Improving Cost-Efficiency and Reducing Environmental Impacts of Intermodal Transportation with Dry Port Concept – Major Rail Transport Corridor in Baltic Sea Region

Transportation plays a major role in the gross domestic product of various nations. There are, however, many obstacles hindering the transportation sector. Cost-efficiency along with proper delivery times, high frequency and reliability are not a straightforward task. Furthermore, environmental friendliness has increased the importance of the whole transportation sector. This development will change roles inside the transportation sector. Even now, but especially in the future, decisions regarding the transportation sector will be partly based on emission levels and other externalities originating from transportation in addition to pure transportation costs. There are different factors, which could have an impact on the transportation sector. IMO’s sulphur regulation is estimated to increase the costs of short sea shipping in the Baltic Sea. Price development of energy could change the roles of different transport modes. Higher awareness of the environmental impacts originating from transportation could also have an impact on the price level of more polluting transport modes. According to earlier research, increased inland transportation, modal shift and slowsteaming can be possible results of these changes in the transportation sector. Possible changes in the transportation sector and ways to settle potential obstacles are studied in this dissertation. Furthermore, means to improve cost-efficiency and to decrease environmental impacts originating from transportation are researched. Hypothetical Finnish dry port network and Rail Baltica transport corridor are studied in this dissertation. Benefits and disadvantages are studied with different methodologies. These include gravitational models, which were optimized with linear integer programming, discrete-event and system dynamics simulation, an interview study and a case study. Geographical focus is on the Baltic Sea Region, but the results can be adapted to other geographical locations with discretion. Results indicate that the dry port concept has benefits, but optimization regarding the location and the amount of dry ports plays an important role. In addition, the utilization of dry ports for freight transportation should be carefully operated, since only a certain amount of total freight volume can be cost-efficiently transported through dry ports. If dry ports are created and located without proper planning, they could actually increase transportation costs and delivery times of the whole transportation system. With an optimized dry port network, transportation costs can be lowered in Finland with three to five dry ports. Environmental impacts can be lowered with up to nine dry ports. If more dry ports are added to the system, the benefits become very minor, i.e. payback time of investments becomes extremely long. Furthermore, dry port network could support major transport corridors such as Rail Baltica. Based on an analysis of statistics and interview study, there could be enough freight volume available for Rail Baltica, especially, if North-West Russia is part of the Northern end of the corridor. Transit traffic to and from Russia (especially through the Baltic States) plays a large role. It could be possible to increase transit traffic through Finland by connecting the potential Finnish dry port network and the studied transport corridor. Additionally, sulphur emission regulation is assumed to increase the attractiveness of Rail Baltica in the year 2015. Part of the transit traffic could be rerouted along Rail Baltica instead of the Baltic Sea, since the price level of sea transport could increase due to the sulphur regulation. Both, the hypothetical Finnish dry port network and Rail Baltica transport corridor could benefit each other. The dry port network could gain more market share from Russia, but also from Central Europe, which is the other end of Rail Baltica. In addition, further Eastern countries could also be connected to achieve higher potential freight volume by rail.

Economic Burden of Psoriasis

Psoriasis may cause a substantial economic burden to patients, health service providers, third parties, and the society as a whole. However, all of these costs may not be adequately considered when assessing the treatment costs for psoriasis. Psoriasis may negatively affect work productivity as psoriasis has a relatively high incidence in working age people that lead to possible costs because of lost productivity. The aims of this thesis were to estimate the economic burden of psoriasis particularly from patients’ and health service providers’ perspectives and to estimate the background factors (e.g., severity of psoriasis) that may have led to high costs. Another aim was to estimate the total medication costs and to estimate psoriasis’ proportion of health-related productivity losses. The patient sample was based on patients with psoriasis who visited the Department of Dermatology in Turku University Hospital during a one-year study period. These patients were sent a questionnaire. From the patients who gave consent, medication information, clinical information, and number of visits to Turku University Hospital were collected. This data was linked to the information from the questionnaire. Overall psoriasis was estimated to cause a substantial economic burden for the patient, health service provider, health insurance system, employer, and the society as a whole. The direct costs represented only a small proportion of the overall financial burden of psoriasis, whereas indirect costs were significant. The estimated annual costs for patients and employers were almost twice the costs to health service providers or the Social Insurance Institution of Finland. In conclusion, the cost contribution of patients and employers should be considered when assessing the costs of different treatments, in addition to commonly studied direct costs of medications and costs to health service providers. Methods used to assess these costs should be well justified and be described clearly to allow comparisons between studies and to evaluate the quality of the results.

Developing cost of poor quality calculations with emphasis on business impact

The main aim of this research was to develop cost of poor quality calculation model which will better reflect business impacts of lost productivity caused by IT incidents for the case company. This objective was pursued by reviewing literature and conducting a study in a Finnish multinational manufacturing company. Broad analysis of the scientific literature allowed to identify main theories and models of Cost of Poor Quality and provided better base for development of measurements of business impacts of lost productivity. Empirical data was gathered with semi-structured interviews and internet based survey. In total, twelve interviews with experts and 39 survey results from business stakeholders were gathered. Main results of empirical study helped to develop the measurement model of cost of poor quality and it was tied to incident priority matrix. Nevertheless, the model was created based on available data. Main conclusions of the thesis were that cost of poor quality measurements could be even further improved if additional data points could be used. New model takes into consideration different cost regions and utilizes on this notion.

Les admissions hospitalières pour les infections urinaires: tendances temporelles, fardeau économique et facteurs prédicateurs de mauvaise évolution des patients

Résumé Introduction: Les infections urinaires (IU) sont les infections bactériennes les plus fréquentes chez les patients hospitalisés. Cette étude décrit les tendances temporelles d'admission et de mortalité liées aux hospitalisations pour les IU, ainsi que le fardeau économique associé. Les prédicteurs de mauvaise évolution clinique et de mortalité sont examinés par la suite. Méthodes: Les données ont été extraites à partir de la base de données du NIS entre le 1er janvier 1998 et le 31 décembre 2010. 1,717,181 hospitalisations liées aux IU ont été retenues. L'incidence et la mortalité ont été calculées et stratifiées selon le sexe, l'âge et la présence de sepsis. Les frais médians et totaux pour les hospitalisations sont calculés et ajustés pour l'inflation. Finalement, les prédicteurs d'avoir un sepsis induit par les IU et de mortalité sont examinés avec une analyse par régression logistique multivariée. Résultats: L'incidence globale d'hospitalisation et la mortalité associées aux IU voit une croissance annuel estimé (EAPC) de +4.764 et +4.610 respectivement (p<0.0001). L'augmentation d'incidence est le plus marquée pour les patients âgés de 55 à 64 ans (EAPC = +7.805; p<0.0001). Les frais médians par hospitalisation ont augmenté de $10 313 en 1998 à $21 049 en 2010 (EAPC +9.405; p<0.0001). Les frais globaux pour les hospitalisations des IU ont augmenté de $8.9 milliard en 1998 à $33.7 milliard en 2010 (EAPC +0.251; p<0.0001). Les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité (p<0.0001). Conclusion: L'incidence et la mortalité associées aux IU ont augmenté au cours de la dernière décennie. Les frais médians ajustés pour l'inflation ainsi que les frais globaux ont augmenté progressivement au cours de la période d'étude. Dans la cohorte étudiée, les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité. Ces données représentent des indicateurs de qualité de soins qui pourraient permettre d'adapter certaines politiques de soins de santé aux besoins des sous-populations plus vulnérables.

Analyse comparative de la pauvreté et de la structure de consommation des ménages dans la principale agglomération des Etats membres de l’UEMOA en 2008

L’objectif de cette étude est de réaliser une analyse comparative de la pauvreté et de la structure de consommation des ménages des capitales des Etats membres de l’Union Economique et Monétaire Ouest Africaine (UEMOA) à partir des données des enquêtes dépenses des ménages (EDM) réalisées en 2008 dans ces agglomérations. En s’appuyant sur l’approche monétaire de la pauvreté mise en oeuvre par la méthode du coût des besoins essentiels, il ressort que plus d’un ménage sur 10, soit 10,5% de l’ensemble de la population étudiée vit sous le seuil de pauvreté estimé à 277450 F CFA de dépenses annuelles par unité de consommation. Le test de dominance stochastique de 1er ordre confirme que l’ampleur du phénomène est en moyenne plus importante dans les villes sahéliennes (Bamako, Niamey, Ouagadougou) que dans les grandes villes côtières (Abidjan, Dakar, Lomé). Par ailleurs, l’analyse économétrique révèle que la taille du ménage et le capital humain du chef de ménage sont des déterminants importants du niveau de vie monétaire des ménages. En effet, tandis que le risque de pauvreté est plus élevé chez les ménages de grande taille, le niveau de vie d’un ménage est d’autant plus élevé que le niveau d’instruction du chef est important. En outre, on observe que dans les agglomérations où le taux de pauvreté est le plus élevé, les ménages accordent un poids plus élevé aux dépenses alimentaires. Enfin, l’estimation des élasticités dépenses totales de la demande à l’aide d’une régression linéaire suggère qu’en moyenne, les besoins de consommation insatisfaits par les ménages portent sur les services (les transports, la communication, la santé, l’éducation et les loisirs).

Studies on the macrobenthos of mudbanks of Southwest cost of India

The present study was undsrtaken.with the objectives to assess the distribution and density of population of benthic animals with special reference to macrofauna from the south west coast of India from ' Malippursa 1 in the north to Alleppey in the south, to evaluate significant difference, if any, in the number and distribution of animals in th md bank regions and other intermittent stations, to examine the influence of bottom stability on the distribution of fauna, to observe the effect of the environmental parameters on the distribution pattern of nacrofauna, and to evaluate the nature and depthpwise distribution of the benthic fishery. The region selected for the investigation is one of the nest important fishing grounds in India for bottom fishing especially for prawns, covering a distance of about 60 kns in length.total number of thirty stations in five transects at right angles to the coast, each consisting of six stations were surveyed. The six stations in a transect were at depths of 5 m, 10m, 20:, 30:, 35m and 45m respectively formation of the Iudbanke, popularly known as 'Ghaknra' in the local language, is a peculiar phenomenon along the ooaet of Kerala and provides a good fishing ground.quantitative distribution of the mecrofauna chewed that the maximum number of organism was near the 35 n contour line in the first three profiles whereas in the fourth and fifth profiles it was at 20 n and 30 m depth respectively. The density of the fauna wee comparatively poor in shallow water etatione at depths 5-‘IO M.was a general decline in the numerical abundance and biomass of the bottom fauna in all the stations during the monsoon period. There has been very little yearly change in the composition of the fauna during the two years‘ study.

Biopsia por congelación para diagnóstico de infección en revisión de reemplazo total de cadera

En estados unidos se realizaron 200.000 reemplazos de cadera en el 2001, de los cuales 36.000 fueron cirugías de revisión. La incidencia de infección en primarios es del 1% mientras que en revisión es 4% . Es determinante detectar la presencia o no de infección, sin embargo no existe una prueba 100% sensible ni 100% especifica. El cultivo intraoperatorio es el patrón de oro, pero inoportuno para tomar decisiones intraoperatorias. La biopsia por congelación es un estudio histopatológico que ayuda a determinar infección intraoperatoria.

El costo de la atención ambulatoria del lupus eritematoso sistémico en Colombia. Contrastes y comparaciones con otras poblaciones.

Introducción: el lupus eritematoso sistémico (LES) es considerado una enfermedad de alto costo. La expresión clínica de la enfermedad depende de la ubicación geografía y la etnicidad. El objetivo de este estudio fue el calcular los costos ambulatorios relacionado al LES en una cohorte colombiana, identificar los predictores de costos y comparar nuestro resultados con otras poblaciones. Métodos: Se realizó una aproximación de tipo prevalencia en 100 pacientes LES en quienes se evaluaron los costos directos médicos, directos no médicos, indirectos e intangibles. Todos los costos médicos fueron evaluados usando una metodología abajo hacia arriba. Los costos directos fueron valorados desde una perspectiva social usando una metodología de micro-costeo. Los costos indirectos se evaluaron mediante una aproximación de capital humano, y los costos intangibles calculados a partir de los años de vida ajustados por calidad (AVAC). Se analizaron los datos por medio de un análisis multivariado. Para comparaciones con otras poblaciones todos los costos fueron expresados como la razón entre los costos y producto interno bruto nacional per cápita. Resultados: La media de costos totales fue 13.031±9.215 USD (ajustados por el factor de conversión de paridad del poder adquisitivo), lo cual representa el 1,66 del PIB per capita de Colombia. Los costos directos son el 64% de los costos totales. Los costos médicos representan el 80% de los costos directos,. Los costos indirectos fueron el 10% y los costos intangibles el 25% de los costos totales. Los medicamentos representaron el 45% de los costos directos. Mayores costos se relacionaron con el estrato socioeconómico, seguro médico privado, AVAC, alopecia, micofenolato mofetilo, y terapia anticoagulante. Los costos directos ajustados de los pacientes con LES en Colombia fueron mayores que en Norte América y en Europa. Conclusiones: el LES impone una carga económica importante para la sociedad. Los costos relacionados con la atención médica y AVAC fueron los principales contribuyentes al alto costo de la enfermedad. Estos resultados pueden ser referencia para determinar políticas en salud pública así como comparar el gasto en salud de forma internacional.

Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Eficiencia de los sistema de salud en los países de América Latina y del Caribe desde el indicador de esperanza de vida al nacer para los años 1990 y 2012 frente al gasto total en salud como porcentaje del producto interno bruto para el año 1995 y 2012 “una oportunidad de brenchmarking para el sistema de protección social colombiano”

Para los países emergentes en América Latina y El Caribe se hace necesario determinar la eficiencia de su sistema de salud para generar beneficios a su población desde el indicador de esperanza de vida al nacer y los recursos que se hacen uso desde Colombia en comparación con sus homólogos. Se evidencia que a pesar de Colombia poseer una economía fuerte durante el análisis de los dos momentos se mantiene en la tendencia general de los demás países y con los mismos resultados del indicador. A su vez se concluye que el momento en que se tomaron las decisiones de cambio del sistema de salud es un factor diferenciador en los resultados obtenidos como fue el caso de Costa Rica identificado con el de mejor desempeño en la relación Indicador de esperanza de vida al nacer y Porcentaje de gasto en salud como parte del Producto interno bruto.

Productivity, labour cost and export adjustment: Detailed results for 24 EU countries. Bruegel Working Paper 2012/11, 12 July 2012

As a background document for Bruegel Policy Contribution 2012/11 ‘Compositional effects on productivity, labour cost and export adjustment’, this working paper presents detailed results for 24 EU countries on: • The sectoral changes in the economy; • The unit labour costs (ULC) based real effective exchange rate (REER) and its main components; • Export performance. • The ULC-REERs are calculated: • For the total economy, the business sector (excluding agriculture, construction and real estate activities), and some main sectors; • Using both actual aggregates and fixed-weight aggregates, as the latter are free from the impacts of compositional changes; • Against 30 trading partners and against three subsets of trading partners: euro-area, non-euro area EU, non-EU.

Costs of Reproduction in Breeding Female Mallards: Predation Risk during Incubation Drives Annual Mortality

The effort expended on reproduction may entail future costs, such as reduced survival or fecundity, and these costs can have an important influence on life-history optimization. For birds with precocial offspring, hypothesized costs of reproduction have typically emphasized nutritional and energetic investments in egg formation and incubation. We measured seasonal survival of 3856 radio-marked female Mallards (Anas platyrhynchos) from arrival on the breeding grounds through brood-rearing or cessation of breeding. There was a 2.5-fold direct increase in mortality risk associated with incubating nests in terrestrial habitats, whereas during brood-rearing when breeding females occupy aquatic habitats, mortality risk reached seasonal lows. Mortality risk also varied with calendar date and was highest during periods when large numbers of Mallards were nesting, suggesting that prey-switching behaviors by common predators may exacerbate risks to adults in all breeding stages. Although prior investments in egg laying and incubation affected mortality risk, most relationships were not consistent with the cost of reproduction hypothesis; birds with extensive prior investments in egg production or incubation typically survived better, suggesting that variation in individual quality drove both relationships. We conclude that for breeding female Mallards, the primary cost of reproduction is a fixed cost associated with placing oneself at risk to predators while incubating nests in terrestrial habitats.

Institutional sustainability: at what price? UNDP and the new cost-sharing model in Brazil

By the turn of the twenty-first century, UNDP had embraced a new form of funding based on ‘cost-sharing’, with this source accounting for 51 per cent of the organisation’s total expenditure worldwide in 2000. Unlike the traditional donor - recipient relationship so common with development projects, the new cost-sharing modality has created a situation whereby UNDP local offices become ‘subcontractors’ and agencies of the recipient countries become ‘clients’. This paper explores this transition in the context of Brazil, focusing on how the new modality may have compromised UNDP’s ability to promote Sustainable Human Development, as established in its mandate. The great enthusiasm for this modality within the UN system and its potential application to other developing countries increase the importance of a systematic assessment of its impact and developmental consequences.

Uncertainties in annual riverine phosphorus load estimation: Impact of load estimation methodology, sampling frequency, baseflow index and catchment population density

Models developed to identify the rates and origins of nutrient export from land to stream require an accurate assessment of the nutrient load present in the water body in order to calibrate model parameters and structure. These data are rarely available at a representative scale and in an appropriate chemical form except in research catchments. Observational errors associated with nutrient load estimates based on these data lead to a high degree of uncertainty in modelling and nutrient budgeting studies. Here, daily paired instantaneous P and flow data for 17 UK research catchments covering a total of 39 water years (WY) have been used to explore the nature and extent of the observational error associated with nutrient flux estimates based on partial fractions and infrequent sampling. The daily records were artificially decimated to create 7 stratified sampling records, 7 weekly records, and 30 monthly records from each WY and catchment. These were used to evaluate the impact of sampling frequency on load estimate uncertainty. The analysis underlines the high uncertainty of load estimates based on monthly data and individual P fractions rather than total P. Catchments with a high baseflow index and/or low population density were found to return a lower RMSE on load estimates when sampled infrequently than those with a tow baseflow index and high population density. Catchment size was not shown to be important, though a limitation of this study is that daily records may fail to capture the full range of P export behaviour in smaller catchments with flashy hydrographs, leading to an underestimate of uncertainty in Load estimates for such catchments. Further analysis of sub-daily records is needed to investigate this fully. Here, recommendations are given on load estimation methodologies for different catchment types sampled at different frequencies, and the ways in which this analysis can be used to identify observational error and uncertainty for model calibration and nutrient budgeting studies. (c) 2006 Elsevier B.V. All rights reserved.

Simulation of the impact of high temperature stress on annual crop yields

Brief periods of high temperature which occur near flowering can severely reduce the yield of annual crops such as wheat and groundnut. A parameterisation of this well-documented effect is presented for groundnut (i.e. peanut; Arachis hypogaeaL.). This parameterisation was combined with an existing crop model, allowing the impact of season-mean temperature, and of brief high-temperature episodes at various times near flowering, to be both independently and jointly examined. The extended crop model was tested with independent data from controlled environment experiments and field experiments. The impact of total crop duration was captured, with simulated duration being within 5% of observations for the range of season-mean temperatures used (20-28 degrees C). In simulations across nine differently timed high temperature events, eight of the absolute differences between observed and simulated yield were less than 10% of the control (no-stress) yield. The parameterisation of high temperature stress also allows the simulation of heat tolerance across different genotypes. Three parameter sets, representing tolerant, moderately sensitive and sensitive genotypes were developed and assessed. The new parameterisation can be used in climate change studies to estimate the impact of heat stress on yield. It can also be used to assess the potential for adaptation of cropping systems to increased temperature threshold exceedance via the choice of genotype characteristics. (c) 2005 Elsevier B.V. All rights reserved.