Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models

Background: WHO's 2013 revisions to its Consolidated Guidelines on antiretroviral drugs recommend routine viral load monitoring, rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources in view of other competing priorities such as expansion of antiretroviral therapy coverage. We assessed the cost-effectiveness of alternative patient monitoring strategies. Methods: We evaluated a range of monitoring strategies, including clinical, CD4 cell count, and viral load monitoring, alone and together, at different frequencies and with different criteria for switching to second-line therapies. We used three independently constructed and validated models simultaneously. We estimated costs on the basis of resource use projected in the models and associated unit costs; we quantified impact as disability-adjusted life years (DALYs) averted. We compared alternatives using incremental cost-effectiveness analysis. Findings: All models show that clinical monitoring delivers significant benefit compared with a hypothetical baseline scenario with no monitoring or switching. Regular CD4 cell count monitoring confers a benefit over clinical monitoring alone, at an incremental cost that makes it affordable in more settings than viral load monitoring, which is currently more expensive. Viral load monitoring without CD4 cell count every 6—12 months provides the greatest reductions in morbidity and mortality, but incurs a high cost per DALY averted, resulting in lost opportunities to generate health gains if implemented instead of increasing antiretroviral therapy coverage or expanding antiretroviral therapy eligibility. Interpretation: The priority for HIV programmes should be to expand antiretroviral therapy coverage, firstly at CD4 cell count lower than 350 cells per μL, and then at a CD4 cell count lower than 500 cells per μL, using lower-cost clinical or CD4 monitoring. At current costs, viral load monitoring should be considered only after high antiretroviral therapy coverage has been achieved. Point-of-care technologies and other factors reducing costs might make viral load monitoring more affordable in future. Funding: Bill & Melinda Gates Foundation, WHO.

Universally Applicable Model for the Quantitative Determination of Lake Sediment Composition Using Fourier Transform Infrared Spectroscopy

ABSTRACT: Fourier transform infrared spectroscopy (FTIRS) can provide detailed information on organic and minerogenic constituents of sediment records. Based on a large number of sediment samples of varying age (0�340 000 yrs) and from very diverse lake settings in Antarctica, Argentina, Canada, Macedonia/Albania, Siberia, and Sweden, we have developed universally applicable calibration models for the quantitative determination of biogenic silica (BSi; n = 816), total inorganic carbon (TIC; n = 879), and total organic carbon (TOC; n = 3164) using FTIRS. These models are based on the differential absorbance of infrared radiation at specific wavelengths with varying concentrations of individual parameters, due to molecular vibrations associated with each parameter. The calibration models have low prediction errors and the predicted values are highly correlated with conventionally measured values (R = 0.94�0.99). Robustness tests indicate the accuracy of the newly developed FTIRS calibration models is similar to that of conventional geochemical analyses. Consequently FTIRS offers a useful and rapid alternative to conventional analyses for the quantitative determination of BSi, TIC, and TOC. The rapidity, cost-effectiveness, and small sample size required enables FTIRS determination of geochemical properties to be undertaken at higher resolutions than would otherwise be possible with the same resource allocation, thus providing crucial sedimentological information for climatic and environmental reconstructions.

Sediment organic matter, grain size, and results of prediction models from northern North Atlantic and Arctic Seas

Sediment samples and hydrographic conditions were studied at 28 stations around Iceland. At these sites, Conductivity-Temperature-Depth (CTD) casts were conducted to collect hydrographic data and multicorer casts were conductd to collect data on sediment characteristics including grain size distribution, carbon and nitrogen concentration, and chloroplastic pigment concentration. A total of 14 environmental predictors were used to model sediment characteristics around Iceland on regional geographic space. For these, two approaches were used: Multivariate Adaptation Regression Splines (MARS) and randomForest regression models. RandomForest outperformed MARS in predicting grain size distribution. MARS models had a greater tendency to over- and underpredict sediment values in areas outside the environmental envelope defined by the training dataset. We provide first GIS layers on sediment characteristics around Iceland, that can be used as predictors in future models. Although models performed well, more samples, especially from the shelf areas, will be needed to improve the models in future.

Gridded climate data from 5 Global Climate Models (GCM) of the Last Glacial Maximum (LGM) downscaled to 30 arc seconds for Europe, with links to NetCDF files

Studies on the impact of historical, current and future global change require very high-resolution climate data (less or equal 1km) as a basis for modelled responses, meaning that data from digital climate models generally require substantial rescaling. Another shortcoming of available datasets on past climate is that the effects of sea level rise and fall are not considered. Without such information, the study of glacial refugia or early Holocene plant and animal migration are incomplete if not impossible. Sea level at the last glacial maximum (LGM) was approximately 125m lower, creating substantial additional terrestrial area for which no current baseline data exist. Here, we introduce the development of a novel, gridded climate dataset for LGM that is both very high resolution (1km) and extends to the LGM sea and land mask. We developed two methods to extend current terrestrial precipitation and temperature data to areas between the current and LGM coastlines. The absolute interpolation error is less than 1°C and 0.5 °C for 98.9% and 87.8% of all pixels for the first two 1 arc degree distance zones. We use the change factor method with these newly assembled baseline data to downscale five global circulation models of LGM climate to a resolution of 1km for Europe. As additional variables we calculate 19 'bioclimatic' variables, which are often used in climate change impact studies on biological diversity. The new LGM climate maps are well suited for analysing refugia and migration during Holocene warming following the LGM.

Proactive and reactive thermal aware optimization techniques to minimize the environmental impact of data centers

Los Centros de Datos se encuentran actualmente en cualquier sector de la economía mundial. Están compuestos por miles de servidores, dando servicio a los usuarios de forma global, las 24 horas del día y los 365 días del año. Durante los últimos años, las aplicaciones del ámbito de la e-Ciencia, como la e-Salud o las Ciudades Inteligentes han experimentado un desarrollo muy significativo. La necesidad de manejar de forma eficiente las necesidades de cómputo de aplicaciones de nueva generación, junto con la creciente demanda de recursos en aplicaciones tradicionales, han facilitado el rápido crecimiento y la proliferación de los Centros de Datos. El principal inconveniente de este aumento de capacidad ha sido el rápido y dramático incremento del consumo energético de estas infraestructuras. En 2010, la factura eléctrica de los Centros de Datos representaba el 1.3% del consumo eléctrico mundial. Sólo en el año 2012, el consumo de potencia de los Centros de Datos creció un 63%, alcanzando los 38GW. En 2013 se estimó un crecimiento de otro 17%, hasta llegar a los 43GW. Además, los Centros de Datos son responsables de más del 2% del total de emisiones de dióxido de carbono a la atmósfera. Esta tesis doctoral se enfrenta al problema energético proponiendo técnicas proactivas y reactivas conscientes de la temperatura y de la energía, que contribuyen a tener Centros de Datos más eficientes. Este trabajo desarrolla modelos de energía y utiliza el conocimiento sobre la demanda energética de la carga de trabajo a ejecutar y de los recursos de computación y refrigeración del Centro de Datos para optimizar el consumo. Además, los Centros de Datos son considerados como un elemento crucial dentro del marco de la aplicación ejecutada, optimizando no sólo el consumo del Centro de Datos sino el consumo energético global de la aplicación. Los principales componentes del consumo en los Centros de Datos son la potencia de computación utilizada por los equipos de IT, y la refrigeración necesaria para mantener los servidores dentro de un rango de temperatura de trabajo que asegure su correcto funcionamiento. Debido a la relación cúbica entre la velocidad de los ventiladores y el consumo de los mismos, las soluciones basadas en el sobre-aprovisionamiento de aire frío al servidor generalmente tienen como resultado ineficiencias energéticas. Por otro lado, temperaturas más elevadas en el procesador llevan a un consumo de fugas mayor, debido a la relación exponencial del consumo de fugas con la temperatura. Además, las características de la carga de trabajo y las políticas de asignación de recursos tienen un impacto importante en los balances entre corriente de fugas y consumo de refrigeración. La primera gran contribución de este trabajo es el desarrollo de modelos de potencia y temperatura que permiten describes estos balances entre corriente de fugas y refrigeración; así como la propuesta de estrategias para minimizar el consumo del servidor por medio de la asignación conjunta de refrigeración y carga desde una perspectiva multivariable. Cuando escalamos a nivel del Centro de Datos, observamos un comportamiento similar en términos del balance entre corrientes de fugas y refrigeración. Conforme aumenta la temperatura de la sala, mejora la eficiencia de la refrigeración. Sin embargo, este incremente de la temperatura de sala provoca un aumento en la temperatura de la CPU y, por tanto, también del consumo de fugas. Además, la dinámica de la sala tiene un comportamiento muy desigual, no equilibrado, debido a la asignación de carga y a la heterogeneidad en el equipamiento de IT. La segunda contribución de esta tesis es la propuesta de técnicas de asigación conscientes de la temperatura y heterogeneidad que permiten optimizar conjuntamente la asignación de tareas y refrigeración a los servidores. Estas estrategias necesitan estar respaldadas por modelos flexibles, que puedan trabajar en tiempo real, para describir el sistema desde un nivel de abstracción alto. Dentro del ámbito de las aplicaciones de nueva generación, las decisiones tomadas en el nivel de aplicación pueden tener un impacto dramático en el consumo energético de niveles de abstracción menores, como por ejemplo, en el Centro de Datos. Es importante considerar las relaciones entre todos los agentes computacionales implicados en el problema, de forma que puedan cooperar para conseguir el objetivo común de reducir el coste energético global del sistema. La tercera contribución de esta tesis es el desarrollo de optimizaciones energéticas para la aplicación global por medio de la evaluación de los costes de ejecutar parte del procesado necesario en otros niveles de abstracción, que van desde los nodos hasta el Centro de Datos, por medio de técnicas de balanceo de carga. Como resumen, el trabajo presentado en esta tesis lleva a cabo contribuciones en el modelado y optimización consciente del consumo por fugas y la refrigeración de servidores; el modelado de los Centros de Datos y el desarrollo de políticas de asignación conscientes de la heterogeneidad; y desarrolla mecanismos para la optimización energética de aplicaciones de nueva generación desde varios niveles de abstracción. ABSTRACT Data centers are easily found in every sector of the worldwide economy. They consist of tens of thousands of servers, serving millions of users globally and 24-7. In the last years, e-Science applications such e-Health or Smart Cities have experienced a significant development. The need to deal efficiently with the computational needs of next-generation applications together with the increasing demand for higher resources in traditional applications has facilitated the rapid proliferation and growing of data centers. A drawback to this capacity growth has been the rapid increase of the energy consumption of these facilities. In 2010, data center electricity represented 1.3% of all the electricity use in the world. In year 2012 alone, global data center power demand grew 63% to 38GW. A further rise of 17% to 43GW was estimated in 2013. Moreover, data centers are responsible for more than 2% of total carbon dioxide emissions. This PhD Thesis addresses the energy challenge by proposing proactive and reactive thermal and energy-aware optimization techniques that contribute to place data centers on a more scalable curve. This work develops energy models and uses the knowledge about the energy demand of the workload to be executed and the computational and cooling resources available at data center to optimize energy consumption. Moreover, data centers are considered as a crucial element within their application framework, optimizing not only the energy consumption of the facility, but the global energy consumption of the application. The main contributors to the energy consumption in a data center are the computing power drawn by IT equipment and the cooling power needed to keep the servers within a certain temperature range that ensures safe operation. Because of the cubic relation of fan power with fan speed, solutions based on over-provisioning cold air into the server usually lead to inefficiencies. On the other hand, higher chip temperatures lead to higher leakage power because of the exponential dependence of leakage on temperature. Moreover, workload characteristics as well as allocation policies also have an important impact on the leakage-cooling tradeoffs. The first key contribution of this work is the development of power and temperature models that accurately describe the leakage-cooling tradeoffs at the server level, and the proposal of strategies to minimize server energy via joint cooling and workload management from a multivariate perspective. When scaling to the data center level, a similar behavior in terms of leakage-temperature tradeoffs can be observed. As room temperature raises, the efficiency of data room cooling units improves. However, as we increase room temperature, CPU temperature raises and so does leakage power. Moreover, the thermal dynamics of a data room exhibit unbalanced patterns due to both the workload allocation and the heterogeneity of computing equipment. The second main contribution is the proposal of thermal- and heterogeneity-aware workload management techniques that jointly optimize the allocation of computation and cooling to servers. These strategies need to be backed up by flexible room level models, able to work on runtime, that describe the system from a high level perspective. Within the framework of next-generation applications, decisions taken at this scope can have a dramatical impact on the energy consumption of lower abstraction levels, i.e. the data center facility. It is important to consider the relationships between all the computational agents involved in the problem, so that they can cooperate to achieve the common goal of reducing energy in the overall system. The third main contribution is the energy optimization of the overall application by evaluating the energy costs of performing part of the processing in any of the different abstraction layers, from the node to the data center, via workload management and off-loading techniques. In summary, the work presented in this PhD Thesis, makes contributions on leakage and cooling aware server modeling and optimization, data center thermal modeling and heterogeneityaware data center resource allocation, and develops mechanisms for the energy optimization for next-generation applications from a multi-layer perspective.

Optimizing the reliability and resource efficiency of MapReduce-based systems

Debido al gran incremento de datos digitales que ha tenido lugar en los últimos años, ha surgido un nuevo paradigma de computación paralela para el procesamiento eficiente de grandes volúmenes de datos. Muchos de los sistemas basados en este paradigma, también llamados sistemas de computación intensiva de datos, siguen el modelo de programación de Google MapReduce. La principal ventaja de los sistemas MapReduce es que se basan en la idea de enviar la computación donde residen los datos, tratando de proporcionar escalabilidad y eficiencia. En escenarios libres de fallo, estos sistemas generalmente logran buenos resultados. Sin embargo, la mayoría de escenarios donde se utilizan, se caracterizan por la existencia de fallos. Por tanto, estas plataformas suelen incorporar características de tolerancia a fallos y fiabilidad. Por otro lado, es reconocido que las mejoras en confiabilidad vienen asociadas a costes adicionales en recursos. Esto es razonable y los proveedores que ofrecen este tipo de infraestructuras son conscientes de ello. No obstante, no todos los enfoques proporcionan la misma solución de compromiso entre las capacidades de tolerancia a fallo (o de manera general, las capacidades de fiabilidad) y su coste. Esta tesis ha tratado la problemática de la coexistencia entre fiabilidad y eficiencia de los recursos en los sistemas basados en el paradigma MapReduce, a través de metodologías que introducen el mínimo coste, garantizando un nivel adecuado de fiabilidad. Para lograr esto, se ha propuesto: (i) la formalización de una abstracción de detección de fallos; (ii) una solución alternativa a los puntos únicos de fallo de estas plataformas, y, finalmente, (iii) un nuevo sistema de asignación de recursos basado en retroalimentación a nivel de contenedores. Estas contribuciones genéricas han sido evaluadas tomando como referencia la arquitectura Hadoop YARN, que, hoy en día, es la plataforma de referencia en la comunidad de los sistemas de computación intensiva de datos. En la tesis se demuestra cómo todas las contribuciones de la misma superan a Hadoop YARN tanto en fiabilidad como en eficiencia de los recursos utilizados. ABSTRACT Due to the increase of huge data volumes, a new parallel computing paradigm to process big data in an efficient way has arisen. Many of these systems, called dataintensive computing systems, follow the Google MapReduce programming model. The main advantage of these systems is based on the idea of sending the computation where the data resides, trying to provide scalability and efficiency. In failure-free scenarios, these frameworks usually achieve good results. However, these ones are not realistic scenarios. Consequently, these frameworks exhibit some fault tolerance and dependability techniques as built-in features. On the other hand, dependability improvements are known to imply additional resource costs. This is reasonable and providers offering these infrastructures are aware of this. Nevertheless, not all the approaches provide the same tradeoff between fault tolerant capabilities (or more generally, reliability capabilities) and cost. In this thesis, we have addressed the coexistence between reliability and resource efficiency in MapReduce-based systems, looking for methodologies that introduce the minimal cost and guarantee an appropriate level of reliability. In order to achieve this, we have proposed: (i) a formalization of a failure detector abstraction; (ii) an alternative solution to single points of failure of these frameworks, and finally (iii) a novel feedback-based resource allocation system at the container level. Finally, our generic contributions have been instantiated for the Hadoop YARN architecture, which is the state-of-the-art framework in the data-intensive computing systems community nowadays. The thesis demonstrates how all our approaches outperform Hadoop YARN in terms of reliability and resource efficiency.

Computerized allocation of police traffic services; a demonstration study. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Computerized allocation of police traffic services; reference volume I. Computer-sensor system description. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Computerized allocation of police traffic services; reference volume II. Accident data handbook. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Finite mixture regression model with random effects: application to neonatal hospital length of stay

A two-component mixture regression model that allows simultaneously for heterogeneity and dependency among observations is proposed. By specifying random effects explicitly in the linear predictor of the mixture probability and the mixture components, parameter estimation is achieved by maximising the corresponding best linear unbiased prediction type log-likelihood. Approximate residual maximum likelihood estimates are obtained via an EM algorithm in the manner of generalised linear mixed model (GLMM). The method can be extended to a g-component mixture regression model with the component density from the exponential family, leading to the development of the class of finite mixture GLMM. For illustration, the method is applied to analyse neonatal length of stay (LOS). It is shown that identification of pertinent factors that influence hospital LOS can provide important information for health care planning and resource allocation. (C) 2002 Elsevier Science B.V. All rights reserved.

Functional-structural plant modelling using a combination of architectural analysis, L-systems and a canonical model of function

This paper presents a new method for producing a functional-structural plant model that simulates response to different growth conditions, yet does not require detailed knowledge of underlying physiology. The example used to present this method is the modelling of the mountain birch tree. This new functional-structural modelling approach is based on linking an L-system representation of the dynamic structure of the plant with a canonical mathematical model of plant function. Growth indicated by the canonical model is allocated to the structural model according to probabilistic growth rules, such as rules for the placement and length of new shoots, which were derived from an analysis of architectural data. The main advantage of the approach is that it is relatively simple compared to the prevalent process-based functional-structural plant models and does not require a detailed understanding of underlying physiological processes, yet it is able to capture important aspects of plant function and adaptability, unlike simple empirical models. This approach, combining canonical modelling, architectural analysis and L-systems, thus fills the important role of providing an intermediate level of abstraction between the two extremes of deeply mechanistic process-based modelling and purely empirical modelling. We also investigated the relative importance of various aspects of this integrated modelling approach by analysing the sensitivity of the standard birch model to a number of variations in its parameters, functions and algorithms. The results show that using light as the sole factor determining the structural location of new growth gives satisfactory results. Including the influence of additional regulating factors made little difference to global characteristics of the emergent architecture. Changing the form of the probability functions and using alternative methods for choosing the sites of new growth also had little effect. (c) 2004 Elsevier B.V. All rights reserved.

HRM in context:applicability of HRM models in India

Using the core aspects of five main models of human resource management (HRM), this article investigates the dominant HRM practices in the Indian manufacturing sector. The evaluation is conducted in the context of the recently liberalized economic environment. In response to ever-increasing levels of globalization of business, the article initially highlights the need for more cross-national comparative HRM research. Then it briefly analyzes the five models of HRM (namely, the `Matching model'; the `Harvard model'; the `Contextual model'; the `5-P model'; and the `European model') and identifies the main research questions emerging from these that could be used to reveal and highlight the HRM practices in different national/regional settings. The findings of the research are based on a questionnaire survey of 137 large Indian firms and 24 in-depth interviews in as many firms. The examination not only helped to present the scenario of HRM practices in the Indian context but also the logic dictating the presence of such practices. The article contributes to the fields of cross-national HRM and industrial relations research. It also has key messages for policy makers and opens avenues for further research.

The effects of changes in recycling patterns on United Kingdom resource consumption

Recycling, substitution and product life extension are identified as significant factors contributing to an extension of the time to exhaustion of industrially Dnportant materials. A quantitative assessment of the significance of virtually all materials to the U.K. is made. Copper is identified as one of the most important materials deserving of further investigation into potential resource savings through increased recycling. The other factors listed above are accounted for in the modelling technique employed. United Kingdom copper flows are qualitatively and statistically described for the years 1949 - 1976. Less accurate statistics are developed for 1922 - 1948. Adaptive expectations type causal models of total, unalloyed, and alloyed copper demand are successfully constructed and are used to generate future scenarios. Evidence is demonstrated for a break in the historical link between U.K. copper demand and industrial production. Simple causal models of potential copper scrap supply are constructed and a comparison made with actual old scrap withdrawals. Accurate adaptive expectations type models of total scrap demand are developed, but no conclusion is reached about the price elasticity of scrap demand. Various scenarios of copper goods demand are forecast and their effect on copper scrap demand. The potential to recover up to an extra 100.000 tonnes/year of generally lower grade old scrap is identified. Policy options are examined and the following recommendations made: 1) A total investment of up to £67 million in secondary refining capacity by the year 2000 is needed. 2) The copper scrap content of copper bearing goods should be specified to aid recovery. 3) A U.K. copper scrap buffer stock scheme would be advantageous for the secondary copper industry. Finally the methodology used is summarised for potential application to other materials.

Fatty acids and stable isotopes as indicators of early-life feeding and potential maternal resource dependency in the bull shark Carcharhinus leucas

The degree of reliance of newborn sharks on energy reserves from maternal resource allocation and the timescales over which these animals develop foraging skills are critical factors towards understanding the ecological role of top predators in marine ecosystems. We used muscle tissue stable carbon isotopic composition and fatty acid analysis of bull sharks Carcharhinus leucas to investigate early-life feeding ecology in conjunction with maternal resource dependency. Values of δ13C of some young-of-the-year sharks were highly enriched, reflecting inputs from the marine-based diet and foraging locations of their mothers. This group of sharks also contained high levels of the 20:3ω9 fatty acid, which accumulates during periods of essential fatty acid deficiency, suggesting inadequate or undeveloped foraging skills and possible reliance on maternal provisioning. A loss of maternal signal in δ13C values occurred at a length of approximately 100 cm, with muscle tissue δ13C values reflecting a transition from more freshwater/estuarine-based diets to marine-based diets with increasing length. Similarly, fatty acids from sharks >100 cm indicated no signs of essential fatty acid deficiency, implying adequate foraging. By combining stable carbon isotopes and fatty acids, our results provided important constraints on the timing of the loss of maternal isotopic signal and the development of foraging skills in relation to shark size and imply that molecular markers such as fatty acids are useful for the determination of maternal resource dependency.

Interoperable resource brokering with policy-based provisioning and job allocation

The increasing needs for computational power in areas such as weather simulation, genomics or Internet applications have led to sharing of geographically distributed and heterogeneous resources from commercial data centers and scientific institutions. Research in the areas of utility, grid and cloud computing, together with improvements in network and hardware virtualization has resulted in methods to locate and use resources to rapidly provision virtual environments in a flexible manner, while lowering costs for consumers and providers. ^ However, there is still a lack of methodologies to enable efficient and seamless sharing of resources among institutions. In this work, we concentrate in the problem of executing parallel scientific applications across distributed resources belonging to separate organizations. Our approach can be divided in three main points. First, we define and implement an interoperable grid protocol to distribute job workloads among partners with different middleware and execution resources. Second, we research and implement different policies for virtual resource provisioning and job-to-resource allocation, taking advantage of their cooperation to improve execution cost and performance. Third, we explore the consequences of on-demand provisioning and allocation in the problem of site-selection for the execution of parallel workloads, and propose new strategies to reduce job slowdown and overall cost.^