Evaluation of the economic costs and benefits of methods for reducing nutrient loads to the Gulf of Mexico: Topic 6 Report for the Integrated Assessment on Hypoxia in the Gulf of Mexico.

In this report we analyze the Topic 5 report’s recommendations for reducing nitrogen losses to the Gulf of Mexico (Mitsch et al. 1999). We indicate the relative costs and cost-effectiveness of different control measures, and potential benefits within the Mississippi River Basin. For major nonpoint sources, such as agriculture, we examine both national and basin costs and benefits. Based on the Topic 2 economic analysis (Diaz and Solow 1999), the direct measurable dollar benefits to Gulf fisheries of reducing nitrogen loads from the Mississippi River Basin are very limited at best. Although restoring the ecological communities in the Gulf may be significant over the long term, we do not currently have information available to estimate the benefits of such measures to restore the Gulf’s long-term health. For these reasons, we assume that measures to reduce nitrogen losses to the Gulf will ultimately prove beneficial, and we concentrate on analyzing the cost-effectiveness of alternative reduction strategies. We recognize that important public decisions are seldom made on the basis of strict benefit–cost analysis, especially when complete benefits cannot be estimated. We look at different approaches and different levels of these approaches to identify those that are cost-effective and those that have limited undesirable secondary effects, such as reduced exports, which may result in lost market share. We concentrate on the measures highlighted in the Topic 5 report, and also are guided by the source identification information in the Topic 3 report (Goolsby et al. 1999). Nonpoint sources that are responsible for the bulk of the nitrogen receive most of our attention. We consider restrictions on nitrogen fertilizer levels, and restoration of wetlands and riparian buffers for denitrification. We also examine giving more emphasis to nitrogen control in regions contributing a greater share of the nitrogen load.

Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

The purpose, costs and benefits of fish introductions: with specific reference to the great lakes of Africa

A reduction in native fish stocks and the need to increase fish production for food, recreation, ornamental purposes and to control disease vectors and weeds have often justified and led to introduction of non-native fishes. Some of these introductions have been followed by benefitial and others by undesirable consequences. For instance introduction of the Nile perch Lates niloticus L. and several tilapiine species into lakes Victoria and Kyoga, and the clupeid Limnothrissa miodon into lakes Kariba and Kivu have resulted in increases in the quantity of fish available to the people around them. Predation by Nile perch and competition with introduced tilapiine species in lakes victoria and Kyoga have caused a severe decline and in some cases total disappearance of many of the native fish species.therefore the concern about fish introductions arises

How much do we spend to save? Calculating the embodied carbon costs of retrofit

The drive to reduce carbon emissions from domestic housing has led to a recent shift of focus from new-­‐build to retrofit. However there are two significant differences. Firstly more work is needed to retrofit existing housing to the same energy efficiency standards as new-­‐build. Secondly the remaining length of service life is potentially shorter. This implies that the capital expenditure – both financial and carbon -­‐ of retrofit may be disproportionate to the savings gained over the remaining life. However the Government’s definition of low and zero carbon continues to exclude the capital (embodied) carbon costs of construction, which has resulted in a lack of data for comparison. The paper addresses this gap by reporting the embodied carbon costs of retrofitting four individual pilot properties in Rampton Drift, part of an Eco-­‐Town Demonstrator Project in Cambridgeshire. Through collecting details of the materials used and their journeys from manufacturer to site, the paper conducts a ‘cradle-­‐to-­‐gate’ life cycle carbon assessment for each property. The embodied carbon figures are calculated using a software tool being developed by the Centre for Sustainable Development at the University of Cambridge. The key aims are to assess the real embodied carbon costs of retrofit of domestic properties, and to test the new tool; it is hoped that the methodology, the tool and the specific findings will be transferable to other projects. Initial changes in operational energy as a result of the retrofit works will be reported and compared with the embodied carbon costs when presenting this paper.

Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

Risk based lifetime costs assessment of a ground source heat pump (GSHP) system design: Methodology and case study

Space heating accounts for a large portion of the world's carbon dioxide emissions. Ground Source Heat Pumps (GSHPs) are a technology which can reduce carbon emissions from heating and cooling. GSHP system performance is however highly sensitive to deviation from design values of the actual annual energy extraction/rejection rates from/to the ground. In order to prevent failure and/or performance deterioration of GSHP systems it is possible to incorporate a safety factor in the design of the GSHP by over-sizing the ground heat exchanger (GHE). A methodology to evaluate the financial risk involved in over-sizing the GHE is proposed is this paper. A probability based approach is used to evaluate the economic feasibility of a hypothetical full-size GSHP system as compared to four alternative Heating Ventilation and Air Conditioning (HVAC) system configurations. The model of the GSHP system is developed in the TRNSYS energy simulation platform and calibrated with data from an actual hybrid GSHP system installed in the Department of Earth Science, University of Oxford, UK. Results of the analysis show that potential savings from a full-size GSHP system largely depend on projected HVAC system efficiencies and gas and electricity prices. Results of the risk analysis also suggest that a full-size GSHP with auxiliary back up is potentially the most economical system configuration. © 2012 Elsevier Ltd.

A global model for effective use and evaluation of e-learning in health.

Healthcare systems worldwide face a wide range of challenges, including demographic change, rising drug and medical technology costs, and persistent and widening health inequalities both within and between countries. Simultaneously, issues such as professional silos, static medical curricula, and perceptions of "information overload" have made it difficult for medical training and continued professional development (CPD) to adapt to the changing needs of healthcare professionals in increasingly patient-centered, collaborative, and/or remote delivery contexts. In response to these challenges, increasing numbers of medical education and CPD programs have adopted e-learning approaches, which have been shown to provide flexible, low-cost, user-centered, and easily updated learning. The effectiveness of e-learning varies from context to context, however, and has also been shown to make considerable demands on users' motivation and "digital literacy" and on providing institutions. Consequently, there is a need to evaluate the effectiveness of e-learning in healthcare as part of ongoing quality improvement efforts. This article outlines the key issues for developing successful models for analyzing e-health learning.