Cost-effective Access Research Articles

Highly Utilized Fiber Plant with Extended Reach and High Splitting Ratio Based on AWG and EDFA Characteristics

In this paper, we propose a hybrid time-division multiplexing and dense wavelength-division multiplexing scheme to implement a cost-effective and scalable long-reach optical access network (LR-OAN). Our main objectives are to increase fiber plant utilization, handle upstream and downstream flow through the same input/output port, extend the reach, and increase the splitting ratio. To this end, we propose the use of an arrayed waveguide grating (AWG) and an erbium-doped fiber amplifier (EDFA) in one configuration. AWG is employed to achieve the first and second objectives, while EDFA is used to achieve the third and fourth objectives. The performance of the proposed LR-OAN is verified using the Optisystem and Matlab software packages under bit error rate constraints and two different approaches (multifiber and single-fiber). Although the single-fiber approach offers a more cost-effective solution because service is provided to each zone via a common fiber, it imposes additional losses, which leads to a reduction in the length of the feeder fiber from 20 km to 10 km.

Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005–2010

IntroductionPeople who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category.MethodsMedical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression.ResultsOf dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care.ConclusionAttention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.

Vehicles Meet Infrastructure: Toward Capacity–Cost Tradeoffs for Vehicular Access Networks

Access infrastructure, such as Wi-Fi access points and cellular base stations (BSs), plays a vital role in providing pervasive Internet services to vehicles. However, the deployment costs of different access infrastructure are highly variable. In this paper, we make an effort to investigate the capacity-cost tradeoffs for vehicular access networks, in which access infrastructure is deployed to provide a downlink data pipe to all vehicles in the network. Three alternatives of wireless access infrastructure are considered, i.e., cellular BSs, wireless mesh backbones (WMBs), and roadside access points (RAPs). We first derive a lower bound of downlink capacity for each type of access infrastructure. We then present a case study based on a perfect city grid of 400 km2 with 0.4 million vehicles, in which we examine the capacity-cost tradeoffs of different deployment solutions in terms of capital expenditures (CAPEX) and operational expenditures (OPEX). The rich implications from our results provide fundamental guidance on the choice of cost-effective access infrastructure for the emerging vehicular networking.

IMPLEMENTATION OF SERVICE ORIENTED WEARABLE SYSTEM FOR PREVENTIVE HEALTHCARE

as an emerging state-of-art technology, wearable systems have been applied to various real life situations and healthcare is one of such important areas. This study reports the implementation of a prototype Service Oriented Wearable System (SOWS). After detailed analysis of healthcare requirements, a system based on Service Oriented Architecture (SOA), wearable devices and sensor networks is implemented to provide continuous remote monitoring, diagnosis, immediate response and treatment for the purpose of preventive healthcare. Technologies based on SOA and sensor networks can support cost effective ubiquitous access to healthcare services, real time service provisioning and processing of heterogeneous data for various wearable devices such as ECG, accelerometer, SpO2 and location sensors. Wearable devices collect and transmit bio signal data to a wearable computer through IEEE/Wi-Fi network. Bio signal data is then uploaded to a Health Server PC (HS-PC) for analysis and storage where it will be accessed by doctors, paramedics or any other authorized personnel.

The CARM Centre: The Creation, Revelation and Evolution of a Print Repository

While the goals of rationalising the retention of low-use print research collections, releasing library space, preserving and providing efficient and cost-effective access to print research collections are common to academic and research libraries on a global level the approaches and developments in the United Kingdom, Europe, the United States and Australia have all been different. This paper describes the creation and evolution of an Australian print repository, the CARM (CAVAL Archival and Research Materials) Centre, within the context of international developments. CAVAL is an Australian not-for-profit company established to provide library services to libraries in the region. CAVAL's members and owners are 11 Universities located in New South Wales, Tasmania and Victoria.

Group Health Coaching: Strengths, Challenges, and Next Steps

There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of “Group Health and Wellness Coaching” is proposed, and important next steps for research and for the training of group coaches are presented.

″Intervention of Destination Management Organization′s In Tourist Destinations for Branding, Image Building and Competitiveness ∼ A Conducive Model for Karnataka″

Destination Management Organization (DMO) is a technical body which is supported by the Host Government. DMO’s initiate a standardized procedure to market a destination by attracting right quantum of tourist, to synergizes activities on tourist destinations. DMOs are also perceived as marketing organizations designed to bring buyers (visitors) in contact with marketers (providers of tourism products and services). DMOs can flourish with Destination marketing as a proactive function. Visitor centered approach to the economic and cultural development of a destination will balance & integrate the interests of visitors, service providers and the community. Core DMO functions are to market the destination as attractive to visitors (i.e., generating prospects) through marketing and promotional activities like, branding, advertising, media production, etc. Providing suppliers with market intelligence plus cost effective access to distribution channels are other functions. The interest also will be on providing some level of support to the visitor at the destination and the future of DMO’s will be as a dominant and most influential body to manage a Destination evolving into a total destination management system. The DMO will become the ultimate source of strategic intelligence and grow as a communication centre for a destination. The research identifies to impart value creation in a networked environment through DMOs in order to enhance a new paradigm for competent destination management and thereby to build on the professional competency through DMOs to foresee the future challenges. Thereby, the DMO community will be sought after by Govt. institutions & large corporations for information and leadership.

Efficient Role Assignment Scheme for Multichannel Wireless Mesh Networks

a wireless mesh network (WMN) is cost-effective access network architecture. The performance of multi-hop communication quickly reduces as the number of hops becomes larger. Nassiri et al. proposed a Molecular MAC protocol for autonomic assignment and use of multiple channels to improve network performance. In the Molecular MAC protocol, each node forms a shortest path-spanning tree to a gateway node linked to a wired Internet. After a tree is formed, the nodes with an even-numbered depth and an odd-numbered depth are assigned with the roles of a nucleus and an electron, respectively. After such roles are assigned, each nucleus selects an idle channel. However, this protocol has the following drawback; since the nodes with an even-numbered depth are assigned with the role of a nucleus, there are many nuclei in the topology. The number of assigned channels tends to increase, since each nucleus selects an idle channel that is not currently being occupied by its neighboring nuclei. In wireless communications networks, channels are very important resources. Thus, it is necessary to assign the minimum number of channels as little as possible. To do so, this paper proposes an efficient role assignment scheme, which can reduce the number of assigned channels by reducing the number of nodes assigned as nuclei and preventing nodes within the transmission range of each other from becoming nuclei. Based on various simulation results, the proposed scheme was verified.

What does and should influence the number of lawyers?

Before we can ask whether there are too many lawyers we must answer several preliminary questions: whom do we consider lawyers, and what does and should influence their number? The term ‘lawyer’, w...

A Cost Effective Architecture for Full Duplex Hybrid WDM/TDM-PON Using DPSK Downstream and Colorless Re-modulated Upstream OOK Data

Hybrid wavelength-division multiplexed/time-division multiplexed passive optical networks WDM/TDM-PONs combine the advance features of both WDM and TDM-PONs to provide a cost-effective access network solution. We propose and demonstrate a cost effective full duplex Hybrid WDM/TDM-PON architecture based on a raw differential phase shift keying (DPSK) format without pulse carving in downstream transmitter. The 10-Gbps DPSK downstream data signal is re-modulated for upstream using an ON-OFF keying (OOK) data signal. Simulation results shows that error free colorless transmission can be achieved in a distance of 25 Km with lower BER and improved receiver sensitivity.

Osteoporose - wann behandeln? Der Stellenwert von FRAX® in der Schweiz

The WHO fracture risk assessment tool FRAX® is a computer based algorithm that provides models for the assessment of fracture probability in men and women. The approach uses easily obtained clinical risk factors (CRFs) to estimate 10-year probability of a major osteoporotic fracture (hip, clinical spine, humerus or wrist fracture) and the 10-year probability of a hip fracture. The estimate can be used alone or with femoral neck bone mineral density (BMD) to enhance fracture risk prediction. FRAX® is the only risk engine which takes into account the hazard of death as well as that of fracture. Probability of fracture is calculated in men and women from age, body mass index, and dichotomized variables that comprise a prior fragility fracture, parental history of hip fracture, current tobacco smoking, ever long-term use of oral glucocorticoids, rheumatoid arthritis, other causes of secondary osteoporosis, daily alcohol consumption of 3 or more units daily. The relationship between risk factors and fracture probability was constructed using information of nine population-based cohorts from around the world. CRFs for fracture had been identified that provided independent information on fracture risk based on a series of meta-analyses. The FRAX® algorithm was validated in 11 independent cohorts with in excess of 1 million patient-years, including the Swiss SEMOF cohort. Since fracture risk varies markedly in different regions of the world, FRAX® models need to be calibrated to those countries where the epidemiology of fracture and death is known. Models are currently available for 31 countries across the world. The Swiss-specific FRAX® model was developed very soon after the first release of FRAX® in 2008 and was published in 2009, using Swiss epidemiological data, integrating fracture risk and death hazard of our country. Two FRAX®-based approaches may be used to explore intervention thresholds. They have recently been investigated in the Swiss setting. In the first approach the guideline that individuals with a fracture probability equal to or exceeding that of women with a prior fragility fracture should be considered for treatment is translated into thresholds using 10-year fracture probabilities. In that case the threshold is age-dependent and increases from 16 % at the age of 60 ys to 40 % at the age of 80 ys. The second approach is a cost-effectiveness approach. Using a FRAX®-based intervention threshold of 15 % for both, women and men 50 years and older, should permit cost-effective access to therapy to patients at high fracture probability in our country and thereby contribute to further reduce the growing burden of osteoporotic fractures.

Maintaining cost-effective access to antiretroviral drug therapy through a collaborative approach to drug procurement, consensus treatment guidelines and regular audit: the experience of London HIV commissioners and providers

BackgroundIn the UK, meeting the £20 billion efficiency challenge in the NHS requires new approaches to protect quality and improve productivity. In London, clinicians, people living with HIV and commissioners...

Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland

FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective. The fracture risk assessment algorithm FRAX® has been recently calibrated for Switzerland. The aim of the present analysis was to determine FRAX-based fracture probabilities at which intervention becomes cost-effective. A previously developed and validated state transition Markov cohort model was populated with Swiss epidemiological and cost input parameters. Cost-effective FRAX-based intervention thresholds (cost-effectiveness approach) and the cost-effectiveness of intervention with alendronate (original molecule) in subjects with a FRAX-based fracture risk equivalent to that of a woman with a prior fragility fracture and no other risk factor (translational approach) were calculated based on the Swiss FRAX model and assuming a willingness to pay of 2 times Gross Domestic Product per capita for one Quality-adjusted Life-Year. In Swiss women and men aged 50 years and older, drug intervention aimed at decreasing fracture risk was cost-effective with a 10-year probability for a major osteoporotic fracture at or above 13.8% (range 10.8% to 15.0%) and 15.1% (range 9.9% to 19.9%), respectively. Age-dependent variations around these mean values were modest. Using the translational approach, treatment was cost-effective or cost-saving after the age 60 years in women and 55 in men who had previously sustained a fragility fracture. Using the latter approach leads to considerable underuse of the current potential for cost-effective interventions against fractures. Using a FRAX-based intervention threshold of 15% for both women and men should permit cost-effective access to therapy to patients at high fracture probability based on clinical risk factors and thereby contribute to further reduce the growing burden of osteoporotic fractures in Switzerland.

Demonstration Survey of Prehistoric Reef-Net Sites with Sidescan Sonar, near Becher Bay, British Columbia, Canada

Sidescan sonar was deployed in challenging shallow-water conditions to demonstrate the potential for recording anchor-stones left on the sea-bed from prehistoric fishing operations. In less than three hours the survey successfully mapped a reef-net site originally recorded in 1985 by diving archaeologists over many hours. In addition, 8 km of coastline were surveyed, resulting in the discovery and recording of one new underwater reef-net site. Our understanding of evolving subsistence practices of the Straits Salish, for whom reef-net fishing was a critical activity, may be enhanced by this survey method which provides cost-effective access to data not otherwise being recorded. © 2011 The Authors

10 MW Class Superconductor Wind Turbine Generators

High temperature superconductor (HTS) technology enables generators with one third the weight and one half the losses of conventional machines. These technologies enable a significant reduction in the size and weight of 10 MW-class generators for direct-drive wind turbine systems and reduce the cost of clean energy relative to conventional copper and permanent-magnet-based generators and gearboxes. With compact and light-weight 10 MW-class HTS generators, installation and low maintenance operation of high power wind turbine systems becomes practical and enable cost-effective access to wind resources. Under a program funded by the NIST-Advanced Technology Program, key generator technologies for a 10 MW class generator have been developed. This paper summarizes work under the NIST and internal programs.

Pediatric oncology for the general pediatrician

Since its establishment as a pediatric subspecialty oncology has become the near exclusive domain of specialized tertiary centers. This has greatly aided progress in the field with formation of exemplary and highly focused international consortia that have continued to streamline clinical research efforts. Recently, the rate of progress in terms of further improvements in overall outcome has paradoxically slowed. Novel strategies are therefore needed to assure continued advances. On the one hand, international and global consortia of subspecialists will continue to focus on the development of much needed improved therapies for those disease groups that have not yet seen their prognosis brighten, and on the other hand, there is a trend to invest in the development of joint-care initiatives that assure cost-effective access to standard therapy for all. This will require closer involvement of the general pediatrician in certain aspects of cancer care in its broadest sense. We hope the upcoming series will aid this process by highlighting selected topics in pediatric oncology that are likely to gain even more relevance for the general pediatrician in the years to come. They include: screening strategies for cancer predisposition syndromes; molecular diagnosis and risk-adjustment of therapy for acute leukemia in childhood; an overview of new agents in clinical development; and the impact of cancer treatment on fertility and available preservation options.

Markets and Policy Challenges in Access to Essential Medicines for Endemic Disease

Access to essential medicines is a core element of the effective health systems that are required to deal with endemic disease. Cost-effective access relies in turn on efficient market functioning and on appropriate polices towards the role of markets at national and international levels. This article argues that current international policy frameworks for promoting access to essential medicines lack coherence and display weak empirical foundations for proposed market interventions. A study of medicines markets in Tanzania questions some assumptions about market functioning underlying international policy, and shows how exploratory field studies can reduce the knowledge gap. Medicines policy should aim for rational use of essential medicines and for universal access free at the point of use to medicines essential to treat endemic diseases and other major causes of death. Unregulated retail market competition in essential medicines should be progressively constrained by government and NGO action. Wholesale market competition, in contrast, should be promoted, while the rebuilding of African pharmaceutical manufacturing is important for promoting and sustaining access. At each market level, public and non-governmental non-profit traders and providers can play a regulatory role alongside greater citizen information and civic activism.

Nonlinear Flight Control Systems Design for Hypersonic Vehicles: Results and Open Problems

Air-breathing hypersonic vehicles (HSVs) are regarded as one of the most promising technology for achieving reliable and cost-effective access to space. Notwithstanding the recent successes of NASA's X-43A and AFRL's X-51 experimental vehicles, the design of flight control systems for HSVs is still an open problem, due to the complexity of the dynamics and the unprecedented level of coupling between the airframe and the propulsion system. The slender geometries and light structures required for these aircraft cause significant flexible effects, whereas a strong coupling between propulsive and aerodynamic forces results from the integration of the scramjet engine into the fuselage. Because of the variability of the vehicle characteristics with flight conditions, significant uncertainties affect the vehicle models, which in turn are known to be unstable and non-minimum phase with respect to the regulated output. Finally, the presence of unavoidable constraints on the control inputs and the stringent requirements imposed by hypersonic regimes on the flight envelope render the control design an even harder endeavor, especially concerning controlling the propulsion system. In this paper, we present an account of nonlinear adaptive control techniques that have been developed, in collaboration with the US Air Force Research Laboratories, towards the design of flight control systems for HSVs. In particular, we present several steps leading to the design of a flight control system architecture comprised of a robust adaptive inner-loop controller and a self-optimizing guidance system. Finally, we briefly discuss open problems and current research directions.

TeleOph: A Secure Real-Time Teleophthalmology System

Teleophthalmology (TeleOph) is an electronic counterpart of today's face-to-face, patient-to-specialist ophthalmology system. It enables one or more ophthalmologists to remotely examine a patient's condition via a confidential and authentic communication channel. Specifically, TeleOph allows a trained nonspecialist in a primary clinic to screen the patients with digital instruments (e.g., camera, ophthalmoscope). The acquired medical data are delivered to the hospital where an ophthalmologist will review the data collected and, if required, provide further consultation for the patient through a real-time secure channel established over a public Internet network. If necessary, the ophthalmologist is able to further sample the images/video of the patient's eyes remotely. In order to increase the productivity of the ophthalmologist in terms of number of patients reviewed, and to increase the efficiency of network resource, we manage the network bandwidth based on a Poisson model to estimate patient arrival at the clinics, and the rate of ophthalmologist consultation service for better overall system efficiency. The main objective of TeleOph is therefore to provide the remote patients with a cost-effective access to specialist's eye checkups at primary healthcare clinics, and at the same time, minimize unnecessary face-to-face consultation at the hospital specialist's center.

Enhancing the performance of secured handover protocols in UMTS-WiMAX interworking

Interworking UMTS and WiMAX networks offers global roaming and cost effective broadband wireless Internet access. Designing efficient Intra and Inter WiMAX handovers in the interworking architecture is a challenging problem. Handovers must be instantaneous and secure at the same time. We attempt to solve this problem by designing Intra and Inter WiMAX handover protocols which are capable of operating in the UMTS-WiMAX interworking architecture and perform mutual pre-authentication between the mobile station and the target network prior to handover. Due to the pre-authentication procedure, our proposed handover protocols outperform standard handover protocols by dispatching fewer handover signaling messages, experiencing less handover delay and preserving computation resources of critical nodes in the interworking architecture. Furthermore, our proposed handover protocols meet essential security requirements and defend against common attacks affecting handover protocols.