The impact of an exercise physiologist coordinated resistance exercise program on the physical function of people receiving hemodialysis: a stepped wedge randomised control study

Background:

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references. Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) > or = 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI > or = 40; BMI > or = 30 and < 40 with Type 2 diabetes at baseline; and BMI > or = 30 and < 35. Models were applied with assumptions on costs and comorbidity.

Vector control of a position sensorless SPMSM drive with RNN based stator flux estimator

A position sensorless Surface Permanent Magnet Synchronous Motor (SPMSM) drive based on single layer Recurrent Neural Network (RNN) is presented in this paper. The motor equations are written in rotor fixed d-q reference frame. A PID controller is used to process the speed error to generate the reference torque current keeping the magnetizing current fixed. The RNN estimator is used to estimate flux components along the stator fixed stationary axes. The flux angle and the reference current phasor angle are used in vector rotator to generate the reference phase currents. Hysteresis current controller block controls the switching of the three phase inverter to apply voltage to the motor stator. Simulation studies on different operating conditions indicate the acceptability of the drive system. The proposed estimator can be used to accurately measure the motor fluxes and rotor angle over a wide speed range. The proposed control scheme is robust under load torque disturbances and motor parameter variations. It is also simple and low cost to implememnt in a practical environment

The control of rodent damage in Australian macadamia orchards by manipulation of adjacent non-crop habitats

 Habitat manipulation was used as a management strategy for the control of rodent (Rattus rattus) damage in Australian macadamia orchard systems. Large, temporally stable non-crop habitats were converted to highly modified grasslands. These sites were manipulated by removing all non-crop vegetation over 10 cm in height to a distance of approximately 20 m from the orchard. Regrowth was controlled by the application of herbicide. The total cost of the habitat manipulation was $AUD 292 per site. Manipulation resulted in a reduction in damage of 65% within the associated orchards. This reduction in rodent damage resulted in a saving of $AUD 980 per site. Therefore habitat manipulation was cost-effective and is a viable startegy for the control of rodent damage in Australian macadamia orchard systems.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

Cost-effectiveness of interventions to prevent cardiovascular disease in Australia's indigenous population

Cardiovascular disease is the leading cause of disease burden in Australia's Indigenous population, and the greatest contributor to the Indigenous 'health gap'. Economic evidence can help identify interventions that efficiently address this discrepancy.

Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial

BACKGROUND: Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider. This study aimed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months, from a health system perspective inclusive of private costs. METHODS: Cost effectiveness analyses alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence. RESULTS: A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI -4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01). There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. Sensitivity analyses varying the cost of informal carers and self-reported health service utilization, favored the intervention. CONCLUSIONS: From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for inpatients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence, for the inpatient stay and 12 months following discharge, without a cost shift into the community. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213 .

Assessing the economic benefits of starling detection and control to Western Australia

The common starling (Sturnus vulgaris) has a proven invasion history in many countries, and at a continental scale in North America and Australasia. In Australia, starlings are firmly established throughout the eastern states and Tasmania. Incursions of starlings into Western Australia (WA) represent a significant threat to this State’s agricultural, public amenity and biodiversity assets. We present models of starling population dynamics that incorporate environmental and control effort variability. We incorporate knowledge of starling ecology with economic data to assess the potential economic cost of starlings establishing in WA, evaluating the cost–benefits for each management scenario. We calculated starling population size will approach carrying capacity in WA within as little as 30 years if left unchecked. A population of this size could cost the WA economy up to $43.7 million annually in 2011/2012 dollars. Over a 50 year horizon, the conservative benefit–cost ratio for ongoing detection and control at the current level of expenditure is 6.03:1. However, even under current levels of control, starling numbers are projected to increase to almost 11 million by 2061. Further improvements in the efficiency of starling detection and control and/or an increased level of expenditure on detection and control are required.

The extra resource burden of in-hospital falls: a cost of falls study

OBJECTIVE: To quantify the additional hospital length of stay (LOS) and costs associated with in-hospital falls and fall injuries in acute hospitals in Australia. DESIGN, SETTING AND PARTICIPANTS: A multisite prospective cohort study conducted during 2011-2013 in the control wards of a falls prevention trial (6-PACK). The trial included all admissions to 12 acute medical and surgical wards of six Australian hospitals. In-hospital falls data were collected from medical record reviews, daily verbal reports by ward nurse unit managers, and hospital incident reporting and administrative databases. Clinical costing data were linked for three of the six participating hospitals to calculate patient-level costs. OUTCOME MEASURES: Hospital LOS and costs associated with in-hospital falls and fall injuries for each patient admission. RESULTS: We found that 966 of a total of 27 026 hospital admissions (3.6%) involved at least one fall, and 313 (1.2%) at least one fall injury, a total of 1330 falls and 418 fall injuries. After adjustment for age, sex, cognitive impairment, admission type, comorbidity and clustering by hospital, patients who had an in-hospital fall had a mean increase in LOS of 8 days (95% CI, 5.8-10.4; P < 0.001) compared with non-fallers, and incurred mean additional hospital costs of $6669 (95% CI, $3888-$9450; P < 0.001). Patients with a fall-related injury had a mean increase in LOS of 4 days (95% CI, 1.8-6.6; P = 0.001) compared with those who fell without injury, and there was also a tendency to additional hospital costs (mean, $4727; 95% CI, -$568 to $10 022; P = 0.080). CONCLUSION: Patients who experience an in-hospital fall have significantly longer hospital stays and higher costs. Programs need to target the prevention of all falls, not just the reduction of fall-related injuries.

Corporate opacity and cost of debt for family firms

This paper uses a sample of Chinese firms to examine the impact of corporate opacity on the relationship between family control and firms’ cost of debt. We find that family control is associated with a lower cost of debt on average, and a negative impact exists mainly in firms with relatively low corporate opacity. We further provide evidence that the moderating effect of corporate opacity becomes more pronounced when investors’ perception of controlling families’ moral hazard of expropriation is higher. Our results are robust to alternative opacity proxies and controlling for endogeneity of family control using the instrumental variable method. Our study highlights that controlling families are heterogeneous in their impact on the shareholder–debtholder relationship in family firms, and debtholders view corporate opacity as an important reference in assessing the extent of potential agency conflicts in China.

Primary voltage control of a single-phase inverter using linear quadratic regulator with integrator

This paper proposes a linear quadratic regulator with integral action, ensuring fast dynamic response and resisting capability of voltage deviation from instantaneous reference grid voltage, to control the inverter voltage that can also be used in a microgrid. The proposed control strategy is based on a linear quadratic regulator, minimizing the cost function of the system, with integral action used to impede voltage degradation from a reference voltage for outside disturbances of the system, such as abrupt load change. The combined integral term assists to recover the voltage difference between grid and reference grid voltage. The validity of the proposed controller has been tested with linear and non-linear loads under various conditions. In both cases, the effectiveness of the controller has been proved. The result of the proposed controller is good to track the instantaneous reference grid voltage.

Real-Time Control Of Floods Along The Demer River, Belgium, By Means Of MPC In Combination With GA And A Fast Conceptual River Model

Climate model projections show that climate change will further increase the risk of flooding in many regions of the world. There is a need for climate adaptation, but building new infrastructure or additional retention basins has its limits, especially in densely populated areas where open spaces are limited. Another solution is the more efficient use of the existing infrastructure. This research investigates a method for real-time flood control by means of existing gated weirs and retention basins. The method was tested for the specific study area of the Demer basin in Belgium but is generally applicable. Today, retention basins along the Demer River are controlled by means of adjustable gated weirs based on fixed logic rules. However, because of the high complexity of the system, only suboptimal results are achieved by these rules. By making use of precipitation forecasts and combined hydrological-hydraulic river models, the state of the river network can be predicted. To fasten the calculation speed, a conceptual river model was used. The conceptual model was combined with a Model Predictive Control (MPC) algorithm and a Genetic Algorithm (GA). The MPC algorithm predicts the state of the river network depending on the positions of the adjustable weirs in the basin. The GA generates these positions in a semi-random way. Cost functions, based on water levels, were introduced to evaluate the efficiency of each generation, based on flood damage minimization. In the final phase of this research the influence of the most important MPC and GA parameters was investigated by means of a sensitivity study. The results show that the MPC-GA algorithm manages to reduce the total flood volume during the historical event of September 1998 by 46% in comparison with the current regulation. Based on the MPC-GA results, some recommendations could be formulated to improve the logic rules.

Application Of Real-Time Control Strategy To Improve Nitrogen Removal In Wastewater Treatment

Biological nitrogen removal is an important task in the wastewater treatment. However, the actual removal of total nitrogen (TN) in the wastewater treatment plant (WWTP) is often unsatisfactory due to several causes, one of which is the insufficient availability of carbon source. One possible approach to improve the nitrogen removal therefore is addition of external carbon source, while the amount of which is directly related to operation cost of a WWTP. It is obviously necessary to determine the accurate amount of addition of external carbon source according to the demand depending on the influent wastewater quality. This study focused on the real-time control of external carbon source addition based on the on-line monitoring of influent wastewater quality. The relationship between the influent wastewater quality (specifically the concentration of COD and ammonia) and the demand of carbon source was investigated through experiments on a pilot-scale A/O reactor (1m3) at the Nanjing WWTP, China. The minimum doses of carbon source addition at different situations of influent wastewater quality were determined to ensure the effluent wastewater quality meets the discharge standard. The obtained relationship is expected to be applied in the full-scale WWTPs. .

DCE: the dynamic conditional execution in a multipath control independent architecture

This thesis presents DCE, or Dynamic Conditional Execution, as an alternative to reduce the cost of mispredicted branches. The basic idea is to fetch all paths produced by a branch that obey certain restrictions regarding complexity and size. As a result, a smaller number of predictions is performed, and therefore, a lesser number of branches are mispredicted. DCE fetches through selected branches avoiding disruptions in the fetch flow when these branches are fetched. Both paths of selected branches are executed but only the correct path commits. In this thesis we propose an architecture to execute multiple paths of selected branches. Branches are selected based on the size and other conditions. Simple and complex branches can be dynamically predicated without requiring a special instruction set nor special compiler optimizations. Furthermore, a technique to reduce part of the overhead generated by the execution of multiple paths is proposed. The performance achieved reaches levels of up to 12% when comparing a Local predictor used in DCE against a Global predictor used in the reference machine. When both machines use a Local predictor, the speedup is increased by an average of 3-3.5%.

Electoral control in the presence of gridlocks

This article presents a game-theoretic partisan model of voting and political bargaining. In a two-period setup, voters ¯rst elect an executive incumbent and the legislators from a pool of candidates belonging to di®erent parties. Once elected, the executive and the legislature bargain over a budget. Party origin and a relevant parameter of the economy, the state of the world, in°uence the bargaining cost, such that political gridlocks may occur. At the end of the ¯rst period voters observe the outcome of bargaining but do not observe the true estate of the world, and decide whether or not to reelect the same parties for the Executive and the Legislature. The model con¯rms the very recent literature by showing that voters tend to have more °exible reelection criteria when they believe the true state of the world is likely to be unfavorable. On the other hand, when voters believe the true state of the world is likely to be favorable, they become more demanding in order to reelect the incumbents. In particular, there will be government shutdown with positive probability in equilibrium. Gridlocks occur due to the imperfect information of voters and they constitute indeed an information revelation mechanism that improves electoral control in the second period.