Cost of drugs manufactured by the University Hospital - role of the Central Pharmacy

The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clinicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.

Building 3D City Models: Testing and Comparing Laser Scanning and Low-Cost UAV Data Using FOSS Technologies

Contém resumo

The implications of mandatory low-cost fuel provision

This work studies fuel retail firms’ strategic behavior in a two-dimensional product differentiation framework. Following the mandatory provision of “low-cost” fuel we consider that capacity constraints force firms to eliminate of one the previously offered qualities. Firms play a two-stage game choosing fuel qualities from three possibilities (low-cost, medium quality and high quality fuel) and then prices having exogenous opposite locations. In the highest level of consumers’ heterogeneity, a subgame perfect Nash equilibrium exists in which firms both choose minimum quality differentiation. Consumers’ are worse off if no differentiation occurs in medium and high qualities. The effect over prices from the mandatory “low-cost” fuel law is ambiguous.

Funcionalidade e qualidade de vida : um estudo no processo de envelhecimento em portadores e não portadores da diabetes tipo 2

RESUMO: Introdução: A diabetes é uma patologia crônica que vêm crescendo exponencialmente em países desenvolvidos e, principalmente, naqueles em desenvolvimento, como é o caso do Brasil. Além de gerar importante custo aos sistemas públicos de saúde, sabe-se que as consequências do mau controle da diabetes tem impacto importante na vida de indivíduos que apresentam a doença, como a perda precoce da funcionalidade e a reduzida qualidade de vida. Nesse sentido, o governo federal brasileiro estabelece em 2002 o Programa Hiperdia, que prevê educação terapêutica e a assistência multiprofissional como estratégias na prevenção e controle das consequências geradas pelo mau controle da diabetes. Objetivo: O estudo aqui proposto tem como objetivo avaliar de que modo a presença e o tempo de diagnóstico da diabetes do tipo 2 (DM2) estão associados à funcionalidade e qualidade de vida de indivíduos assistidos pelo Programa Hiperdia. Metodologia: Foram avaliados indivíduos com idade igual ou superior a 40 anos, residentes na cidade de Viçosa-Minas Gerais/Brasil, distribuídos em diferentes grupos conforme as perspectivas de análise 1 (estudo da presença da DM2) e 2 (estudo do tempo de diagnóstico da patologia). Para a perspectiva 1 dois diferentes grupos foram comparados: controle (CTL), indivíduos sem DM2 ou qualquer patologia em órgãos alvo da doença; e DM2, indivíduos diagnosticados com diabetes do tipo 2. Já para a perspectiva 2 de análise pessoas diagnosticadas com DM2 foram distribuídas em dois diferentes grupos: G1, indivíduos com tempo de diagnóstico da DM2 ≥ 1 ano e ≤ 5 anos; e G2, indivíduos com tempo de diagnóstico da DM2 ≥ 10 anos. Previamente, avaliamos o estado cognitivo dos participantes por meio do Mini Mental State Exam. Dados sociodemográficos e clínicos (rastreio de sintomas depressivos, sonolência diurna excessiva e antropometria) também foram avaliados, além da verificação do perfil bioquímico por meio de informações provenientes de prontuários médicos. Para o estudo da funcionalidade, os instrumentos Activities of Daily Living, Instrumental Activities of Daily Living e o Life Style Questionnaire foram utilizados, assim como o SF-36v2 para a avaliação da qualidade de vida. Por fim, outras variáveis como conhecimento sobre a DM2 e gestão da patologia também foram investigadas. 10 Resultados: 198 indivíduos (CTL: 81; DM2: 117) com idade ≥ 40 anos foram avaliados, dos quais 55,5% apresentaram idade igual ou superior a 60 anos. A maioria corresponderam ao sexo feminino (62,6%). Foram verificados similares resultados para o estado cognitivo em ambas as perspectivas de análise. Pode-se dizer que, para a perspectiva 1 (CTL vs. DM2), os grupos apresentaram diferenças estatísticas significantes para a maioria das variáveis estudadas e tendência para a variável estilo de vida, com resultados desfavorecedores ao grupo DM2. Para a perspectiva 2 (G1 vs. G2), nossos resultados não evidenciam diferenças significantes para o tempo de diagnóstico em nenhuma das variáveis estudadas. Conclusões: Os resultados do estudo mostram que a presença da DM2 em situação de inadequado controle, bem como o insuficiente conhecimento sobre a patologia entre os indivíduos assistidos pelo Centro Hiperdia podem representar um importante fator para a verificação da reduzida funcionalidade e qualidade de vida. Isto sugere a necessidade de ajustes na execução do Programa, de modo a tornar possível o alcance dos objetivos propostos pelo mesmo. Referente ao tempo de diagnóstico da DM2, em nossa amostra, os resultados indicam que este parece não representar um fator desfavorecedor da funcionalidade e qualidade de vida.---------------------------ABSTRACT: Introduction: Type 2 diabetes (DM2) is a chronic disease that has been growing exponentially in developed countries, and even more so in developing countries such as Brazil. In addition, the pathology generates a significant cost to public healthcare systems. It is well known that the poor control of diabetes has important consequences on the lives of individuals diagnosed with the disease, such as the early loss of functionality and a reduced quality of life. In this sense, the Brazilian federal government established the Programa Hiperdia in 2002, a program that provides therapeutic education and multidisciplinary care in order to prevent and control the consequences of diabetes. Objective: The aim of this study is to evaluate how the presence and the diagnosis time of DM2 are associated with the functionality and quality of life of individuals assisted by the Programa Hiperdia. Methodology: We evaluated individuals aged 40 years or older living in Viçosa, Minas Gerais/Brazil, and divided them into different groups according to the analytical perspectives 1 (the study of the presence of DM2) and 2 (the study of the diagnosis time of DM2). For perspective 1, two different groups were compared: the DM2 group, which consisted of individuals diagnosed with type 2 diabetes, and the control group (CTL), which consisted of individuals without type 2 diabetes or any disease in the target organs. For perspective 2, people diagnosed with type 2 diabetes were divided into two different groups: G1, individuals with diagnosis time ≥ 1 year and ≤ 5 years; and G2, individuals with diagnosis time ≥ 10 years. Prior to group assignment, we assessed the cognitive status of all participants with the Mini Mental State Exam (MMSE). Sociodemographic and clinical data (i.e. screening of depressive symptoms, excessive daytime sleepiness and anthropometry) were also evaluated, as well as the biochemical profile based on information from the local Hiperdia center. To study functionality, Activities of Daily Living, Instrumental Activities of Daily Living and Life Style Questionnaire were administered. Quality of life was assessed via the SF-36v2 Health Survey. Finally, variables such as knowledge about DM2 and disease management were also verified. Results: 198 subjects (CTL: 81; DM2: 117) aged ≥ 40 years were evaluated, of whom 55.5% were aged 60 years or older. The majority of subjects were women (62,6%). Cognitive status scores were similar amongst both analytical perspectives. In terms of perspective 1 (DM2. vs. CTL), it showed statistically significant differences between the groups for the most part of the variables studied, and poorer results in the DM2 group. Regarding perspective 2 (G1 vs. G2), our results did not show significant differences for the diagnosis time in any of the variables studied. Conclusions: Our findings show that the presence of DM2 with inadequate control of the condition, as well as lack of knowledge about the disease among individuals assisted by the Hiperdia center may represent an important factor in the poor functionality and reduced quality of life when compared to the control group. This suggests that the Program likely needs some adjustments on its implementation in order to make possible the achievement of the objectives proposed. With respect to the diagnosis time for DM2 in our sample, the results indicate that it does not seem to be a factor in poor functionality nor quality of life.

[Editorial] Introduction to the special issue on COST Action FA1001

This Special Issue gathers selected contributions from experts of the action on several aspects of food structure design explored throughout the actions activity, from basic science to applications and behavior of foods during digestion.

Comparing standard and low-cost tools for gradient evaluation along potential cycling paths

Promoting the use of non-motorized modes of transport, such as cycling, is an important contribution to the improvement of mobility, accessibility and equity in cities. Cycling offers a fast and cheap transportation option for short distances, helping to lower pollutant emissions and contributing to a healthier way of life. In order to make the cycling mode more competitive in relation to motorized traffic, it is necessary to evaluate the potential of alternatives from the perspective of the physical effort. One way to do so consists of assessing the suitability of locations for implementing cycling infrastructures. In this work, four tools to determine the gradient along potential cycling paths are compared. Furthermore, an evaluation of the reliability of some low-cost tools to measure this parameter was conducted, by comparison with standard measurements using cartographic plans, on a field case study applied to the city of Braga, Portugal. These tools revealed a good level of accuracy for the planning stage, but proved to be less reliable for use in design.

Princípios para a reabilitação sustentável low cost de edifícios antigos: estudo de um quarteirão no centro da cidade do Porto

Dissertação de mestrado em Construção e Reabilitação Sustentável

Cost-effective and lightweight mobile units for MixAR: A comparative trial among different setups

Cultural heritage has arousing the interest of the general public (e.g. tourists), resulting in the increasing number of visitations to archaeological sites. However, many buildings and monuments are severely damaged or completely destroyed, which doesn’t allow to get a full experience of “travelling in time”. Over the years, several Augmented Reality (AR) approaches were proposed to overcome these issues by providing three-dimensional visualization of reconstructed ancient structures in situ. However, most of these systems were made available through heavy and expensive technological bundles. Alternatively, MixAR intends to be a lightweight and cost-effective Mixed Reality system which aims to provide the visualization of virtual ancient buildings reconstructions in situ, properly superimposed and aligned with real-world ruins. This paper proposes and compares different AR mobile units setups to be used in the MixAR system, with low-cost and lightweight requirements in mind, providing different levels of immersion. It was propounded four different mobile units, based on: a laptop computer, a single-board computer (SBC), a tablet and a smartphone, which underwent a set of tests to evaluate their performances. The results show that mobile units based on laptop computer and SBC reached a good overall performance while mobile units based on tablet and smartphone did not meet such a satisfactory result even though they are acceptable for the intended use.

Melhoria da eficiência energética em edifícios dos anos 70: implementação de soluções sustentáveis low-tech e low-cost

Dissertação de mestrado em Construção e Reabilitação Sustentáveis

A cost study of common surface finish systems for steel structures

This paper presents part of a study aimed at finding a suitable, yet cost-effective, surface finish for a steel structure subject to the car washing environment and corrosive chemicals. The initial, life cycle and average equivalent annual (AEAC) costs for surface finishing methods were calculated for a steel structure using the LCCC algorithm developed by American Galvanizers Association (AGA). The cost study consisted of 45 common surface finish systems including: hot-dip galvanization (HDG), metallization, acrylic, alkyd and epoxy as well as duplex coatings such as epoxy zinc and inorganic zinc (IOZ). The results show that initial, life cycle and AEAC costs for hot dip galvanization are the lowest among all the other methods, followed by coal tar epoxy painting. The annual average cost of HDG for this structure was estimated about €0.22/m2, while the other cost-effective alternatives were: IOZ, polyurea, epoxy waterborne and IOZ/epoxy duplex coating.

Cost optimal strategies for the renovation of residential neighbourhoods towards energy and emissions neutrality – Rainha Dona Leonor case study

Buildings are one of the major consumers of energy in Europe. This makes them an important target when aiming to reduce the energy consumptions and carbon emissions. The majority of the European building stock has already some decades and so it needs renovation in order to keep its functionality. Taking advantage of these interventions, the energy performance of the buildings may also be improved. In Portugal the renovation techniques, both regarding energy efficiency measures as well as measures for the use of renewable energy sources, are normally planned at the building scale. It is important to explore the possibility of having large scale interventions, has it has been done in other countries, namely at neighbourhood scale with district energy system in order to optimize the results in terms of costs and environmental impact.

Cost-effective energy and carbon emission optimization in building renovation – A case-study in a low income neighbourhood

Construction sector is one of the major responsible for energy consumption and carbon emissions and renovation of existing buildings plays an important role in the actions to mitigate climate changes. Present work is based on the methodology developed in IEA Annex 56, allowing identifying cost optimal and cost effective renovation scenarios improving the energy performance. The analysed case study is a residential neighbourhood of the municipality of Gaia in Portugal. The analysis compares a reference renovation scenario (without improving the energy performance of the building) with a series of alternative renovation scenarios, including the one that is being implemented.

IEA EBC Annex56 vision for cost effective energy and carbon emissions optimization in building renovation

Building sector has become an important target for carbon emissions reduction, energy consumption and resources depletion. Due to low rates of replacement of the existing buildings, their low energy performances are a major concern. Most of the current regulations are focused on new buildings and do not account with the several technical, functional and economic constraints that have to be faced in the renovation of existing buildings. Thus, a new methodology is proposed to be used in the decision making process for energy related building renovation, allowing finding a cost-effective balance between energy consumption, carbon emissions and overall added value.

Project scheduling and cost minimization with multiple availability constrained resources under stochastic conditions

The authors propose a mathematical model to minimize the project total cost where there are multiple resources constrained by maximum availability. They assume the resources as renewable and the activities can use any subset of resources requiring any quantity from a limited real interval. The stochastic nature is inferred by means of a stochastic work content defined per resource within an activity and following a known distribution and the total cost is the sum of the resource allocation cost with the tardiness cost or earliness bonus in case the project finishes after or before the due date, respectively. The model was computationally implemented relying upon an interchange of two global optimization metaheuristics – the electromagnetism-like mechanism and the evolutionary strategies. Two experiments were conducted testing the implementation to projects with single and multiple resources, and with or without maximum availability constraints. The set of collected results shows good behavior in general and provide a tool to further assist project manager decision making in the planning phase.