Large Program Cost Estimating: Nuanced Implementation Assumptions Make Non-Nuanced Impacts

Against all odds, and an ongoing neoliberal barrage of criticism, Canada has maintained support for agricultural supply management programs instituted in the 1960s and 70s. The supply management organizations—and many academics—see supply management as one means by which to achieve food sovereignty, given the programmatic emphasis on the protection of family farms and restriction of unnecessary imports. However, to achieve this, supply management systems must balance a tendency for exclusion with the needs of small-scale, diversified producers. This chapter provides an assessment of one attempt to address this balance in Ontario, Canada, where small-flock chicken farmers looking to supply the new local food market ran up against the limits of the supply management system. Province-wide research with local food initiatives and consultations with our multi-stakeholder advisory groups determined that transformation of the supply management program was worth pursuing. In order to challenge potential policy solutions, I sought a series of frank, candid conversations with those intimately involved with the issues, from leaders of farm organizations and NGOs pushing for increased small-flock exemptions, to spokespersons for supply management organizations—as well as current and former provincial regulators. What follows is a brief history of the intersection of food sovereignty and supply management, a discussion of the challenges and potential policy solutions to integrate the two concepts in practice, and an analysis of the new Artisanal Chicken policy that has been developed in response—and which may offer a sustainable model to which other jurisdictions could aspire.

Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society's drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals' lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners.

Because of the herd-immunity phenomenon, the benefits of immunization against hepatitis A extend beyond those received by those who are vaccinated. This analysis estimates the impact of herd immunity on the cost-effectiveness of routine hepatitis A immunization among US children. In an economic model, the costs and benefits of hepatitis A immunization were estimated for immunizing all US children at age 1 year over a 10-year period starting in 2005. The future burden of disease from hepatitis A was also estimated with this model, and the fraction that would be prevented by herd immunity was modeled by using a previously published analysis of the relationship between hepatitis A vaccination coverage and declines in hepatitis A incidence. Without accounting for herd-immunity effects, the costs of routine immunization would average 32,000 dollars per quality-adjusted life-year gained for the first 10 cohorts immunized starting with the 2005 birth cohort. Herd-immunity effects would be expected to produce substantial additional benefits, lowering the cost of the immunization program to 1000 dollars per quality-adjusted life-year gained for the first 10 cohorts. Herd-immunity benefits would be greatest for the first few cohorts, more than doubling the benefits of immunization, and would decline over time. In a univariate sensitivity analysis, estimates were most sensitive to vaccination costs but remained below 20,000 dollars per quality-adjusted life-year under all of the assumptions. Herd-immunity effects more than double the savings from hepatitis A immunization during the first 10 years of the program. After accounting for these effects, immunization is close to cost-neutral on a cost-per-quality-adjusted-life-year basis.

Barriers and activities to implementing or expanding influenza vaccination programs in low- and middle-income countries: A global survey

The development trends of programmatic and methodical support of master's training – teachers/lecturers of foreign languages in the context of the modern educational paradigm are highlighted in the article. Based on the analysis of scientific and pedagogical sources, the author draws conclusions about standardization as an essential condition for the quality of educational programs and their compliance with European requirements. The transformation of educational programs and methodological materials takes place on the basis of student-centered and competency-based approaches to their development and implementation. Among the important areas of development of programming and its methodical support, the author names the deepening of the scientific component of the content of master’s education, as well as strengthening the practical work of specialists with higher education for greater compliance of professional training with the interests of students and the requirements of employers. The current trend of modern education is its digitalization, which provides new forms and methods of teaching and learning, promoting the use of digital tools of cognitive activity, which optimizes the production activity of teachers and students. The technological approach to the creation of educational programs is emphasized, based on the structuring of their content of educational programs and methodical materials, which emphasizes the distribution of educational material and promotes orderly learning built according to technological logic. The effectiveness of the implementation of educational programs is ensured by the compliance of program learning outcomes with the structured competencies that master’s students must assimilate.

Increasingly, oil and gas companies look to service providers to deliver validated solutions for difficult operational problems, quickly and dependably. This paper describes a transformation program designed to meet this need and create a quantum leap in operational efficiency and service. Descriptions with lessons learned are outlined for the two components of the program—a support organization that links service delivery personnel directly with technology centers and other parts of the field and a knowledge management (KM) methodology that encourages knowledge sharing and reuse. Specifically the paper describes the program's support organization, information technology (IT) tools, processes, metrics, and change management, including training, communications, and recognition.The primary application of this enabler is to maximize the performance of field engineers by providing secure, convenient access to validated information such as best practices or to expert groups for virtual collaboration. In addition the impact on new technology development, technology sustaining, and service training and documentation has been substantial.Results have been excellent in service improvement, product development, and financial benefits.

American Institute of Mining, Metallurgical, and Petroleum Engineers, Inc. This paper was prepared for the 43rd Annual Fall Meeting of the Society of Petroleum Engineers of AIME, to be held in Houston, Tex., Sept. 29-Oct. 2, 1968. Permission to copy is restricted to an abstract of not more than 300 words. Illustrations may not be copied. The abstract should contain conspicuous acknowledgment of where and by whom the paper is presented. Publication elsewhere after publication in the JOURNAL paper is presented. Publication elsewhere after publication in the JOURNAL OF PETROLEUM TECHNOLOGY or the SOCIETY OF PETROLEUM ENGINEERS JOURNAL is usually granted upon request to the Editor of the appropriate journal provided agreement to give proper credit is made. provided agreement to give proper credit is made. Discussion of this paper is invited. Three copies of any discussion should be sent to the Society of Petroleum Engineers office. Such discussion may be presented at the above meeting and, with the paper, may be considered for publication in one of the two SPE magazines. Abstract Drilling exploratory wells in the petroleum industry is an economic undertaking petroleum industry is an economic undertaking in which the probability of success of the individual venture is low, but the payoffs from successful wells compensate for the costs of the failures. There is a recent trend toward expressing the possible payoffs in terms of a probability distribution. probability distribution. Appraisal methods were developed that were predicated toward the use of a predetermined predicated toward the use of a predetermined risk factor, as is generally used in statistical decision methods. Cumulative values of groups of exploratory ventures were shown by computer simulation to approximate closely the normal distribution. Solutions developed include determination of the maximum fractional participation in a relatively large venture, participation in a relatively large venture, determination of the maximum appraisal price consistent with financial resources of the economic unit, and determination of the value of information that increases the chance of success. A maximum appraisal price is limited by required expected rate of return when capital resources are very large. However, the appraisal price is dominated by risk where capital resources are not relatively large. Introduction The evaluation of petroleum exploratory ventures is concerned with the appraisal of economic undertakings wherein the probability of complete failure of the individual venture is high and the probability of success is low and the magnitude of the occasional success itself is variable. For an individual well, even when it is located with geologic guidance, there is quite a low probability of discovering sufficient quantities of oil to repay the drilling and completion costs. However, where a drilling program consists of a score of such wells, there is often a high probability that the better discoveries will repay the costs of the entire program as well as pay the necessary profits. profits. Several of the methods that have been proposed for evaluate exploratory ventures have proposed for evaluate exploratory ventures have used an expected value, if successful, in combination with some method for handling the relative success ratio. The binomial distribution has been used for describing the distribution of occurrences of successful and unsuccessful trials, and the lognormal distribution has been recognized as adequate for describing the distribution of sizes of resource deposits.

programs, analogous to the much more rigorous statistical research Incidentally, the per-member-per-month costs associated with term ‘number needed to treat’ (NNT).[2-4] The former term atdiabetes-only disease management programs can be far lower or tempts to use estimated program savings derived from average even higher depending on program design. A sweet spot for hospitalization cost reductions alone to justify (or not) the program disease management generally has been proposed but is difficult to costs of a proposed disease management program. The original quantify.[5] Given the widespread variation in disease definition article, published in April 2006, first introduced this concept and and actual initiative elements at the program level, creating generreceived considerable reaction in the industry.[1] The article sugalizations here is fraught with limitations. gested that disease management efforts would need to have very Actually, diabetes, as a choice, is an interesting example in significant impacts on inpatient utilization in order to justify their itself; financial analyses of the DCCT (Diabetes Control and cost. The current text also goes on to suggest that other intervenComplications) trials recognized that costs may even go up for tions provided at costs lower than expensive professional services properly-managed patients with diabetes in the short term when might help (without referenced justification), and that alternative compared with usual care.[6] However, the substantial benefits evaluation methods such as cost-effectiveness analyses using qualobtained across a number of other axes and the likely long-term ity-adjusted life years (QALYs) might be at least part of an answer health and financial benefit clearly overwhelmed the more simple to the problem created by this metric. Lowering costs might thus financial-only analysis when this was reviewed. improve the return on investment (ROI) potential. So how should one look at the economic case for diabetes There has been widespread controversy in the literature for a disease management programs? The industry is increasingly number of years regarding the proper method of calculating a favoring a multidimensional approach that examines impact from narrowly defined financial impact of disease management (and, a variety of directions; Dr Linden is aware of this approach.[7,8] more broadly, medical management) programs. In disease manIn terms of clinical quality outcomes, the delivery of improved agement, the issue is particularly acute since the high cost variacare has been linked to enhanced economic outcomes through tion at the member level in these conditions makes it difficult to reduced future costs,[6] improved productivity,[9] and reduced medshow statistical significance for all but large populations of paical care costs.[10] Improvement in clinical quality itself has multitients. The economic business case for medical management prople links to other outcomes in terms of physical well-being, grams is clearly more complex than the approach recommended activities of daily living, and enhanced productivity at work. and requires a multidimensional approach to valuation. Focusing a

Proximity off-shoring (near-shoring) on the Information Technology sector has been a common practice over the past 2 decades, mainly for software development functions. But the benefits harvested from the delivery of professional services on a near-shore model can be replicated to other functions from a business transformation programme, such as competence and training management projects, improving cultural affinity at an overall effective cost, reducing complexity and risks associated with remoteness. Using a large business transformation programme from a global consumer goods company as a single case study, the present paper analyses the benefits and main challenges of incorporating such delivery model in these types of projects, focusing its attention mainly on the financial and quality aspects. The analysis suggests that, when compared to traditional services delivery (on-site consultants), near-shoring practices can have a very positive financial impact for the vendor and the customer, translating into an increase on the Return on Investment (ROI) without a significant increase of risks or losses in quality — The service's cost can have a significant reduction on the vendor side, with a consequent reduction to the end client. Regardless these benefits, it is suggested that traditional consulting still plays an un-replaceable role in these types of projects, especially by providing expert insights on the industry/solution and specifics of the local market and culture. Furthermore, it is suggested that it is equally important the commitment from top management for such initiatives, with the implementation of a clear and focused governance model to reduce eventual risks from remoteness or cultural clashes. Finally, the article also points out some directions for further research on the topic.

Information Technology leaders are demonstrating an increased concern on the distance dimension while considering sourcing initiatives. This suggests that, in Information Technology outsourcing activities, “distance is not dead”—actually, distance is seen as a source of challenges that can hurt the project overall health. In order to reduce these risks keeping an effective cost, proximity offshoring (nearshoring) is getting more used over the past two decades, but the academic literature on the subject is still on its beginnings. Using an Information Technology project, part of a large business transformation program that took place in Geneva (Switzerland), done by a vendor that delivered more than 2500 days in consulting as the main case study, this paper analyzes and discusses the benefits and challenges of incorporating nearshoring practices in these types of initiatives. The analysis starts by suggesting that nearshoring can add value to Information Technology projects if managed the right way—when compared to traditional services delivery (onsite consultants), nearshoring practices can have an outstanding result, with a very positive financial impact, showing considerable savings and avoiding a significant increase of risks or losses in quality, leading to an increased return on investment (ROI). Finally, some recommendations are suggested as the starting point for a framework for nearshore usage, pointing directions for further research. A similar analysis was already published by the same authors for a training project, aiming to understand if the same trends are applicable in several types of services delivered using nearshoring practices.

Early discharge program cost savings for patients with newly diagnosed acute myeloid leukemia after intensive induction chemotherapy

A general holistic framework, also called a process—named “Lean Product Development Flow (LPDF)”—for organizing the engineering work of Product Development (PD), has been proposed as a contribution to the emerging field of Lean Systems Engineering. The framework is based on Lean Principles, with emphasis on PD value‐pulling workflow pulsed by takt periods. The value is defined as (1) mission assurance/product quality, (the traditional goals of Systems Engineering) and (2) reduced program cost and schedule achieved by a radical reduction of waste. LPDF is recommended for smaller design programs based on a high degree of legacy knowledge, with technologies mature enough so that the program feasibility is not in question. LPDF may involve limited‐scope research, provided that it can be identified early in the program, and carried out separate from the main workflow. The paper is focused on aerospace and defense programs, which are presently burdened with as much as 60–90% of waste, but the process is also applicable to commercial programs. LPDF can be applied to the entire PD, to one or more milestones, and to a multilevel program. LPDF requires both detailed preparations and disciplined execution. The preparations include detailed Value Stream Mapping, separation of research from the main workflow, parsing of the Value Stream map into Takt Periods, architecting the LPDF team using dynamic allocation of resources, and team training. LPDF execution is organized as a flow through a series of short and equal work Takt Periods, each followed by an Integrative Event for structured, comprehensive coordination. Strategic and flexible tactical mitigations of uncertainties must be applied during the flow. LPDF also requires excellent leadership of a Chief Engineer, modeled after Toyota and Honda, who is a dedicated program “owner,” an expert systems designer, a strong leader focused on the program and product integrity, and skilled in consensus‐building. The Chief Engineer is responsible for the entire program, with Assistant Chiefs assisting in selected technical areas, and a Project Manager assisting with program administration. An industrial pilot program is currently being undertaken to validate the method. © 2004 Wiley Periodicals, Inc. Syst Eng 7: 352–376, 2004

Rutgers Robert Wood Johnson Medical School.