The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

BACKGROUND: Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. OBJECTIVE: To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. METHODS: The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. RESULTS: For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. CONCLUSIONS: The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more comprehensive collaborative programs, such as medication reviews, adherence-enhancing interventions, or disease management approaches.

Total Cost of Transportation Analysis of Road and Highway Issues, TR-477, Phase 2, 2003

A prior project, HR-388, (which was entitled "Total Cost of Transportation analysis of road and highway issues"), explored the use of a total economic cost basis for evaluation of road based transportation issues. It was conducted as a proof-of-concept effort between 1996 and 2002, with the final report presented in May 2002. TR-477 rebuilt the analytical model using current data, then performed general, system level, county level, and road segment level analyses. The results are presented herein and will be distributed to all county engineers for information and local use.

Rakennusinvestointien käsittelyprosessin tehostaminen

Suomen valtionhallinnon maaliskuussa 2005 julkaisemat tuloksellisuuden tavoitteet koskettavat kaikkia hallinnonaloja. Maa- ja metsätalousministeriön ohjeistamat Työvoima- ja elinkeinokeskusten maaseutuosastot ovat yksikköjä, joita vaikuttavuus- ja tuloksellisuustavoitteet velvoittavat. Tehokasta elintarviketuotantoa ja maatalouden kustannuskehityksen hallintaa voidaan tarkastella kiinteiden tuotannontekijöiden, kuten maatalousrakennusten ja investointituilla tuetun rakentamisen, vaikuttavuuden kautta. Työn tavoitteena oli tehostaa rakennusinvestointien käsittelyprosessia: kehittää sekä tehostamisen menetelmiä että työväline toiminnan ohjaukseen maa- ja metsätalousministeriölle. Ratkaisuja etsittiin teorian ja empirian pohjalta kehitettävien käsitteistöjen ja menetelmien avulla. Teoriaosuudessa haettiin kirjallisuudesta välineitä joilla prosesseja voitaisiin analysoida, mitata ja kehittää. Prosessimallinnukset, Italian vastaavan järjestelmän tutkimus ja Suomen rakennustoimelle tehty kysely muodostavat empiirisen aineiston, jonka perusteella lopulliset tehostamisen keinot ja konstruktiot kehitettiin. Tehostamisen menetelmäksi kehitettiinaluehallinnolle sovellettu suorituskyvyn mittausjärjestelmä, panosprisma. Tuloksellisuus, vaikuttavuus ja laatu riippuvat työn tuottamisen lähtökohdista. Prosessia voidaan tehostaa kiinnittämällä huomiota tulosohjaukseen, asiakirjojen saatavuuteen ja laatuun, neuvonnan oikea-aikaiseen ajoittuvuuteen ja riittävyyteen sekä tietojärjestelmien kehittämiseen. Näiden avulla voidaan saavuttaa käsittelyprosessin aika- ja kustannussäästöjä, tukivarojen käyttöön saaminen ja hyödynnettävyys paranevat ja tukipäätöksen tuottamisen asiakaspalveluprosessi tehostuu.

Why do municipalities cooperate to provide local public services? An empirical analysis

Intermunicipal cooperation is being increasingly adopted in various countries as a part of local service delivery reforms. This paper draws on survey data from Spain’s municipalities to examine the reasons underpinning the decisions of local governments to engage in intermunicipal cooperation and privatisation. Our empirical analysis indicates that small municipalities prefer to rely on cooperation for reducing costs, while their larger counterparts prefer to privatise the delivery of services. By cooperating, scale economies can be achieved with lower transaction costs and fewer concerns for competition than is the case via private production.

Vertical relations and local competition : an empirical approach

The analysis of vertical industry relations forms an essential element in the field of industrial organization. This paper tests hypotheses derived from transaction cost theory and the principal-agent problem in Chile’s petrol market. It shows that local competition plays an important role in the choice of a disintegrated vertical structure, and that low levels of service investment have the same effect. Conversely, the number of own-brand outlets and a high level of investment in services reduce the probability of disintegration. The paper demonstrates that vertical disintegration has a null effect on wholesale petrol prices and a positive effect on retail petrol prices of between 1.6 and 7 per cent, depending on fuel type.

Development of a population-based cost-effectiveness model of chronic graft versus host disease in Spain

Chronic graft-versus-host disease (cGvHD) is the leading cause of late nonrelapse mortality (transplant-related mortality) after hematopoietic stem cell transplant. Given that there are a wide range of treatment options for cGvHD, assessment of the associated costs and efficacy can help clinicians and health care providers allocate health care resources more efficiently. OBJECTIVE: The purpose of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with rituximab (Rmb) and with imatinib (Imt) in patients with cGvHD at 5 years from the perspective of the Spanish National Health System. METHODS: The model assessed the incremental cost-effectiveness/utility ratio of ECP versus Rmb or Imt for 1000 hypothetical patients by using microsimulation cost-effectiveness techniques. Model probabilities were obtained from the literature. Treatment pathways and adverse events were evaluated taking clinical opinion and published reports into consideration. Local data on costs (2010 Euros) and health care resources utilization were validated by the clinical authors. Probabilistic sensitivity analyses were used to assess the robustness of the model. RESULTS: The greater efficacy of ECP resulted in a gain of 0.011 to 0.024 quality-adjusted life-year in the first year and 0.062 to 0.094 at year 5 compared with Rmb or Imt. The results showed that the higher acquisition cost of ECP versus Imt was compensated for at 9 months by greater efficacy; this higher cost was partially compensated for ( 517) by year 5 versus Rmb. After 9 months, ECP was dominant (cheaper and more effective) compared with Imt. The incremental cost-effectiveness ratio of ECP versus Rmb was 29,646 per life-year gained and 24,442 per quality-adjusted life-year gained at year 2.5. Probabilistic sensitivity analysis confirmed the results. The main study limitation was that to assess relative treatment effects, only small studies were available for indirect comparison. CONCLUSION: ECP as a third-line therapy for cGvHD is a more cost-effective strategy than Rmb or Imt.

Choosing hybrid organizations for local services delivery : An empirical analysis of partial privatization

The empirical literature about factors explaining local government delivery choices has traditionally focused the attention on the public or private production dilemma. However, hybrid organizational forms such as mixed public-private firms are increasingly used in several European countries. This paper makes use of survey data from Spanish municipalities to examine motivations of local governments for engaging in hybrid organizational forms. Data refer to two very relevant local services: water distribution and solid waste collection. The empirical analysis indicates that the use of mixed firms emerge as a type of pragmatically based ‘third way’ between pure public and pure private production. Indeed, local governments make use of mixed firms when cost considerations (scale economies, transaction costs and soon), financial constraints and private interests exert contradictory pressures. On the contrary, political and ideological factors do not play any significant role on the local government decision of engaging or not in joint ventures with private partners.

Local privatization, intermunicipal cooperation, transaction costs and political interests: Evidence from Spain

Several empirical studies have analyzed the factors that influence local privatization. Variables related to fiscal stress, cost reduction, political processes and ideological attitudes are the most common explanatory variables used in these studies. In this paper, we add to this literature by examining the influence of transaction costs and political factors on local governments’ choices through new variables. In addition to this, we consider the role of additional aspects, such as intermunicipal cooperation as a potential alternative to privatization in order to exploit scale economies or scope economies. We consider two relevant services: solid waste collection and water distribution. Results from our estimates show that privatization (that is, contracting out to a private firm) is less common for water distribution than for solid waste collection. Higher transaction costs in water distribution are consistent with this finding. Furthermore, we find that municipalities with a conservative ruling party privatize more often regardless of the ideological orientation of the constituency. This shows that those political interests able to influence local elections are more important in determining the form of delivery than is the basic ideological stance of the constituency. Finally, we find that intermunicipal cooperation is an alternative to local privatization.

Balancing effluent quality, economic cost and greenhouse gas emissions during the evaluation of (plant-wide) control/operational strategies in WWTPs

The objective of this paper was to show the potential additional insight that result from adding greenhouse gas (GHG) emissions to plant performance evaluation criteria, such as effluent quality (EQI) and operational cost (OCI) indices, when evaluating (plant-wide) control/operational strategies in wastewater treatment plants (WWTPs). The proposed GHG evaluation is based on a set of comprehensive dynamic models that estimate the most significant potential on-site and off-site sources of CO2, CH4 and N2O. The study calculates and discusses the changes in EQI, OCI and the emission of GHGs as a consequence of varying the following four process variables: (i) the set point of aeration control in the activated sludge section; (ii) the removal efficiency of total suspended solids (TSS) in the primary clarifier; (iii) the temperature in the anaerobic digester; and (iv) the control of the flow of anaerobic digester supernatants coming from sludge treatment. Based upon the assumptions built into the model structures, simulation results highlight the potential undesirable effects of increased GHG production when carrying out local energy optimization of the aeration system in the activated sludge section and energy recovery from the AD. Although off-site CO2 emissions may decrease, the effect is counterbalanced by increased N2O emissions, especially since N2O has a 300-fold stronger greenhouse effect than CO2. The reported results emphasize the importance and usefulness of using multiple evaluation criteria to compare and evaluate (plant-wide) control strategies in a WWTP for more informed operational decision making

Cost Reduction of Permanent Magnet Synchronous Machines

Electrical machine drives are the most electrical energy-consuming systems worldwide. The largest proportion of drives is found in industrial applications. There are, however many other applications that are also based on the use of electrical machines, because they have a relatively high efficiency, a low noise level, and do not produce local pollution. Electrical machines can be classified into several categories. One of the most commonly used electrical machine types (especially in the industry) is induction motors, also known as asynchronous machines. They have a mature production process and a robust rotor construction. However, in the world pursuing higher energy efficiency with reasonable investments not every application receives the advantage of using this type of motor drives. The main drawback of induction motors is the fact that they need slipcaused and thus loss-generating current in the rotor, and additional stator current for magnetic field production along with the torque-producing current. This can reduce the electric motor drive efficiency, especially in low-speed, low-power applications. Often, when high torque density is required together with low losses, it is desirable to apply permanent magnet technology, because in this case there is no need to use current to produce the basic excitation of the machine. This promotes the effectiveness of copper use in the stator, and further, there is no rotor current in these machines. Again, if permanent magnets with a high remanent flux density are used, the air gap flux density can be higher than in conventional induction motors. These advantages have raised the popularity of PMSMs in some challenging applications, such as hybrid electric vehicles (HEV), wind turbines, and home appliances. Usually, a correctly designed PMSM has a higher efficiency and consequently lower losses than its induction machine counterparts. Therefore, the use of these electrical machines reduces the energy consumption of the whole system to some extent, which can provide good motivation to apply permanent magnet technology to electrical machines. However, the cost of high performance rare earth permanent magnets in these machines may not be affordable in many industrial applications, because the tight competition between the manufacturers dictates the rules of low-cost and highly robust solutions, where asynchronous machines seem to be more feasible at the moment. Two main electromagnetic components of an electrical machine are the stator and the rotor. In the case of a conventional radial flux PMSM, the stator contains magnetic circuit lamination and stator winding, and the rotor consists of rotor steel (laminated or solid) and permanent magnets. The lamination itself does not significantly influence the total cost of the machine, even though it can considerably increase the construction complexity, as it requires a special assembly arrangement. However, thin metal sheet processing methods are very effective and economically feasible. Therefore, the cost of the machine is mainly affected by the stator winding and the permanent magnets. The work proposed in this doctoral dissertation comprises a description and analysis of two approaches of PMSM cost reduction: one on the rotor side and the other on the stator side. The first approach on the rotor side includes the use of low-cost and abundant ferrite magnets together with a tooth-coil winding topology and an outer rotor construction. The second approach on the stator side exploits the use of a modular stator structure instead of a monolithic one. PMSMs with the proposed structures were thoroughly analysed by finite element method based tools (FEM). It was found out that by implementing the described principles, some favourable characteristics of the machine (mainly concerning the machine size) will inevitable be compromised. However, the main target of the proposed approaches is not to compete with conventional rare earth PMSMs, but to reduce the price at which they can be implemented in industrial applications, keeping their dimensions at the same level or lower than those of a typical electrical machine used in the industry at the moment. The measurement results of the prototypes show that the main performance characteristics of these machines are at an acceptable level. It is shown that with certain specific actions it is possible to achieve a desirable efficiency level of the machine with the proposed cost reduction methods.

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.

Local food security initiatives: systemic limitations in Vancouver, Canada

This paper approaches the topic of urban/community gardening not through the lens of urban theory per se but in light of basic farming realities such as growing season and land availability. Food security comprises availability and affordability. In the context of North American and Western European societies, only food affordability normally merits public discourse. In practice, governments have little or no means to change food affordability, in view of prevailing capitalistic free-market structures. In the current wave of popular exuberance, civic politicians and others have promoted the belief that community gardening could be the pathway to produce affordable food. The formidable obstacles to this pursuit include the availability of (low-cost) land within the highly-densified city limit, insufficient ambient temperature and water supply during the growing season and the contemporary structure of society. Overcoming these fundamental hurdles carries significant negative environmental and economic consequences.

Local model predictive control experiences with differential driven wheeled mobile robots

This work extends a previously developed research concerning about the use of local model predictive control in differential driven mobile robots. Hence, experimental results are presented as a way to improve the methodology by considering aspects as trajectory accuracy and time performance. In this sense, the cost function and the prediction horizon are important aspects to be considered. The aim of the present work is to test the control method by measuring trajectory tracking accuracy and time performance. Moreover, strategies for the integration with perception system and path planning are briefly introduced. In this sense, monocular image data can be used to plan safety trajectories by using goal attraction potential fields

Diagnóstico y propuesta de negocio para el cultivo de mora orgánica en el municipio de El Colegio “Municipio Saludable y Polo de Desarrollo Local”

El proyecto denominado “Municipio Saludable- Polo de Desarrollo Local” es un convenio entre la Universidad Del Rosario y la Gobernación de Cundinamarca, en el cual durante dos años algunos alumnos han contribuido con su conocimiento para plantear estrategias y alternativas aplicables para el desarrollo económico y social del Municipio de “El Colegio”. Gracias a éste proyecto surge la necesidad de darle continuidad a los planteamientos de estrategias y alternativas de desarrollo para el sector económico del Municipio, con el fin de que dichas propuestas sean viables y sostenibles. Para el caso del presente trabajo de investigación, el análisis, los planteamientos y las estrategias están enfocados al sector agrícola tomando como objeto de estudio los cultivos de mora castilla en la inspección de la Victoria. Para este proceso se identificaron tres grandes temas que permitieran identificar las posibilidades de convertir el cultivo de mora castilla en cultivos de mora orgánica. Dichos 3 temas son: Caracterización de la Inspección de la Victoria, Buenas Prácticas Agrícolas (BPA), Mercados orgánicos y por último el nuevo Plan estratégico. El principal objetivo de dividir en 3 fases el estudio consistía en primer lugar, en adquirir información veraz de la situación actual que presenta la inspección en relación a los cultivos de mora castilla; en segundo lugar, a lo largo de la investigación se observó que existía un proceso de transición entre la transformación de cultivos tradicionales a cultivos orgánicos, el cual era necesario contemplar con el fin de analizar su aplicabilidad en los cultivos de mora de la Inspección, dicho proceso de transición se denomina “Buenas prácticas Agrícolas”; el tercer y último tema es la fase final en la que el cultivo llega a convertirse en un cultivo orgánico, para este punto es preciso analizar cuáles son las ventajas y desventajas que conlleva su implementación y los procesos pertinentes de certificación para poder realizar una comercialización adecuada. Por último, después de haber concluido las 3 fases del estudio se generan una serie de recomendaciones y estrategias que dan lugar a la ejecución adecuada de la propuesta de transformación; una de las más importantes es que es indispensable llevar a cabo todo el proceso de transición de mora de castilla a mora orgánica, para asegurar el buen rendimiento del nuevo cultivo, el manejo de los costos y la calidad del producto. A partir de ello, en el largo plazo será posible entrar a competir al mercado de la agricultura ecológica y poder ofrecer un producto de valor agregado; todo lo anterior con una meta adicional de conquistar mercados extranjeros cumpliendo estándares internacionales y logrando suplir una demanda que todavía no ha sido atendida.

The dynamics of local hiv-1 epidemics: the colombian and belgian cohorts

We aimed to characterize the HIV-1 epidemic of the Belgian and Colombian cohorts using an integrated approach that includes socio-demographic information, clinical data, and viral sequences, analyzed with statistical and phylogenetic approaches.