Performance tiers: Implementing comparative effectiveness analysis in the health care setting through operations research and spatial methods

This dissertation develops and tests a comparative effectiveness methodology utilizing a novel approach to the application of Data Envelopment Analysis (DEA) in health studies. The concept of performance tiers (PerT) is introduced as terminology to express a relative risk class for individuals within a peer group and the PerT calculation is implemented with operations research (DEA) and spatial algorithms. The analysis results in the discrimination of the individual data observations into a relative risk classification by the DEA-PerT methodology. The performance of two distance measures, kNN (k-nearest neighbor) and Mahalanobis, was subsequently tested to classify new entrants into the appropriate tier. The methods were applied to subject data for the 14 year old cohort in the Project HeartBeat! study.^ The concepts presented herein represent a paradigm shift in the potential for public health applications to identify and respond to individual health status. The resultant classification scheme provides descriptive, and potentially prescriptive, guidance to assess and implement treatments and strategies to improve the delivery and performance of health systems. ^

THE EVALUATION OF PUBLIC HEALTH COMPONENTS OF INTERNATIONAL DISASTER RELIEF OPERATIONS: INDOCHINESE REFUGEES IN THAILAND, 1979-1982

Refugee populations suffer poor health status and yet the activities of refugee relief agencies in the public health sector have not been subjected previously to comprehensive evaluation. The purpose of this study was to examine the effectiveness and cost of the major public health service inputs of the international relief operation for Indochinese refugees in Thailand coordinated by the United Nations High Commissioner for Refugees (UNHCR). The investigator collected data from surveillance reports and agency records pertaining to 11 old refugee camps administered by the Government of Thailand Ministry of Interior (MOI) since an earlier refugee influx, and five new Khmer holding centers administered directly by UNHCR, from November, 1979, to March, 1982.^ Generous international funding permitted UNHCR to maintain a higher level of public health service inputs than refugees usually enjoyed in their countries of origin or than Thais around them enjoyed. Annual per capita expenditure for public health inputs averaged approximately US$151. Indochinese refugees in Thailand, for the most part, had access to adequate general food rations, to supplementary feeding programs, and to preventive health measures, and enjoyed high-quality medical services. Old refugee camps administered by MOI consistently received public health inputs of lower quantity and quality compared with new UNHCR-administered holding centers, despite comparable per capita expenditure after both types of camps had stabilized (static phase).^ Mortality and morbidity rates among new Khmer refugees were catastrophic during the emergency and transition phases of camp development. Health status in the refugee population during the static phase, however, was similar to, or better than, health status in the refugees' countries of origin or the Thai communities surrounding the camps. During the static phase, mortality and morbidity generally remained stable at roughly the same low levels in both types of camps.^ Furthermore, the results of multiple regression analyses demonstrated that combined public health inputs accounted for from one to 23 per cent of the variation in refugee mortality and morbidity. The direction of associations between some public health inputs and specific health outcome variables demonstrated no clear pattern. ^

An assessment of post-disaster psychological stress in hazardous waste operations and emergency response (HAZWOPER) workers

Personnel involved in natural or man-made disaster response and recovery efforts may be exposed to a wide variety of physical and mental stressors that can exhibit long-lasting and detrimental psychopathological outcomes. In a disaster situation, huge numbers of "secondary" responders can be involved in contaminant clean-up and debris removal and can be at risk of developing stress-related mental health outcomes. The Occupational Safety and Health Administration (OSHA) worker training hierarchy typically required for response workers, known as "Hazardous Waste Operations and Emergency Response" (HAZWOPER), does not address the mental health and safety concerns of workers. This study focused on the prevalence of traumatic stress experienced by secondary responders that had received or expressed interest in receiving HAZWOPER training through the National Institute of Environmental Health Sciences Worker Education and Training Program (NIEHS WETP). ^ The study involved the modification of two preexisting and validated survey tools to assess secondary responder awareness of physical, mental, and traumatic stressors on mental health and sought to determine if a need existed to include traumatic stress-related mental health education in the current HAZWOPER training regimen. The study evaluated post-traumatic stress disorder (PTSD), resiliency, mental distress, and negative effects within a secondary responder population of 176 respondents. Elevated PTSD levels were seen in the study population as compared to a general responder population (32.9% positive vs. 8%-22.5% positive). Results indicated that HAZWOPER-trained disaster responders were likely to test positive for PTSD, whereas, untrained responders with no disaster experience and responders who possessed either training or disaster experience only were likely to test PTSD negative. A majority (68.75%) of the population tested below the mean resiliency to cope score (80.4) of the average worker population. Results indicated that those who were trained only or who possessed both training and disaster work experience were more likely to have lower resiliency scores than those with no training or experience. There were direct correlations between being PTSD positive and having worked at a disaster site and experiencing mental distress and negative effects. However, HAZWOPER training status does not significantly correlate with mental distress or negative effect. ^ The survey indicated clear support (91% of respondents) for mental health education. The development of a pre- and post-deployment training module is recommended. Such training could provide responders with the necessary knowledge and skills to recognize the symptomology of PTSD, mental stressors, and physical and traumatic stressors, thus empowering them to employ protective strategies or seek professional help if needed. It is further recommended that pre-deployment mental health education be included in the current HAZWOPER 24- and 40-hour course curriculums, as well as, consideration be given towards integrating a stand-alone post-deployment mental health education training course into the current HAZWOPER hierarchy.^

Tax differentials and inflow of foreign direct investments : evidence from foreign operations of U.S. multinational companies

This paper concerns the measurement of the impact of tax differentials across countries on inflow of Foreign Direct Investment (FDI) by using comprehensive data on the foreign operations of U.S. multinational corporations that has been collected by the Bureau of Economic Analysis (BEA), the U.S. Department of Commerce. In particular, this research focuses on examining: (1) how responsive FDI locations are to tax differentials across countries, (2) how different the tax effect on FDI inflow is between developed and developing countries, and (3) whether investment location decisions have become more or less sensitive to tax differences between countries over time ranging from the late 1990s to the early 2000s. Estimation results suggest that high rates of corporate income taxation are associated with reduced foreign assets of U.S. multinational firms in all industries by decreasing the return to foreign asset investment. Further, foreign assets of U.S. multinationals in all industries have become more responsive to non-income tax differentials across countries than to income tax differences from 1999 to 2004. Empirical estimates also indicate that foreign investment by American firms is associated with higher tax sensitivity more in developed countries than in those that are developing.

The Effect of Sequence of Operations on Fatigue Life of LSP Treated Open-hole Aluminium Specimens

Fastener holes in aeronautical structures are typical sources of fatigue cracks due to their induced local stress concentration. A very efficient solution to this problem is to establish compressive residual stresses around the fastener holes that retard the fatigue crack nucleation and its subsequent local propagation. Previous work done on the subject of the application of LSP treatment on thin, open-hole specimens [1] has proven that the LSP effect on fatigue life of treated specimens can be detrimental, if the process is not properly optimized. In fact, it was shown that the capability of the LSP to introduce compressive residual stresses around fastener holes in thin-walled structures representative of typical aircraft constructions was not superior to the performance of conventional techniques, such as cold-working.

Control of integrated unit operations

As a thermal separation method, distillation is one of the most important technologies in the chemical industry. Given its importance, it is no surprise that increasing efforts have been made in reducing its energy inefficiencies. A great deal of research is focused in the design and optimization of the Divided-Wall Column. Its applications are still reduced due to distrust of its controllability. Previous references studied the decentralized control of DWC but still few papers deal about Model Predictive Control. In this work we present a decentralized control of both a DWC column along with its equivalent MPC schema.

Risk analysis for UAV safe operations: a rationalization for an agricultural environment

The road to the automation of the agricultural processes passes through the safe operation of the autonomous vehicles. This requirement is a fact in ground mobile units, but it still has not well defined for the aerial robots (UAVs) mainly because the normative and legislation are quite diffuse or even inexistent. Therefore, to define a common and global policy is the challenge to tackle. This characterization has to be addressed from the field experience. Accordingly, this paper presents the work done in this direction, based on the analysis of the most common sources of hazards when using UAV's for agricultural tasks. The work, based on the ISO 31000 normative, has been carried out by applying a three-step structure that integrates the identification, assessment and reduction procedures. The present paper exposes how this method has been applied to analyze previous accidents and malfunctions during UAV operations in order to obtain real failure causes. It has allowed highlighting common risks and hazardous sources and proposing specific guards and safety measures for the agricultural context.

Efficient management of available technologies. Aplication to mining operations for industry supplies

Nowadays, processing Industry Sector is going through a series of changes, including right management and reduction of environmental affections. Any productive process which looks for sustainable management is incomplete if Cycle of Life of mineral resources sustainability is not taken into account. Raw materials for manufacturing are provided by mineral resources extraction processes, such as copper, aluminum, iron, gold, silver, silicon, titanium? Those elements are necessary for Mankind development and are obtained from the Earth through mineral extractive processes. Mineral extraction processes are operations which must take care about the environmental consequences. Extraction of huge volumes of rock for their transformation into raw materials for industry must be optimized to reduce ecological cost of the final product as l was possible. Reducing the ecological balance on a global scale has no sense to design an efficient manufacturing in secondary industry (transformation), if in first steps of the supply chain (extraction) impact exceeds the savings of resources in successive phases. Mining operations size suggests that it is an environmental aggressive activity, but precisely because of its great impact must be the first element to be considered. That idea implies that a new concept born: Reduce economical and environmental cost This work aims to make a reflection on the parameters that can be modified to reduce the energy cost of the process without an increasing in operational costs and always ensuring the same production capacity. That means minimize economic and environmental cost at same time. An efficient design of mining operation which has taken into account that idea does not implies an increasing of the operating cost. To get this objective is necessary to think in global operation view to make that all departments involved have common guidelines which make you think in the optimization of global energy costs. Sometimes a single operational cost must be increased to reduce global cost. This work makes a review through different design parameters of surface mining setting some key performance indicators (KPIs) which are estimated from an efficient point of view. Those KPIs can be included by HQE Policies as global indicators. The new concept developed is that a new criteria has to be applied in company policies: improve management, improving OPERATIONAL efficiency. That means, that is better to use current resources properly (machinery, equipment,?) than to replace them with new things but not used correctly. As a conclusion, through an efficient management of current technologies in each extractive operation an important reduction of the energy can be achieved looking at downstream in the process. That implies a lower energetic cost in the whole cycle of life in manufactured product.

Environmental risk assessment in open pit blasting operations: compliance with ISO 31010:2010

All activities of an organization involve risks that should be managed. The risk management process aids decision making by taking account of uncertainty and the possibility of future events or circumstances (intended or unintended) and their effects on agreed objectives. With that idea, new ISO Standard has been drawn up. ISO 31010 has been recently issued which provides a structured process that identifies how objectives may be affected, and analyses the risk in term of consequences and their probabilities before deciding on whether further treatment is required. In this lecture, that ISO Standard has been adapted to Open Pit Blasting Operations, focusing in Environmental effects which can be managed properly. Technique used is Fault Tree Analysis (FTA), which is applied in all possible scenarios, providing to Blasting Professionals the tools to identify, analyze and manage environmental effects in blasting operations. Also this lecture can help to minimize each effect, studying each case. This paper also can be useful to Project Managers and Occupational Health and Safety Departments (OH&S) because blasting operations can be evaluated and compared one to each other to determine the risks that should be managed in different case studies. The environmental effects studied are: ground vibrations, flyrock and air overpressure (airblast). Sometimes, blasting operations are carried out near populated areas where environmental effects may impose several limitations on the use of explosives. In those cases, where these factors approach certain limits, National Standards and Regulations have to be applied.

Safety and health in forest harvesting operations. Diagnosis and preventive actions. A review

Aim of study: to review the present state of the art in relation to the main labour risks and the most relevant results of recent studies evaluating the safety and health conditions of the forest harvesting work and better ways to reduce accidents. Area of study: It focuses mainly on developed Countries, where the general concern about work risks prevention, together with the complex idiosyncrasy of forest work in forest harvesting operations, has led to a growing interest from the forest scientific and technical community. Material and Methods: The main bibliographic and Internet references have been identified using common reference analysis tools. Their conclusions and recommendations have been comprehensively summarized. Main results: Collection of the principal references and their most important conclusions relating to the main accident risk factors, their causes and consequences, the means used towards their prevention, both instrumental as well as in the aspects of training and business management, besides the influence of the growing mechanization of logging operations on those risks. Research highlights: Accident risk is higher in forest harvesting than in most other work sectors, and the main risk factors such as experience, age, seasonality, training, protective equipment, mechanization degree, etc. have been identified and studied. The paper summarizes some relevant results, one of the principal being that the proper entrepreneurial risk management is a key factor leading to the success in minimizing labour risks..

Concept of operations for ATM by managing uncertainty through multiple metering points

This paper presents an operational concept for Air Traffic Management, and in particular arrival management, in which aircraft are permitted to operate in a manner consistent with current optimal aircraft operating techniques. The proposed concept allows aircraft to descend in the fuel efficient path managed mode and with arrival time not actively controlled. It will be demonstrated how the associated uncertainty in the time dimension of the trajectory can be managed through the application of multiple metering points strategically chosen along the trajectory. The proposed concept does not make assumptions on aircraft equipage (e.g. time of arrival control), but aims at handling mixed-equipage scenarios that most likely will remain far into the next decade and arguably beyond.

Reduced carbon and energy footprint in highway operations: the Highway Energy Assessment (HERA) methodology

Global demand for mobility is increasing and the environmental impact of transport has become an important issue in transportation network planning and decision-making, as well as in the operational management phase. Suitable methods are required to assess emissions and fuel consumption reduction strategies that seek to improve energy efficiency and furthering decarbonization. This study describes the development and application of an improved modeling framework – the HERA (Highway EneRgy Assessment) methodology – that enables to assess the energy and carbon footprint of different highways and traffic flow scenarios and their comparison. HERA incorporates an average speed consumption model adjusted with a correction factor which takes into account the road gradient. It provides a more comprehensive method for estimating the footprint of particular highway segments under specific traffic conditions. It includes the application of the methodology to the Spanish highway network to validate it. Finally, a case study shows the benefits from using this methodology and how to integrate the objective of carbon footprint reductions into highway design, operation and scenario comparison.

Quality cost in bus operations based on activity-based costing

The study of service quality and its implication for transport contracts has several approaches in research and practical applications, where the main emphasis is the consideration of quality from the user's point of view, thus obtaining a customer satisfaction index as a measurement of the overall quality with no further implications for service providers. The main aim of this paper is to estimate the real economic impact of improving quality attributes for a bus operator. An application of the activity-based costing methodology is developed for a bus contract in Madrid, using quality data from surveys together with economic and performance information, and focusing on headway as a quality variable. Results show the consistency and practicality of this methodology, overcoming simplifications from traditional procedures. This method is a powerful tool in quality-based contracting as well as for effective investment in transport quality under poverty funding constraints