Cost-effectiveness of peer role play and standardized patients in undergraduate communication training.

BACKGROUND The few studies directly comparing the methodological approach of peer role play (RP) and standardized patients (SP) for the delivery of communication skills all suggest that both methods are effective. In this study we calculated the costs of both methods (given comparable outcomes) and are the first to generate a differential cost-effectiveness analysis of both methods. METHODS Medical students in their prefinal year were randomly assigned to one of two groups receiving communication training in Pediatrics either with RP (N = 34) or 19 individually trained SP (N = 35). In an OSCE with standardized patients using the Calgary-Cambridge Referenced Observation Guide both groups achieved comparable high scores (results published). In this study, corresponding costs were assessed as man-hours resulting from hours of work of SP and tutors. A cost-effectiveness analysis was performed. RESULTS Cost-effectiveness analysis revealed a major advantage for RP as compared to SP (112 vs. 172 man hours; cost effectiveness ratio .74 vs. .45) at comparable performance levels after training with both methods. CONCLUSIONS While both peer role play and training with standardized patients have their value in medical curricula, RP has a major advantage in terms of cost-effectiveness. This could be taken into account in future decisions.

Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: A systematic review.

OBJECTIVE The improvement in diagnostic accuracy and optimization of treatment planning in periodontology through the use of three-dimensional imaging with cone beam computed tomography (CBCT) is discussed controversially in the literature. The objective was to identify the best available external evidence for the indications of CBCT for periodontal diagnosis and treatment planning in specific clinical situations. DATA SOURCES A systematic literature search was performed for articles published by 2 March 2015 using electronic databases and hand search. Two reviewers performed the study selection, data collection, and validity assessment. PICO and PRISMA criteria were applied. From the combined search, seven studies were finally included. CONCLUSION The case series were published from the years 2009 to 2014. Five of the included publications refer to maxillary and/or mandibular molars and two to aspects related to vertical bony defects. Two studies show a high accuracy of CBCT in detecting intrabony defect morphology when compared to periapical radiographs. Particularly, in maxillary molars, CBCT provides high accuracy for detecting furcation involvement and morphology of surrounding periodontal tissues. CBCT has demonstrated advantages, when more invasive treatment approaches were considered in terms of decision making and cost benefit. Within their limits, the available data suggest that CBCT may improve diagnostic accuracy and optimize treatment planning in periodontal defects, particularly in maxillary molars with furcation involvement, and that the higher irradiation doses and cost-benefit ratio should be carefully analyzed before using CBCT for periodontal diagnosis and treatment planning.

Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi.

OBJECTIVE To estimate the cost-effectiveness of prevention of mother-to-child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') compared with ART during pregnancy or breastfeeding only unless clinically indicated ('Option B'). DESIGN Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme. METHODS Individual-based simulation model. We simulated cohorts of 10 000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterized the model with data from the literature and by analysing programmatic data. We compared total costs of antenatal and postnatal care, and lifetime costs and disability-adjusted life-years of the infected infants between Option B+ and Option B. RESULTS During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared with 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted. CONCLUSION Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.

Physician adoption of a practice guideline: Effect on the cost of medical care for adult patients with diabetes

In the demanding environment of healthcare reform, reduction of unwanted physician practice variation is promoted, often through evidence-based guidelines. Guidelines represent innovations that direct change(s) in physician practice; however, compliance has been disappointing. Numerous studies have analyzed guideline development and dissemination, while few have evaluated the consequences of guideline adoption. The primary purpose of this study was to explore and analyze the relationship between physician adoption of the glycated hemoglobin test guideline for management of adult patients with diabetes, and the cost of medical care. The study also examined six personal and organizational characteristics of physicians and their association with innovativeness, or adoption of the guideline. ^ Cost was represented by approved charges from a managed care claims database. Total cost, and diabetes and related complications cost, first were compared for all patients of adopter physicians with those of non-adopter physicians. Then, data were analyzed controlling for disease severity based on insulin dependency, and for high cost cases. There was no statistically significant difference in any of eight cost categories analyzed. This study represented a twelve-month period, and did not reflect cost associated with future complications known to result from inadequate management of glycemia. Guideline compliance did not increase annual cost, which, combined with the future benefit of glycemic control, lends support to the cost effectiveness of the guideline in the long term. Physician adoption of the guideline was recommended to reduce the future personal and economic burden of this chronic disease. ^ Only half of physicians studied had adopted the glycated hemoglobin test guideline for at least 75% of their diabetic patients. No statistically significant relationship was found between any physician characteristic and guideline adoption. Instead, it was likely that the innovation-decision process and guideline dissemination methods were most influential. ^ A multidisciplinary, multi-faceted approach, including interventions for each stage of the innovation-decision process, was proposed to diffuse practice guidelines more effectively. Further, it was recommended that Organized Delivery Systems expand existing administrative databases to include clinical information, decision support systems, and reminder mechanisms, to promote and support physician compliance with this and other evidence-based guidelines. ^

Cost-effectiveness analysis of a 2-stage community-based hepatocellular carcinoma screening program in Taiwan

Hepatocellular carcinoma (HCC) has been ranked as the top cause of death due to neoplasm malignancy in Taiwan for years. The high incidence of HCC in Taiwan is primarily attributed to high prevalence of hepatitis viral infection. Screening the subjects with liver cirrhosis for HCC was widely recommended by many previous studies. The latest practice guideline for management of HCC released by the American Association for the Study of Liver Disease (AASLD) in 2005 recommended that the high risk groups, including cirrhotic patients, chronic HBV/HCV carriers, and subjects with family history of HCC and etc., should undergo surveillance.^ This study aims to investigate (1) whether the HCC screening program can prolong survival period of the high risk group, (2) what is the incremental cost-effectiveness ratio of the HCC screening program in Taiwan, as compared with a non-screening strategy from the payer perspective, (3) which high risk group has the lowest ICER for the HCC screening program from the insurer's perspective, in comparison with no screening strategy of each group, and (4) the estimated total cost of providing the HCC screening program to all high risk groups.^ The high risk subjects in the study were identified from the communities with high prevalence of hepatitis viral infection and classified into three groups (cirrhosis group, early cirrhosis group, and no cirrhosis group) at different levels of risk to HCC by status of liver disease at the time of enrollment. The repeated ultrasound screenings at an interval of 3, 6, and 12 months were applied to cirrhosis group, early cirrhosis group, and no cirrhosis group, respectively. The Markov-based decision model was constructed to simulate progression of HCC and to estimate the ICER for each group of subjects.^ The screening group had longer survival in the statistical results and the model outcomes. Owing to the low HCC incidence rate in the community-based screening program, screening services only have limited effect on survival of the screening group. The incremental cost-effectiveness ratio of the HCC screening program was $3834 per year of life saved, in comparison with the non-screening strategy. The estimated total cost of each group from the screening model over 13.5 years approximately consumes 0.13%, 1.06%, and 0.71% of total amount of adjusted National Health Expenditure from Jan 1992 to Jun 2005. ^ The subjects at high risk of developing HCC to undergo repeated ultrasound screenings had longer survival than those without screening, but screening was not the only factor to cause longer survival in the screening group. The incremental cost-effectiveness ratio of the 2-stage community-based HCC screening program in Taiwan was small. The HCC screening program was worthy of investment in Taiwan. In comparison with early cirrhosis group and no cirrhosis group, cirrhosis group has the lowest ICER when the screening period is less than 19 years. The estimated total cost of providing the HCC screening program to all high risk groups consumes approximately 1.90% of total amount of adjusted 13.5-year NHE in Taiwan.^

Children with acute leukemia: A comparison of outcomes and cost-effectiveness from allogeneic blood stem cell and bone marrow transplantation

The relative merits of PBSCT versus BMT for children with standard and high risk hematologic malignancies remain unclear. In a retrospective single center study, we compared allogeneic peripheral blood stem cell transplantation (PBSCT) (n=30) with bone marrow transplantation (BMT) (n=110) in children with acute leukemia. We studied recipients of HLA matched sibling stem cells, and of stem cells from alternative donors (HLA mismatched and/or unrelated) and determined whether sourcing the stem cells from PB or marrow affected engraftment, incidence of acute and chronic GvHD, and disease-free survival at 1 year. Our results show a modest reduction in time to engraftment from PB stem cells and no greater risk of GvHD, but illustrate that the severity of the underlying disease is by far the greatest determinant of 1 year survival. Patients in the BMT group had a higher treatment success rate and lower costs than the recipients of the PBSCT within the standard but not the high risk disease group, where the treatment success rate and the cumulative costs were lower in the PBSCT group compared to the BMT group. Our current incremental cost-effectiveness ratio and analysis of uncertainty suggest that allogeneic transplantation of bone marrow grafts was a more cost-effective treatment option compared to peripheral blood stem cells in patients with standard risk childhood acute leukemia disease. For high risk disease our data are less prescriptive, since the differences were more limited and the range of costs much larger. Neither option demonstrated a clear advantage from a cost-effectiveness standpoint.^

A PROPOSED SAMPLE-BASED TECHNIQUE TO ESTIMATE THE STANDARDIZED MORTALITY RATIO

Evaluation of a series of deaths due to a particular disease is a frequently requested task in occupational epidemiology. There are several techniques available to determine whether a series represents an occupational health problem. Each of these techniques, however, is subject to certain limitations including cost, applicability to a given situation, feasibility relative to available resources, or potential for bias. In light of these problems, a technique was developed to estimate the standardized mortality ratio at a greatly reduced cost. The technique is demonstrated by its application in the investigation of brain cancer among employees of a large chemical company. ^

Health outcomes, quality improvement and cost-effectiveness of the Community Diabetes Education (CoDE) program: Results of a randomized controlled trial

The objectives of this dissertation were to evaluate health outcomes, quality improvement measures, and the long-term cost-effectiveness and impact on diabetes-related microvascular and macrovascular complications of a community health worker-led culturally tailored diabetes education and management intervention provided to uninsured Mexican Americans in an urban faith-based clinic. A prospective, randomized controlled repeated measures design was employed to compare the intervention effects between: (1) an intervention group (n=90) that participated in the Community Diabetes Education (CoDE) program along with usual medical care; and (2) a wait-listed comparison group (n=90) that received only usual medical care. Changes in hemoglobin A1c (HbA1c) and secondary outcomes (lipid status, blood pressure and body mass index) were assessed using linear mixed-models and an intention-to-treat approach. The CoDE group experienced greater reduction in HbA1c (-1.6%, p<.001) than the control group (-.9%, p<.001) over the 12 month study period. After adjusting for group-by-time interaction, antidiabetic medication use at baseline, changes made to the antidiabetic regime over the study period, duration of diabetes and baseline HbA1c, a statistically significant intervention effect on HbA1c (-.7%, p=.02) was observed for CoDE participants. Process and outcome quality measures were evaluated using multiple mixed-effects logistic regression models. Assessment of quality indicators revealed that the CoDE intervention group was significantly more likely to have received a dilated retinal examination than the control group, and 53% achieved a HbA1c below 7% compared with 38% of control group subjects. Long-term cost-effectiveness and impact on diabetes-related health outcomes were estimated through simulation modeling using the rigorously validated Archimedes Model. Over a 20 year time horizon, CoDE participants were forecasted to have less proliferative diabetic retinopathy, fewer foot ulcers, and reduced numbers of foot amputations than control group subjects who received usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life-year gained was estimated for CoDE intervention participants over the same time period. The results from the three areas of program evaluation: impact on short-term health outcomes, quantification of improvement in quality of diabetes care, and projection of long-term cost-effectiveness and impact on diabetes-related health outcomes provide evidence that a community health worker can be a valuable resource to reduce diabetes disparities for uninsured Mexican Americans. This evidence supports formal integration of community health workers as members of the diabetes care team.^

Zum Einfluss vorschulischer Kinderbetreuung auf den Bildungsweg und den erwarteten Erfolg am Arbeitsmarkt

In dem Beitrag wird der Frage nachgegangen, welchen Einfluss die Inanspruchnahme frühkindlicher Bildungs- und Betreuungsangebote auf den späteren Schulbesuch von Kindern hat und wie sich dies längerfristig auf die zu erwartenden Lebenseinkommen und damit einhergehend den langfristigen volkswirtschaftlichen Nutzen auswirkt. Untersucht werden Kinder in Deutschland der Jahrgänge 1990 bis 1995. Die Datengrundlage liefert das Sozio-oekonomische Panel (SOEP). Der Schwerpunkt der Analysen liegt auf der Bestimmung des Effekts des Krippenbesuchs auf die spätere Einstufung in die verschiedenen Schultypen in Abhängigkeit der sozialen Herkunft und des Migrationshintergrunds der Kinder. Ausgehend von diesen Schätzungen werden dann die zu erwartenden, über den Bildungsabschluss vermittelten Auswirkungen des Krippenbesuchs auf das spätere Lebenseinkommen bestimmt, um einen Eindruck der langfristigen volkswirtschaftlichen Folgen vorschulischer Kinderbetreuung zu erhalten. Der Beitrag zeigt, dass der Krippenbesuch die Wahrscheinlichkeit einer Einstufung ins Gymnasium nach Kontrolle relevanter Drittvariablen im Schnitt um rund 14 Prozentpunkte erhöht. Dieser Einfluss entspricht einem erwarteten Lebenseinkommenszuwachs von rund 27000 Euro. Wird dieser Ertrag auf den Zeitpunkt des Krippenbesuchs abdiskontiert und den Kosten eines durchschnittlichen Krippenbesuchs in der Höhe von rund 8000 Euro gegenübergestellt, so ergibt sich ein Kosten-Nutzen-Verhältnis von 1 zu 2.7. (DIPF/Orig.).

Intermodal exchange stations in the city of Madrid

The City of Madrid is putting into operation Intermodal Exchange Stations (IESs) to make connections between urban and suburban transportation modes easier for users of public transportation. The purpose of this article is to evaluate the actual effects that the implementation of IESs in the City of Madrid has on the affected stakeholders: users, public transportation operators, infrastructure managers, the government, the abutters and other citizens. We develop a methodology intended to help assess the welfare gains and losses for each stakeholder. Then we apply this methodology to the case study of the Avenida de América IES in the city of Madrid. We found that it is indeed possible to arrive at win–win solutions for the funding of urban transportation infrastructure, as long as the cost-benefit ratio of the project is high enough. Commuters save travel time. Bus companies diminish their costs of operation. The abutters gain in quality of life. The private operator of the infrastructure makes a fair profit. And the government is able to promote these infrastructure facilities without spending more of its scarce budgetary resources.

Towards data-aware cost-driven adaptation for service orchestrations.

Several activities in service oriented computing, such as automatic composition, monitoring, and adaptation, can benefit from knowing properties of a given service composition before executing them. Among these properties we will focus on those related to execution cost and resource usage, in a wide sense, as they can be linked to QoS characteristics. In order to attain more accuracy, we formulate execution costs / resource usage as functions on input data (or appropriate abstractions thereof) and show how these functions can be used to make better, more informed decisions when performing composition, adaptation, and proactive monitoring. We present an approach to, on one hand, synthesizing these functions in an automatic fashion from the definition of the different orchestrations taking part in a system and, on the other hand, to effectively using them to reduce the overall costs of non-trivial service-based systems featuring sensitivity to data and possibility of failure. We validate our approach by means of simulations of scenarios needing runtime selection of services and adaptation due to service failure. A number of rebinding strategies, including the use of cost functions, are compared.

Low-cost retrofitting solutions for RC frames using masonry infill panels

A large number of reinforced concrete (RC) frame structures built in earthquake-prone areas such as Haiti are vulnerable to strong ground motions. Structures in developing countries need low-cost seismic retrofit solutions to reduce their vulnerability. This paper investigates the feasibility of using masonry infill walls to reduce deformations and damage caused by strong ground motions in brittle and weak RC frames designed only for gravity loads. A numerical experiment was conducted in which several idealized prototypes representing RC frame structures of school buildings damaged during the Port-au-Prince earthquake (Haiti, 2010) were strengthened by adding elements representing masonry infill walls arranged in different configurations. Each configuration was characterized by the ratio Rm of the area of walls in the direction of the ground motion (in plan) installed in each story to the total floor area. The numerical representations of these idealized RC frame structures with different values of Rm were (hypothetically) subjected to three major earthquakes with peak ground accelerations of approximately 0.5g. The results of the non-linear dynamic response analyses were summarized in tentative relationships between Rm and four parameters commonly used to characterize the seismic response of structures: interstory drift, Park and Ang indexes of damage, and total amount of energy dissipated by the main frame. It was found that Rm=4% is a reasonable minimum design value for seismic retrofitting purposes in cases in which available resources are not sufficient to afford conventional retrofit measures.

User benefit assessment by a dynamic LUTI model for Madrid

Assessing users’ benefit in a transport policy implementation has been studied by many researchers using theoretical or empirical measures. However, few of them measure users’ benefit in a different way from the consumer surplus. Therefore, this paper aims to assess a new measure of user benefits by weighting consumer surplus in order to include equity assessment for different transport policies simulated in a dynamic middle-term LUTI model adapted to the case study of Madrid. Three different transport policies, including road pricing, parking charge and public transport improvement have been simulated through the Metropolitan Activity Relocation Simulator, MARS, the LUTI calibrated model for Madrid). A social welfare function (WF) is defined using a cost benefit analysis function that includes mainly costs and benefits of users and operators of the transport system. Particularly, the part of welfare function concerning the users, (i.e. consumer surplus), is modified by a compensating weight (CW) which represents the inverse of household income level. Based on the modified social welfare function, the effects on the measure of users benefits are estimated and compared with the old WF ́s results as well. The result of the analysis shows that road pricing leads a negative effect on the users benefits specially on the low income users. Actually, the road pricing and parking charge implementation results like a regressive policy especially at long term. Public transport improvement scenario brings more positive effects on low income user benefits. The integrated (road pricing and increasing public services) policy scenario is the one which receive the most user benefits. The results of this research could be a key issue to understanding the relationship between transport systems policies and user benefits distribution in a metropolitan context.

Towards cost reduction in concentrating solar power: innovative design for an efficient fresnel based solar field

Energía termosolar (de concentración) es uno de los nombres que hacen referencia en español al término inglés “concentrating solar power”. Se trata de una tecnología basada en la captura de la potencia térmica de la radiación solar, de forma que permita alcanzar temperaturas capaces de alimentar un ciclo termodinámico convencional (o avanzado); el futuro de esta tecnología depende principalmente de su capacidad para concentrar la radiación solar de manera eficiente y económica. La presente tesis está orientada hacia la resolución de ciertos problemas importantes relacionados con este objetivo. La mencionada necesidad de reducir costes en la concentración de radiación solar directa, asegurando el objetivo termodinámico de calentar un fluido hasta una determinada temperatura, es de vital importancia. Los colectores lineales Fresnel han sido identificados en la literatura científica como una tecnología con gran potencial para alcanzar esta reducción de costes. Dicha tecnología ha sido seleccionada por numerosas razones, entre las que destacan su gran libertad de diseño y su actual estado inmaduro. Con el objetivo de responder a este desafío se desarrollado un detallado estudio de las propiedades ópticas de los colectores lineales Fresnel, para lo cual se han utilizado métodos analíticos y numéricos de manera combinada. En primer lugar, se han usado unos modelos para la predicción de la localización y la irradiación normal directa del sol junto a unas relaciones analíticas desarrolladas para estudiar el efecto de múltiples variables de diseño en la energía incidente sobre los espejos. Del mismo modo, se han obtenido analíticamente los errores debidos al llamado “off-axis aberration”, a la apertura de los rayos reflejados en los espejos y a las sombras y bloqueos entre espejos. Esto ha permitido la comparación de diferentes formas de espejo –planos, circulares o parabólicos–, así como el diseño preliminar de la localización y anchura de los espejos y receptor sin necesidad de costosos métodos numéricos. En segundo lugar, se ha desarrollado un modelo de trazado de rayos de Monte Carlo con el objetivo de comprobar la validez del estudio analítico, pero sobre todo porque este no es preciso en el estudio de la reflexión en espejos. El código desarrollado está específicamente ideado para colectores lineales Fresnel, lo que ha permitido la reducción del tiempo de cálculo en varios órdenes de magnitud en comparación con un programa comercial más general. Esto justifica el desarrollo de un nuevo código en lugar de la compra de una licencia de otro programa. El modelo ha sido usado primeramente para comparar la intensidad de flujo térmico y rendimiento de colectores Fresnel, con y sin reflector secundario, con los colectores cilíndrico parabólicos. Finalmente, la conjunción de los resultados obtenidos en el estudio analítico con el programa numérico ha sido usada para optimizar el campo solar para diferentes orientaciones –Norte-Sur y Este-Oeste–, diferentes localizaciones –Almería y Aswan–, diferentes inclinaciones hacia el Trópico –desde 0 deg hasta 32 deg– y diferentes mínimos de intensidad del flujo en el centro del receptor –10 kW/m2 y 25 kW/m2–. La presente tesis ha conducido a importantes descubrimientos que deben ser considerados a la hora de diseñar un campo solar Fresnel. En primer lugar, los espejos utilizados no deben ser plano, sino cilíndricos o parabólicos, ya que los espejos curvos implican mayores concentraciones y rendimiento. Por otro lado, se ha llegado a la conclusión de que la orientación Este-Oeste es más propicia para localizaciones con altas latitudes, como Almería, mientras que en zonas más cercanas a los trópicos como Aswan los campos Norte-Sur conducen a mayores rendimientos. Es de destacar que la orientación Este-Oeste requiere aproximadamente la mitad de espejos que los campos Norte-Sur, puediendo estar inclinados hacia los Trópicos para mejorar el rendimiento, y que alcanzan parecidos valores de intensidad térmica en el receptor todos los días a mediodía. Sin embargo, los campos con orientación Norte-Sur permiten un flujo más constante a lo largo de un día. Por último, ha sido demostrado que el uso de diseños pre-optimizados analíticamente, con anchura de espejos y espaciado entre espejos variables a lo ancho del campo, pueden implicar aumentos de la energía generada por metro cuadrado de espejos de hasta el 6%. El rendimiento óptico anual de los colectores cilíndrico parabólicos es 23 % mayor que el rendimiento de los campos Fresnel en Almería, mientras que la diferencia es de solo 9 % en Aswan. Ello implica que, para alcanzar el mismo precio de electricidad que la tecnología de referencia, la reducción de costes de instalación por metro cuadrado de espejo debe estar entre el 10 % y el 25 %, y que los colectores lineales Fresnel tienen más posibilidades de ser desarrollados en zonas de bajas latitudes. Como consecuencia de los estudios desarrollados en esta tesis se ha patentado un sistema de almacenamiento que tiene en cuenta la variación del flujo térmico en el receptor a lo largo del día, especialmente para campos con orientación Este-Oeste. Este invento permitiría el aprovechamiento de la energía incidente durante más parte del año, aumentando de manera apreciable los rendimientos óptico y térmico. Abstract Concentrating solar power is the common name of a technology based on capturing the thermal power of solar radiation, in a suitable way to reach temperatures able to activate a conventional (or advanced) thermodynamic cycle to generate electricity; this quest mainly depends on our ability to concentrate solar radiation in a cheap and efficient way. The present thesis is focused to highlight and help solving some of the important issues related to this problem. The need of reducing costs in concentrating the direct solar radiation, but without jeopardizing the thermodynamic objective of heating a fluid up to the required temperature, is of prime importance. Linear Fresnel collectors have been identified in the scientific literature as a technology with high potential to reach this cost reduction. This technology has been selected because of a number of reasons, particularly the degrees of freedom of this type of concentrating configuration and its current immature state. In order to respond to this challenge, a very detailed exercise has been carried out on the optical properties of linear Fresnel collectors. This has been done combining analytic and numerical methods. First, the effect of the design variables on the ratio of energy impinging onto the reflecting surface has been studied using analytically developed equations, together with models that predict the location and direct normal irradiance of the sun at any moment. Similarly, errors due to off-axis aberration, to the aperture of the reflected energy beam and to shading and blocking effects have been obtained analytically. This has allowed the comparison of different shapes of mirrors –flat, cylindrical or parabolic–, as well as a preliminary optimization of the location and width of mirrors and receiver with no need of time-consuming numerical models. Second, in order to prove the validity of the analytic results, but also due to the fact that the study of the reflection process is not precise enough when using analytic equations, a Monte Carlo Ray Trace model has been developed. The developed code is designed specifically for linear Fresnel collectors, which has reduced the computing time by several orders of magnitude compared to a wider commercial software. This justifies the development of the new code. The model has been first used to compare radiation flux intensities and efficiencies of linear Fresnel collectors, both multitube receiver and secondary reflector receiver technologies, with parabolic trough collectors. Finally, the results obtained in the analytic study together with the numeric model have used in order to optimize the solar field for different orientations –North-South and East-West–, different locations –Almería and Aswan–, different tilts of the field towards the Tropic –from 0 deg to 32 deg– and different flux intensity minimum requirements –10 kW/m2 and 25 kW/m2. This thesis work has led to several important findings that should be considered in the design of Fresnel solar fields. First, flat mirrors should not be used in any case, as cylindrical and parabolic mirrors lead to higher flux intensities and efficiencies. Second, it has been concluded that, in locations relatively far from the Tropics such as Almería, East-West embodiments are more efficient, while in Aswan North- South orientation leads to a higher annual efficiency. It must be noted that East-West oriented solar fields require approximately half the number of mirrors than NS oriented fields, can be tilted towards the Equator in order to increase the efficiency and attain similar values of flux intensity at the receiver every day at midday. On the other hand, in NS embodiments the flux intensity is more even during each single day. Finally, it has been proved that the use of analytic designs with variable shift between mirrors and variable width of mirrors across the field can lead to improvements in the electricity generated per reflecting surface square meter up to 6%. The annual optical efficiency of parabolic troughs has been found to be 23% higher than the efficiency of Fresnel fields in Almería, but it is only around 9% higher in Aswan. This implies that, in order to attain the same levelized cost of electricity than parabolic troughs, the required reduction of installation costs per mirror square meter is in the range of 10-25%. Also, it is concluded that linear Fresnel collectors are more suitable for low latitude areas. As a consequence of the studies carried out in this thesis, an innovative storage system has been patented. This system takes into account the variation of the flux intensity along the day, especially for East-West oriented solar fields. As a result, the invention would allow to exploit the impinging radiation along longer time every day, increasing appreciably the optical and thermal efficiencies.

The impact of the internet on the pricing strategies of the European low cost airlines

This study seeks to analyse the price determination of low cost airlines in Europe and the effect that Internet has on this strategy. The outcomes obtained reveal that both users and companies benefit from the use of ICTs in the purchase and sale of airline tickets: the Internet allows consumers to increase their bargaining power comparing different airlines and choosing the most competitive flight, while companies can easily check the behaviour of users to adapt their pricing strategies using internal information. More than 2500 flights of the largest European low cost airlines have been used to carry out the study. The study revealed that the most significant variables for understanding pricing strategies were the number of rivals, the behaviour of the demand and the associated costs. The results indicated that consumers should buy their tickets before 25 days prior to departure.