310 research outputs found
The evolution of income-related inequalities in health care utilization in Switzerland over time
This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996health care utilization; inequality
The evolution of income-related health inequalities in Switzerland over time
This paper presents new evidence on income-related health inequality and its development over time in Switzerland. We employ the methods lined out in van Doorslaer and Jones (2003) and van Doorslaer and Koolman (2004) measuring health using an interval regression approach to compute concentration indices and decomposing inequality into its determining factors. Nationally representative survey data for 1982, 1992, 1997 and 2002 are used to carry out the analysis. Looking at each of the four years separately the results indicates the usual positive relationship between income and health, but the distribution is among the least unequal in Europe. No clear trend emerges in the evolution of the inequality indices over the two decades. Inequality is somewhat lower in 1982 and 1992 as compared to 1997 and 2002 but the differences are not significant. The most important contributors to health inequality are income, education and activity status, in particular retirement. Regional differences including the widely varying health care supply, by contrast, do not exert any systematic influenceInequalities in health; concentration index; decomposition analysis
The evolution of income-related inequalities in health care utilization in Switzerland over time
This study investigates equity in access to health care in Switzerland over time, using
nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple
quintile distributions and concentration indices are used to assess horizontal equity, i.e.
the extent to which adults in equal need for medical care appear to have equal rates of
medical care utilization. Looking at each of the four survey years separately the results
indicate that by and large, there is little or no inequity in use except with respect to
specialist visits which are clearly pro rich distributed as in most other OECD countries.
We neither find much significant variation over time despite the fact that the share of
health care has grown from close to 8% to more than 11% over this period and that a
major reform of the health care system has taken place in 1996
The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets
Compares systems of universal insurance coverage based on individual mandates, consumer choice of health plans, and regulated insurance market competition in Switzerland and the Netherlands. Discusses insights and implications for U.S. reform efforts
Freeform Extrusion of High Solids Loading Ceramic Slurries, Part I: Extrusion Process Modeling
A novel solid freeform fabrication method has been developed for the manufacture of
ceramic-based components in an environmentally friendly fashion. The method is based on the
extrusion of ceramic slurries using water as the binding media. Aluminum oxide (Al2O3) is
currently being used as the part material and solids loading as high as 60 vol. % has been
achieved. This paper describes a manufacturing machine that has been developed for the
extrusion of high solids loading ceramic slurries. A critical component of the machine is the
deposition system, which consists of a syringe, a plunger, a ram actuated by a motor that forces
the plunger down to extrude material, and a load cell to measure the extrusion force. An
empirical, dynamic model of the ceramic extrusion process, where the input is the commanded
ram velocity and the output is the extrusion force, is developed. Several experiments are
conducted and empirical modeling techniques are utilized to construct the dynamic model. The
results demonstrate that the ceramic extrusion process has a very slow dynamic response, as
compared to other non-compressible fluids such as water. A substantial amount of variation
exists in the ceramic extrusion process, most notably in the transient dynamics, and a constant
ram velocity may either produce a relatively constant steady-state extrusion force or it may cause
the extrusion force to steadily increase until the ram motor skips. The ceramic extrusion process
is also subjected to significant disturbances such as air bubble release, which causes a dramatic
decrease in the extrusion force, and nozzle clogging, which causes the extrusion force to slowly
increase until the clog is released or the ram motor skips.Mechanical Engineerin
Freeform Extrusion of High Solids Loading Ceramic Slurries, Part II: Extrusion Process Control
Part I of this paper provided a detailed description of a novel fabrication machine for high solids
loading ceramic slurry extrusion and presented an empirical model of the ceramic extrusion
process, with ram velocity as the input and extrusion force as the output. A constant force is
desirable in freeform extrusion processes as it correlates with a constant material deposition rate
and, thus, good part quality. The experimental results in Part I demonstrated that a constant ram
velocity will produce a transient extrusion force. In some instances the extrusion force increased
until ram motor skipping occurred. Further, process disturbances, such as air bubble release and
nozzle clogging that cause sudden changes in extrusion force, were often present. In this paper a
feedback controller for the ceramic extrusion process is designed and experimentally
implemented. The controller intelligently adjusts the ram motor velocity to maintain a constant
extrusion force. Since there is tremendous variability in the extrusion process characteristics, an
on-off controller is utilized in this paper. Comparisons are made between parts fabricated with
and without the feedback control. It is demonstrated that the use of the feedback control reduces
the effect of process disturbances (i.e., air bubble release and nozzle clogging) and dramatically
improves part quality.Mechanical Engineerin
On The Study of Establishing a Responsive Infrastructure for a Massively Multiplayer On-Line Game
A massively multiplayer online game (MMOG) often requires a game publisher to deploy dozens or hundreds of n-tiered servers to support millions of concurrent players around the world. Planning such a massive network infrastructure, particularly in an environment where uncertain demand and limited server capacity could cause congestions in a host site and the network, poses a great challenge. A slow response time stemming from an ill-designed infrastructure could render an otherwise technically superior MMOG noncompetitive in the marketplace. In this study, we focus on three critical issues related to establishing an MMOG server infrastructure: selecting host facilities on a broadband provider’s backbone network nodes, assigning client clusters represented by the Point of Presences (PoPs) to these MMOG facilities, and determining the required capacity for each host site. The problem is first formulated as a non-linear integer program based on an M/M/1 queuing system in each host facility. We then develop an exact solution approach obtained from solving a minimum cost set-covering problem. The efficiency of the solution approach is also reported
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Thiopurines are negatively associated with anthropometric parameters in pediatric Crohn's disease.
AimTo determine the distribution of anthropometric parameter (AP)-z-scores and characterize associations between medications/serum biomarkers and AP-z-scores in pediatric Crohn's disease (CD).MethodsCD patients [< chronological age (CA) 21 years] were enrolled in a cross-sectional study. Descriptive statistics were generated for participants' demographic characteristics and key variables of interest. Paired t-tests were used to compare AP-z-scores calculated based on CA (CA z-scores) and bone age (BA) (BA z-scores) for interpretation of AP's. Linear regression was utilized to examine associations between medications and serum biomarkers with AP-z-scores calculated based on CA (n = 82) and BA (n = 49). We reported regression coefficients as well as their corresponding p-values and 95% confidence intervals.ResultsMean CA at the time of the study visit was 15.3 ± 3.5 (SD; range = 4.8-20.7) years. Mean triceps skinfold (P = 0.039), subscapular skinfold (P = 0.002) and mid-arm circumference (MAC) (P = 0.001) BA z-scores were higher than corresponding CA z-scores. Medications were positively associated with subscapular skinfold [adalimumab (P = 0.018) and methotrexate (P = 0.027)] and BMI CA z-scores [adalimumab (P = 0.029)]. Azathioprine/6-mercaptopurine were negatively associated with MAC (P = 0.045), subscapular skinfold (P = 0.014), weight (P = 0.002) and BMI (P = 0.013) CA z-scores. ESR, CRP, and WBC count were negatively associated, while albumin and IGF-1 BA z-scores were positively associated, with specific AP z-scores (P < 0.05). Mean height CA z-scores were higher in females, not males, treated with infliximab (P = 0.038). Hemoglobin (P = 0.018) was positively associated, while platelets (P = 0.005), ESR (P = 0.003) and CRP (P = 0.039) were negatively associated with height CA z-scores in males, not females.ConclusionOur results suggest poor efficacy of thiopurines and a possible sex difference in statural growth response to infliximab in pediatric CD. Prospective longitudinal studies are required
Aqueous-Based Extrusion Fabrication of Ceramics on Demand
Aqueous-Based Extrusion Fabrication is an additive manufacturing technique that
extrudes ceramic slurries of high solids loading layer by layer for part fabrication. The
material reservoir in a previously developed system has been modified to allow for
starting and stopping of the extrusion process on demand. Design pros and cons are
examined and a comparison between two material reservoir designs is made. Tests are
conducted to determine the optimal deposition parameters for starting and stopping the
extrudate on demand. The collected test data is used for the development of a deposition
strategy that improves material deposition consistency, including reduced material
buildup at sharp corners. Example parts are fabricated using the deposition strategy and
hardware design.Mechanical Engineerin
Adaptive Control of Freeze-Form Extrusion Fabrication Processes
Freeze-form Extrusion Fabrication (FEF) is an additive manufacturing process that extrudes high solids loading aqueous ceramic pastes in a layer-by-layer fashion below the paste freezing temperature for component fabrication. Due to effects such as the air bubble release, agglomerate breakdown, change in paste properties during extrusion as a result of liquid phase migration, etc., the extrusion force is difficult to control. In this paper, an adaptive controller is proposed to regulate the extrusion force. Recursive Least Squares is used to estimate extrusion force model parameters during fabrication and a low-order control scheme capable of tracking general reference trajectories is designed and implemented to regulate the extrusion process. The controller is implemented to regulate the extrusion process. The controller is implemented fro sinusoidal, triangular, and square reference trajectories and the results demonstrate excellent tracking performance of the adaptive extrusion force controller. Several parts were fabricated with the adaptive extrusion force controller. These results illustrate the need for extrusion force control and that variable reference extrusion
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