Sequential cost-reimbursement rules

This paper studies cost-sharing rules under dynamic adverse selection. We present a typical principal-agent model with two periods, set up in Laffont and Tirole's (1986) canonical regulation environment. At first, when the contract is signed, the firm has prior uncertainty about its efficiency parameter. In the second period, the firm learns its efficiency and chooses the level of cost-reducing effort. The optimal mechanism sequentially screens the firm's types and achieves a higher level of welfare than its static counterpart. The contract is indirectly implemented by a sequence of transfers, consisting of a fixed advance payment based on the reported cost estimate, and an ex-post compensation linear in cost performance.

Las decisiones de proyecto y los costes de construcción en la vivienda rural, aplicado al estudio de la vivienda autopromovida en la provincia de Cáceres

En la coyuntura actual, en la que existe por un lado, exceso en la oferta de vivienda (de alto precio o de segunda residencia), y aparece por otro demanda de vivienda (de bajo precio y/o social), el mercado inmobiliario se encuentra paradójicamente bloqueado. Así, surge esta investigación como fruto de este momento histórico, en el cual se somete a debate económico el producto vivienda, no solo como consecuencia de la profunda crisis económica, sino también para la correcta gestión de los recursos desde el punto de vista de lo eficiente y sostenible. Se parte de la hipótesis de que es necesario determinar un estimador de costes de construcción de vivienda autopromovida como una de las soluciones a la habitación en el medio rural de Extremadura, para lo cual se ha tomado como modelo de análisis concretamente la Vivienda Autopromovida subvencionada por la Junta de Extremadura en el marco de la provincia de Cáceres. Con esta investigación se pretende establecer una herramienta matemática precisa que permita determinar la inversión a los promotores, el posible margen de beneficios a los contratistas y el valor real de la garantía en el préstamo a las entidades financieras. Pero el objetivo de mayor proyección social de esta investigación consiste en facilitar una herramienta sencilla a la Junta de Extremadura para que pueda establecer las ayudas de una manera proporcional. De este modo se ayuda a optimizar los recursos, lo cual en época de crisis resulta aun más acuciante, ya que conociendo previamente y con bastante exactitud el importe de las obras se pueden dirigir las ayudas de forma proporcional a las necesidades reales de la ejecución. De hecho, ciertas características difíciles de cuantificar para determinar las ayudas en materia de vivienda, como la influencia del número de miembros familiares o la atención a la discapacidad, se verían contempladas de forma indirecta en el coste estimado con el método aquí propuesto, ya que suponen siempre un aumento de las superficies construidas y útiles, de los huecos de fachadas o del tamaño de locales húmedos y por tanto se contemplan en la ecuación del modelo determinado. Por último, contar con un estimador de costes potencia la forma de asentamiento de la construcción mediante autopromocion de viviendas ya que ayuda a la toma de decisiones al particular, subvencionado o no. En efecto, la herramienta es valida en cierta medida para cualquier autopromocion, constituye un sistema de construcción con las menores posibilidades especulativas y lo más sostenible, es abundante en toda Extremadura, y consigue que el sector de la construcción sea un sistema más eficiente al optimizar su proceso económico de producción. SUMMARY Under the present circumstances, in which there is, on one hand, an excess in the supply of housing (high-price or second-home), and on the other hand a demand for housing (low cost and/or social), paradoxically the property market is at a standstill. This research has come about as a result of this moment in time, in which the product: housing, is undergoing economic debate, not only on account of this serious economic crisis, but for the proper management of resources from the point of view of efficiency and sustainability. A building-costs estimator for owner-developed housing is deemed necessary as one of the solutions for the rural environment that is Extremadura. To this end, it is the Owner-Developed House which has been taken as analysis model. It is subsidized by the Extremadura Regional Government in Caceres Province. This research establishes an accurate mathematical tool to work out the developers’ investment, the builder’s potential profit margin and the reality of the loan for the Financial Institution. But the result of most social relevance in this research is to provide the Extremadura Regional Government with a simple tool, so that it can draw up the Subventions proportionally. Thus, the resources are optimized, an even more vital matter in times of economic slump, due to the fact that if the cost of the building works is known with some accuracy beforehand, the subventions can be allocated in a way that is proportional to the real needs of execution. In fact certain elements related to housing subventions which are hard to quantify, such as the influence of number of family members or disability support, would be covered indirectly in cost estimate with the proposed method, since they inevitably involve an increase in built area, exterior wall openings and the size of plumbed rooms. As such they are covered in the determined model equation. Lastly, the availability of a cost-estimator reinforces the ownerdeveloped building model, since it assists decision-making by the individual, whether subsidized or not. This is because the tool is valid to some extent in any owner-development, and this building scheme, which is common in Extremadura, is the most sustainable, and the least liable to speculation. It makes the building sector more efficient by optimizing the economic production process.

Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancer

Contrast enhanced magnetic resonance imaging (CE MRI) is the most sensitive tool for screening women who are at high familial risk of breast cancer. Our aim in this study was to assess the cost-effectiveness of X-ray mammography (XRM), CE MRI or both strategies combined. In total, 649 women were enrolled in the MARIBS study and screened with both CE MRI and mammography resulting in 1881 screens and 1-7 individual annual screening events. Women aged 35-49 years at high risk of breast cancer, either because they have a strong family history of breast cancer or are tested carriers of a BRCA1, BRCA2 or TP53 mutation or are at a 50% risk of having inherited such a mutation, were recruited from 22 centres and offered annual MRI and XRM for between 2 and 7 years. Information on the number and type of further investigations was collected and specifically calculated unit costs were used to calculate the incremental cost per cancer detected. The numbers of cancer detected was 13 for mammography, 27 for CE MRI and 33 for mammography and CE MRI combined. In the subgroup of BRCA1 (BRCA2) mutation carriers or of women having a first degree relative with a mutation in BRCA1 (BRCA2) corresponding numbers were 3 (6), 12 (7) and 12 (11), respectively. For all women, the incremental cost per cancer detected with CE MRI and mammography combined was 28 pound 284 compared to mammography. When only BRCA1 or the BRCA2 groups were considered, this cost would be reduced to 11 pound 731 (CE MRI vs mammography) and 15 pound 302 (CE MRI and mammography vs mammography). Results were most sensitive to the unit cost estimate for a CE MRI screening test. Contrast-enhanced MRI might be a cost-effective screening modality for women at high risk, particularly for the BRCA1 and BRCA2 subgroups. Further work is needed to assess the impact of screening on mortality and health-related quality of life.

Capacity-based cost modeling for light rail and bus rapid transit systems

Choosing between Light Rail Transit (LRT) and Bus Rapid Transit (BRT) systems is often controversial and not an easy task for transportation planners who are contemplating the upgrade of their public transportation services. These two transit systems provide comparable services for medium-sized cities from the suburban neighborhood to the Central Business District (CBD) and utilize similar right-of-way (ROW) categories. The research is aimed at developing a method to assist transportation planners and decision makers in determining the most feasible system between LRT and BRT. ^ Cost estimation is a major factor when evaluating a transit system. Typically, LRT is more expensive to build and implement than BRT, but has significantly lower Operating and Maintenance (OM) costs than BRT. This dissertation examines the factors impacting capacity and costs, and develops cost models, which are a capacity-based cost estimate for the LRT and BRT systems. Various ROW categories and alignment configurations of the systems are also considered in the developed cost models. Kikuchi's fleet size model (1985) and cost allocation method are used to develop the cost models to estimate the capacity and costs. ^ The comparison between LRT and BRT are complicated due to many possible transportation planning and operation scenarios. In the end, a user-friendly computer interface integrated with the established capacity-based cost models, the LRT and BRT Cost Estimator (LBCostor), was developed by using Microsoft Visual Basic language to facilitate the process and will guide the users throughout the comparison operations. The cost models and the LBCostor can be used to analyze transit volumes, alignments, ROW configurations, number of stops and stations, headway, size of vehicle, and traffic signal timing at the intersections. The planners can make the necessary changes and adjustments depending on their operating practices. ^

Methodology to create cost estimation models for engineer-to-order operations

This research addresses the problem of cost estimation for product development in engineer-to-order (ETO) operations. An ETO operation starts the product development process with a product specification and ends with delivery of a rather complicated, highly customized product. ETO operations are practiced in various industries such as engineering tooling, factory plants, industrial boilers, pressure vessels, shipbuilding, bridges and buildings. ETO views each product as a delivery item in an industrial project and needs to make an accurate estimation of its development cost at the bidding and/or planning stage before any design or manufacturing activity starts. ^ Many ETO practitioners rely on an ad hoc approach to cost estimation, with use of past projects as reference, adapting them to the new requirements. This process is often carried out on a case-by-case basis and in a non-procedural fashion, thus limiting its applicability to other industry domains and transferability to other estimators. In addition to being time consuming, this approach usually does not lead to an accurate cost estimate, which varies from 30% to 50%. ^ This research proposes a generic cost modeling methodology for application in ETO operations across various industry domains. Using the proposed methodology, a cost estimator will be able to develop a cost estimation model for use in a chosen ETO industry in a more expeditious, systematic and accurate manner. ^ The development of the proposed methodology was carried out by following the meta-methodology as outlined by Thomann. Deploying the methodology, cost estimation models were created in two industry domains (building construction and the steel milling equipment manufacturing). The models are then applied to real cases; the cost estimates are significantly more accurate than the actual estimates, with mean absolute error rate of 17.3%. ^ This research fills an important need of quick and accurate cost estimation across various ETO industries. It differs from existing approaches to the problem in that a methodology is developed for use to quickly customize a cost estimation model for a chosen application domain. In addition to more accurate estimation, the major contributions are in its transferability to other users and applicability to different ETO operations. ^

Double Hybrid Functionals and the Π-System Bond Length Alternation Challenge: Rivaling Accuracy of Post-HF Methods

Predicting accurate bond length alternations (BLAs) in long conjugated oligomers has been a significant challenge for electronic-structure methods for many decades, made particularly important by the close relationships between BLA and the rich optoelectronic properties of π-delocalized systems. Here, we test the accuracy of recently developed, and increasingly popular, double hybrid (DH) functionals, positioned at the top of Jacobs Ladder of DFT methods of increasing sophistication, computational cost, and accuracy, due to incorporation of MP2 correlation energy. Our test systems comprise oligomeric series of polyacetylene, polymethineimine, and polysilaacetylene up to six units long. MP2 calculations reveal a pronounced shift in BLAs between the 6-31G(d) basis set used in many studies of BLA to date and the larger cc-pVTZ basis set, but only modest shifts between cc-pVTZ and aug-cc-pVQZ results. We hence perform new reference CCSD(T)/cc-pVTZ calculations for all three series of oligomers against which we assess the performance of several families of DH functionals based on BLYP, PBE, and TPSS, along with lower-rung relatives including global- and range-separated hybrids. Our results show that DH functionals systematically improve the accuracy of BLAs relative to single hybrid functionals. xDH-PBE0 (N4 scaling using SOS-MP2) emerges as a DH functional rivaling the BLA accuracy of SCS-MP2 (N5 scaling), which was found to offer the best compromise between computational cost and accuracy the last time the BLA accuracy of DFT- and wave function-based methods was systematically investigated. Interestingly, xDH-PBE0 (XYG3), which differs to other DHs in that its MP2 term uses PBE0 (B3LYP) orbitals that are not self-consistent with the DH functional, is an outlier of trends of decreasing average BLA errors with increasing fractions of MP2 correlation and HF exchange.

Estudo de uma solução alternativa para o prolongamento do Molhe - Cais do Porto das Velas, Açores

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Civil Especialização em Hidráulica

Validity of self-reported hearing loss in adults: performance of three single questions

OBJECTIVE: To estimate the validity of three single questions used to assess self-reported hearing loss as compared to pure-tone audiometry in an adult population. METHODS: A validity study was performed with a random sub-sample of 188 subjects aged 30 to 65 years, drawn from the fourth wave of a population-based cohort study carried out in Salvador, Northeastern Brazil. Data were collected in household visits using questionnaires. Three questions were used to separately assess self-reported hearing loss: Q1, "Do you feel you have a hearing loss?"; Q2, "In general, would you say your hearing is 'excellent,' 'very good,' 'good,' 'fair,' 'poor'?"; Q3, "Currently, do you think you can hear 'the same as before', 'less than before only in the right ear', 'less than before only in the left ear', 'less than before in both ears'?". Measures of accuracy were estimated through seven measures including Youden index. Responses to each question were compared to the results of pure-tone audiometry to estimate accuracy measures. RESULTS: The estimated sensitivity and specificity were 79.6%, 77.4% for Q1; 66.9%, 85.1% for Q2; and 81.5%, 76.4% for Q3, respectively. The Youden index ranged from 51.9% (Q2) to 57.0% (Q1) and 57.9% (Q3). CONCLUSIONS: Each of all three questions provides responses accurate enough to support their use to assess self-reported hearing loss in epidemiological studies with adult populations when pure-tone audiometry is not feasible.

Matching CO2 large point sources and potential geological storage sites in mainland Portugal

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia do Ambiente, Perfil Gestão e Sistemas Ambientais

Análise comparativa de sistemas de classificação de doentes de reabilitação

RESUMO - Caracterização do problema: A inadequação e ineficácia do sistema de financiamento ―por diária‖ dos cuidados de reabilitação resultaram na necessidade de criação de sistemas de classificação de doentes de reabilitação em regime de internamento, em muitos países. Também em Portugal é necessário implementar um sistema de financiamento, baseado num sistema de classificação de doentes, ajustado pela complexidade e necessidade de cuidados destes doentes. Objectivos: Caracterização dos cuidados de reabilitação em Portugal, e do actual sistema de financiamento destes doentes; realização de uma revisão de literatura dos sistemas de classificação de doentes de reabilitação já existentes, de modo a compreender quais as variáveis de agrupamento utilizadas e qual a capacidade de previsão dos custos destes mesmos sistemas; perceber a importância da implementação de um dos sistemas de classificação em Portugal, e quais as suas vantagens. Metodologia: Da revisão de literatura efectuada, foram encontrados quatro sistemas de classificação de doentes implementados e/ou em vias de serem implementados como base para um sistema de financiamento, nos EUA, Austrália e Canadá. Foi efectuada uma extensa caracterização e análise crítica dos mesmos. Conclusões: Podemos concluir, que dos poucos sistemas de classificação de doentes de reabilitação existentes, optou-se pelo estudo de uma possível adopção do sistema norte-americano para a realidade portuguesa, por ser o único sistema de classificação já utilizado para fins de financiamento para todos os doentes de reabilitação desde 2002, o que inclui mais variáveis de decisão na classificação dos doentes, e o que permite a maior previsão dos custos dos doentes em termos percentuais.

Estimativa dos custos das infeções nosocomiais da corrente sanguínea relacionadas com o cateter venoso central no Centro Hospitalar de Lisboa Ocidental

RESUMO - Introdução: As Infeções nosocomiais da corrente sanguínea associada a cateter venoso central (INCS-CVC) provocam um aumento das despesas hospitalares, traduzindo num aumento dos dias de internamento, consumo de antibióticos e de meios complementares de diagnóstico e terapêutica (MCDT). O presente estudo pretende avaliar os custos das INCS-CVC nos serviços de internamento do CHLO, no ano de 2012. Metodologia: Realizou-se um estudo retrospetivo de caso-controlo para determinar os custos adicionais inerentes às INCS-CVC. Foram identificados, em 2012, 32 doentes com infeção e 31 sem infeção. Os controlos foram extraídos da população tendo igual grupo diagnóstico Homogéneo (GDH), idade, sexo, serviço e duração de internamento e presença de CVC. As principais fontes de informação foram os registos da Comissão Controlo de Infeção (CCI) e do processo clinico eletrónico (PCE). A estimativa dos custos teve em consideração a duração de internamento, consumo de antibióticos e de MCDT. Resultados: A idade média dos casos e controlos foi de 66 e 69, respetivamente (p=0,432), 50% dos casos e 51,6% dos controlos eram do sexo masculino. Um total de 22 casos foi comparado com 22 controlos. A duração média de internamento dos casos e controlos foi de 70,8 e 36,6 dias, respetivamente (p=0,000). Em média o custo adicional por doente com antibióticos foi de 256€ (p=0,001). Nos casos o consumo de análises clinica foi 2,5 vezes superior e de exames imagiológicos 2 vezes superior aos controlos. O custo total médio adicional por doente foi de 20.737,6€. Conclusão: A ocorrência de INCS-CVC resultou num aumento significativo de utilização de recursos hospitalares e consequentemente num aumento dos custos hospitalares.

Midwest Regional Rail Passenger Initiative Status Report December 2006

This report is submitted as required per Code of Iowa section 327J.3(5), "The director shall report annually to the general assembly concerning the development and operation of the midwest regional rail system and the state's passenger rail service." The Midwest Regional Rail Initiative (MWRRI) is a nine-state effort to develop an implementation plan for a 3,000-mile, high-speed rail system hubbed in Chicago. Studies done since 1996 have concluded that such a regional system, including a line from Chicago to Omaha through Davenport, Iowa City and Des Moines, is viable. Most of the system would be upgraded to allow 110 mile-per-hour service. Some low volume lines, including the Iowa portions, would be upgraded for 79 mile-per-hour service. The nine-state coalition released an updated 2004 executive report for the system. As reported, the updated cost estimate for the Chicago to Omaha corridor, which includes a branch to Quincy, Ill., is $638 million for infrastructure and $167 million for rolling stock. These costs are higher than first estimated in 1998 and are given in 2002 dollars, (not adjusted for the cost of inflation). Operating subsidies would be required during an extended start-up phase. The allocation of these subsidy costs among the various states has not been determined, and is still a subject for analysis and negotiation. Little progress on implementation is expected unless a federal funding package is passed for passenger rail initiatives. Continued congressional discussion on policy directions relative to Amtrak clouds the issue of passenger rail funding. However, Congress is expected to address passenger rail issues and funding in 2007. Participation of the Iowa Department of Transportation in the MWRRI is authorized under Iowa Code section 327J.3.

A Comparison of Mobile Scanning to a Total Station Survey at the I-35 and IA 92 Interchange in Warren County, Iowa, August 15, 2012

The purpose of this project was to investigate the potential for collecting and using data from mobile terrestrial laser scanning (MTLS) technology that would reduce the need for traditional survey methods for the development of highway improvement projects at the Iowa Department of Transportation (Iowa DOT). The primary interest in investigating mobile scanning technology is to minimize the exposure of field surveyors to dangerous high volume traffic situations. Issues investigated were cost, timeframe, accuracy, contracting specifications, data capture extents, data extraction capabilities and data storage issues associated with mobile scanning. The project area selected for evaluation was the I-35/IA 92 interchange in Warren County, Iowa. This project covers approximately one mile of I-35, one mile of IA 92, 4 interchange ramps, and bridges within these limits. Delivered LAS and image files for this project totaled almost 31GB. There is nearly a 6-fold increase in the size of the scan data after post-processing. Camera data, when enabled, produced approximately 900MB of imagery data per mile using a 2- camera, 5 megapixel system. A comparison was done between 1823 points on the pavement that were surveyed by Iowa DOT staff using a total station and the same points generated through the MTLS process. The data acquired through the MTLS and data processing met the Iowa DOT specifications for engineering survey. A list of benefits and challenges is included in the detailed report. With the success of this project, it is anticipate[d] that additional projects will be scanned for the Iowa DOT for use in the development of highway improvement projects.

Materiaalitarpeen suunnitteluprosessin kehittäminen ja varastonohjauksen parantaminen Elektroniikkalaitoksessa

Työ on tehty Puolustusvoimien Elektroniikkalaitoksella Riihimäellä. Elektroniikkalaitos toimii yhtenä vastuuvarikkona ja vastaa omalta osaltaan elektroniikka-alan järjestelmien kunnossapidosta. Työn tarkoituksena on selvittää materiaalitarpeen suunnitteluprosessi, kehittää varastonohjausta ja tutustua SAP-toiminnallisuuksien hyödyntämiseen. Materiaalitarpeen suunnittelemisella ja varastonohjauksen parantamisella pyritään kustannussäästöihin ja kunnossapitoprosessin kokonaisvaltaiseen tehostamiseen. Työssä käsitellään Elektroniikkalaitoksen materiaaliprosessia ja sen suhdetta kunnossapitoprosessiin sekä selvitetään materiaalitarpeen muodostumista ja kysynnän ennustamistarpeita. Samalla esitetään myös varastonohjauksen parantamiskohteita. Materiaalitarpeen suunnitteluprosessista on luotu toimintamalli, jota on testattu pilottiprojektin avulla. Työssätarkastellaan SAP-toiminnallisuuksien hyödyntämistä sekä materiaalitarpeen suunnittelussa, että varastonohjauksessa. Lisäksi esitellään kustannusarviolomake, joka on luotu osaksi materiaalitarpeen suunnitteluprosessia helpottamaan materiaalitäydennysten kustannusarviointia.

Potential health-care service utilization substitution effects induced by case management for emergency department frequent users

BACKGROUND: In most of the emergency departments (ED) in developed countries, a subset of patients visits the ED frequently. Despite their small numbers, these patients are the source of a disproportionally high number of all ED visits, and use a significant proportion of healthcare resources. They place a heavy economic burden on hospital and healthcare systems budgets overall. Several interventions have been carried out to improve the management of these ED frequent users. Case management has been shown in some North American studies to reduce ED utilization and costs. In these studies, cost analyses have been carried out from the hospital perspective without examining the costs induced by healthcare consumed in the community. However, case management might reduce ED visits and costs from the hospital's perspective, but induce substitution effects, and increase health service utilization outside the hospital. This study examined if an interdisciplinary case-management intervention-compared to standard ED care -reduced costs generated by frequent ED users not only from the hospital perspective, but also from the healthcare system perspective-that is, from a broader perspective taking into account the costs of healthcare services used outside the hospital. METHODS: In this randomized controlled trial, 250 adult frequent emergency department users (5 or more visits during the previous 12 months) who visited the ED of the University Hospital of Lausanne, Switzerland, between May 2012 and July 2013 were allocated to one of two groups: case management intervention (CM) or standard ED care (SC), and followed up for 12 months. Depending on the perspective of the analysis, costs were evaluated differently. For the analysis from the hospital's perspective, the true value of resources used to provide services was used as a cost estimate. These data were obtained from the hospital's analytical accounting system. For the analysis from the health-care system perspective, all health-care services consumed by users and charged were used as an estimate of costs. These data were obtained from health insurance providers for a subsample of participants. To allow comparisons in a same time period, individual monthly average costs were calculated. Multivariate linear models including a fixed effect "group" were run using socio-demographic characteristics and health-related variables as controlling variables (age, gender, educational level, citizenship, marital status, somatic and mental health problems, and risk behaviors).