790 resultados para Health economic evaluation
Resumo:
This work studies the development of polymer membranes for the separation of hydrogen and carbon monoxide from a syngas produced by the partial oxidation of natural gas. The CO product is then used for the large scale manufacture of acetic acid by reaction with methanol. A method of economic evaluation has been developed for the process as a whole and a comparison is made between separation of the H2/CO mixture by a membrane system and the conventional method of cryogenic distillation. Costs are based on bids obtained from suppliers for several different specifications for the purity of the CO fed to the acetic acid reactor. When the purity of the CO is set at that obtained by cryogenic distillation it is shown that the membrane separator offers only a marginal cost advantage. Cost parameters for the membrane separation systems have been defined in terms of effective selectivity and cost permeability. These new parameters, obtained from an analysis of the bids, are then used in a procedure which defines the optimum degree of separation and recovery of carbon monoxide for a minimum cost of manufacture of acetic acid. It is shown that a significant cost reduction is achieved with a membrane separator at the optimum process conditions. A method of "targeting" the properties of new membranes has been developed. This involves defining the properties for new (hypothetical -yet to be developed) membranes such that their use for the hydrogen/carbon monoxide separation will produce a reduced cost of acetic acid manufacture. The use of the targeting method is illustrated in the development of new membranes for the separation of hydrogen and carbon monoxide. The selection of polymeric materials for new membranes is based on molecular design methods which predict the polymer properties from the molecular groups making up the polymer molecule. Two approaches have been used. One method develops the analogy between gas solubility in liquids and that in polymers. The UNIFAC group contribution method is then used to predict gas solubility in liquids. In the second method the polymer Permachor number, developed by Salame, has been correlated with hydrogen and carbon monoxide permeabilities. These correlations are used to predict the permeabilities of gases through polymers. Materials have been tested for hydrogen and carbon monoxide permeabilities and improvements in expected economic performance have been achieved.
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A fluidized bed process development unit of 0.8 m internal diameter was designed on basis of results obtained from a bench scale laboratory unit. For the scaling up empirical models from the literature were used. The process development unit and peripheral equipment were constructed, assembled and commissioned, and instruments were provided for data acquisition. The fluidization characteristics of the reactor were determined and were compared to the design data. An experimental programme was then carried out and mass and energy balances were made for all the runs. The results showed that the most important independent experimental parameter was the air factor, with an optimum at 0.3. The optimum higher heating value of the gas produced was 6.5 MJ/Nm3, while the thermal efficiency was 70%. Reasonably good agreement was found between the experimental results, theoretical results from a thermodynamic model and data from the literature. It was found that the attainment of steady state was very sensitive to a continuous and constant feedstock flowrate, since the slightest variation in feed flow resulted in fluctuations of the gas quality. On the basis of the results a set of empirical relationships was developed, which constitutes an empirical model for the prediction of the performance of fluidized bed gasifiers. This empirical model was supplemented by a design procedure by which fluidized bed gasifiers can be designed and constructed. The design procedure was then extended to cover feedstock feeding and gas cleaning in a conceptual design of a fluidized bed gasification facility. The conceptual design was finally used to perform an economic evaluation of a proposed gasification facility. The economics of this plant (retrofit application) were favourable.
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Despite the considerable potential of advanced manufacturing technologies (AMT) for improving the economic performance of many firms, a growing body of literature highlights many instances where realising this potential has proven to be a more difficult task than initially envisaged. Focussing upon the implementation of new manufacturing technologies in several smaller to medium sized enterprises (SME), the research examines the proposition that many of these problems can be attributed in part to inadequate consideration of the integrated nature of such technologies, where the effects of their implementation are not localised, but are felt throughout a business. The criteria for the economic evaluation of such technologies are seen as needing to reflect this, and the research develops an innovative methodology employing micro-computer based spreadsheets, to demonstrate how a series of financial models can be used to quantify the effects of new investments upon overall company performance. Case studies include: the development of a prototype machine based absorption costing system to assist in the evaluation of CNC machine tool purchases in a press making company; the economics and strategy of introducing a flexible manufacturing system for the production of ballscrews; and analysing the progressive introduction of computer based printing presses in a packaging and general print company. Complementary insights are also provided from discussion with the management of several other companies which have experienced technological change. The research was conducted as a collaborative CASE project in the Interdisciplinary Higher Degrees Scheme and was jointly funded by the SERC and Gaydon Technology Limited and later assisted by PE-Inbucon. The findings of the research shows that the introduction of new manufacturing technologies usually requires a fundamental rethink of the existing practices of a business. In particular, its implementation is seen as ideally needing to take place as part of a longer term business and manufacturing strategy, but that short term commercial pressures and limited resources often mean that firms experience difficulty in realising this. The use of a spreadsheet based methodology is shown to be of considerable assistance in evaluating new investments, and is seen as being the limit of sophistication that a smaller business is willing to employ. Several points for effective modelling practice are also given, together with an outline of the context in which a modelling approach is most applicable.
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The use of the pyrolysis process to obtain valuable products from biomass is amongst the technologies being investigated as a source for renewable energy. The pyrolysis process yields products such as biochar, bio-oil and non condensable gases. The main objective of this project is to increase energy recovery from sewage sludge by utilising the intermediate pyrolysis process. The intermediate pyrolysis has a residence time ranging from 5 to 10 minutes. The main product yields from sewage sludge pyrolysis are 50 wt% biochar, 40 wt% bio-oil and 10 wt% non condensable gases. The project was carried out on a pilot plant scale reactor with a load capacity of 20 kg/h. This enabled a high yield of biochar and bio-oil. The characterisation of the products indicated that the organic phase of the bio-oil had good fuel properties such as having high energy content of 39 MJ/kg, low acid number of 21.5, high flash point of 150 and viscosity of 35 cSt. An increase in pyrolysis experiments enabled large quantities of pyrolysis oil production. Co-pyrolysis of sewage sludge was carried out on laboratory scale with mixed wood, rapeseed and straw. It found that there was an increase in bio-oil quantity with rapeseed while co-pyrolysis with wood helped to mask the smell of the sludge pyrolysis oil. Engine test were successfully carried out in an old Lister engine with pyrolysis oil fractions of 30% and 50% blended with biodiesel. This indicates that these pyrolysis oil fractions can be used in similar engine types without any problems however long term effects in ordinary engines are unknown. An economic evaluation was carried out about the implementation of the intermediate pyrolysis process for electricity production in a CHP using the pyrolysis oil. The prices of electricity per kWh were found to be very high.
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Background - The loss of cholinergic, dopaminergic and noradrenergic innervations seen in Parkinson's Disease Dementia (PDD) suggest a potential role for cholinesterase inhibitors. Concerns have been expressed about a theoretical worsening of Parkinson's disease related symptoms, particularly movement symptoms. Objectives - To assess the efficacy, safety, tolerability and health economic data relating to the use of cholinesterase inhibitors in PDD. Search methods - The trials were identified from the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 19 April 2005 using the search term parkinson*. This register contains records from major health care databases and many ongoing trial databases and is updated regularly. Comprehensive searches of abstracts from major scientific meetings were performed. Pharmaceutical companies were approached for information regarding additional and ongoing studies. Selection criteria - Randomized, double-blind, placebo-controlled studies assessing the effectiveness of cholinesterase inhibitors in PDD. Inclusion and exclusion criteria were stated to limit bias. Data collection and analysis - Two reviewers (IM, CF) independently reviewed the quality of the studies utilizing criteria from the Cochrane Collaboration Handbook. Medications were examined separately and as a group. The outcome measures assessed were in the following domains: neuropsychiatric features, cognition, global impression, daily living activities, quality of life, burden on caregiver, Parkinsonian related symptoms, treatment acceptability as determined by withdrawal from trials, safety as determined by the frequency of adverse events, institutionalisation, death and health economic factors. Main results - A detailed and systematic search of relevant databases identified one published randomized, double-blind, placebo-controlled study (Emre 2004) involving 541 patients that compared rivastigmine with placebo. Rivastigmine produced statistically significant improvements in several outcome measures. On the primary cognitive measure, the ADAS-Cog, rivastigmine was associated with a 2.80 point ADAS-Cog improvement [WMD -2.80, 95% Cl -4.26 to -1.34, P = 0.0002] and a 2.50 point ADCS-ADL improvement [95% Cl 0.43 to 4.57, P = 0.02] relative to placebo. Clinically meaningful (moderate or marked) improvement occurred in 5.3% more patients on rivastigmine, and meaningful worsening occurred in 10.1% more patients on placebo. Tolerability appeared to be a significant issue. Significantly more patients on rivastigmine dropped out of the study due to adverse events [62/362 versus 14/179, OR 2.44, 95% Cl 1.32 to 4.48, P = 0.004]. Nausea [20/179 versus 105/362, OR 3.25, 95% Cl 1.94 to 5.45, P < 0.00001], tremor [7/179 versus 37/362, OR 2.80, 95% Cl 1.22 to 6.41, P = 0.01] and in particular vomiting [3/179 versus 60/362, OR 11.66, 95% Cl 3.60 to 37.72, P < 0.0001] were significantly more common with rivastigmine. However, significantly fewer patients died on rivastigmine than placebo [4/362 versus 7/179, OR 0.27, 95% CI 0.08 to 0.95, P = 0.04] Authors' conclusions - Rivastigmine appears to improve cognition and activities of daily living in patients with PDD. This results in clinically meaningful benefit in about 15% of cases. There is a need for more studies utilising pragmatic measures such as time to residential care facility and both patient and carer quality of life assessments. Future trials should involve other cholinesterase inhibitors, utilise tools to analyse the data that limit any bias and measure health economic factors. It is unlikely that relying solely on the last observation carried forward (LOCF) is sufficient. Publication of the observed case data in the largest trial would assist (Emre 2004). Adverse events were associated with the cholinergic activity of rivastigmine, but may limit patient acceptability as evidenced by the high drop out rate in the active arm.
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In this paper, we describe recent architectural and technological advances of the end to end optical network architecture proposed by the DISCUS project (the DIStributed Core for unlimited bandwidth supply for all Users and Services). The two main targets of DISCUS are the principle of equivalence in the access and the reduction of optical-to-electronic conversions in the metro-core network. Technological advances and techno-economic evaluation of Long-Reach Passive Optical Networks (LR-PON), as well as the optimal metro-core node architecture and the required network control plane framework are reported. Network infrastructure sharing challenges are also discussed. © 2014 IEEE.
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REVIEW QUESTION / OBJECTIVE : The objective of this review is to identify the effectiveness of the interventions in preventing progression of pre-frailty and frailty in older adults. More specifically, the review questions are: - What is the effectiveness of interventions in preventing or reducing frailty in older adults? - How does effectiveness vary with degree of frailty? - Are there factors that influence the effectiveness of interventions? - What is the economic feasibility of interventions for pre-frailty and frailty? INCLUSION CRITERIA : Types of participants This review will consider studies that include older adults (female and male) aged 65 years and over, explicitly identified as pre-frail or frail by the researchers or associated medical professionals according to a pre-specified scale or index, and who have received health care and support services in any type of setting (primary care, nursing homes, hospitals). This review will exclude studies that: - Include participants who have been selected because they have one specific illness - Consider people with a terminal diagnosis only. - Types of intervention(s)/phenomena of interest: The clinical/medical component of the review will consider studies that evaluate any type of interventions to prevent the progression of pre-frailty and frailty in older adults. These interventions will include, but will not be limited to, physical activity, multifactorial intervention, psychosocial intervention, health and social care provision, and cognitive, nutrition or medication/medical maintenance and adherence focused interventions. The economic component of the review will consider studies that have performed any type of health economic analysis of ...
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In recent decades, the collective leadership of the Solidary Economical Enterprises (ESS) that are active in providing collection and recycling services, has been presented as a proposal for the organization of urban space with the creation of new enterprises and solidarity production chains. Are activities that have gained a new stimulus to the creation of the National Secretariat of Solidarity Economy and the National Policy on Solid Waste that assigned a leading role in these social actors. These experiences contribute to building a participatory development path, resembling with the pluralistic perspective of development of the Indian economist Amartya Sen, that goes beyond the simplistic design of the increased income, focusing on the process of expanding freedoms that people enjoy. The aim of this work is to situate the perspective of endogenous development with the Collection Services segment and Material Recycling in the field of Solidarity Economy, through the analysis of the experience of the Cooperative of Selective Collection and Recycling Friends of the planet, located in the municipality of Lauro to Freitas - BA, from 2004 to 2013. for this the following procedures were adopted: analysis of the main contributions of the international literature on the phenomenon of pluriactivity; review of national literature that analyzes the emergence and evolution of the projects of solidarity economy in Brazil; bibliographical and documentary research; and socio-economic evaluation of the EES. The guiding problem of this work, understandably, is: what is the meaning of endogenous perspective with the Materials Collection and Recycling Services segment in the field of Solidarity Economy? It starts with the hypothesis that the development of these practices requires an environment that removes the main sources of deprivation involving the conditions of existence of these enterprises. The results show that not enough development to be built with the participation of social actors, but there are minimally necessary conditions for such experiences can take hold in order to achieve their goals. Thus, not only is it a strictly economic issue, but requires political actions for a process of social transformation.
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Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.
Resumo:
Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.
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This project was funded by National Institute for Health Research (NIHR) Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 20, No. 50. See the NIHR Journals Library website for further project information.
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This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 4, No. 24. See the NIHR Journals Library website for further project information.
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This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.
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Bitumen extraction from surface-mined oil sands results in the production of large volumes of Fluid Fine Tailings (FFT). Through Directive 085, the Province of Alberta has signaled that oil sands operators must improve and accelerate the methods by which they deal with FFT production, storage and treatment. This thesis aims to develop an enhanced method to forecast FFT production based on specific ore characteristics. A mass relationship and mathematical model to modify the Forecasting Tailings Model (FTM) by using fines and clay boundaries, as the two main indicators in FFT accumulation, has been developed. The modified FTM has been applied on representative block model data from an operating oil sands mining venture. An attempt has been made to identify order-of-magnitude associated tailings treatment costs, and to improve financial performance by not processing materials that have ultimate ore processing and tailings storage and treatment costs in excess of the value of bitumen they produce. The results on the real case study show that there is a 53% reduction in total tailings accumulations over the mine life by selectively processing only lower tailings generating materials through eliminating 15% of total mined ore materials with higher potential of fluid fines inventory. This significant result will assess the impact of Directive 082 on mining project economic and environmental performance towards the sustainable development of mining projects.
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Purpose - The roles of ‘conventional’ (fixed-route and fixed-timetable) bus services is examined and compared to demand-responsive services, taking rural areas in England as the basis for comparison. It adopts a ‘rural’ definition of settlements under a population of 10,000. Design/methodology/approach - Evidence from the National Travel Survey, technical press reports and academic work is brought together to examine the overall picture. Findings - Inter-urban services between towns can provide a cost-effective way of serving rural areas where smaller settlements are suitably located. The cost structures of both fixed-route and demand-responsive services indicate that staff time and cost associated with vehicle provision are the main elements. Demand-responsive services may enable larger areas to be covered, to meet planning objectives of ensuring a minimum of level of service, but experience often shows high unit cost and public expenditure per passenger trip. Economic evaluation indicates user benefits per passenger trip of similar magnitude to existing average public expenditure per trip on fixed-route services. Considerable scope exists for improvements to conventional services through better marketing and service reliability. Practical implications - The main issue in England is the level of funding for rural services in general, and the importance attached to serving those without access to cars in such areas. Social implications - The boundary between fixed-route and demand-responsive operation may lie at relatively low population densities. Originality/value - The chapter uses statistical data, academic research and operator experience of enhanced conventional bus services to provide a synthesis of outcomes in rural areas.