Estimation des coûts engendrés par l'occupation inappropriée des lits de soins aigus du CHUV par des patients en attente de placement

[Table des matières] 1. Pourquoi s'intéresser à l'occupation inappropriée des lits de soins aigus au CHUV ?. - 1.1. Etat des lieux. - 1.1.1. Les chiffres du CHUV. - 1.1.2. La cellule de gestion des flux de patients. - 1.1.3. L'unité de patients en attente de placement. - 1.1.4. La pénurie de lits dans les EMS vaudois. - 1.1.5. Le vieillissement de la population vaudoise. - 1.2. Evidences nationales et internationales. - - 2. Estimation des coûts. - 2.1. Coûts chiffrables. - 2.1.1. Perte financière directe. - 2.1.2. Coûts des transferts pour engorgement. - 2.1.3. Coût d'opportunité. - 2.2. Coûts non chiffrables. - 2.2.1. Patients. - 2.2.2. Personnel médical. - 2.2.3. CHUV. - - 3. Propositions. - 3.1. Prises en charge alternatives. - 3.1.1. Les réseaux intégrés de services aux personnes âgées. - 3.1.2. Les courts séjours gériatriques. - 3.1.3. Autres solutions. - 3.2. Prévention. - 3.2.1. Prévention des chutes. - 3.2.2. La prévention par l'information aux personnes âgées. - 3.2.3. La prévention par l'information à l'ensemble de la population

Status of biomass gasification

Kaasutuksen kannattavuus ja toteutustapa on ollut tarkea ja useiden tutkimuksien kohde. Biomassan kaasutuksen ja siina kaytettavien laitteiden nykytila on epavarma. Niinpa lisatutkimukselle ja tarkasteluille on edelleen tarvetta. Tama tyo keskittyy nykyisin kaytettavien kaasutusprosessien ja laitteiden tarkasteluun. Tyossa kaydaan lapi useita uusimpia kaasutusprojekteja ja esitetaan niista tutkimustarpeita. Lisaksi kaasutusprosessissa pitaa saada hallintaan niille tyypillisia ongelmia kuten kaasun puhdistus, kaasun kasittely, biomassan kasittely ja kaasuttimen muuraus, joista esitetaan lisatietoa. Edelleen esitetaan kaasutusprosessien taydellinen luokittelu. On huomattava etta biomassan kaasutusta tarvitaan jotta saadaan toteutettua EUn hahmotteleman ja saataman energiapolitiikan vaatima kasvu ja kehitys.

Fouling tendency in biomass-fired boilers

Although it is well known that firing biomass fuels leads to increased deposition buildup on heat transfer surfaces in boiler compared with firing coal, existing empirical knowledge about combustion of different types of biofuels is limited. The aim of this study is to give greater awareness and understanding of the circumstances which are able to decrease considerably deposition build up on heat transfer surfaces when firing different types of biofuels. The crucial part of this thesis is experimental investigation of fouling tendency while firing biomass fuels, such as straw, bark, and peat having different chemical composition. In order to give comprehensive overview of ash deposition phenomena the number of not less important issues such as mechanisms of ash deposition, effect of fouling on heat transfer, and design of boilers subjected to ash buildup were examined as well. The answers obtained in this study may be a step towards a better knowledge of firing biofuels as separately as in mixtures, and may provide solutions for successful combustion technique of biomass fuels.

Bayesian Estimation of Noise

In mathematical modeling the estimation of the model parameters is one of the most common problems. The goal is to seek parameters that fit to the measurements as well as possible. There is always error in the measurements which implies uncertainty to the model estimates. In Bayesian statistics all the unknown quantities are presented as probability distributions. If there is knowledge about parameters beforehand, it can be formulated as a prior distribution. The Bays’ rule combines the prior and the measurements to posterior distribution. Mathematical models are typically nonlinear, to produce statistics for them requires efficient sampling algorithms. In this thesis both Metropolis-Hastings (MH), Adaptive Metropolis (AM) algorithms and Gibbs sampling are introduced. In the thesis different ways to present prior distributions are introduced. The main issue is in the measurement error estimation and how to obtain prior knowledge for variance or covariance. Variance and covariance sampling is combined with the algorithms above. The examples of the hyperprior models are applied to estimation of model parameters and error in an outlier case.

A correlation sensitivity analysis of non-life underwriting risk in solvency capital requirement estimation

This paper analyses the impact of using different correlation assumptions between lines of business when estimating the risk-based capital reserve, the Solvency Capital Requirement -SCR-, under Solvency II regulations. A case study is presented and the SCR is calculated according to the Standard Model approach. Alternatively, the requirement is then calculated using an Internal Model based on a Monte Carlo simulation of the net underwriting result at a one-year horizon, with copulas being used to model the dependence between lines of business. To address the impact of these model assumptions on the SCR we conduct a sensitivity analysis. We examine changes in the correlation matrix between lines of business and address the choice of copulas. Drawing on aggregate historical data from the Spanish non-life insurance market between 2000 and 2009, we conclude that modifications of the correlation and dependence assumptions have a significant impact on SCR estimation.

Optimised Utilization of Bioenergy in Poland

The aim of the study was to ford out the availability of biomasses, which are available for energy production, in Poland. Biomasses which were examined were forest residues and surplus straw. Availability was examined by 16 Polish voivodeships, which are provinces in Poland. After fording out the amounts of biomasses for energy production was examined the need of biomass in the biggest CHP plants in Poland. It was expected that all the plants uses 15 % of biomass as the fuel. In the first parts of the report are explained the legislation which effects to biomass use in energy production in EU level and in Polish level. Also the combustion methods best for biomasses are explained by examples. After this, is studied the general situation of renewable energy use in Poland and the facts about the country. In the last parts it's explained the calculations and is shown the example cases. When it was found out the needs and supply of biomass it was examined by examples how it could be transported to the plants from the producers. Also was examined costs effected, if there were logistical terminals between the producer and the end user. The estimation was done by setting prices for the biomass, and fording out average costs for producing and transporting biomass. There are a lot of surplus biomasses in Poland which could be used for energy production, and this is a one way to reach the goals that EU has set of renewable energies. But because biomasses doesn't have such a good calorific value, it isn't worth able to transport it very long distances. In the research was set the prices for producer 9€/MWh and for end user 15€/MWh, the maximum transportation distance for forest residues was 52 km and for straw 56 km. These are example estimations and it has to be remembered that there are a lot of factors that makes inaccurate. The model is really sensitive and by changing one parameter the results change a lot.

Feasibility Study and Market Review of Small Scale Bioenergy Heating Plants in North-West Russia

The paper is focused on feasibility study and market review of small scale bioenergy heating plants in the Russian North-West region. The main focus is effective and competitive usage of low-grade wood for heating purposes in the region. As example of economical feasibility estimation it was chosen the project of reconstruction of small scale boiler plant in Leningrad region that Brofta Oy is planning to implement the nearest time. It includes calculation the payback time with and without interest, the estimation of probable investments, the evaluation of possible risks and research on the potential of small scale heating plants projects. Calculations show that the profitability of this kind of projects is high, but payback time is not very short, because of high level of initial investments. Though, the development of small scale bioenergy heating plants in the region is considered to be the best way to solve the problems of heat supply in small settlements using own biomass resources.

Use of Biomass Gasification for Transport

This thesis represents an overview of biomass gasification technology together with some practical aspects of this technology application for transport in Finland. The main aim of this work is an assessment whether this technology is perspective in the nearest future for the wide use on transport or not. The first part of the thesis is a kind of survey of the previous works and materials con-cerning the usage of biomass gasification for transport. The second part concentrates more on the practical moments of its use for mobile applications in Finland (taxation, emissions, etc.).

Utilisation of biomass for energy production in the North-West Russian forest industry

Traditionally, fossil fuels have always been the major sources of the modern energy production. However prices on these energy sources have been constantly increasing. The utilization of local biomass resources for energy production can substitute significant part of the required energy demand in different energy sectors. The introduction of the biomass usage can easily be started in the forest industry first as it possesses biomass in a large volume. The forest industry energy sector has the highest potential for the fast bioenergy development in the North-West Russia. Therefore, the question concerning rational and effective forest resources use is important today as well as the utilization of the forestry by-products. This work describes and analyzes the opportunities of utilising biomass, mainly, in the form of the wood by-products, for energy production processes in general, as well as for the northwest Russian forest industry conditions. The study also covers basic forest industry processes and technologies, so, the reader can get familiar with the information about the specific character of the biomass utilization. The work gives a comprehensive view on the northwest forest industry situation from the biomass utilisation point of view. By presenting existing large-scale sawmills and pulp and paper mills the work provides information for the evaluation of the future development of CHP investments in the northwest Russian forest industry.

Models for the estimation of thermodynamic properties of layered double hydroxides: application to the study of their anion exchange characteristics

Several models for the estimation of thermodynamic properties of layered double hydroxides (LDHs) are presented. The predicted thermodynamic quantities calculated by the proposed models agree with experimental thermodynamic data. A thermodynamic study of the anion exchange process on LDHs is also made using the described models. Tables for the prediction of monovalent anion exchange selectivities on LDHs are provided. Reasonable agreement is found between the predicted and the experimental monovalent anion exchange selectivities.

Estimation of Water Circulation in a Mediterranean Salt Marsh and its Relationship with Flooding Causes

Variations in water volume in small depressions in Mediterranean salt marshes in Girona (Spain) are described and the potential causes for these variations analysed. Although the basins appear to be endorrheic, groundwater circulation is intense, as estimated from the difference between water volume observed and that expected from the balance precipitation / evaporation. The rate of variation in volume (VR = AV / VAt) may be used to estimate groundwater supply ('circulation'), since direct measurements of this parameter are impossible. Volume.conductivity figures can also be used to estimate the quantity of circulation, and to investigate the origin of water supplied to the system. The relationships between variations in the volume of water in the basins and the main causes of flooding are also analysed. Sea storms, rainfall levels and strong, dry northerly winds are suggested as the main causes of the variations in the volumes of basins. The relative importance assigned to these factors has changed, following the recent regulation of freshwater flows entering the system

Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data

During the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions. Methods: Cubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations. Results: We started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975–79, Catalonia 1980–89) and after (USA and Catalonia 1990–2001). Survival in Catalonia in the 1980–89 period was worse than in the USA during 1975–79, but the differences disappeared in 1990–2001. Conclusion: Our results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia

Market of biomass fuels in Finland : IEA Bioenergy Task 40 and EUBIONET III - Country report of Finland 2009

This study considered the current situation of solid and liquid biomass fuels in Finland. The fact that industry consumes more than half of the total primary energy, widely applied combined heat and power production and a high share of solid biomass fuels in the total energy consumption are specific to the Finnish energy system. Wood is the most important source of bioenergy in Finland, representing 20% of the total energy consumption in 2007. Almost 80% of the woodbased energy is recovered from industrial by-products and residues. As a member of the European Union, Finland has committed itself to the Union’s climate and energy targets, such as reducing its overall emissions of green house gases to at least 20% below 1990 levels by 2020, and increasing the share of renewable energy in the gross final consumption. The renewable energy target approved for Finland is 38%. The present National Climate and Energy Strategy was introduced in November 2008. The strategy covers climate and energy policy measures up to 2020, and in brief thereafter, up to 2050. In recent years, the actual emissions have exceeded the Kyoto commitment and the trend of emissions is on the increase. In 2007, the share of renewable energy in the gross final energy consumption was approximately 25% (360 PJ). Without new energy policy measures, the final consumption of renewable energy would increase to 380 PJ, which would be approximately only 31% of the final energy consumption. In addition, green house gas emissions would exceed the 1990 levels by 20%. Meeting the targets will need the adoption of more active energy policy measures in coming years. The international trade of biomass fuels has a substantial importance for the utilisation of bioenergy in Finland. In 2007, the total international trading of solid and liquid biomass fuels was approximately 77 PJ, of which import was 62 PJ. Most of the import is indirect and takes place within the forest industry’s raw wood imports. In 2007, as much as 21% of wood energy was based on foreign-origin wood. Wood pellets and tall oil form the majority of export streams of biomass fuels. The indirect import of wood fuels peaked in 2006 to 61 PJ. The foreseeable decline in raw wood import to Finland will decrease the indirect import of wood fuels. In 2004– 2007, the direct trade of solid and liquid biomass fuels has been on a moderate growth path. In 2007, the import of palm oil and export of bio-diesel emerged, as a large, 170 000 t/yr biodiesel plant came into operation in Porvoo.

Cost estimation framework for modular product

Cost estimation is an important, but challenging process when designing a new product or a feature of it, verifying the product prices given by suppliers or planning a cost saving actions of existing products. It is even more challenging when the product is highly modular, not a bulk product. In general, cost estimation techniques can be divided into two main groups - qualitative and quantitative techniques - which can further be classified into more detailed methods. Generally, qualitative techniques are preferable when comparing alternatives and quantitative techniques when cost relationships can be found. The main objective of this thesis was to develop a method on how to estimate costs of internally manufactured and commercial elevator landing doors. Because of the challenging product structure, the proposed cost estimation framework is developed under three different levels based on past cost information available. The framework consists of features from both qualitative and quantitative cost estimation techniques. The starting point for the whole cost estimation process is an unambiguous, hierarchical product structure so that the product can be classified into controllable parts and is then easier to handle. Those controllable parts can then be compared to existing past cost knowledge of similar parts and create as accurate cost estimates as possible by that way.