Multi-state transition model in Continuing Care Retirement Communities (CCRC): A case study

2021 ◽  
Author(s):  
Chan Lay Guat ◽  
Saidatul Anisah Binti Abdul Rashid
Author(s):  
Satoshi Kanai ◽  
Takeshi Kishinami

Abstract This paper describes a visual simulation tool for reliable off-line development, verification and debugging of the control code of the Programmable Logic Controller (PLC) in the sequence control system. First, we discuss the uniform modeling method of the dynamic behavior of various components in a factory (actuators, sensors, operating panels, etc.) as the object model and state transition model. Then we propose the implementation method of the object model by VRML and JAVA. They enable us to uniformly describe the state-transition and corresponding dynamic behavior of the 3-D geometry of each object model. Moreover, we can use a standard VRML viewer which has the event-driven execution mechanism as a visual simulation tool. The effectiveness of proposed implementation and simulation is confirmed through the case study on the co-simulation of combining the component model with a real PLC.


2014 ◽  
pp. 63-68
Author(s):  
Marius Minea ◽  
Cornel Izbasa ◽  
Calin Jebelean

This paper presents a case study in the application of formal methods to the verification of communication protocols. We analyze one component block of telephone switching software developed in the SDL language at Alcatel Network Systems Romania. We use the IF toolset from VERIMAG Grenoble to build a state-transition model of the system and verify selected properties. We present the steps performed for translation and verification and discuss the potential for automating the process and using it on a larger scale.


Author(s):  
Musa Partahi Marbun ◽  
Ngapuli Irmea Sinisuka ◽  
Nanang Hariyanto

<span lang="EN-US">The purpose of this study is to develop a method to determine spare transformer number and location. Using Markov Chain method, state transition model and steady state probability was used on each 500-kV substation in order to analyze the effect of spare number and location variation with the reliability changes.  To give an actual result of the case study, calculation of spare transformer number and location on 500/150 kV transformers in Java Bali System was analyzed. The steady state probability results will vary depending on the number of spare transformer, these results can then be used to assess the spare transformer needed. The variation of spare transformer location can be used to analyze the best possible location of the spare in order to satisfy the reliability required. The methodology presented shows an integrated calculation for determining the spare transformer number and location.</span>


2021 ◽  
Author(s):  
Liat Ayalon ◽  
Sharon Avidor

Abstract Background and objectives during the coronavirus disease 2019 pandemic in Israel, people residing in continuing care retirement communities (CCRC) found themselves under strict instructions to self-isolate, imposed by the CCRC managements before, during and after the nationwide lockdown. The present study explored the personal experiences of CCRC residents during the lockdown. Research design and methods in-depth interviews were conducted with 24 CCRC residents from 13 different CCRCs. Authors performed a thematic analysis of interview transcripts, using constant comparisons and contrasts. Results three major themes were identified: (i) ‘Us vs. them: Others are worse off’. Older residents engaged in constant attempts to compare their situation to that of others. The overall message behind these downward comparisons was that the situation is not so bad, as others are in a worse predicament; (ii) ‘Us vs. them: Power imbalance’. This comparison emphasised the unbalanced power-relations between older adults and the staff and management in the setting and (iii) ‘We have become prisoners of our own age’. Interviewees described strong emotions of despair, depression and anger, which were intensified when the rest of society returned back to a new routine, whilst they were still under lockdown. Discussion and implications the measures imposed on residents by managements of CCRCs during the lockdown, and the emotional responses of distress among some of the residents, revealed that CCRCs have components of total institutions, not normally evident. This underscores the hidden emotional costs of the lockdown among those whose autonomy was compromised.


2020 ◽  
Vol 40 (8) ◽  
pp. 1003-1019
Author(s):  
Ingrid E. H. Kremer ◽  
Mickael Hiligsmann ◽  
Josh Carlson ◽  
Marita Zimmermann ◽  
Peter J. Jongen ◽  
...  

Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.


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