Public price of climate change

Aim of the paper: The purpose is to gather the practices and to model the impacts of climate change on fiscal spending and revenues, responsibilities and opportunities, balance and debt related to climate change (CC). Methodology of the paper: The methodology will distinguish fiscal cost of mitigation and adaptation, besides direct and indirect costs. It will also introduce cost benefit analyses to evaluate the propensity of policy makers for action or passivity. Several scenarios will be drafted to see the different outcomes. The scenarios shall contain the possible losses in the natural and artificial environment and resources. Impacts on public budget are based on damage of income opportunities and capital/wealth/natural assets. There will be a list of actions when the fiscal correction of market failures will be necessary. Findings: There will be a summary and synthesis of estimation models on CC impacts on public finances, and morals of existing/existed budgeting practices on mitigation. The model will be based on damages (and maybe benefits) from CC, adjusted with probabilities of sce-narios and policy making propensity for action. Findings will cover the way of funding of fiscal costs. Practical use, value added: From the synthesis of model, the fiscal cost of mitigation and adaptation can be estimated for any developed, emerging and developing countries. The paper will try to reply, also, for the challenge how to harmonize fiscal and developmental sustainability.

Influência da absorção de umidade no comportamento mecânico nos compósitos poliméricos híbridos Kevlar/vidro quando imerso em água do mar e petróleo

The polymer matrix composite materials are being used on a large scale in the most different industrial fields such as aerospace, automotive, oil, among others, since the industrial perspectives is currently working with materials which have a good mechanical performance at high service life and cost / benefit. Thus, the determination of the mechanical properties is indispensable for the characterization of waste resulting in greater expansion of this type of material. Thus, this work will be obtained three plates laminated with tereftálica polymeric matrix reinforced by a bidirectional woven E-glass and kevlar both industrially made, where the plates are manufactured by manual lamination process (hand lay-up), all laminates have five enhancement layers, the first hybrid laminate will consist of bidirectional woven E-glass fiber, kevlar fiber interspersed with layers, is formed by the second bidirectional woven kevlar fiber at the ends of the laminate (two layers), and in the center the glass fiber fabric (three layers), the third plate is composed of only the bidirectional woven E-glass fiber. Then were prepared specimens (CP) by standard, to determine the mechanical properties of tensile and bending in three points. After fabrication of the specimens, they were immersed in oil and seawater. After that, there was a comparison of the mechanical properties for the test condition in the dry state. Showing that there was a considerable increase in the properties studied because the effect of hybridization in laminates.

Flammability Standards – A Major Role in Flame Retardant Exposure? Televisions as a case study.

Flame retardants (FRs) are added to materials to enhance the fire safety level of readily combustible polymers. Although they have been purported to aid in preventing fires in some cases, they have also become a significant cause for concern given the vast data on environmental persistence and human and animal adverse health effects. Evidence since the 1980s has shown that Canadian, American and Europeans have detectable levels of FRs in their bodies. North Americans in particular have high levels of these chemicals due to stringent flammability standards and the higher use of polybrominated diphenyl ethers (PBDEs) in North America as opposed to Europe. FRs have been detected in household dust and some evidence suggests that TVs could be a significant source of exposure to FRs. It is imperative to re-visit the flammability standard (UL94V) that allows for FR use in TVs plastic materials by providing a risk versus benefit analysis to determine if this standard provides a fire safety benefit and if it plays a major role in FR exposure. This report first examined the history of televisions and the progression to the UL94V flammability test standard to understand why FRs were first added to polymers used in the manufacturing of TVs. It has been demonstrated to be due to fire hazards resulting from the use of plastic materials in cathode-ray tube (CRT) TVs that had an “instant-on” feature and high voltage and operating temperatures. In providing a risk versus benefit analysis, this paper presents the argument that 1) by providing a market survey the current flammability test standard (UL94V) is outdated and lacks relevance to current technology as flat, thin, energy efficient Liquid Crystal Displays (LCDs) dominate over traditionally used heavy, bulky and energy-intensive CRTs; 2) FRs do not impart fire safety benefits considering that there is a lack of valid fire safety concern, such as reduced internal and external ignition and fire hazard, and a lack of valid fire data and hazard for television fires in general and finally; 3) the standard is overly stringent as it does not consider the risk due to exposure to FRs in household dust due to the proliferation and greater use of televisions in households. Therefore, this report argues that the UL94V standard has become trapped in history and needs to be updated as it may play a major role in FR exposure.

Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol.

BACKGROUND:
Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50% of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice.
METHODS:
Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4.
DISCUSSION:
The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting.

Cabazitaxel for Hormone-Relapsed Metastatic Prostate Cancer Previously Treated With a Docetaxel-Containing Regimen: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures cabazitaxel (Jevtana(®), Sanofi, UK) to submit evidence for the clinical and cost effectiveness of cabazitaxel for treatment of patients with metastatic hormone-relapsed prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the company's submission to NICE. Clinical evidence for cabazitaxel was derived from a multinational randomised open-label phase III trial (TROPIC) of cabazitaxel plus prednisone or prednisolone compared with mitoxantrone plus prednisone or prednisolone, which was assumed to represent best supportive care. The NICE final scope identified a further three comparators: abiraterone in combination with prednisone or prednisolone; enzalutamide; and radium-223 dichloride for the subgroup of people with bone metastasis only (no visceral metastasis). The company did not consider radium-223 dichloride to be a relevant comparator. Neither abiraterone nor enzalutamide has been directly compared in a trial with cabazitaxel. Instead, clinical evidence was synthesised within a network meta-analysis (NMA). Results from TROPIC showed that cabazitaxel was associated with a statistically significant improvement in both overall survival and progression-free survival compared with mitoxantrone. Results from a random-effects NMA, as conducted by the company and updated by the ERG, indicated that there was no statistically significant difference between the three active treatments for both overall survival and progression-free survival. Utility data were not collected as part of the TROPIC trial, and were instead taken from the company's UK early access programme. Evidence on resource use came from the TROPIC trial, supplemented by both expert clinical opinion and a UK clinical audit. List prices were used for mitoxantrone, abiraterone and enzalutamide as directed by NICE, although commercial in-confidence patient-access schemes (PASs) are in place for abiraterone and enzalutamide. The confidential PAS was used for cabazitaxel. Sequential use of the advanced hormonal therapies (abiraterone and enzalutamide) does not usually occur in clinical practice in the UK. Hence, cabazitaxel could be used within two pathways of care: either when an advanced hormonal therapy was used pre-docetaxel, or when one was used post-docetaxel. The company believed that the former pathway was more likely to represent standard National Health Service (NHS) practice, and so their main comparison was between cabazitaxel and mitoxantrone, with effectiveness data from the TROPIC trial. Results of the company's updated cost-effectiveness analysis estimated a probabilistic incremental cost-effectiveness ratio (ICER) of £45,982 per quality-adjusted life-year (QALY) gained, which the committee considered to be the most plausible value for this comparison. Cabazitaxel was estimated to be both cheaper and more effective than abiraterone. Cabazitaxel was estimated to be cheaper but less effective than enzalutamide, resulting in an ICER of £212,038 per QALY gained for enzalutamide compared with cabazitaxel. The ERG noted that radium-223 is a valid comparator (for the indicated sub-group), and that it may be used in either of the two care pathways. Hence, its exclusion leads to uncertainty in the cost-effectiveness results. In addition, the company assumed that there would be no drug wastage when cabazitaxel was used, with cost-effectiveness results being sensitive to this assumption: modelling drug wastage increased the ICER comparing cabazitaxel with mitoxantrone to over £55,000 per QALY gained. The ERG updated the company's NMA and used a random effects model to perform a fully incremental analysis between cabazitaxel, abiraterone, enzalutamide and best supportive care using PASs for abiraterone and enzalutamide. Results showed that both cabazitaxel and abiraterone were extendedly dominated by the combination of best supportive care and enzalutamide. Preliminary guidance from the committee, which included wastage of cabazitaxel, did not recommend its use. In response, the company provided both a further discount to the confidential PAS for cabazitaxel and confirmation from NHS England that it is appropriate to supply and purchase cabazitaxel in pre-prepared intravenous-infusion bags, which would remove the cost of drug wastage. As a result, the committee recommended use of cabazitaxel as a treatment option in people with an Eastern Cooperative Oncology Group performance status of 0 or 1 whose disease had progressed during or after treatment with at least 225 mg/m(2) of docetaxel, as long as it was provided at the discount agreed in the PAS and purchased in either pre-prepared intravenous-infusion bags or in vials at a reduced price to reflect the average per-patient drug wastage.

Faktorer som kan påverka företags val mellan K2 och K3 : En jämförelsestudie mellan två branscher

Titel: Faktorer som kan påverka företags val mellan K2 och K3 Författare: Angelica Höglund och Julia Wiman Handledare: Klas Sundberg Bakgrund och problem: Det nya K-regelverket som infördes 1 januari 2014 innebär att mindre onoterade företag idag har valmöjligheten att välja mellan regelverken K2 och K3. För dessa mindre företag är valet av regelverk viktigt då det kommer att påverka företagets räkenskaper. Syfte: Syftet med studien är att studera fördelningen av K2 och K3 för mindre onoterade företag inom två olika branscher, dessa är byggbranschen och juridik,- ekonomi- och konsultbranschen, samt vilka faktorer som kan påverka valet av regelverk. Teori: Studien bygger på två teorier, dessa är positive accounting theory och institutionell teori. Metod: I studien används en kvantitativ forskningsmetod där årsredovisningar har granskats och sammanställts, samt en kvalitativ metod som bygger på fyra semistrukturerade intervjuer där de identifierade faktorerna analyserats utifrån en analysmodell. Resultat och slutsats: Utifrån det empiriska materialet identifierades sju faktorer, dessa var leasing, företagets storlek, rättvisande bild, revisorns påverkan, komponentavskrivning, kostnad/nytta och koncernredovisning. Ovanstående faktorer har kategoriserats och analyserats utifrån PAT och institutionell teori. Förslag till vidare forskning: Ett förslag vore att forska vidare på de identifierade faktorerna för att undersöka i hur stor utsträckning de påverkar företagens beslut. En intressant studie hade även varit att genomföra en fallstudie som utgår från att upprätta en årsredovisning utifrån både K2 och K3 för att studera de skillnader som kan uppkomma.

Production planning, pricing and market coordination for news vendor problem with price dependent demand

Thesis (Ph.D.)--University of Washington, 2016-08

New Framework and Metrics for Economic Evaluation of Medical Technology in the Presence of Heterogeneity and Its Application to the Evaluation of Bariatric Surgery

Thesis (Ph.D.)--University of Washington, 2016-07

Melhoria de procedimentos internos no laboratório do Instituto dos Vinhos do Douro e do Porto, I.P.

Este relatório foi elaborado no âmbito do estágio curricular realizado na Direção de Serviços Técnicos e de Certificação do Instituto dos Vinhos do Douro e do Porto, I.P. Teve como principal objetivo apresentar propostas de alteração de procedimentos internos do laboratório do Instituto dos Vinhos do Douro e do Porto, I.P., no sentido de reduzir o tempo de resposta às solicitações, procurando uma melhor rentabilização tanto de equipamentos como de recursos humanos. Para atingir tal objetivo, foi elaborado o diagnóstico da situação, com base na informação recolhida na Direção de Serviços Técnicos e de Certificação, incluindo os dados fornecidos pelo software GLAB que dá apoio às operações realizadas no laboratório do Instituto dos Vinhos do Douro e do Porto. Além disso, foi efetuado o acompanhamento do circuito das amostras de produtos vínicos desde a sua receção, à análise nos setores do laboratório e posterior validação dos resultados. Dado que o estudo da entrada de amostras no setor Análise Mineral foi maioritariamente inconclusivo, apurou-se o custo por análise na determinação do chumbo e, ainda, foi realizada uma simulação determinar a despesa necessária para reduzir o número de amostras analisadas de cada vez que se liga o equipamento. Foi ainda comparado o custo da determinação do parâmetro furfural, análise que tanto pode ser realizada no setor Cromatografia Gasosa como no setor Cromatografia Líquida. Para isso, foram utlizados vários testes estatísticos. Com base na avaliação efetuada foram identificadas e propostas as seguintes oportunidades de melhoria: - Automação de uma das atividades realizadas no setor Físico-Química I, atividade esta necessária à preparação das análises; - Contrabalançar a sazonalidade verificada na receção de amostras dos clientes com as amostras provenientes da Direção de Serviços de Fiscalização e Controlo; - Inserção de algumas variáveis no software GLAB. É de realçar que a proposta referente à automação de uma das atividades realizadas no setor Físico-Química foi implementada pelo IVDP. Foram, também, identificadas propostas de futuras investigações.

Carcinoma of unknown primary (CUP); some considerations about pathogenesis and diagnostic strategy, particularly focusing on CUPS pertaining to the Urology

he term "carcinoma of unknown primary" (CUP) defines a malignant condition in which a metastatic cancer is documented in absence of a detectable primary site. It occurs in about 2÷6 % of cancer patients, according to various literature reports. The primary tumor site results indefinable because of several either single or associated factors, even remaining occult at autopsy in 15÷25% of CUP patients. The metastatic spread pattern of CUP is quite unlike that expected for analogous known primary malignancy. For instance, the unknown prostate cancer often metastasizes to the lungs and liver while the its known analogous usually spreads to the bone. Whether certain genetic abnormalities might play a role in determining a CUP condition, it remains undefined. Most CUP are adenocarcinoma, squamous cell carcinoma, either undifferentiated or differentiated carcinoma, whereas less frequently may be sarcoma, melanoma or neuroendocrine tumor. As CUP diagnostic management is concerned, two opposite approach modalities may be adopted, one, named "shotgun modality", consisting in a multiplicity of examinations aimed at achieving the identification of the primary tumor and the other, a nihilistic modality, by adopting tout court a palliative therapy of the metastatic disease. A reasonable intermediate diagnostic strategy consists in undertaking some procedures with a specific target and low cost/benefit ratio. Selected imaging studies, serum tumor markers, immunohistochemical analyses and genetic- molecular examinations on biopsy material allow sometimes to reach the detection of primary malignancies that might be responsive to a potential treatments. Nevertheless, in spite of recent sophisticated -laboratory and imaging progress, CUP remains a strong challenge in clinical oncology.

Análise do custo-benefício de sistemas de cobertas em edificações comerciais para o clima de Natal/RN visando eficiência energética

This research consists in studying the influence of the various type of construction systems of roofs with their energy efficiency as well as on the cost benefit for the commercial buildings on the temperatures condition of the city of Natal/RN. The main goal of this research is to analyze the cost benefit of the construction systems of roofs available on the market, taking into consideration the energy efficiency of the commercial buildings artificially air conditioned in order to be used by the projectors and to be adequated to the temperatures condition of the city of Natal/RN. The method of valuation of the cost benefit of roof systems consists in six steps: Features and simulation of the reference building; Analyze of sensitivity; Analyzes, features and simulation of alternatives of roof construction systems; Analyze of the cost of implementation; Analyze of the benefits of the alternatives comparing to the base case; And finally the analyze of the cost benefit. The model type chosen as reference was stores with pre molded buildings and system of roof with fiber ciment and ceiling . The thermal results showed the influence of the roof system on the energy efficiency of the building. The Final results of the simulations of the alternatives comes to a conclusion that the absortance is the variable that presents the best cost benefit relation and the reduction on the thermal transmittance still has limitations because of the high cost

Wie lässt sich Klassenführungsexpertise messen? Überprüfung eines videobasierten Erhebungsinstruments für Lehrkräfte unter Anwendung der Generalisierbarkeitstheorie

Klassenführungsexpertise stellt ein wesentliches Merkmal der professionellen Kompetenz von Lehrkräften dar und geht mit positiven Wirkungen sowohl hinsichtlich der Qualität des Unterrichts als auch im Kontext sonderpädagogischer Förderung einher. Um kognitive Anforderungsdimensionen von Klassenführungsexpertise zu erfassen, wurde ein Testverfahren entwickelt, das anhand von 4 Videovignetten und 27 Items die Genauigkeit der Wahrnehmung (1), die holistische Wahrnehmung (2) und die Rechtfertigung einer Handlung (3) als situationsspezifische Eigenschaften von Klassenführungsexpertise misst. In der vorliegenden Generalisierbarkeitsstudie wurde unter Verwendung einer Stichprobe (n=188) von Lehramtsstudierenden, Referendaren und Referendarinnen sowie berufstätigen Lehrpersonen den Fragen nachgegangen, (a) wieviel Varianz auf die verschiedenen Facetten (Personen, Videos, Items) zurückzuführen ist sowie b) ob sich die Generalisierbarkeit der Befunde durch eine höhere Anzahl an Videovignetten verbessern lässt. Die Ergebnisse zeigen erwartungskonform, dass der Großteil der erklärbaren Varianz auf die Items (22%) zurückzuführen ist. Die Videovignetten (0.54%) bzw. die Interaktion der Videos mit den Personen (1.77%) erklären hingegen nur einen marginalen Varianzanteil. Es bleibt ein großer Anteil nicht aufzuklärender Residualvarianz (66%). Der Generalisierbarkeitskoeffizient liegt mit Ep2=.75 im zufriedenstellenden Bereich und lässt sich durch eine höhere Anzahl an Videos nur geringfügig steigern (Ep2=.84 bei 10 Videos). Die Ergebnisse weisen darauf hin, dass die gewählten Videovignetten eine repräsentative Auswahl an Unterrichtssituationen darstellen, eine höhere Anzahl an Videos aus ökonomischen Gründen jedoch nicht zu empfehlen ist. (DIPF/Orig.)

Projeto de uma ferramenta específica para cravação de terminais elétricos

A necessidade contínua de incrementar a produtividade em todos os sectores leva a que sejam utilizados equipamentos cada vez mais sofisticados, permitindo novas técnicas de abordagem dos processos de fabrico, velocidades mais elevadas e maior precisão no produto final. No entanto, quase todos os equipamentos necessitam de ferramentas adequadas, que tirem partido efetivamente das potencialidades dos equipamentos disponíveis. A Engenharia tem aqui um papel extremamente importante, já que terá de conceber as ferramentas atendendo à satisfação de um elevado número de requisitos, que passam genericamente por tirar o máximo partido dos fatores tecnológicos proporcionados pelos equipamentos, cumprir com a cadência de produção necessária, assegurar a qualidade estipulada, garantir a segurança dos colaboradores que com ela trabalham e permitir uma fácil montagem e afinação, reduzindo assim os tempos de preparação e as possibilidades de fabrico de peças fora das especificações. Este trabalho foi desenvolvido em torno de uma necessidade real, tendo sido estipulados os requisitos necessários pelo cliente e tendo sido elaborado todo o projeto da ferramenta em torno desses mesmos requisitos. Foi efetuada uma otimização da ferramenta ainda na fase de anteprojeto, permitindo minimizar o seu custo e maximizar o seu rendimento e aptidão para o fim em vista. Os materiais foram cuidadosamente selecionados, tendo em vista a utilização de cada componente e a relação custo‐benefício. Foi ainda efetuada uma orçamentação da mesma, assim como um plano de instruções para a operação e manutenção da ferramenta. Deste modo, este trabalho é o resumo de grande parte do conhecimento adquirido, quer ao longo da vida académica, quer ao longo da experiência profissional.

O ato de agradecimento nas interações comerciais : contributo para o seu estudo

O presente estudo, no âmbito da Pragmática Linguística, resulta de uma investigação, que observa a realização dos atos ilocutórios expressivos de agradecimento nas interações comerciais. O objetivo é tentar compreender os processos linguísticos subjacentes à realização dos referidos atos ilocutórios, nomeadamente através do recenseamento dos diferentes tipos de agradecimento, da descrição dos atos de fala predominantes e das funções semântico-pragmáticas do agradecimento. Um dos aspetos mais importantes será o recensear dos tipos de agradecimento mais usados nas interações comerciais. Para tal, parte-se da observação detalhada de um corpus recolhido no âmbito específico de interações comerciais que ocorreram entre 10 de fevereiro de 2014 a 30 de setembro de 2014. Os resultados obtidos convergem no sentido de que o agradecimento é um ato expressivo reativo que pode ser verbal ou não verbal, com a finalidade de estabelecer a relação custo-benefício entre locutor e ouvinte, tendo em conta e respeitando os vários contextos socioculturais. De facto, o ato de agradecer, tal como os restantes atos ilocutórios expressivos, depende da forma como é expressado, dos gestos que o acompanham e das emoções que lhe são inerentes.

Rastreio neonatal da galactosémia custo/beneficio da introdução no programa nacional de diagnóstico precoce

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014