time of software testing without sacrificing the quality of the developed software. It is often not enough to only demonstrate that a piece of software is functioning correctly. Usually, many other aspects of the software, such as performance, security, scalability, usability, etc., need also to be verified. Testing these aspects of the software is traditionally referred to as nonfunctional testing. One of the major challenges with non-functional testing is that it is usually carried out at the end of the software development process when most of the functionality is implemented. This is due to the fact that non-functional aspects, such as performance or security, apply to the software as a whole. In this thesis, we study the use of model-based testing. We present approaches to automatically generate tests from behavioral models for solving some of these challenges. We show that model-based testing is not only applicable to functional testing but also to non-functional testing. In its simplest form, performance testing is performed by executing multiple test sequences at once while observing the software in terms of responsiveness and stability, rather than the output. The main contribution of the thesis is a coherent model-based testing approach for testing functional and performance related issues in software systems. We show how we go from system models, expressed in the Unified Modeling Language, to test cases and back to models again. The system requirements are traced throughout the entire testing process. Requirements traceability facilitates finding faults in the design and implementation of the software. In the research field of model-based testing, many new proposed approaches suffer from poor or the lack of tool support. Therefore, the second contribution of this thesis is proper tool support for the proposed approach that is integrated with leading industry tools. We o er independent tools, tools that are integrated with other industry leading tools, and complete tool-chains when necessary. Many model-based testing approaches proposed by the research community suffer from poor empirical validation in an industrial context. In order to demonstrate the applicability of our proposed approach, we apply our research to several systems, including industrial ones.

Logistics Cost Optimization of Road Freight Shipments in a Consumer Goods Company

In the industry of the case company, transportation and warehousing costs account for more than 10% of the total cost which is more than on average. A Finnish company has an understanding that by sending larger shipments in parcels, they could save tens of thousands of euros annually in freight costs in Finland’s domestic shipments. To achieve these savings and optimize total logistics cost, company’s interest is to find out which is the cost efficient way of shipping road shipments of certain volumes; in parcel boxes or on pallets, and what should be the split volume determining the shipment type. Distribution center (DC) costs affect this decision and therefore they need to be also evaluated to determine the total logistics cost savings. Main results were achieved by executing activity-based costing-calculations including DC and road freight costs to determine the ideal split volume with which the total logistics cost is optimal. Calculations were done for Finland’s DC, separately for two main road freight destinations, Finland and Sweden, which cover 50% of road shipment spend. Data for calculations was collected both manually and automatically from various internal and external sources, such as the company ERP system and logistics service providers’ (LSP) reporting. DC processes were studied in practice and compared to model processes. Currently used freight rates were compared to existing pricing models and freight service tendering process was evaluated by participating in the process and comparing it to the models based on literature. The results show that the potential savings are not as significant as the company hoped for, mainly because of packing work increasing DC labor cost. Annual savings by setting ideal split volume per country would account for 0,4 % of the warehousing and transportation costs of shipments in scope of this thesis. Split volume should be set separately for each route, mainly because the pricing model for road freight is different in each country. For some routes bigger parcels should be sent but for some routes pallets should be used more. Next step is to do these calculations for remaining routes to determine total savings potential. Other findings show that the processes in the DC are designed well and the company could achieve savings by executing tenders more efficiently. Company should also pay more attention to parcel pricing and packing the shipments accordingly.