A fuzzy levelised energy cost method for renewable energy technology assessment

Renewable energy project development is highly complex and success is by no means guaranteed. Decisions are often made with approximate or uncertain information yet the current methods employed by decision-makers do not necessarily accommodate this. Levelised energy costs (LEC) are one such commonly applied measure utilised within the energy industry to assess the viability of potential projects and inform policy. The research proposes a method for achieving this by enhancing the traditional discounting LEC measure with fuzzy set theory. Furthermore, the research develops the fuzzy LEC (F-LEC) methodology to incorporate the cost of financing a project from debt and equity sources. Applied to an example bioenergy project, the research demonstrates the benefit of incorporating fuzziness for project viability, optimal capital structure and key variable sensitivity analysis decision-making. The proposed method contributes by incorporating uncertain and approximate information to the widely utilised LEC measure and by being applicable to a wide range of energy project viability decisions. © 2013 Elsevier Ltd. All rights reserved.

Improving the cost-effectiveness of photographic screening for diabetic macular oedema:a prospective, multi-centre, UK study

Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.

The benefit of combining standard automated perimetry and multifocal visual evoked potential hemifield intersector analysis in suspecious glaucomatous visual field defects

Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard SAP visual field assessment, and others were not very informative and needed more adjustment and research work. In this study we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. The purpose of this study is to examine the benefit of adding mfVEP hemifield Intersector analysis protocol to the standard HFA test when there is suspicious glaucomatous visual field loss. 3 groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey visual field HFA test 24-2, optical coherence tomography of the optic nerve head, and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the Hemifield Sector Analysis HSA protocol. The retinal nerve fibre (RNFL) thickness was recorded to identify subjects with suspicious RNFL loss. The hemifield Intersector analysis of mfVEP results showed that signal to noise ratio (SNR) difference between superior and inferior hemifields was statistically significant between the 3 groups (ANOVA p<0.001 with a 95% CI). The difference between superior and inferior hemispheres in all subjects were all statistically significant in the glaucoma patient group 11/11 sectors (t-test p<0.001), partially significant 5/11 in glaucoma suspect group (t-test p<0.01) and no statistical difference between most sectors in normal group (only 1/11 was significant) (t-test p<0.9). Sensitivity and specificity of the HSA protocol in detecting glaucoma was 97% and 86% respectively, while for glaucoma suspect were 89% and 79%. The use of SAP and mfVEP results in subjects with suspicious glaucomatous visual field defects, identified by low RNFL thickness, is beneficial in confirming early visual field defects. The new HSA protocol used in the mfVEP testing can be used to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patient. Using this protocol in addition to SAP analysis can provide information about focal visual field differences across the horizontal midline, and confirm suspicious field defects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss. The Intersector analysis protocol can detect early field changes not detected by standard HFA test.

A cost-effective steam-driven RO plant for brackish groundwater

Desalination is a costly means of providing freshwater. Most desalination plants use either reverse osmosis (RO) or thermal distillation. Both processes have drawbacks: RO is efficient but uses expensive electrical energy; thermal distillation is inefficient but uses less expensive thermal energy. This work aims to provide an efficient RO plant that uses thermal energy. A steam-Rankine cycle has been designed to drive mechanically a batch-RO system that achieves high recovery, without the high energy penalty typically incurred in a continuous-RO system. The steam may be generated by solar panels, biomass boilers, or as an industrial by-product. A novel mechanical arrangement has been designed for low cost, and a steam-jacketed arrangement has been designed for isothermal expansion and improved thermodynamic efficiency. Based on detailed heat transfer and cost calculations, a gain output ratio of 69-162 is predicted, enabling water to be treated at a cost of 71 Indian Rupees/m3 at small scale. Costs will reduce with scale-up. Plants may be designed for a wide range of outputs, from 5 m3/day, up to commercial versions producing 300 m3/day of clean water from brackish groundwater.

Exploration of a simple, low cost, micro gas turbine recuperator solution for a domestic combined heat and power unit

For micro gas turbines (MGT) of around 1 kW or less, a commercially suitable recuperator must be used to produce a thermal efficiency suitable for use in UK Domestic Combined Heat and Power (DCHP). This paper uses computational fluid dynamics (CFD) to investigate a recuperator design based on a helically coiled pipe-in-pipe heat exchanger which utilises industry standard stock materials and manufacturing techniques. A suitable mesh strategy was established by geometrically modelling separate boundary layer volumes to satisfy y + near wall conditions. A higher mesh density was then used to resolve the core flow. A coiled pipe-in-pipe recuperator solution for a 1 kW MGT DCHP unit was established within the volume envelope suitable for a domestic wall-hung boiler. Using a low MGT pressure ratio (necessitated by using a turbocharger oil cooled journal bearing platform) meant unit size was larger than anticipated. Raising MGT pressure ratio from 2.15 to 2.5 could significantly reduce recuperator volume. Dimensional reasoning confirmed the existence of optimum pipe diameter combinations for minimum pressure drop. Maximum heat exchanger effectiveness was achieved using an optimum or minimum pressure drop pipe combination with large pipe length as opposed to a large pressure drop pipe combination with shorter pipe length. © 2011 Elsevier Ltd. All rights reserved.

Mennyit ér a zajterhelés csökkenése? Zajvédelmi intézkedések értékelése a haszonértékelések átvitelével (The value of silence. An application of benefit-transfer methodology for evaluating noise-control actions)

Mind ez ideig a gyakorlatban kevéssé aknázták ki azt a lehetőséget, hogy a természeti tőke pénzbeli értékelése számszerű, egzakt információt nyújthat a döntéshozóknak. A szerzők a zajvédelmi intézkedések példáján keresztül tekintik át a természeti tőkejavak közgazdasági értékelésében rejlő lehetőségeket. Ismertetik a költség-haszon elemzés környezeti javakkal bővített formájának előnyeit, majd az általában elhanyagolt, a nem piaci javak által nyújtott haszon közgazdasági értékelésére alkalmas eljárásokat, külön kitérve a zajterhelés területére. Nagy hangsúlyt helyeznek a haszonfelmérések átvitelének széles körben alkalmazható módszereire. Bemutatják az általuk gyakorlatban végzett kutatás során szerzett tapasztalatokat, különös tekintettel arra, hogy a haszonértékelések átvitele hogyan járulhat hozzá a természeti tőkejavakkal kapcsolatos döntések során a társadalmi haszon maximalizálásához. _____ The paper offers an overview of the economic valuation of transportation-induced noise and cost-benefit analysis of noise-control measures and actions. Although economic valuation can provide hard, monetized data for decision-makers, it is relatively underused in practice. The study focuses on benefit-transfer methodology, where values obtained in previous cases are used as the basis for current evaluation. A specific application of benefit transfer is presented by a recent pilot project in Hungary, whereby a tool was developed for LGOs, enabling them to make preliminary assessments of the benefits of potential noise-control measures and rank possible options. This can help to optimize the benefits to society using limited resources.

Systematic Review Protocol to Evaluate the Effectiveness and Cost Effectiveness of Personalised Surveillance after Colorectal Adenomatous Polypectomy

Lifetime risk of developing colorectal cancer (CRC) is 5% and five-year survival at early-stage is 92%. CRC risk following index colonoscopy should establish post-screening surveillance benefit, which may be greater in high-risk patients. This review evaluated published cost-effectiveness estimates of post-polypectomy surveillance to assess the potential for personalised recommendations by risk sub-group. Current data suggested colonoscopy identifies those at low-risk of CRC, who may not benefit from intensive surveillance, which risks unnecessary harms and inefficient use of colonoscopy resources. Meta-analyses of incidence of advanced-neoplasia post-polypectomy for low-risk was comparable to those without adenoma; both rates were under the lifetime risk of 5%. Therefore, greater personalisation through de-intensified strategies for low-risk individuals could be beneficial and could employ non-invasive testing such as faecal immunochemical tests (FIT) combined with primary prevention or chemoprevention, thereby reserving colonoscopy for targeted use in personalised risk-stratified surveillance.
This systematic review aims to:
1. Assess if there is evidence supporting a program of personalised surveillance in patients with colorectal adenoma according to risk sub-group.
2. Compare the effectiveness of surveillance colonoscopy with alternative prevention strategies.
3. Assess trade-off between costs, benefits and adverse effects which must be considered in a decision to adopt or reject personalised surveillance.

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial

Background
Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions

Methods/design
This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention “dose”, website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.

Discussion
The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a ‘points’ based loyalty platform, whereby local businesses ‘sponsor’ the incentive (retail vouchers) in return for increased footfall to their business.

TP53 mutational status and cetuximab benefit in rectal cancer: 5-year results of the EXPERT-C trial.

In this updated analysis of the EXPERT-C trial we show that, in magnetic resonance imaging-defined, high-risk, locally advanced rectal cancer, adding cetuximab to a treatment strategy with neoadjuvant CAPOX followed by chemoradiotherapy, surgery, and adjuvant CAPOX is not associated with a statistically significant improvement in progression-free survival (PFS) and overall survival (OS) in both KRAS/BRAF wild-type and unselected patients. In a retrospective biomarker analysis, TP53 was not prognostic but emerged as an independent predictive biomarker for cetuximab benefit. After a median follow-up of 65.0 months, TP53 wild-type patients (n = 69) who received cetuximab had a statistically significant better PFS (89.3% vs 65.0% at 5 years; hazard ratio [HR] = 0.23; 95% confidence interval [CI] = 0.07 to 0.78; two-sided P = .02 by Cox regression) and OS (92.7% vs 67.5% at 5 years; HR = 0.16; 95% CI = 0.04 to 0.70; two-sided P = .02 by Cox regression) than TP53 wild-type patients who were treated in the control arm. An interaction between TP53 status and cetuximab effect was found (P <.05) and remained statistically significant after adjusting for statistically significant prognostic factors and KRAS.

Effectiveness and Cost-effectiveness of Outpatient Physiotherapy After Knee Replacement for Osteoarthritis: Study Protocol for a Randomised Controlled Trial

Background: Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design: Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion: This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency.

Carcinoma of unknown primary (CUP); some considerations about pathogenesis and diagnostic strategy, particularly focusing on CUPS pertaining to the Urology

he term "carcinoma of unknown primary" (CUP) defines a malignant condition in which a metastatic cancer is documented in absence of a detectable primary site. It occurs in about 2÷6 % of cancer patients, according to various literature reports. The primary tumor site results indefinable because of several either single or associated factors, even remaining occult at autopsy in 15÷25% of CUP patients. The metastatic spread pattern of CUP is quite unlike that expected for analogous known primary malignancy. For instance, the unknown prostate cancer often metastasizes to the lungs and liver while the its known analogous usually spreads to the bone. Whether certain genetic abnormalities might play a role in determining a CUP condition, it remains undefined. Most CUP are adenocarcinoma, squamous cell carcinoma, either undifferentiated or differentiated carcinoma, whereas less frequently may be sarcoma, melanoma or neuroendocrine tumor. As CUP diagnostic management is concerned, two opposite approach modalities may be adopted, one, named "shotgun modality", consisting in a multiplicity of examinations aimed at achieving the identification of the primary tumor and the other, a nihilistic modality, by adopting tout court a palliative therapy of the metastatic disease. A reasonable intermediate diagnostic strategy consists in undertaking some procedures with a specific target and low cost/benefit ratio. Selected imaging studies, serum tumor markers, immunohistochemical analyses and genetic- molecular examinations on biopsy material allow sometimes to reach the detection of primary malignancies that might be responsive to a potential treatments. Nevertheless, in spite of recent sophisticated -laboratory and imaging progress, CUP remains a strong challenge in clinical oncology.

Multilevel mesh partitioning for optimising subdomain aspect ratio

Multilevel algorithms are a successful class of optimisation techniques which address the mesh partitioning problem for mapping meshes onto parallel computers. They usually combine a graph contraction algorithm together with a local optimisation method which refines the partition at each graph level. To date these algorithms have been used almost exclusively to minimise the cut-edge weight in the graph with the aim of minimising the parallel communication overhead. However it has been shown that for certain classes of problem, the convergence of the underlying solution algorithm is strongly influenced by the shape or aspect ratio of the subdomains. In this paper therefore, we modify the multilevel algorithms in order to optimise a cost function based on aspect ratio. Several variants of the algorithms are tested and shown to provide excellent results.

Load balancing for aspect ratio in adaptive finite element simulations

In parallel adaptive finite element simulations the work load on the individual processors may change frequently. To (re)distribute the load evenly over the processors a load balancing heuristic is needed. Common strategies try to minimise subdomain dependencies by optimising the cutsize of the partitioning. However for certain solvers cutsize only plays a minor role, and their convergence is highly dependent on the subdomain shapes. Degenerated subdomain shapes cause them to need significantly more iterations to converge. In this work a new parallel load balancing strategy is introduced which directly addresses the problem of generating and conserving reasonably good subdomain shapes in a dynamically changing Finite Element Simulation. Geometric data is used to formulate several cost functions to rate elements in terms of their suitability to be migrated. The well known diffusive method which calculates the necessary load flow is enhanced by weighting the subdomain edges with the help of these cost functions. The proposed methods have been tested and results are presented.

Multilevel mesh partitioning for aspect ratio

Multilevel algorithms are a successful class of optimisation techniques which address the mesh partitioning problem. They usually combine a graph contraction algorithm together with a local optimisation method which refines the partition at each graph level. To date these algorithms have been used almost exclusively to minimise the cut-edge weight, however it has been shown that for certain classes of solution algorithm, the convergence of the solver is strongly influenced by the subdomain aspect ratio. In this paper therefore, we modify the multilevel algorithms in order to optimise a cost function based on aspect ratio. Several variants of the algorithms are tested and shown to provide excellent results.

Análise experimental e numérica do comportamento de estruturas de solo reforçado com geossintéticos : solo granular versus fino

As estruturas de solo reforçado com geossintéticos são normalmente constituídas por solos granulares com boas propriedades físicas e mecânicas. O uso de apenas este tipo de solos pode proporcionar o aumento, por vezes insustentável, do custo da execução das estruturas e o aumento do seu impacto ambiental. Deste modo, as estruturas de solo reforçado perdem a sua vantagem competitiva em relação a outros tipos de estruturas (muros de betão, muros de gravidade, muros de gabiões, etc.). Para resolver este problema podem ser utilizados outros tipos de solos (solos locais, finos, com propriedades físicas e mecânicas piores mas, no entanto, mais baratos) para a execução deste tipo de estruturas. De forma geral, com este estudo pretendeu-se contribuir para o incremento do conhecimento sobre a utilização de solos finos para a construção de estruturas de solo reforçado (muros e taludes). Para tal avaliaram-se as diferenças no comportamento mecânico dos materiais compósitos (solo granular reforçado versus solo fino reforçado) e das estruturas de solo reforçado constituídas com os dois tipos de solos. Assim, os objetivos deste estudo foram avaliar: a influência de vários parâmetros nas propriedades mecânicas e na capacidade de carga dos solos reforçados com geossintéticos; a influência de vários parâmetros no dimensionamento das estruturas de solo reforçado; e o comportamento das estruturas dimensionadas (incluindo a estabilidade global e a influência do processo construtivo) recorrendo a uma ferramenta numérica (PLAXIS). Para cumprir os objetivos propostos foram realizadas análises experimentais em laboratório (análise do comportamento do solo reforçado através de ensaios triaxiais e de California Bearing Ratio) e análises numéricas (dimensionamento de estruturas de solo reforçado; modelação numérica do comportamento através de uma ferramenta numérica comercial com o método dos elementos finitos). Os resultados dos ensaios experimentais mostraram que o comportamento mecânico e a capacidade de carga do solo foram incrementados com a inclusão das camadas de geossintético. Este efeito variou com os diversos parâmetros analisados mas, de forma geral, foi mais importante no solo fino (solo com propriedades mecânicas piores). As análises numéricas mostraram que as estruturas de solo fino precisaram de maior densidade de reforços para serem estáveis. Além disso, as estruturas de solo fino foram mais deformáveis e o efeito do seu processo construtivo foi mais importante (principalmente para estruturas de solo fino saturado).