Browsing by Subject "economics"
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Item Celestina ludens: The Negotiation of Pain from Game Theory and the Phenomenology of Reading in Celestina(University of Valencia, Spain., 2022) Mallorquí-Ruscalleda, EnricResumen: En este trabajo, en el que se recuperan algunas de mis ideas previas fundacionales sobre Celestina, parto de la teoría de juegos y la fenomenología de la lectura para analizar los diferentes juegos que organizan y estructuran el texto de Rojas (y “antiguo autor”). Esto me permite demostrar que la estrategia, negogiación y economía, siempre en relación al dolor, son fundamentales para entender el texto. Palabras clave: Celestina, teoría de juegos, fenomelogía de la lectura, dolor, juegos, estrategia, negociación, economía. Abstract: In this paper, which recovers some of my previous foundational ideas on Celestina, I use game theory and the phenomenology of reading to analyze the different games that organize and structure Rojas’s (and “old author”) text. This allows me to demonstrate that strategy, negotiation and economy, always in relation to pain, are fundamental to understanding the text.Item Cost effectiveness of telecare management for pain and depression in patients with cancer: results from a randomized trial(Elsevier, 2014-11) Choi Yoo, Sung J.; Nyman, John A.; Cheville, Andrea L.; Kroenke, Kurt; Department of Medicine, IU School of MedicineOBJECTIVE: Pain and depression are prevalent and treatable symptoms among patients with cancer, yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes. This article investigates the incremental cost effectiveness of the INCPAD intervention. METHODS: The INCPAD trial was conducted in 16 community-based urban and rural oncology practices in Indiana. Of the 405 participants, 202 were randomized to the intervention group and 203 to the usual-care group. Intervention costs were determined, and effectiveness outcomes were depression-free days and quality-adjusted life years. RESULTS: The intervention group was associated with a yearly increase of 60.3 depression-free days (S.E. = 15.4; P < 0.01) and an increase of between 0.033 and 0.066 quality-adjusted life years compared to the usual care group. Total cost of the intervention per patient was US$1189, which included physician, nurse care manager and automated monitoring set-up and maintenance costs. Incremental cost per depression-free day was US$19.72, which yields a range of US$18,018 to US$36,035 per quality-adjusted life year when converted to that metric. When measured directly, the incremental cost per quality-adjusted life year ranged from US$10,826 based on the modified EQ-5D to US$73,286.92 based on the SF-12. CONCLUSION: Centralized telecare management, coupled with automated symptom monitoring, appears to be a cost effective intervention for managing pain and depression in cancer patients.Item Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2015-06-19) Ciaranello, Andrea L.; Doherty, Kathleen; Penazzato, Martina; Lindsey, Jane C.; Harrison, Linda; Kelly, Kathleen; Walensky, Rochelle P.; Essajee, Shaffiq; Losina, Elena; Muhe, Lulu; Wools-Kaloustian, Kara; Ayaya, Samuel; Weinstein, Milton C.; Palumbo, Paul; Freedberg, Kenneth A.; Department of Medicine, IU School of MedicineBACKGROUND: The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier. DESIGN/METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as 'very cost-effective,' interventions with ICERs below 3× gross domestic product/YLS as 'cost-effective,' and interventions leading to longer life expectancy and lower lifetime costs as 'cost-saving'. RESULTS: Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective. CONCLUSIONS: On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life expectancy and is cost-saving or very cost-effective compared to first-line nevirapine. This supports WHO guidelines, but increasing access to pediatric ART is critical regardless of the regimen used.Item Determining the Drivers of Academic Success in Surgery: An Analysis of 3,850 Faculty(Public Library of Science, 2015) Valsangkar, Nakul P.; Zimmers, Teresa A.; Kim, Bradford J.; Blanton, Casi; Joshi, Mugdha M.; Bell, Teresa M.; Nakeeb, Attila; Dunnington, Gary L.; Koniaris, Leonidas G.; Department of Surgery, IU School of MedicineOBJECTIVE: Determine drivers of academic productivity within U.S. departments of surgery. METHODS: Eighty academic metrics for 3,850 faculty at the top 50 NIH-funded university- and 5 outstanding hospital-based surgical departments were collected using websites, Scopus, and NIH RePORTER. RESULTS: Mean faculty size was 76. Overall, there were 35.3% assistant, 27.8% associate, and 36.9% full professors. Women comprised 21.8%; 4.9% were MD-PhDs and 6.1% PhDs. By faculty-rank, median publications/citations were: assistant, 14/175, associate, 39/649 and full-professor, 97/2250. General surgery divisions contributed the most publications and citations. Highest performing sub-specialties per faculty member were: research (58/1683), transplantation (51/1067), oncology (41/777), and cardiothoracic surgery (48/860). Overall, 23.5% of faculty were principal investigators for a current or former NIH grant, 9.5% for a current or former R01/U01/P01. The 10 most cited faculty (MCF) within each department contributed to 42% of all publications and 55% of all citations. MCF were most commonly general (25%), oncology (19%), or transplant surgeons (15%). Fifty-one-percent of MCF had current/former NIH funding, compared with 20% of the rest (p<0.05); funding rates for R01/U01/P01 grants was 25.1% vs. 6.8% (p<0.05). Rate of current-NIH MCF funding correlated with higher total departmental NIH rank (p < 0.05). CONCLUSIONS: Departmental academic productivity as defined by citations and NIH funding is highly driven by sections or divisions of research, general and transplantation surgery. MCF, regardless of subspecialty, contribute disproportionally to major grants and publications. Approaches that attract, develop, and retain funded MCF may be associated with dramatic increases in total departmental citations and NIH-funding.Item Economic Analysis of Software Defined Networking (SDN) Under Various Network Failure Scenarios(IEEE, 2019-05) Karakus, Murat; Durresi, Arjan; Computer and Information Science, School of ScienceFailures are inevitable in an operational network. They can happen anytime in different sizes and components of a network. They impact the network economics regarding CAPEX (Capital Expenditure), OPEX (Operational Expenditure), revenue lost due to service provisioning cut and so on. In order to mitigate the damages resulting from these failures, reactions of network architectures and designs are crucial for the future of the network. Recently, Software Defined Networking (SDN) has got the attention of researchers from both academia and industry as a means in order to increase network availability and reliability due to features, such as centralized automated control and global network view, it promises in networking. To this end, we explore the effects of programmable network architectures, i.e. SDN technology, and traditional network architectures, i.e. MPLS (Multiprotocol Label Switching) technology, on network economics by exploiting Number of Satisfied Service Requests and our predefined Unit Service Cost Scalability metrics under network failure scenarios: i) a random single data plane link failure and ii) a random controller (i.e. control plane) failure. To the best of our knowledge, this study is the first to consider a comparison of a programmable network architecture, i.e. SDN, along with different control plane models, Centralized (Single) Control Plane (CCP), Distributed (Flat) Control Plane (DCP), and Hierarchical Control Plane (HCP), and a non-programmable network architecture, i.e. MPLS, regarding network economics in case of network failures.Item Economic Impact Analysis of Control Plane Architectures in Software Defined Networking (SDN)(IEEE, 2018-05) Karakus, Murat; Durresi, Arjan; Computer and Information Science, School of ScienceEconomical and operational facets of networks drive the necessity for significant changes towards fundamentals of networking architectures. Recently, the momentum of programmable networking attempts illustrates the significance of economic aspects of network technologies. Software Defined Networking (SDN) has got the attention of researchers from both academia and industry as a means to decrease network costs and generate revenue for service providers due to features it promises in networking. In this article, we perform an economic analysis of SDN about different popular SDN control plane architectures: Centralized Control Plane (CCP), Distributed Control Plane with Local View (DCP_LV), and Hierarchical Control Plane (HCP) model. In particular, we investigate the economic impact of these control plane architectures about the unit cost for a service with bandwidth QoS parameter as well as Total Cost of Ownership (TCO) and network revenue for network owners under different traffic patterns. We characterize the unit cost for a service concerning CAPEX, OPEX, and workload of a network in a certain time period and apply the calculation methods in different SDN control plane models. Our experiments and analysis show that CCP model shows the highest TCO while DCP_LV model results in lowest amount among them. In addition, HCP model shows the lowest unit cost for a service among all models while CCP gives the highest cost for the same service tier. This work aims at being a useful primer to providing insights regarding the economic impact of control plane architectures in SDN for network researchers and owners to plan their investments.Item Economic Viability of Software Defined Networking (SDN)(Elsevier, 2018-04) Karakus, Murat; Durresi, Arjan; Computer and Information Science, School of ScienceEconomical and operational facets of networks drive the necessity for significant changes towards fundamentals of networking architectures. Recently, the momentum of programmable networking attempts illustrates the significance of economic aspects of network technologies. Software Defined Networking (SDN) has got the attention of researchers from both academia and industry as a means to decrease network costs and generate revenue for service providers due to features it promises in networking. In this article, we investigate how programmable network architectures, i.e. SDN technology, affect the network economics compared to traditional network architectures, i.e. MPLS technology. We define two metrics, Unit Service Cost Scalability and Cost-to-Service, to evaluate how SDN architecture performs compared to MPLS architecture. Also, we present mathematical models to calculate certain cost parts of a network. In addition, we compare different popular SDN control plane models, Centralized Control Plane (CCP), Distributed Control Plane (DCP), and Hierarchical Control Plane (HCP), to understand the economic impact of them with regards to the defined metrics. We use video traffic with different patterns for the comparison. This work aims at being a useful primer to providing insights regarding which technology and control plane model are appropriate for a specific service, i.e. video, for network owners to plan their investments.Item Effect of Hospice Use on Costs of Care for Long-Stay Nursing Home Decedents(Wiley Blackwell (Blackwell Publishing), 2016-04) Unroe, Kathleen T.; Sachs, Greg A.; Dennis, M. E.; Hickman, Susan E.; Stump, Timothy E.; Tu, Wanzhu; Callahan, Christopher M.; Medicine, School of MedicineOBJECTIVES: To analyze the costs for long-stay (>90 days) nursing home (NH) decedents with and without hospice care. DESIGN: Retrospective cohort study using a 1999-2009 data set of linked Medicare and Medicaid claims and minimum data set (MDS) assessments. SETTING: Indiana NHs. PARTICIPANTS: Long-stay NH decedents (N = 2,510). MEASUREMENTS: Medicare costs were calculated for 2, 7, 14, 30, 90, and 180 days before death; Medicaid costs were calculated for dual-eligible beneficiaries. Total costs and costs for hospice, NH, and inpatient care are reported. RESULTS: Of 2,510 long-stay NH decedents, 35% received hospice. Mean length of hospice was 103 days (median 34 days). Hospice users were more likely to have cancer (P < .001), a do-not-resuscitate order in place (P < .001), greater cognitive impairment (P < .001), and worse activity of daily living (ADL) function (P < .001) and less likely to have had a hospitalization in the year before death (P < .001). In propensity score analyses, hospice users had lower total Medicare costs for all time periods up to and including 90 days before death. For dually eligible beneficiaries, overall costs and Medicare costs were significantly lower for hospice users up to 30 days before death. Medicaid costs were not different between the groups except for the 2-day time period. CONCLUSION: In this analysis of costs to Medicare and Medicaid for long-stay NH decedents, use of hospice did not increase costs in the last 6 months of life. Evidence supporting cost savings is sensitive to analyses that vary the time period before death.Item Health Outcomes and Cost of Care Among Older Adults with Schizophrenia: A 10-Year Study Using Medical Records across the Continuum of Care(Elsevier, 2014-05) Hendrie, Hugh C.; Tu, Wanzhu; Tabbey, Rebeka; Purnell, Christianna E.; Ambuehl, Roberta J.; Callahan, Christopher M.; Department of Psychiatry, IU School of MedicineObjectives The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared to older patients without schizophrenia. Design, Setting, Participants An observational cohort study of 31,588 older adults (mean age 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999–2008. 1635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients’ electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements Rates of comorbid conditions, health care utilization, costs, and mortality. Results Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% v. 38.84%), chronic obstructive pulmonary disease (52.71% v. 41.41%), and hypothyroidism (36.72% v. 26.73%) than the patients without schizophrenia (p<0.001). They had significantly lower rates of cancer (30.78% v. 43.18%) and significantly higher rates of dementia (64.46% v. 32.13%). The patients with schizophrenia had significantly higher mortality risk (HR: 1.25, CI: 1.07–1.47) than the patients without schizophrenia. They also had significantly higher rates of health care utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions The management of older adult patients with schizophrenia is creating a serious burden for our health care system, requiring the development of integrated models of health care.Item Pay-as-You-Go Financing and Capital Outlay Volatility: Evidence from the States over Two Recent Economic Cycles(2009-12) Wang, Wen; Hou, YilinPay-as-you-go (pay-go or cash) and pay-as-you-use (pay-use or debt) are two mechanisms to finance capital projects. While pay-go faces multiple constraints, pay-use smoothes outlays, stabilizes tax rates, and improves inter-generational equity. Thus, pay-use has dominated infrastructure financing for decades. In recent years, there has been revived academic interest in pay-go as an alternate financing mechanism; however, there is a large gap in the literature and inadequate evidence on the effects of pay-go, especially its effects on capital outlay volatility. This paper fills in the niche. Examining state experience over the two recent economic cycles, this paper finds evidence that suggests that pay-go is associated with lower volatility in capital spending in the long run, but may increase short-run variability. We recommend that states couple pay-go in boom years with pay-use in lean years. In unison, the two mechanisms can reduce aggregate volatility and increase long-run stability of capital expenditures.