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Stochastic impulse control of exchange rates with Freidlin–Wentzell perturbations
- Part of
- Gregory Gagnon
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- Journal:
- Journal of Applied Probability / Volume 54 / Issue 1 / March 2017
- Published online by Cambridge University Press:
- 04 April 2017, pp. 23-41
- Print publication:
- March 2017
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This paper pioneers a Freidlin–Wentzell approach to stochastic impulse control of exchange rates when the central bank desires to maintain a target zone. Pressure to stimulate the economy forces the bank to implement diffusion monetary policy involving Freidlin–Wentzell perturbations indexed by a parameter ε∈ [0,1]. If ε=0, the policy keeps exchange rates in the target zone for all times t≥0. When ε>0, exchange rates continually exit the target zone almost surely, triggering central bank interventions which force currencies back into the zone or abandonment of all targets. Interventions and target zone deviations are costly, motivating the bank to minimize these joint costs for any ε∈ [0,1]. We prove convergence of the value functions as ε→0 achieving a value function approximation for small ε. Via sample path analysis and cost function bounds, intervention followed by target zone abandonment emerges as the optimal policy.
Noise Pollution: Do We Need a Solution? An Analysis of Noise in a Cardiac Care Unit
- Kevin M. Ryan, Matthew Gagnon, Tyler Hanna, Brad Mello, Mustapha Fofana, Gregory Ciottone, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 4 / August 2016
- Published online by Cambridge University Press:
- 23 May 2016, pp. 432-435
- Print publication:
- August 2016
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Introduction
Hospitals are meant to be places for respite and healing; however, technological advances and reliance on monitoring alarms has led to the environment becoming increasingly noisy. The coronary care unit (CCU), like the emergency department, provides care to ill patients while being vulnerable to noise pollution. The World Health Organization (WHO; Geneva, Switzerland) recommends that for optimum rest and healing, sound levels should average approximately 30 decibels (dB) with maximum readings less than 40 dB.
ProblemThe purpose of this study was to measure and analyze sound levels in three different locations in the CCU, and to review alarm reports in relation to sound levels.
MethodsOver a one-month period, sound recorders (Extech SDL600; Extech Instruments; Nashua, New Hampshire USA) were placed in three separate locations in the CCU at the West Roxbury Veterans’ Administration (VA) Hospital (Roxbury, Massachusetts USA). Sound samples were recorded once per second, stored in Comma Separated Values format for Excel (Microsoft Corporation; Redmond, Washington USA), and then exported to Microsoft Excel. Averages were determined, plotted per hour, and alarm histories were reviewed to determine alarm noise effect on total noise for each location, as well as common alarm occurrences.
ResultsPatient Room 1 consistently had the lowest average recordings, though all averages were >40 dB, despite decreases between 10:00 pm and 7:00 am. During daytime hours, recordings maintained levels >50 dB. Overnight noise remained above recommended levels 55.25% of the period in Patient Room 1 and 99.61% of the same time period in Patient Room 7. The nurses’ station remained the loudest location of all three. Alarms per hour ranged from 20-26 during the day. Alarms per day averaged: Patient Room 1-57.17, Patient Room 7-122.03, and the nurses’ station - 562.26. Oxygen saturation alarms accounted for 33.59% of activity, and heart-related (including ST segment and pacemaker) accounted for 49.24% of alarms.
ConclusionThe CCU cares for ill patients requiring constant monitoring. Despite advances in technology, measured noise levels for the hospital studied exceeded WHO standards of 40 dB and peaks of 45 dB, even during night hours when patients require rest. Further work is required to reduce noise levels and examine effects on patient satisfaction, clinical outcomes, and length of stay.
,Ryan KM ,Gagnon M ,Hanna T ,Mello B ,Fofana M ,Ciottone G .Molloy M Noise Pollution: Do We Need a Solution? An Analysis of Noise in a Cardiac Care Unit . Prehosp Disaster Med.2016 ;31 (4 ):432 –435 .
Invited Paper D Industry perspective regarding outcomes research in oncology
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- By Kati Copley-Merriman, M.S., M.B.A., Senior Director/Site Leader Pfizer Inc., Joseph Jackson, Ph.D., Group Director Bristol-Myers Squibb, J. Gregory Boyer, Ph.D., Assistant Executive Director Pharmacia Corp, Joseph C. Cappelleri, Ph.D., Director, Biostatistics Pfizer Inc., Robert DeMarinis, Ph.D., Assistant Vice President Wyeth-Ayerst Research, Joseph DiCesare, M.P.H., R.Ph., Executive Director Novartis Pharmaceuticals Corp., M. Haim Erder, Ph.D., Director Amgen Inc., Jean Paul Gagnon, Ph.D., Director Aventis Pharmaceuticals Inc., Lou Garrison, Ph.D., Vice President and Head F. Hoffman-La Roche AG, Kathleen Gondek, Ph.D., Director Bayer Corp., Kim A. Heithoff, Ph.D., Director Schering-Plough Pharmaceuticals, Tom Hughes, Ph.D., Director Eli Lilly and Company, David Miller, Ph.D., Vice President GlaxoSmithKline, Margaret Rothman, Ph.D., Executive Director Johnson & Johnson Pharmaceutical Services, LLC, Nancy Santanello, M.D., M.S., Executive Director Merck Research Laboratories, Richard Willke, Ph.D., Senior Director/Group Leader Pharmacia Corp, Bruce Wong, M.D., Vice President Bristol-Myers Squibb
- Edited by Joseph Lipscomb, National Cancer Institute, Bethesda, Maryland, Carolyn C. Gotay, Claire Snyder, National Cancer Institute, Bethesda, Maryland
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- Book:
- Outcomes Assessment in Cancer
- Published online:
- 18 December 2009
- Print publication:
- 23 December 2004, pp 623-638
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Summary
Introduction
The goal of treatment for many persons with cancer is not cure but improvement or maintenance of functioning and well-being during their remaining period of life. This is particularly true for patients with advanced or metastatic cancers. Trials to produce evidence of effectiveness or for regulatory approval may include patient assessments of benefit as well as classical clinical endpoints used in oncology settings. These patient assessments of treatment benefit may or may not be related to the traditional measures of treatment success such as survival, tumor shrinkage, or time to tumor progression. For this reason, additional outcome measures to estimate benefit or risk/benefit trade-offs have been developed. Outcomes measures in this category of health assessment are referred to as patient-reported outcomes (PROs) because they are used to collect data directly from the patient.
It is increasingly recognized that the patient's perspective is unique and represents a valuable contribution to drug evaluation and treatment processes. This is particularly important when studying the effects of treatments on cancer symptoms such as pain and fatigue, outcomes not accurately measured by observers. Recent changes in the health care system have greatly empowered patients who are now considered partners rather than passive consumers. To maximize their contribution, they need to be informed about the outcomes associated with treatment. Patients are not always concerned with the same questions as treating physicians or clinical researchers.