Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer

BACKGROUND AND PURPOSE: Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990. METHODS: We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis. RESULTS: The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee. CONCLUSIONS: Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.

A decentralized cloud firewall framework with resources provisioning cost optimization

Cloud computing is becoming popular as the next infrastructure of computing platform. Despite the promising model and hype surrounding, security has become the major concern that people hesitate to transfer their applications to clouds. Concretely, cloud platform is under numerous attacks. As a result, it is definitely expected to establish a firewall to protect cloud from these attacks. However, setting up a centralized firewall for a whole cloud data center is infeasible from both performance and financial aspects. In this paper, we propose a decentralized cloud firewall framework for individual cloud customers. We investigate how to dynamically allocate resources to optimize resources provisioning cost, while satisfying QoS requirement specified by individual customers simultaneously. Moreover, we establish novel queuing theory based model M/Geo/1 and M/Geo/m for quantitative system analysis, where the service times follow a geometric distribution. By employing Z-transform and embedded Markov chain techniques, we obtain a closed-form expression of mean packet response time. Through extensive simulations and experiments, we conclude that an M/Geo/1 model reflects the cloud firewall real system much better than a traditional M/M/1 model. Our numerical results also indicate that we are able to set up cloud firewall with affordable cost to cloud customers.

Cost-effectiveness of recruitment methods in a population-based epidemiological study: the Melbourne Visual Impairment Project

The cost-effectiveness of five recruitment methods was evaluated to determine the best method of encouraging eligible persons to participate in the Melbourne Visual Impairment Project (a population-based epidemiological study). The evaluation was divided into two phases. Phase 1 included one of two types of initial contact, by direct personal contact or by telephone. Phase 2 involved recruiting residents after an attempt had been made by either the telephone or the doorstep approach, and included a second attempt by a field interviewer, subsequent attempts by senior field staff, and finally, financial incentives. The cost-effectiveness of each method was determined by dividing the approach's cost by the effectiveness ratio. We identified 269 eligible households with 356 eligible residents. An 89 per cent response rate was achieved at the examination centre, comprising 61 per cent from Phase 1 and 28 per cent from Phase 2. Although both recruitment methods in Phase 1 were equally cost-effective, there was a significant difference in the effectiveness of each method in actually recruiting residents. The doorstep method was more costly per attender but was far more effective at 76 per cent recruitment than the telephone method at 47 per cent (P < 0.001). We have demonstrated a practical two-stage approach (the doorstep method in Phase 1 and follow-up strategies in Phase 2) to population-based recruitment involving the middle to elderly age group that should be relevant to many epidemiological studies.

Cost-effective authentic and anonymous data sharing with forward security

Data sharing has never been easier with the advances of cloud computing, and an accurate analysis on the shared data provides an array of benefits to both the society and individuals. Data sharing with a large number of participants must take into account several issues, including efficiency, data integrity and privacy of data owner. Ring signature is a promising candidate to construct an anonymous and authentic data sharing system. It allows a data owner to anonymously authenticate his data which can be put into the cloud for storage or analysis purpose. Yet the costly certificate verification in the traditional public key infrastructure (PKI) setting becomes a bottleneck for this solution to be scalable. Identity-based (ID-based) ring signature, which eliminates the process of certificate verification, can be used instead. In this paper, we further enhance the security of ID-based ring signature by providing forward security: If a secret key of any user has been compromised, all previous generated signatures that include this user still remain valid. This property is especially important to any large scale data sharing system, as it is impossible to ask all data owners to re-authenticate their data even if a secret key of one single user has been compromised. We provide a concrete and efficient instantiation of our scheme, prove its security and provide an implementation to show its practicality.

Marine object detection using background modelling and blob analysis

Monitoring marine object is important for understanding the marine ecosystem and evaluating impacts on different environmental changes. One prerequisite of monitoring is to identify targets of interest. Traditionally, the target objects are recognized by trained scientists through towed nets and human observation, which cause much cost and risk to operators and creatures. In comparison, a noninvasive way via setting up a camera and seeking objects in images is more promising. In this paper, a novel technique of object detection in images is presented, which is applicable to generic objects. A robust background modelling algorithm is proposed to extract foregrounds and then blob features are introduced to classify foregrounds. Particular marine objects, box jellyfish and sea snake, are successfully detected in our work. Experiments conducted on image datasets collected by the Australian Institute of Marine Science (AIMS) demonstrate the effectiveness of the proposed technique.

Human threats to sandy beaches: a meta-analysis of ghost crabs illustrates global anthropogenic impacts

Beach and coastal dune systems are increasingly subjected to a broad range of anthropogenic pressures that on many shorelines require significant conservation and mitigation interventions. But these interventions require reliable data on the severity and frequency of adverse ecological impacts. Such evidence is often obtained by measuring the response of 'indicator species'.Ghost crabs are the largest invertebrates inhabiting tropical and subtropical sandy shores and are frequently used to assess human impacts on ocean beaches. Here we present the first global meta-analysis of these impacts, and analyse the design properties and metrics of studies using ghost-crabs in their assessment. This was complemented by a gap analysis to identify thematic areas of anthropogenic pressures on sandy beach ecosystems that are under-represented in the published literature.Our meta-analysis demonstrates a broad geographic reach, encompassing studies on shores of the Pacific, Indian, and Atlantic Oceans, as well as the South China Sea. It also reveals what are, arguably, two major limitations: i) the near-universal use of proxies (i.e. burrow counts to estimate abundance) at the cost of directly measuring biological traits and bio-markers in the organism itself; and ii) descriptive or correlative study designs that rarely extend beyond a simple 'compare and contrast approach', and hence fail to identify the mechanistic cause(s) of observed contrasts.Evidence for a historically narrow range of assessed pressures (i.e., chiefly urbanisation, vehicles, beach nourishment, and recreation) is juxtaposed with rich opportunities for the broader integration of ghost crabs as a model taxon in studies of disturbance and impact assessments on ocean beaches. Tangible advances will most likely occur where ghost crabs provide foci for experiments that test specific hypotheses associated with effects of chemical, light and acoustic pollution, as well as the consequences of climate change (e.g. species range shifts).

Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

Speculative attacks on debts and optimum currency area: a welfare analysis

Traditionally the issue of an optimum currency area is based on the theoretical underpinnings developed in the 1960s by McKinnon [13], Kenen [12] and mainly Mundell [14], who is concerned with the benefits of lowering transaction costs vis-à- vis adjustments to asymmetrical shocks. Recently, this theme has been reappraised with new aspects included in the analysis, such as: incomplete markets, credibility of monetary policy and seigniorage, among others. For instance, Neumeyer [15] develops a general equilibrium model with incomplete asset markets and shows that a monetary union is desirable when the welfare gains of eliminating the exchange rate volatility are greater than the cost of reducing the number of currencies to hedge against risks. In this paper, we also resort to a general equilibrium model to evaluate financial aspects of an optimum currency area. Our focus is to appraise the welfare of a country heavily dependent on foreign capital that may suffer a speculative attack on its public debt. The welfare analysis uses as reference the self-fulfilling debt crisis model of Cole and Kehoe ([6], [7] and [8]), which is employed here to represent dollarization. Under this regime, the national government has no control over its monetary policy, the total public debt is denominated in dollars and it is in the hands of international bankers. To describe a country that is a member of a currency union, we modify the original Cole-Kehoe model by including public debt denominated in common currency, only purchased by national consumers. According to this rule, the member countries regain some influence over the monetary policy decision, which is, however, dependent on majority voting. We show that for specific levels of dollar debt, to create inflation tax on common-currency debt in order to avoid an external default is more desirable than to suspend its payment, which is the only choice available for a dollarized economy when foreign creditors decide not to renew their loans.

Three applications of the marginal cost of public funds concept

This paper illustrates the use of the marginal cost of public funds concept in three contexts. First, we extend Parry’s (2003) analysis of the efficiency effects excise taxes in the U.K., primarily by incorporating the distortion caused by imperfect competition in the cigarette market and distinguishing between the MCFs for per unit and ad valorem taxes on cigarettes. Our computations show, contrary to the standard result in the literature, that the per unit tax on cigarettes has a slightly lower MCF than the ad valorem tax on cigarettes. Second, we calculate the MCF for a payroll tax in a labour market with involuntary unemployment, using the Shapiro and Stiglitz (1984) efficiency wage model as our framework. Our computations, based on Canadian labour market data, indicate that incorporating the distortion caused by involuntary unemployment raises the MCF by 25 to 50 percent. Third, we derive expressions for the distributionally-weighted MCFs for the exemption level and the marginal tax rate for a “flat tax”, such as the one that has been adopted by the province of Alberta. This allows us to develop a restricted, but tractable, version of the optimal income tax problem. Computations indicate that the optimal marginal tax rate may be quite high, even with relatively modest pro-poor distributional preferences.

Risky business: social media metrics and political risk analysis

A quantificação do risco país – e do risco político em particular – levanta várias dificuldades às empresas, instituições, e investidores. Como os indicadores econômicos são atualizados com muito menos freqüência do que o Facebook, compreender, e mais precisamente, medir – o que está ocorrendo no terreno em tempo real pode constituir um desafio para os analistas de risco político. No entanto, com a crescente disponibilidade de “big data” de ferramentas sociais como o Twitter, agora é o momento oportuno para examinar os tipos de métricas das ferramentas sociais que estão disponíveis e as limitações da sua aplicação para a análise de risco país, especialmente durante episódios de violência política. Utilizando o método qualitativo de pesquisa bibliográfica, este estudo identifica a paisagem atual de dados disponíveis a partir do Twitter, analisa os métodos atuais e potenciais de análise, e discute a sua possível aplicação no campo da análise de risco político. Depois de uma revisão completa do campo até hoje, e tendo em conta os avanços tecnológicos esperados a curto e médio prazo, este estudo conclui que, apesar de obstáculos como o custo de armazenamento de informação, as limitações da análise em tempo real, e o potencial para a manipulação de dados, os benefícios potenciais da aplicação de métricas de ferramentas sociais para o campo da análise de risco político, particularmente para os modelos qualitativos-estruturados e quantitativos, claramente superam os desafios.

Graph analysis of dream reports is especially informative about psychosis

Early psychiatry investigated dreams to understand psychopathologies. Contemporary psychiatry, which neglects dreams, has been criticized for lack of objectivity. In search of quantitative insight into the structure of psychotic speech, we investigated speech graph attributes (SGA) in patients with schizophrenia, bipolar disorder type I, and non-psychotic controls as they reported waking and dream contents. Schizophrenic subjects spoke with reduced connectivity, in tight correlation with negative and cognitive symptoms measured by standard psychometric scales. Bipolar and control subjects were undistinguishable by waking reports, but in dream reports bipolar subjects showed significantly less connectivity. Dream-related SGA outperformed psychometric scores or waking-related data for group sorting. Altogether, the results indicate that online and offline processing, the two most fundamental modes of brain operation, produce nearly opposite effects on recollections: While dreaming exposes differences in the mnemonic records across individuals, waking dampens distinctions. The results also demonstrate the feasibility of the differential diagnosis of psychosis based on the analysis of dream graphs, pointing to a fast, low-cost and language-invariant tool for psychiatric diagnosis and the objective search for biomarkers. The Freudian notion that ‘‘dreams are the royal road to the unconscious’’ is clinically useful, after all.

Graph analysis of dream reports is especially informative about psychosis

Early psychiatry investigated dreams to understand psychopathologies. Contemporary psychiatry, which neglects dreams, has been criticized for lack of objectivity. In search of quantitative insight into the structure of psychotic speech, we investigated speech graph attributes (SGA) in patients with schizophrenia, bipolar disorder type I, and non-psychotic controls as they reported waking and dream contents. Schizophrenic subjects spoke with reduced connectivity, in tight correlation with negative and cognitive symptoms measured by standard psychometric scales. Bipolar and control subjects were undistinguishable by waking reports, but in dream reports bipolar subjects showed significantly less connectivity. Dream-related SGA outperformed psychometric scores or waking-related data for group sorting. Altogether, the results indicate that online and offline processing, the two most fundamental modes of brain operation, produce nearly opposite effects on recollections: While dreaming exposes differences in the mnemonic records across individuals, waking dampens distinctions. The results also demonstrate the feasibility of the differential diagnosis of psychosis based on the analysis of dream graphs, pointing to a fast, low-cost and language-invariant tool for psychiatric diagnosis and the objective search for biomarkers. The Freudian notion that ‘‘dreams are the royal road to the unconscious’’ is clinically useful, after all

Graph analysis of dream reports is especially informative about psychosis

Early psychiatry investigated dreams to understand psychopathologies. Contemporary psychiatry, which neglects dreams, has been criticized for lack of objectivity. In search of quantitative insight into the structure of psychotic speech, we investigated speech graph attributes (SGA) in patients with schizophrenia, bipolar disorder type I, and non-psychotic controls as they reported waking and dream contents. Schizophrenic subjects spoke with reduced connectivity, in tight correlation with negative and cognitive symptoms measured by standard psychometric scales. Bipolar and control subjects were undistinguishable by waking reports, but in dream reports bipolar subjects showed significantly less connectivity. Dream-related SGA outperformed psychometric scores or waking-related data for group sorting. Altogether, the results indicate that online and offline processing, the two most fundamental modes of brain operation, produce nearly opposite effects on recollections: While dreaming exposes differences in the mnemonic records across individuals, waking dampens distinctions. The results also demonstrate the feasibility of the differential diagnosis of psychosis based on the analysis of dream graphs, pointing to a fast, low-cost and language-invariant tool for psychiatric diagnosis and the objective search for biomarkers. The Freudian notion that ‘‘dreams are the royal road to the unconscious’’ is clinically useful, after all

Graph analysis of dream reports is especially informative about psychosis

Early psychiatry investigated dreams to understand psychopathologies. Contemporary psychiatry, which neglects dreams, has been criticized for lack of objectivity. In search of quantitative insight into the structure of psychotic speech, we investigated speech graph attributes (SGA) in patients with schizophrenia, bipolar disorder type I, and non-psychotic controls as they reported waking and dream contents. Schizophrenic subjects spoke with reduced connectivity, in tight correlation with negative and cognitive symptoms measured by standard psychometric scales. Bipolar and control subjects were undistinguishable by waking reports, but in dream reports bipolar subjects showed significantly less connectivity. Dream-related SGA outperformed psychometric scores or waking-related data for group sorting. Altogether, the results indicate that online and offline processing, the two most fundamental modes of brain operation, produce nearly opposite effects on recollections: While dreaming exposes differences in the mnemonic records across individuals, waking dampens distinctions. The results also demonstrate the feasibility of the differential diagnosis of psychosis based on the analysis of dream graphs, pointing to a fast, low-cost and language-invariant tool for psychiatric diagnosis and the objective search for biomarkers. The Freudian notion that ‘‘dreams are the royal road to the unconscious’’ is clinically useful, after all.

Graph analysis of dream reports is especially informative about psychosis

Early psychiatry investigated dreams to understand psychopathologies. Contemporary psychiatry, which neglects dreams, has been criticized for lack of objectivity. In search of quantitative insight into the structure of psychotic speech, we investigated speech graph attributes (SGA) in patients with schizophrenia, bipolar disorder type I, and non-psychotic controls as they reported waking and dream contents. Schizophrenic subjects spoke with reduced connectivity, in tight correlation with negative and cognitive symptoms measured by standard psychometric scales. Bipolar and control subjects were undistinguishable by waking reports, but in dream reports bipolar subjects showed significantly less connectivity. Dream-related SGA outperformed psychometric scores or waking-related data for group sorting. Altogether, the results indicate that online and offline processing, the two most fundamental modes of brain operation, produce nearly opposite effects on recollections: While dreaming exposes differences in the mnemonic records across individuals, waking dampens distinctions. The results also demonstrate the feasibility of the differential diagnosis of psychosis based on the analysis of dream graphs, pointing to a fast, low-cost and language-invariant tool for psychiatric diagnosis and the objective search for biomarkers. The Freudian notion that ‘‘dreams are the royal road to the unconscious’’ is clinically useful, after all