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CIMIDENT HE Report BMC Oral Health Appendix. Health Economics Analysis. Methods and analysis of costs for the two implant procedures and subsequent comparison. (DOCX 83Â kb)

T Allen, T Mason, W WhittakerManchester Centre for Health Economics, University of Manchester, Manchester, United KingdomAbstract: Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers' payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data.Keywords: pay for performance, primary care, financial incentives, quality of health care

Gamma titanium aluminides (γ-TiAl) display significantly improved high temperature mechanical properties over conventional titanium alloys. Due to their low densities, these alloys are increasingly becoming strong candidates to replace nickel-base superalloys in future gas turbine aeroengine components. To determine the safe operating life of such components, a good understanding of their creep properties is essential. Of particular importance to gas turbine component design is the ability to accurately predict the rate of accumulation of creep strain to ensure that excessive deformation does not occur during the component’s service life and to quantify the effects of creep on fatigue life. The theta (θ) projection technique is an illustrative example of a creep curve method which has, in this paper, been utilised to accurately represent the creep behaviour of the γ-TiAl alloy Ti -45Al-2Mn-2Nb. Furthermore, a continuum damage approach based on the θ-projection method has also been used to represent tertiary creep damage and accurately predict creep rupture.

Affordable test articles for descent and landing are crucial for developing commercial lunar landing capability. To ensure successful lunar landing, flight software must be tested over mission-length durations on hardware exhibiting dynamics analogous to those of true flight articles. Energetic and structural constraints typically preclude affordable long-duration lander tests.

Robotic regolith excavation on the Moon and Mars enables outposts, fuel depots, and sustained space exploration. In any space mission, mass is always at a premium because it is the main driver behind launch costs. Low mass and reduced gravity (1/6 of Earth gravity on the Moon, 1/3 on Mars) results in machines with limited weight available to produce traction or plunge tools into regolith. Bucket-wheel excavators have been shown to produce low resistance forces that enable lightweight operation, but in the past have had difficulty transferring regolith from bucket-wheel to collection bin. Exposed conveyors and chains fare poorly in harsh lunar regolith and vacuum. A novel excavator configuration, with bucket-wheel mounted centrally and transverse to driving direction, achieves direct transfer into a collection bin. Experiments with a bucket-wheel digging in lunar simulant show that transverse bucket-wheel orientation does not increase resistance significantly. Excavation resistance is shown to depend mostly on the ratio of bucket-wheel rotation rate to forward advance rate.

Using data from the first fourteen waves of the British Household Panel Survey, we estimate a discrete duration model of interregional migration in Great Britain. By exploiting retrospective information on residency we control for late entry as well as unobserved heterogeneity. We find considerable duration dependence in region of residence in the raw data, most but not all of which disappears when controlling for observable and unobservable differences between individuals. Older workers are less likely to switch region while the better educated are more mobile. There are also some differences between males and females in their likelihood to migrate.

Controlling slip is crucial to reliable descent of steep unconsolidated slopes such as those found in lunar craters. The ability to enter these craters provides opportunities to explore potential in-situ resources, such as water ice. We present a rover prototype with a novel, actuated, omni-directional plowing device and control method for maneuvering on steep slopes. Data from field experiments show reliable control during descent on loose sand slopes up to 40°, with twenty-fold reduction in downhill slip and a threefold reduction in slip during point turns. In particular, the data indicates that plowing eliminates slip caused by shear failure created in angle-of-repose material.

Scarab is a demonstration of a lunar rover design to explore polar cold traps for water ice as a potential resource. The envisioned mission scenario lands the rover on the floor of a permanently shadowed crater. The radioisotope powered rover then traverses kilometers in darkness, stopping to drill into the near subsurface and take data. The vehicle design employs a passive kinematic suspension with an active adjustability to lower for drilling and aid in driving. Scarab was designed and built in 2007 and is currently in lab and field testing and further development.

The primary challenge of descending steep, loose slopes is avoiding avalanche, tipover and maintaining control of locomotion. Theory suggests that for loose, granular soil,the strength lies under, not on, the surface. This has not hitherto been exploited for controlling robot descent. In order to take advantage of this, a prototype robot capable of utilizing sub-surface strength was developed and tested. Two unique features are low center-of gravity and an actuated plow capable of penetrating the ground for controlling descent and facilitating pivot. Tests show unprecedented control during descent on loose soil slopes up to 40 degrees. Avalanche sliding is reduced twenty-fold , pivot turning is improved threefold.

Using nationally representative, longitudinal data from the first 14 waves of the British Household Panel Survey we examine the labour market returns to inter-regional migration in Great Britain. Controlling for endogeneity, heterogeneity and self-selection, we find substantial long-run wage premiums associated with migration for both males and females who move for job-related reasons. There is, however, no evidence that moving across regions increases the probability of employment for males and females; in fact, some female movers experience a long-run employment penalty.

The Urban Challenge represents a technological leap beyond the previous Grand Challenges. The challenge encompasses three primary behaviors: driving on roads, handling intersections and maneuvering in zones. In implementing urban driving we have decomposed the problem into five components. Mission Planning determines an efficient route through an urban network of roads. A behavioral layer executes the route through the environment, adapting to local traffic and exceptional situations as necessary. A motion planning layer safeguards the robot by considering the feasible trajectories available, and selecting the best option. Perception combines data from lidar, radar and vision systems to estimate the location of other vehicles, static obstacles and the shape of the road. Finally, the robot is a mechatronic system engineered to provide the power, sensing and mobility necessary to navigate an urban course. Rigorous component and system testing evaluates progress using standardized tests. Observations from these experiments shape the design of subsequent development spirals and enable the rapid detection and correction of bugs. The system described in the paper exhibits a majority of the basic navigation and traffic skills required for the Urban Challenge. From these building blocks more advanced capabilities will quickly develop.