Down's Syndrome: cost, quality and value of life

Routine prenatal screening is based on the assumption that it is reasonable for prospective parents to choose to prevent a life with Down's syndrome. This paper questions whether Down's syndrome necessarily involves the costs, limitations and suffering which are assumed in the prenatal literature, and examines the lack of evidence about the value and quality of life with Down's syndrome. Tensions between the aims of prenatal screening policies to support women's personal choices, prevent distress, and reduce the suffering and costs of disability, versus the inadvertent effects of screening which can undermine these aims, are considered. Strengths and weaknesses in medically and socially based models of research about disability, and their validity and reliability are reviewed. From exploratory qualitative research with 40 adults who have congenital conditions which are tested for prenatally, interviews with five adults with Down's syndrome are reported. Interviewees discuss their relationships, education and employment, leisure interests, hopes, aspects of themselves and of society they would like to change, and their views on prenatal screening. They show how some people with Down's syndrome live creative, rewarding and fairly independent lives, and are not inevitably non-contributing dependents. Like the other 35 interviewees, they illustrate the importance of social supports, and their problems with excluding attitudes and barriers. Much more social research with people who have congenital conditions is required, if prenatal screening policies and counselling are to be evidence based

Low Cost Quality of Service Multicast Routing in High Speed Networks

Many of the services envisaged for high speed networks, such as B-ISDN/ATM, will support real-time applications with large numbers of users. Examples of these types of application range from those used by closed groups, such as private video meetings or conferences, where all participants must be known to the sender, to applications used by open groups, such as video lectures, where partcipants need not be known by the sender. These types of application will require high volumes of network resources in addition to the real-time delay constraints on data delivery. For these reasons, several multicast routing heuristics have been proposed to support both interactive and distribution multimedia services, in high speed networks. The objective of such heuristics is to minimise the multicast tree cost while maintaining a real-time bound on delay. Previous evaluation work has compared the relative average performance of some of these heuristics and concludes that they are generally efficient, although some perform better for small multicast groups and others perform better for larger groups. Firstly, we present a detailed analysis and evaluation of some of these heuristics which illustrates that in some situations their average performance is reversed; a heuristic that in general produces efficient solutions for small multicasts may sometimes produce a more efficient solution for a particular large multicast, in a specific network. Also, in a limited number of cases using Dijkstra's algorithm produces the best result. We conclude that the efficiency of a heuristic solution depends on the topology of both the network and the multicast, and that it is difficult to predict. Because of this unpredictability we propose the integration of two heuristics with Dijkstra's shortest path tree algorithm to produce a hybrid that consistently generates efficient multicast solutions for all possible multicast groups in any network. These heuristics are based on Dijkstra's algorithm which maintains acceptable time complexity for the hybrid, and they rarely produce inefficient solutions for the same network/multicast. The resulting performance attained is generally good and in the rare worst cases is that of the shortest path tree. The performance of our hybrid is supported by our evaluation results. Secondly, we examine the stability of multicast trees where multicast group membership is dynamic. We conclude that, in general, the more efficient the solution of a heuristic is, the less stable the multicast tree will be as multicast group membership changes. For this reason, while the hybrid solution we propose might be suitable for use with closed user group multicasts, which are likely to be stable, we need a different approach for open user group multicasting, where group membership may be highly volatile. We propose an extension to an existing heuristic that ensures multicast tree stability where multicast group membership is dynamic. Although this extension decreases the efficiency of the heuristics solutions, its performance is significantly better than that of the worst case, a shortest path tree. Finally, we consider how we might apply the hybrid and the extended heuristic in current and future multicast routing protocols for the Internet and for ATM Networks.

OPTIMIZING PROJECT TIME-COST-QUALITY BY USING GENETIC ALGORITHMS

Project management causes the problem of efficient resource assignment, activity, time constraints and relationships between activities. Traditional scheduling methods like CPM and PERT are incomplete tools to use in practice because they do not consider constraints regarding resources and cannot be realistic as they consider infinite resources. Optimization of project time-costs-quality is very complex and can be achieved by using meta-heuristic methods as Genetic Algorithms, Ant Algorithm, Tabu Search. In this article we study the state of the art in this domain, define the optimization problem we want to solve and propose some improvements for a genetic algorithm, starting from GENOCOP I (Genetic Algorithm for Numerical Optimizations of Constrained Problems) developed by Michalewicz and Janikow[12], later improved to GENOCOP V (Suzuki [9]).planning and scheduling, time-costs trade-off problem, genetic algorithms

A Quality and Cost Approach for Comparison of Small-World Networks

We propose an approach based on analysis of cost-quality tradeoffs for comparison of efficiency of various algorithms for small-world network construction. A number of both known in the literature and original algorithms for complex small-world networks construction are shortly reviewed and compared. The networks constructed on the basis of these algorithms have basic structure of 1D regular lattice with additional shortcuts providing the small-world properties. It is shown that networks proposed in this work have the best cost-quality ratio in the considered class.Comment: 27 pages, 16 figures, 1 tabl

Cost Quality Management

Within the contemporary economic conditions, enterprises might achieve a competitive advantage if only they sell goods and services with high quality and lower prices. Customers, usually, prefer quality goods with acceptable prices, while such goods create reputation with the particular brand. The perfect control system is necessary to achieve a high quality product, which the cost quality management is considered to be an indispensable part in. The cost quality is nevertheless created to ensure that customers’ requirements are being appropriately attained. The most important objective of quality costs controlling is to assist the management in enhancing the product’s value permanently. The superior cost quality control system helps the management to achieve other strategic objectives, such as: producing goods with acceptable costs and deliver the products to their customers in time.enterprise, goods, clients, prices, brands, quality, cost quality control, management

Serrano v. Priest’s Inputs and Outputs

A report on the litigation strategies and cost-quality issues involved in the Serrano V Priest case in which the California Supreme Court ruled that spending for a child\u27s publicly financed education should not be a function of wealth. Also discussed are the relevance of the Supreme Court\u27s Rodriquez decision as well as the response of the California legislature

Cost, quality and learning based governance of transactions : Western, Japanese and a third way

The paper considers a (static) portfolio system that satisfies adding-up contraints and the gross substitution theorem. The paper shows the relationship of the two conditions to the weak dominant diagonal property of the matrix of interest rate elasticities. This enables to investigate the impact of simultaneous changes in interest rates on the asset demands.

The impact on cost, quality, and patient satisfaction when delivering care to acutely ill adults in an at-home care model versus an inpatient hospital setting.

The impact on cost, quality, and patient satisfaction when delivering care to acutely ill adults in an at-home care model versus an inpatient hospital setting. Hospital level care for certain acute conditions can be safely delivered in the patient’s home while lowering the cost per episode of care, maintaining or improving patient experience, and improving safety and patient/care giver education as well as care coordination, at the Critical Access Hospital (CAH) level

The 2009 Health Care Leader Forum - a conference summary

On March 30–31, 2009, the Federal Reserve Bank of Chicago and the Detroit Regional Chamber co-sponsored the third annual forum on health care. This year’s program focused on the role of employers in improving the health care system in terms of cost, quality, and accessibility.Health care reform