Late-stage, primary open-angle glaucoma in Europe:Social and health care maintenance costs and quality of life of patients from 4 countries

Objective: The purpose of this study was to estimate costs and quality of life (QoL) of late-stage glaucoma patients in 4 European countries. Methods: Retrospective review of medical charts of patients with POAG who were followed in a low-vision or vision rehabilitation center in one of 4 countries for at least 1 year was used to determine patient characteristics, health status, and health care resource use. Visual impairment was measured by best-corrected visual acuity (Snellen score). Patients were also interviewed over the telephone in order to assess their health-related QoL (using EuroQol EQ-5D) and use of resources including: the number of visits to rehabilitation centers, visits to hospital and non-hospital specialists, the use of low-vision devices, medication, tests, and the use of hired home help. The costs associated with resource use were calculated from the perspective of a third-party payer of health and social care based on resource usage and unit costs in each country. Results: Patients undergoing visual rehabilitation in France (n=21), Denmark (n=59), Germany (n=60), and the United Kingdom (n=22) were identified, interviewed and had their medical charts reviewed. Annual maintenance costs of late-stage glaucoma amounted to €830 (±445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (±0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also positively correlated to health care costs, but negatively correlated to costs of home help. Conclusions: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential savings from a better preventive treatment are to be found for social care payers rather than health care payers. © 2008 Informa UK Ltd All rights reserved.

The value of cultural assets. Maintenance Costs and economic sustainability at heritage

Under the 12th International Conference on Building Materials and Components is inserted this communication related to the field of management of those assets that constitute the Spanish Cultural Heritage and maintenance. This work is related to the field of management of those assets that constitute the Spanish Cultural Heritage which share an artistic or historical background. The conservation and maintenance become a social demand necessary for the preservation of public values, requiring the investment of necessary resources. The legal protection involves a number of obligations and rights to ensure the conservation and heritage protection. The duty of maintenance and upkeep exceeds the useful life the property that must endure more for their cultural value for its usability. The establishment of the necessary conditions to prevent deterioration and precise in order to fulfill its social function, seeking to prolong the life of the asset, preserving their physical integrity and its ability to convey the values protected. This obligation implies a substantial financial effort to the holder of the property, either public or private entity, addressing a problem of economic sustainability. Economic exploitation, with the aim of contributing to their well-maintained, is sometimes the best way to get resources. The work will include different lines of research with the following objectives. - Establishment of processes for assessing total costs over the building life cycle (LCC), during the planning stages or maintenance budgets to determine the most advantageous operating system. - Relationship between the value of property and maintenance costs, and establishing a sensitivity analysis.

A methodological framework for modeling pavement maintenance costs for projects with performance-based contracts

Performance-based maintenance contracts differ significantly from material and method-based contracts that have been traditionally used to maintain roads. Road agencies around the world have moved towards a performance-based contract approach because it offers several advantages like cost saving, better budgeting certainty, better customer satisfaction with better road services and conditions. Payments for the maintenance of road are explicitly linked to the contractor successfully meeting certain clearly defined minimum performance indicators in these contracts. Quantitative evaluation of the cost of performance-based contracts has several difficulties due to the complexity of the pavement deterioration process. Based on a probabilistic analysis of failures of achieving multiple performance criteria over the length of the contract period, an effort has been made to develop a model that is capable of estimating the cost of these performance-based contracts. One of the essential functions of such model is to predict performance of the pavement as accurately as possible. Prediction of future degradation of pavement is done using Markov Chain Process, which requires estimating transition probabilities from previous deterioration rate for similar pavements. Transition probabilities were derived using historical pavement condition rating data, both for predicting pavement deterioration when there is no maintenance, and for predicting pavement improvement when maintenance activities are performed. A methodological framework has been developed to estimate the cost of maintaining road based on multiple performance criteria such as crack, rut and, roughness. The application of the developed model has been demonstrated via a real case study of Miami Dade Expressways (MDX) using pavement condition rating data from Florida Department of Transportation (FDOT) for a typical performance-based asphalt pavement maintenance contract. Results indicated that the pavement performance model developed could predict the pavement deterioration quite accurately. Sensitivity analysis performed shows that the model is very responsive to even slight changes in pavement deterioration rate and performance constraints. It is expected that the use of this model will assist the highway agencies and contractors in arriving at a fair contract value for executing long term performance-based pavement maintenance works.

A Methodological Framework for Modeling Pavement Maintenance Costs for Projects with Performance-based Contracts

Performance-based maintenance contracts differ significantly from material and method-based contracts that have been traditionally used to maintain roads. Road agencies around the world have moved towards a performance-based contract approach because it offers several advantages like cost saving, better budgeting certainty, better customer satisfaction with better road services and conditions. Payments for the maintenance of road are explicitly linked to the contractor successfully meeting certain clearly defined minimum performance indicators in these contracts. Quantitative evaluation of the cost of performance-based contracts has several difficulties due to the complexity of the pavement deterioration process. Based on a probabilistic analysis of failures of achieving multiple performance criteria over the length of the contract period, an effort has been made to develop a model that is capable of estimating the cost of these performance-based contracts. One of the essential functions of such model is to predict performance of the pavement as accurately as possible. Prediction of future degradation of pavement is done using Markov Chain Process, which requires estimating transition probabilities from previous deterioration rate for similar pavements. Transition probabilities were derived using historical pavement condition rating data, both for predicting pavement deterioration when there is no maintenance, and for predicting pavement improvement when maintenance activities are performed. A methodological framework has been developed to estimate the cost of maintaining road based on multiple performance criteria such as crack, rut and, roughness. The application of the developed model has been demonstrated via a real case study of Miami Dade Expressways (MDX) using pavement condition rating data from Florida Department of Transportation (FDOT) for a typical performance-based asphalt pavement maintenance contract. Results indicated that the pavement performance model developed could predict the pavement deterioration quite accurately. Sensitivity analysis performed shows that the model is very responsive to even slight changes in pavement deterioration rate and performance constraints. It is expected that the use of this model will assist the highway agencies and contractors in arriving at a fair contract value for executing long term performance-based pavement maintenance works.

Exposing the myth of the 1:5:200 ratio relating initial cost, maintenance and staffing costs of office buildings

In an attempt to focus clients' minds on the importance of considering the construction and maintenance costs of a commercial office building (both as a factor in staff productivity and as a fraction of lifetime staff costs) there is an often-quoted ratio of costs of 1:5:200, where for every one pound spent on construction cost, five are spent on maintenance and building operating costs and 200 on staffing and business operating costs. This seems to stem from a paper published by the Royal Academy of Engineering, in which no data is given and no derivation or defence of the ratio appears. The accompanying belief that higher quality design and construction increases staff productivity, and simultaneously reduces maintenance costs, how ever laudable, appears unsupported by research, and carries all the hallmarks of an "urban myth". In tracking down data about real buildings, a more realistic ratio appears to depend on a huge variety of variables, as well as the definition of the number of "lifetime" years. The ill-defined origins of the original ratio (1:5:200) describing these variables have made replication impossible. However, by using published sources of data, we have found that for three office buildings, a more realistic ratio is 1:0.4:12. As there is nothing in the public domain about what comprised the original research that gave rise to 1:5:200, it is not possible to make a true comparison between these new calculations and the originals. Clients and construction professionals stand to be misled because the popularity and widespread use of the wrong ratio appears to be mis-informing important investment and policy decisions.

Improved Road Design for Future Maintenance - Analysis of Road Barrier Repair Costs

The cost of a road construction over its service life is a function of the design, quality of construction, maintenance strategies and maintenance operations. Unfortunately, designers often neglect a very important aspect which is the possibility to perform future maintenance activities. The focus is mainly on other aspects such as investment costs, traffic safety, aesthetic appearance, regional development and environmental effects. This licentiate thesis is a part of a Ph.D. project entitled “Road Design for lower maintenance costs” that aims to examine how the life-cycle costs can be optimized by selection of appropriate geometrical designs for the roads and their components. The result is expected to give a basis for a new method used in the road planning and design process using life-cycle cost analysis with particular emphasis on road maintenance. The project started with a review of literature with the intention to study conditions causing increased needs for road maintenance, the efforts made by the road authorities to satisfy those needs and the improvement potential by consideration of maintenance aspects during planning and design. An investigation was carried out to identify the problems which obstruct due consideration of maintenance aspects during the road planning and design process. This investigation focused mainly on the road planning and design process at the Swedish Road Administration. However, the road planning and design process in Denmark, Finland and Norway were also roughly evaluated to gain a broader knowledge about the research subject. The investigation was carried out in two phases: data collection and data analysis. Data was collected by semi-structured interviews with expert actors involved in planning, design and maintenance and by a review of design-related documents. Data analyses were carried out using a method called “Change Analysis”. This investigation revealed a complex combination of problems which result in inadequate consideration of maintenance aspects. Several urgent needs for changes to eliminate these problems were identified. Another study was carried out to develop a model for calculation of the repair costs for damages of different road barrier types and to analyse how factors such as road type, speed limits, barrier types, barrier placement, type of road section, alignment and seasonal effects affect the barrier damages and the associated repair costs. This study was carried out using a method called the “Case Study Research Method”. Data was collected from 1087 barrier repairs in two regional offices of the Swedish Road Administration, the Central Region and the Western Region. A table was established for both regions containing the repair cost per vehicle kilometre for different combinations of barrier types, road types and speed limits. This table can be used by the designers in the calculation of the life-cycle costs for different road barrier types.

Group maintenance scheduling : a case study for a pipeline network

This paper presents a group maintenance scheduling case study for a water distributed network. This water pipeline network presents the challenge of maintaining aging pipelines with the associated increases in annual maintenance costs. The case study focuses on developing an effective maintenance plan for the water utility. Current replacement planning is difficult as it needs to balance the replacement needs under limited budgets. A Maintenance Grouping Optimization (MGO) model based on a modified genetic algorithm was utilized to develop an optimum group maintenance schedule over a 20-year cycle. The adjacent geographical distribution of pipelines was used as a grouping criterion to control the searching space of the MGO model through a Judgment Matrix. Based on the optimum group maintenance schedule, the total cost was effectively reduced compared with the schedules without grouping maintenance jobs. This optimum result can be used as a guidance to optimize the current maintenance plan for the water utility.

Condition-based maintenance optimisation without a predetermined strategy structure for a two-component series system

Most existing research on maintenance optimisation for multi-component systems only considers the lifetime distribution of the components. When the condition-based maintenance (CBM) strategy is adopted for multi-component systems, the strategy structure becomes complex due to the large number of component states and their combinations. Consequently, some predetermined maintenance strategy structures are often assumed before the maintenance optimisation of a multi-component system in a CBM context. Developing these predetermined strategy structure needs expert experience and the optimality of these strategies is often not proofed. This paper proposed a maintenance optimisation method that does not require any predetermined strategy structure for a two-component series system. The proposed method is developed based on the semi-Markov decision process (SMDP). A simulation study shows that the proposed method can identify the optimal maintenance strategy adaptively for different maintenance costs and parameters of degradation processes. The optimal maintenance strategy structure is also investigated in the simulation study, which provides reference for further research in maintenance optimisation of multi-component systems.

Design, manufacturing and maintenance of sugar mill equipment

The ISSCT Engineering Workshop 2008 in Brazil was well attended with 62 participants including 39 overseas visitors from 15 countries. The workshop addressed the theme Design, manufacturing and maintenance of sugar mill equipment. From the technical sessions, the following conclusions were drawn: • Several speakers articulated a shared vision of the future of the Brazilian sugar industry. This shared vision gives considerable confidence that the vision can become a reality. • There is an increased focus on energy products. As a result, the reduction of factory energy consumption in order to maximise the energy available for products is also a focus. • New equipment and products are being developed with reduced power consumption, lower capital and maintenance costs, and better performance. • Methods presented for reducing maintenance costs included the use of a maintenance management system, condition monitoring and material selection. The workshop was held in conjunction with Piracicaba’s annual SIMTEC exhibition for the sugar and alcohol industries that provides a forum for technical presentations and discussion, and showcases products and services from manufacturers and service providers. In return for holding the workshop in conjunction with SIMTEC, SIMTEC provided sponsorship for the workshop, including paying travel and accommodation costs for two invited speakers, and organisation for the workshop. The ISSCT and SIMTEC technical programs were arranged so that their technical sessions did not clash, and the ISSCT program was extended a day to provide an opportunity for ISSCT participants to attend the SIMTEC exhibition. Informal feedback from workshop participants suggested that the arrangement between ISSCT and SIMTEC worked well. Site visits to two manufacturing facilities and two sugar mills were arranged as part of the workshop.

Optimizing preventative maintenance strategies for linear assets

Linear assets are engineering infrastructure, such as pipelines, railway lines, and electricity cables, which span long distances and can be divided into different segments. Optimal management of such assets is critical for asset owners as they normally involve significant capital investment. Currently, Time Based Preventive Maintenance (TBPM) strategies are commonly used in industry to improve the reliability of such assets, as they are easy to implement compared with reliability or risk-based preventive maintenance strategies. Linear assets are normally of large scale and thus their preventive maintenance is costly. Their owners and maintainers are always seeking to optimize their TBPM outcomes in terms of minimizing total expected costs over a long term involving multiple maintenance cycles. These costs include repair costs, preventive maintenance costs, and production losses. A TBPM strategy defines when Preventive Maintenance (PM) starts, how frequently the PM is conducted and which segments of a linear asset are operated on in each PM action. A number of factors such as required minimal mission time, customer satisfaction, human resources, and acceptable risk levels need to be considered when planning such a strategy. However, in current practice, TBPM decisions are often made based on decision makers’ expertise or industrial historical practice, and lack a systematic analysis of the effects of these factors. To address this issue, here we investigate the characteristics of TBPM of linear assets, and develop an effective multiple criteria decision making approach for determining an optimal TBPM strategy. We develop a recursive optimization equation which makes it possible to evaluate the effect of different maintenance options for linear assets, such as the best partitioning of the asset into segments and the maintenance cost per segment.

Routine maintenance and sustainability of existing social housing

Improving the sustainability of the housing stock is a major challenge facing the UK social housing sector. UK social housing accounts for approximately 18% of total UK housing and generates maintenance costs in the region of 1.25 billion pounds per annum. The extent to which routine maintenance can be used as a vehicle to improve the overall sustainability (social, environmental and economic) of existing social housing is one focus of a 5 year EPSRC funded research programme. This paper reports the findings of a questionnaire survey examining current social housing maintenance practices and attitudes towards sustainability. The research found that, whilst the stock condition survey is the favoured format for determining maintenance need and economics the basis for priority setting; neither systematically addresses wider sustainability issues; and, whilst cost is a major barrier to more sustainable solutions being adopted, landlords are able and have the desire to improve their practices.

Routine maintenance and sustainability of existing social housing

Presently the UK social housing stock accounts for approximately 18% of the total UK housing with maintenance costs in the region of £1.25 billion per annum. In terms of its impact on the environment, housing is generally responsible for approximately 27% of the UK’s CO2 emissions. The extent to which routine maintenance (planned preventative and responsive) can be used as a vehicle to improve the overall sustainability (social, environmental and economic) of existing social housing is one focus of a 5 year EPSRC funded research programme. This paper reports on the findings of a series of in-depth interviews with social housing providers examining current social housing maintenance practices and attitudes towards sustainability. This paper will report the initial findings of interviews and outline a new performance based multi-criteria maintenance model from which an AHP hierarchy will be presented, integrating the principles of sustainability into maintenance strategies

Automated Methods for Virtual Maintainability & Aerospace Maintenance Planning

Abstract. Modern business practices in engineering are increasingly turning to post manufacture service provision in an attempt to generate additional revenue streams and ensure commercial sustainability. Maintainability has always been a consideration during the design process but in the past it has been generally considered to be of tertiary importance behind manufacturability and primary product function in terms of design priorities. The need to draw whole life considerations into concurrent engineering (CE) practice has encouraged companies to address issues such as maintenance, earlier in the design process giving equal importance to all aspects of the product lifecycle. The consideration of design for maintainability (DFM) early in the design process has the potential to significantly reduce maintenance costs, and improve overall running efficiencies as well as safety levels. However a lack of simulation tools still hinders the adaptation of CE to include practical elements of design and therefore further research is required to develop methods by which ‘hands on’ activities such as maintenance can be fully assessed and optimised as concepts develop. Virtual Reality (VR) has the potential to address this issue but the application of these traditionally high cost systems can require complex infrastructure and their use has typically focused on aesthetic aspects of mature designs. This paper examines the application of cost effective VR technology to the rapid assessment of aircraft interior inspection during conceptual design. It focuses on the integration of VR hardware with a typical desktop engineering system and examines the challenges with data transfer, graphics quality and the development of practical user functions within the VR environment. Conclusions drawn to date indicate that the system has the potential to improve maintenance planning through the provision of a usable environment for inspection which is available as soon as preliminary structural models are generated as part of the conceptual design process. Challenges still exist in the efficient transfer of data between the CAD and VR environments as well as the quantification of any benefits that result from the proposed approach. The result of this research will help to improve product maintainability, reduce product development cycle times and lower maintenance costs.