Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings

Objectives:
To report if there is a difference in costs from a societal perspective between adults receiving rehabilitation in an inpatient rehabilitation setting versus an alternative setting. If there are cost differences, to report whether opting for the least expensive program setting adversely affects patient outcomes.

Data Sources:
Electronic databases from the earliest possible date until May 2011. All languages were included.

Study Selection
Multiple reviewers identified randomized controlled trials with a full economic evaluation that compared adult inpatient rehabilitation with an alternative. There were 29 included trials with 6746 participants.

Data Extraction
Multiple observers extracted data independently. Trial appraisal included a risk of bias assessment and a checklist to report the strength of the economic evaluation.

Data Synthesis:
Results were synthesized using standardized mean differences (SMDs) and meta-analyses for the primary outcome of cost. The Grading of Recommendations Assessment, Development, and Evaluation was applied to assess for risk of bias across studies for meta-analyses. There was high-quality evidence that cost was significantly reduced for rehabilitation in the home versus inpatient rehabilitation in a meta-analysis of 732 patients poststroke (pooled SMD [δ]=−.28; 95% confidence interval [CI], −.47 to −.09), without compromise to patient outcomes. Results of individual trials in other patient groups (orthopedic, rheumatoid arthritis, and geriatric) receiving rehabilitation in the home or community were generally consistent with the meta-analysis. There was moderate quality evidence that cost was significantly reduced for inpatient rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463 patients poststroke (δ=.31; 95% CI, .15–.48), with improvement to patient outcomes. These results were not replicated in 2 individual trials with a geriatric and a mixed cohort, where costs did not differ between general acute care and inpatient rehabilitation. Three of the 4 individual trials, inclusive of a stroke or orthopedic population, reported less cost for an intensive inpatient rehabilitation program compared with usual inpatient rehabilitation. Sensitivity analysis included a health service perspective and varied inflation rates with no change to the significant findings of the meta-analyses.

Conclusions:
Based on this systematic review and meta-analyses, a single rehabilitation service may not provide health economic benefits for all patient groups and situations. For some patients, inpatient rehabilitation may be the most cost-effective method of providing rehabilitation; yet, for other patients, rehabilitation in the home or community may be the most cost-effective model of care. To achieve cost-effective outcomes, the ideal combination of rehabilitation services and patient inclusion criteria, as well as further data for nonstroke populations, warrants further research.

Multi-sensory face biometric fusion (for personal identification)

The objective of this work is to recognize faces using sets of images in visual and thermal spectra. This is challenging because the former is greatly affected by illumination changes, while the latter frequently contains occlusions due to eye-wear and is inherently less discriminative. Our method is based on a fusion of the two modalities. Specifically: we examine (i) the effects of preprocessing of data in each domain, (ii) the fusion of holistic and local facial appearance, and (iii) propose an algorithm for combining the similarity scores in visual and thermal spectra in the presence of prescription glasses and significant pose variations, using a small number of training images (5-7). Our system achieved a high correct identification rate of 97% on a freely available test set of 29 individuals and extreme illumination changes.

A modified Intelligent Water Drops algorithm and its application to optimization problems

The Intelligent Water Drop (IWD) algorithm is a recent stochastic swarm-based method that is useful for solving combinatorial and function optimization problems. In this paper, we investigate the effectiveness of the selection method in the solution construction phase of the IWD algorithm. Instead of the fitness proportionate selection method in the original IWD algorithm, two ranking-based selection methods, namely linear ranking and exponential ranking, are proposed. Both ranking-based selection methods aim to solve the identified limitations of the fitness proportionate selection method as well as to enable the IWD algorithm to escape from local optima and ensure its search diversity. To evaluate the usefulness of the proposed ranking-based selection methods, a series of experiments pertaining to three combinatorial optimization problems, i.e., rough set feature subset selection, multiple knapsack and travelling salesman problems, is conducted. The results demonstrate that the exponential ranking selection method is able to preserve the search diversity, therefore improving the performance of the IWD algorithm. © 2014 Elsevier Ltd. All rights reserved.

A novel fuzzy multi-objective framework to construct optimal prediction intervals for wind power forecast

The forecasting behavior of the high volatile and unpredictable wind power energy has always been a challenging issue in the power engineering area. In this regard, this paper proposes a new multi-objective framework based on fuzzy idea to construct optimal prediction intervals (Pis) to forecast wind power generation more sufficiently. The proposed method makes it possible to satisfy both the PI coverage probability (PICP) and PI normalized average width (PINAW), simultaneously. In order to model the stochastic and nonlinear behavior of the wind power samples, the idea of lower upper bound estimation (LUBE) method is used here. Regarding the optimization tool, an improved version of particle swam optimization (PSO) is proposed. In order to see the feasibility and satisfying performance of the proposed method, the practical data of a wind farm in Australia is used as the case study.

A new algorithm to design minimal multi-functional observers for linear systems

Designing minimum possible order (minimal) observers for Multi-Input Multi-Output (MIMO) linear systems have always been an interesting subject. In this paper, a new methodology to design minimal multi-functional observers for Linear Time-Invariant (LTI) systems is proposed. The approach is applicable, and it also helps in regulating the convergence rate of the observed functions. It is assumed that the system is functional observable or functional detectable, which is less conservative than assuming the observability or detectability of the system. To satisfy the minimality of the observer, a recursive algorithm is provided that increases the order of the observer by appending the minimum required auxiliary functions to the desired functions that are going to be estimated. The algorithm increases the number of functions such that the necessary and sufficient conditions for the existence of a functional observer are satisfied. Moreover, a new methodology to solve the observer design interconnected equations is elaborated. Our new algorithm has advantages with regard to the other available methods in designing minimal order functional observers. Specifically, it is compared with the most common schemes, which are transformation based. Using numerical examples it is shown that under special circumstances, the conventional methods have some drawbacks. The problem partly lies in the lack of sufficient numerical degrees of freedom proposed by the conventional methods. It is shown that our proposed algorithm can resolve this issue. A recursive algorithm is also proposed to summarize the observer design procedure. Several numerical examples and simulation results illustrate the efficacy, superiority and different aspects of the theoretical findings.

Evaluation of three field monitoring-density estimation protocols and their relevance to Komodo dragon conservation

Finding practical ways to robustly estimate abundance or density trends in threatened species is a key facet for effective conservation management. Further identifying less expensive monitoring methods that provide adequate data for robust population density estimates can facilitate increased investment into other conservation initiatives needed for species recovery. Here we evaluated and compared inference-and cost-effectiveness criteria for three field monitoring-density estimation protocols to improve conservation activities for the threatened Komodo dragon (Varanus komodoensis). We undertook line-transect counts, cage trapping and camera monitoring surveys for Komodo dragons at 11 sites within protected areas in Eastern Indonesia to collect data to estimate density using distance sampling methods or the Royle-Nichols abundance induced heterogeneity model. Distance sampling estimates were considered poor due to large confidence intervals, a high coefficient of variation and that false absences were obtained in 45 % of sites where other monitoring methods detected lizards present. The Royle-Nichols model using presence/absence data obtained from cage trapping and camera monitoring produced highly correlated density estimates, obtained similar measures of precision and recorded no false absences in data collation. However because costs associated with camera monitoring were considerably less than cage trapping methods, albeit marginally more expensive than distance sampling, better inference from this method is advocated for ongoing population monitoring of Komodo dragons. Further the cost-savings achieved by adopting this field monitoring method could facilitate increased expenditure on alternative management strategies that could help address current declines in two Komodo dragon populations.

Software engineering for multi-tenancy computing challenges and implications

Multi-tenancy is a cloud computing phenomenon. Multiple instances of an application occupy and share resources from a large pool, allowing different users to have their own version of the same application running and coexisting on the same hardware but in isolated virtual spaces. In this position paper we survey the current landscape of multi-tenancy, laying out the challenges and complexity of software engineering where multi-tenancy issues are involved. Multitenancy allows cloud service providers to better utilise computing resources, supporting the development of more exible services to customers based on economy of scale, reducing overheads and infrastructural costs. Nevertheless, there are major challenges in migration from single tenant applications to multi-tenancy. These have not been fully explored in research or practice to date. In particular, the reengineering effort of multi-tenancy in Software-as-a-Service cloud applications requires many complex and important aspects that should be taken into consideration, such as security, scalability, scheduling, data isolation, etc. Our study emphasizes scheduling policies and cloud provisioning and deployment with regards to multi-tenancy issues. We employ CloudSim and MapReduce in our experiments to simulate and analyse multi-tenancy models, scenarios, performance, scalability, scheduling and reliability on cloud platforms.

Using Multi-Objective Optimization To Maximize Multiple Benefits For Sustainable Drainage Design

For many years, drainage design was mainly about providing sufficient network capacity. This traditional approach had been successful with the aid of computer software and technical guidance. However, the drainage design criteria had been evolving due to rapid population growth, urbanisation, climate change and increasing sustainability awareness. Sustainable drainage systems that bring benefits in addition to water management have been recommended as better alternatives to conventional pipes and storages. Although the concepts and good practice guidance had already been communicated to decision makers and public for years, network capacity still remains a key design focus in many circumstances while the additional benefits are generally considered secondary only. Yet, the picture is changing. The industry begins to realise that delivering multiple benefits should be given the top priority while the drainage service can be considered a secondary benefit instead. The shift in focus means the industry has to adapt to new design challenges. New guidance and computer software are needed to assist decision makers. For this purpose, we developed a new decision support system. The system consists of two main components – a multi-criteria evaluation framework for drainage systems and a multi-objective optimisation tool. Users can systematically quantify the performance, life-cycle costs and benefits of different drainage systems using the evaluation framework. The optimisation tool can assist users to determine combinations of design parameters such as the sizes, order and type of drainage components that maximise multiple benefits. In this paper, we will focus on the optimisation component of the decision support framework. The optimisation problem formation, parameters and general configuration will be discussed. We will also look at the sensitivity of individual variables and the benchmark results obtained using common multi-objective optimisation algorithms. The work described here is the output of an EngD project funded by EPSRC and XP Solutions.

Evaluating And Optimizing Sustainable Drainage Design To Maximize Multiple Benefits: Case Studies In China

In the past, the focus of drainage design was on sizing pipes and storages in order to provide sufficient network capacity. This traditional approach, together with computer software and technical guidance, had been successful for many years. However, due to rapid population growth and urbanisation, the requirements of a “good” drainage design have also changed significantly. In addition to water management, other aspects such as environmental impacts, amenity values and carbon footprint have to be considered during the design process. Going forward, we need to address the key sustainability issues carefully and practically. The key challenge of moving from simple objectives (e.g. capacity and costs) to complicated objectives (e.g. capacity, flood risk, environment, amenity etc) is the difficulty to strike a balance between various objectives and to justify potential benefits and compromises. In order to assist decision makers, we developed a new decision support system for drainage design. The system consists of two main components – a multi-criteria evaluation framework for drainage systems and a multi-objective optimisation tool. The evaluation framework is used for the quantification of performance, life-cycle costs and benefits of different drainage systems. The optimisation tool can search for feasible combinations of design parameters such as the sizes, order and type of drainage components that maximise multiple benefits. In this paper, we will discuss real-world application of the decision support system. A number of case studies have been developed based on recent drainage projects in China. We will use the case studies to illustrate how the evaluation framework highlights and compares the pros and cons of various design options. We will also discuss how the design parameters can be optimised based on the preferences of decision makers. The work described here is the output of an EngD project funded by EPSRC and XP Solutions.

MCDA: análise de decisão multicritério como ferramenta de avaliação de instalações portuárias: o caso dos terminais de contêineres brasileiros

Este trabalho busca avaliar, com suporte da metodologia MCDA - análise de decisão multicritério, os terminais de contêineres brasileiros quanto a suas potencialidades como vetores de crescimento sustentado da economia, no médio e longo prazo, para priorização de investimentos públicos e privados. O trabalho se consubstancia em um levantamento bibliográfico do tema decisório, que lhe serve de base, seguido de um estudo do tema portuário, a fim de levantar os fatores que tornam viável o florescimento e desenvolvimento de um sítio portuário, além de buscar tendências do setor de contêineres no Brasil. Após estas etapas, foi desenvolvido uma modelagem para o problema de avaliação dos terminais, com ajuda do software Expert Choice. Os resultados obtidos apontam para uma alteração sensível de paradigma no panorama portuário nacional em um cenário futuro. Portos que hoje se localizam na parte superior da lista de movimentação de contêineres, à frente nas estatísticas, podem não ter para onde se expandir, enquanto outros, que se encontram menos pujantes, podem florescer nas próximas décadas, devido às características de cada sítio portuário. As mais relevantes foram selecionadas como critérios do modelo desenvolvido, são eles: águas abrigadas, retroáreas, acessos terrestres e marítimos, equacionamento de questões ambientais, localização estratégica, vocação regional, extensão de cais e áreas de expansão. Entre as conclusões deste estudo, pode-se citar: 1 - O Porto de Santos, tradicional líder do ranking nacional em movimentação de contêineres, deve se manter entre os primeiros, graças à sua proximidade com o principal centro econômico e industrial nacional, a região da grande São Paulo, embora esteja com sua capacidade perto do limite operacional, conta com áreas de expansão, como o projeto Barnabé-Bagres. 2 - Outro porto que se destacou na classificação final foi o de Itaguaí, já hoje com movimentação crescente e enorme potencial de crescimento na área de contêineres. Possui excelente condição de águas abrigadas, boa localização estratégica, entre Rio de Janeiro e São Paulo, dois pólos econômicos fortes, com influência decisiva no cenário nacional, e que dispõe de consistente plano de expansão, especialmente relacionado ao aumento de contêineres.

Análise de critérios de decisão em estratégia de arranjos produtivos locais: um estudo aplicando o processo de hierarquia analítica (AHP) no setor de cerâmica

This master thesis has the objective of investigating the strategic decision criteria of participants of Local Production Arrangements (LPA) in Brazil. The LPA s are an initiative of support agents to enterprises with the purpose of organizing joint actions for the development of groups (clusters) of enterprises. The choice of the actions is a decision of the participating enterprises and this paper aims at applying a Multi-criteria Analysis Method to analyze the criteria of entrepreneurs that are participating of a LPA. The used method is the Process of Analytical Hierarchy (PAH) and an application is presented along with questionnaires to participants of a ceramic LPA in the northeast of Brazil. The main results show that, in first place, from the implicit strategy of each enterprise there is only one objective for the LPA group and so, at the beginning, an action decided by all of them tends to favor some more than others. In second place, it was observed that there are general inconsistencies between the strategic objectives and the importance as to criteria, even though there have been cases of coherency. As the main conclusion it is pointed that the use of Methods of MCDA is useful to improve the decision making process and to bring more transparency to the logic of the found results

Avaliação da produção de sedimento na bacia hidrográfica do rio Potengi através do modelo SWAT

Anthropic disturbances in watersheds, such as inappropriate building development, disorderly land occupation and unplanned land use, may strengthen the sediment yield and the inflow into the estuary, leading to siltation, changes in the reach channel conformation, and ecosystem/water quality problems. Faced with such context, this study aims to assess the applicability of SWAT model to estimate, even in a preliminary way, the sediment yield distribution along the Potengi River watershed, as well as its contribution to the estuary. Furthermore, an assessment of its erosion susceptibility was used for comparison. The susceptibility map was developed by overlaying rainfall erosivity, soil erodibility, the slope of the terrain and land cover. In order to overlap these maps, a multi-criteria analysis through AHP method was applied. The SWAT was run using a five year period (1997-2001), considering three different scenarios based on different sorts of human interference: a) agriculture; b) pasture; and c) no interference (background). Results were analyzed in terms of surface runoff, sediment yield and their propagation along each river section, so that it was possible to find that the regions in the extreme west of the watershed and in the downstream portions returned higher values of sediment yield, reaching respectively 2.8 e 5.1 ton/ha.year, whereas central areas, which were less susceptible, returned the lowest values, never more than 0.7 ton/ha.ano. It was also noticed that in the west sub-watersheds, where one can observe the headwaters, sediment yield was naturally forced by high declivity and weak soils. In another hand, results suggest that the eastern part would not contribute to the sediment inflow into the estuary in a significant way, and the larger part of the sediment yield in that place is due to anthropic activities. For the central region, the analysis of sediment propagation indicates deposition predominance in opposition to transport. Thus, it s not expected that isolated rain storms occurring in the upstream river portions would significantly provide the estuary with sediment. Because the model calibration process hasn t been done yet, it becomes essential to emphasize that values presented here as results should not be applied for pratical aims. Even so, this work warns about the risks of a growth in the alteration of natural land cover, mainly in areas closer to the headwaters and in the downstream Potengi River

Study of liposomes stability containing soy phosphatidyleholine and hydrogenated soy phosphatydylcholine adding or not cholesterol by turbidity method

Study of Liposomes Stability Containing Soy Phosphatidyleholine and Hydrogenated Soy Phosphatydylcholine Adding or Not Cholesterol by Turbidity Method. Liposomes are structures composed by phospholipids as soy phosphatidylcholine (PC) and hydrogenated soy phosphatydylcholine (PCH). Among the methods used to prove liposomes stability, turbidity method is widely used. The objective of this work was to study the liposomes stability containing PC or PCH with and without cholesterol (CHOL) by turbidity method. Liposomes were stored a 30 degrees C during 90 days and periodically absorbance readings at 410 nm were made to verify possible turbidity alterations. Increases in the turbidity with time occurred for PC liposomes. In the presence of CHOL higher turbidity was obtained probably reflecting the increase in the size of liposomes. For PCH liposomes the presence of CHOL did not affect the turbidity suggesting higher physical stability of the structures.

Secular dynamics and family identification among highly inclined asteroids in the Euphrosyne region

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The stable archipelago in the region of the Pallas and Hansa dynamical families

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)