The cost of excessive postoperative use of antimicrobials: the context of a public hospital

OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact.METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08.RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost.CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital.

Teaching project: a low-cost swine model for chest tube insertion training

Objective: to describe and evaluate the acceptance of a low-cost chest tube insertion porcine model in a medical education project in the southwest of Paraná, Brazil. Methods: we developed a low-cost and low technology porcine model for teaching chest tube insertion and used it in a teaching project. Medical trainees - students and residents - received theoretical instructions about the procedure and performed thoracic drainage in this porcine model. After performing the procedure, the participants filled a feedback questionnaire about the proposed experimental model. This study presents the model and analyzes the questionnaire responses. Results: seventy-nine medical trainees used and evaluated the model. The anatomical correlation between the porcine model and human anatomy was considered high and averaged 8.1±1.0 among trainees. All study participants approved the low-cost porcine model for chest tube insertion. Conclusion: the presented low-cost porcine model for chest tube insertion training was feasible and had good acceptability among trainees. This model has potential use as a teaching tool in medical education.

Sähkön tuotantokustannusvertailu

Työssä vertaillaan eri sähköntuotantovaihtoehtojen taloudellista kannattavuutta. Kannattavuusvertailu suoritetaan pelkkää sähköä tuottaville voimalaitoksille. Raportti on jatkoa aikaisemmille tutkimuksille, joista viimeisin julkaistiin 2008. Tutkittavat voimalaitostyypit ovat: ydinvoimalaitos, maakaasukombilauhdevoimalaitos, kivihiililauhdevoimalaitos, turvelauhdevoimalaitos, puulauhdevoimalaitos, tuulivoimala ja uutena aurinkovoimala. Kannattavuustarkastelu suoritetaan annuiteettimenetelmällä käyttäen 5 % reaalikorkoa ja maaliskuun 2012 hintatasoa. Laskelmien perusteella 8000 tunnin huipunkäyttöajalla ydinsähkön tuotantokustannus, kun laitos rakennetaan olemassaolevalle tontille olisi 43,7 €/MWh, täysin uuden ydinvoimalaitoksen 57,9 €/MWh, kaasusähkön 75,4 €/MWh, turvelauhteen 75,4 €/MWh ja hiilisähkön hiilidioksidin talteenotolla 64,4 €/MWh, kun hiilidioksidipäästöoikeuden hintana käytetään 23 €/t. Vastaavasti uusiutuvista puupolttoainelauhdesähkön tuotantokustannus olisi 70,2 €/MWh kun taas 2200 tunnin huipunkäyttöajalla maalla sijaitsevan tuulivoimalaitoksen sähkön tuotantokustannus 52,7 €/MWh ja merellä sijaitsevan tuulivoimalaitoksen 76,8 €/MWh. Erillistarkastelussa arvioitiin suurien keskittävää teknologiaa käyttävän aurinko-voimalaitoksen tuotantokustannuksen ylittävän 100 €/MWh ollen todennäköisesti lähempänä 150 €/MWh. Arvio piensähkön tuotantokustannuksista aurinkosähköisillä paneeleilla vaihtelee 90 – 130 €/MWh. Merkittävin kustannussäästö syntyy, jos aurinkosähköpaketteja voidaan tarjota kuluttajalle kokonaistoimituksena avaimet käteen. Aurinkosähkön tuottaminen kotikeräimillä näyttääkin olevan vaiheessa, jossa se on selkeästi pienkäyttäjälle edullista mikäli sijoitettava pääoma 6000 – 18000 € ei vaadi ulkopuolista rahoitusta.

Structural and operational optimisation : applications in energy systems

In this work mathematical programming models for structural and operational optimisation of energy systems are developed and applied to a selection of energy technology problems. The studied cases are taken from industrial processes and from large regional energy distribution systems. The models are based on Mixed Integer Linear Programming (MILP), Mixed Integer Non-Linear Programming (MINLP) and on a hybrid approach of a combination of Non-Linear Programming (NLP) and Genetic Algorithms (GA). The optimisation of the structure and operation of energy systems in urban regions is treated in the work. Firstly, distributed energy systems (DES) with different energy conversion units and annual variations of consumer heating and electricity demands are considered. Secondly, district cooling systems (DCS) with cooling demands for a large number of consumers are studied, with respect to a long term planning perspective regarding to given predictions of the consumer cooling demand development in a region. The work comprises also the development of applications for heat recovery systems (HRS), where paper machine dryer section HRS is taken as an illustrative example. The heat sources in these systems are moist air streams. Models are developed for different types of equipment price functions. The approach is based on partitioning of the overall temperature range of the system into a number of temperature intervals in order to take into account the strong nonlinearities due to condensation in the heat recovery exchangers. The influence of parameter variations on the solutions of heat recovery systems is analysed firstly by varying cost factors and secondly by varying process parameters. Point-optimal solutions by a fixed parameter approach are compared to robust solutions with given parameter variation ranges. In the work enhanced utilisation of excess heat in heat recovery systems with impingement drying, electricity generation with low grade excess heat and the use of absorption heat transformers to elevate a stream temperature above the excess heat temperature are also studied.

One chip solution for low-cost active magnetic bearing system

In this work the implementation of the active magnetic bearing control system in a single FPGA is studied. Requirements for the full magnetic bearing control system are reviewed. Different control methods for active magnetic bearings are described shortly. Flux and the current base controllers are implemented in a FPGA. Suitability of the con-trollers for a low-cost magnetic bearing application is studied. Floating-point arithmetic’s are used in the controllers to ease designing burden and improve calculation precision. Per-formance of the flux controller is verified with simulations.

Paperitehtaan sähkötasehallinta ja sähkön kysyntäjousto energiakustannusten hallinnassa

Paperiteollisuus on energiaintensiivistä teollisuutta, jossa on tehty pitkään työtä tuotantoprosessien energiatehokkuuden parantamiseksi. Paperitehtaan energiakustannuksiin voidaan kuitenkin vaikuttaa myös sähkötaseen hallinnalla ja sähkön kysyntäjouston avulla. Tehtaan seuraavan vuorokauden sähkön kulutus pyritään ennustamaan mahdollisimman tarkasti, mutta esimerkiksi paperitehtaan häiriötilanteissa sähkötase poikkeaa ennustetusta. Tällöin sähkötasetta voidaan korjata ensisijaisesti sähkön jälkimarkkinoiden eli Elbas- kaupankäynnin avulla. Ellei tasetta saada korjattua sähkön jälkimarkkinoilla tase-ero korjataan tasesähköllä, jonka hinta muodostuu säätösähkömarkkinoilla. Tasesähkön hinta saattaa poiketa Elspot- markkinahinnasta voimakkaasti, jolloin tase-erosta joko hyödytään tai hävitään kustannusmielessä. Tämän työn tarkoituksena on selvittää sähkötasehallinnan parantamisen ja sähkön kysyntäjouston vaikutukset paperitehtaan energiakustannuksiin. Työssä tutkittiin tehtaan sähkö-tasehallinnan nykytilannetta ja selvitettiin tase-erojen kustannusvaikuttavuutta. Lisäksi työssä luotiin ajomalleja sähkön kysyntäjouston toteuttamiselle massatehtaan eri tuotantoprosesseille, sekä määritettiin rajahintoja seuraavan vuorokauden energiaennusteeseen. Onnistunut energiaennuste perustuu paperitehtaan käynnin tarkkoihin ja ajankohtaisiin lähtötietoihin. Sähkötaseen poikkeamiin voidaan puolestaan varautua paremmin, kun informaatio tehtaan prosessien alasajosta tulee voimalaitoksen tietoon mahdollisimman aikaisin. Sähkötaseen poikkeamien hallinta voidaan tehdä, joko Elbas- kaupan tai tasesähkön avulla. Ajankohdasta ja tasepoikkeaman volyymista riippuen täytyy tehdä valinta, kumpi vaihtoehdoista on kustannusmielessä kannattavampi. Paperitehtaan eri prosesseille luoduilla ajomalleilla saatiin esiin huomattava säästöpotentiaali. Ajomallien noudattaminen vaatii suunnitelmallista tuotannon hallintaa ja sähkön Elspot- hinnan käyttäytymisen säännöllistä seurantaa. Seuraavan vuorokauden rajahintatietojen määrittämisen pohjalta voidaan arvioida, millä Elspot- hinnalla sähkön myynti muuttuu paperin tuotantoa kannattavammaksi.

Projektien markkinoinnin ja myynnin kehittäminen rakennusalan pk-yrityksessä Venäjän markkinoilla

Tämä diplomityö keskittyy kehittämään työssä käsiteltävän Venäjällä toimivan rakennusalan urakoitsijan projektien markkinointia ja myyntiä. Työssä paneudutaan projektimarkkinoinnin kautta yrityksen markkinointiin ja myyntiin. Käsittelyn aiheena ovat myös proaktiivinen markkinointi ja Venäjän rakennusmarkkinoiden aiheuttamat erityispiirteet. Tutkimuksesta selvisi, että yrityksellä on erityisesti ollut vaikeuksia saada ison luokan projekteja. Usein tähän on ollut syynä kilpailijoiden parempi taloudellinen kilpailukyky. Muutama projekti on myös keskeytynyt tai peruuntunut. Onnistuneiden tarjouskilpailuiden taustalla taas ovat olleet referenssikäynnit, hyvät suhteet asiakkaaseen ja laadukas suorittaminen. Projektimarkkinoinnin kirjallisuuden ja yrityksessä suoritettujen teemahaastattelujen pohjalta yritykselle kehitettiin ennakoivaa markkinointia painottava kokonaisvaltainen markkinointi- ja myyntiprosessi. Tärkeimpiä kohtia prosessissa ovat proaktiivinen projektien etsintä ja projektin valmistelu. Projekteja etsitään osallistumalla teollisuuden alan konferensseihin sekä ottamalla itse yhteyttä asiakkaaseen ja eri toimijoihin. Potentiaaliset projektit seulotaan suuremmasta joukosta ennalta määrättyjen kriteereiden avulla. Projekteihin pyritään aktiivisesti vaikuttamaan ennen tarjouskilpailua, jolloin myös järjestetään referenssikäyntejä. Neuvotteluissa sovelletaan kilpailutilanteen mukaan joustavaa kustannusperusteista hinnoittelua. Suoritetun urakan jälkeen asiakasyrityksen investointisuunnitelmia tutkitaan ja tarpeen vaatiessa pyritään säilyttämään yhteys nukkuvan suhteen aikana. Tällöin järjestetään asiakkaan kanssa seminaareja sekä epävirallisia ta-pahtumia. Yrityksen markkinointia ja myyntiä hankaloittavat Venäjän rakennusmarkkinoiden erityispiirteet. Epävarmuudesta aiheutuvat riskit pitää huomioida katteessa, mutta usein Venäjän erityisolosuhteet tulee vain hyväksyä, koska niihin on vaikea vaikuttaa.

Cost-effectiveness analysis in South Karelia Central Hospital

The target organization of this study, otherwise South-Karelia Social and Health Care District (Eksote) provides health, senior, family and social welfare services. South Karelia Central Hospital provides special health care and offers health services from all of the most important medical specialties. Eksote has in use 15D instrument to measure the health-related quality of life (HRQoL) of their patients before and after their interventions for observing the health effects of the medical care. Furthermore, 15D allows measuring the effectiveness and cost-effectiveness of health care when comparing these before and after results of the 15D measurements and adding the costs of the interventions into this research. The main purposes of this study were to analyze the effectiveness and cost-effectiveness of medical care in South Karelia Central Hospital by using the gathered 15D data to calculate effectiveness and cost-effectiveness ratios and to analyze the reliability and availability of the data. Study has been conducted using literature review and quantitative research methods. The results indicate that from the patients within the eight units selected to this study the 15D change information was available from the 52 %, the 15D change and the cost information from 38 % and the information of quality-adjusted life years (QALYs) produced and the cost information from 35 %. The effectiveness and cost-effectiveness of medical care were greatest at the units of Pain Outpatient Clinic and Rheumatic Diseases Outpatient Clinic. The most effective medical care is given in the unit where the average price of one produced QALY is the highest (Orthopedics). However, the calculated standard deviations pointed out that there are great variances in the effectiveness and cost-effectiveness within the units also.

Modelling of potentiometric ion sensors

Potentiometric ion sensors are a very important subgroup of electrochemical sensors, very attractive for practical applications due to their small size, portability, low-energy consumption, relatively low cost and not changing the sample composition. They are investigated by the researchers from many fields of science. The continuous development of this field creates the necessity for a detailed description of sensor response and the electrochemical processes important in the practical applications of ion sensors. The aim of this thesis is to present the existing models available for the description of potentiometric ion sensors as well as their applicability and limitations. This includes the description of the diffusion potential occurring at the reference electrodes. The wide range of existing models, from most idealised phase boundary models to most general models, including migration, is discussed. This work concentrates on the advanced modelling of ion sensors, namely the Nernst-Planck-Poisson (NPP) model, which is the most general of the presented models, therefore the most widely applicable. It allows the modelling of the transport processes occurring in ion sensors and generating the potentiometric response. Details of the solution of the NPP model (including the numerical methods used) are shown. The comparisons between NPP and the more idealized models are presented. The applicability of the model to describe the formation of diffusion potential in reference electrode, the lower detection limit of both ion-exchanger and neutral carrier electrodes and the effect of the complexation in the membrane are discussed. The model was applied for the description of both types of electrodes, i.e. with the inner filling solution and solidcontact electrodes. The NPP model allows the electrochemical methods other than potentiometry to be described. Application of this model in Electrochemical Impedance Spectroscopy is discussed and a possible use in chrono-potentiometry is indicated. By combining the NPP model with evolutionary algorithms, namely Hierarchical Genetic Strategy (HGS), a novel method allowing the facilitation of the design of ion sensors was created. It is described in detail in this thesis and its possible applications in the field of ion sensors are indicated. Finally, some interesting effects occurring in the ion sensors (i.e. overshot response and influence of anionic sites) as well as the possible applications of NPP in biochemistry are described.

A quality and cost approach for welding process selection

The aim of this work was to propose, apply and evaluate a methodical approach to select welding processes in a productive environment based on market requirements of Quality and Costs. A case study was used. The welds were carried out in laboratory, simulating the joint conditions of a manufacturer and using several welding processes: SMAW, GTAW, pulsed GTAW, GMAW with CO2 and Ar based shielding gases and pulsed GMAW. For Quality analysis geometrical aspects of the beads were considered and for Cost analysis, welding parameters and consumable prices. Quantitative indices were proposed and evaluated. After that, evaluation of both Quality and Costs was done, showing to be possible to select the most suitable welding process to a specific application, taking into account the market conditions of a company.

Impact of reliability of supply on long-term development approaches to electricity distribution networks

The Finnish electricity distribution sector, rural areas in particular, is facing major challenges because of the economic regulation, tightening supply security requirements and the ageing network asset. Therefore, the target in the distribution network planning and asset management is to develop and renovate the networks to meet these challenges in compliance with the regulations in an economically feasible way. Concerning supply security, the new Finnish Electricity Market Act limits the maximum duration of electricity supply interruptions to six hours in urban areas and 36 hours in rural areas. This has a significant impact on distribution network planning, especially in rural areas where the distribution networks typically require extensive modifications and renovations to meet the supply security requirements. This doctoral thesis introduces a methodology to analyse electricity distribution system development. The methodology is based on and combines elements of reliability analysis, asset management and economic regulation. The analysis results can be applied, for instance, to evaluate the development of distribution reliability and to consider actions to meet the tightening regulatory requirements. Thus, the methodology produces information for strategic decision-making so that DSOs can respond to challenges arising in the electricity distribution sector. The key contributions of the thesis are a network renovation concept for rural areas, an analysis to assess supply security, and an evaluation of the effects of economic regulation on the strategic network planning. In addition, the thesis demonstrates how the reliability aspect affects the placement of automation devices and how the reserve power can be arranged in a rural area network.

Power-line-communication-based data transmission concept for an LVDC electricity distribution network – Analysis and implementation

Communications play a key role in modern smart grids. New functionalities that make the grids ‘smart’ require the communication network to function properly. Data transmission between intelligent electric devices (IEDs) in the rectifier and the customer-end inverters (CEIs) used for power conversion is also required in the smart grid concept of the low-voltage direct current (LVDC) distribution network. Smart grid applications, such as smart metering, demand side management (DSM), and grid protection applied with communications are all installed in the LVDC system. Thus, besides remote connection to the databases of the grid operators, a local communication network in the LVDC network is needed. One solution applied to implement the communication medium in power distribution grids is power line communication (PLC). There are power cables in the distribution grids, and hence, they may be applied as a communication channel for the distribution-level data. This doctoral thesis proposes an IP-based high-frequency (HF) band PLC data transmission concept for the LVDC network. A general method to implement the Ethernet-based PLC concept between the public distribution rectifier and the customerend inverters in the LVDC grid is introduced. Low-voltage cables are studied as the communication channel in the frequency band of 100 kHz–30 MHz. The communication channel characteristics and the noise in the channel are described. All individual components in the channel are presented in detail, and a channel model, comprising models for each channel component is developed and verified by measurements. The channel noise is also studied by measurements. Theoretical signalto- noise ratio (SNR) and channel capacity analyses and practical data transmission tests are carried out to evaluate the applicability of the PLC concept against the requirements set by the smart grid applications in the LVDC system. The main results concerning the applicability of the PLC concept and its limitations are presented, and suggestion for future research proposed.

Pienvesivoimalan uusinta

Diplomityön tavoitteena on tutkia eri vaihtoehtojen kannattavuutta pienvesivoimalan uusinnassa. Sähkönhinnan muodostus ja tulokseen vaikuttavat tekijät käsitellään kokonaisuuksinaan. Työssä tehdään kustannuslaskenta valmistajien tarjouksien perusteella ja suoritetaan esittely eri tarjouksista. Valmisteluosassa tutustutaan mitoitusarvoihin ja jos niitä ei ole miten ne selvitetään. Mittauksen kautta saadut arvot käsitellään ja sovelletaan siten, että valmistajat pystyvät käyttämään niitä. Lisäksi tutustutaan turbiinin laskentaan ja mitoitetaan Kaplan-turbiini työssä käytettyyn pienvesivoimalaan.

Overview on the Cost-effectiveness of Maritime Safety Policy Instruments

Maritime safety is an issue that has gained a lot of attention in the Baltic Sea area due to the dense maritime traffic and transportation of oil in the area. Lots of effort has been paid to enhance maritime safety in the area. The risk exists that excessive legislation and other requirements mean more costs for limited benefit. In order to utilize both public and private resources efficiently, awareness is required of what kind of costs maritime safety policy instruments cause and whether the costs are in relation to benefits. The aim of this report is to present an overview of the cost-effectiveness of maritime safety policy instruments focusing on the cost aspect: what kind of costs maritime safety policy causes, to whom, what affects the cost-effectiveness and how cost-effectiveness is studied. The study is based on a literature review and on the interviews of Finnish maritime experts. The results of this study imply that cost-effectiveness is a complicated issue to evaluate. There are no uniform practices for which costs and benefits should be included in the evaluation and how they should be valued. One of the challenges is how to measure costs and benefits during the course of a longer time period. Often a lack of data erodes the reliability of evaluation. In the prevention of maritime accidents, costs typically include investments in ship structures or equipment, as well as maintenance and labor costs. Also large investments may be justifiable if they respectively provide significant improvements to maritime safety. Measures are cost-effective only if they are implemented properly. Costeffectiveness is decreased if a measure causes overlapping or repetitious work. Costeffectiveness is also decreased if the technology isn’t user-friendly or if it is soon replaced with a new technology or another new appliance. In future studies on the cost-effectiveness of maritime safety policy, it is important to acknowledge the dependency between different policy instruments and the uncertainty of the factors affecting cost-effectiveness. The costs of a single measure are rarely relatively significant and the effect of each measure on safety tends to be positive. The challenge is to rank the measures and to find the most effective combination of different policy instruments. The greatest potential offered for the analysis of cost-effectiveness of individual measures is their implementation in clearly defined risk situations, in which different measures are truly alternative to each other. Overall, maritime safety measures do not seem to be considered burdening for the shipping industry in Finland at the moment. Generally actors in the Finnish shipping industry seem to find maintaining a high safety level important and act accordingly.

Energiatehokkaille ratkaisuille perustuva investointipotentiaali sairaalan saneeraushankkeessa

Tämän diplomityön tavoitteena oli tutkia ympäristömyönteisiä energiatehokkaita ratkaisuja, joita voitaisiin hyödyntää Kymenlaakson keskussairaalan rakennus- ja saneeraushankkeessa. Energiatehokkaiden ratkaisujen mahdollistamista vuotuisista käyttökustannussäästöistä laskettiin investointipotentiaali, jota voidaan hyödyntää saneerausinvestoinnin rahoituksessa. Työ jakautuu teoreettiseen kirjallisuusselvitykseen ja empiiriseen osuuteen, joka on toiminta-analyyttinen case-tutkimus. Investointipotentiaalin määrittämiseksi muodostettiin kolme skenaariota eritasoisisten energiankulutusta vähentävien toimenpiteiden ja tutkimustulosten sekä toteutusvaiheessa olevan saneeraushankeen pohjalta. Skenaariot muodostuivat erilaisista lämmön- ja sähkönkulutuksen vähentämisen yhdistelmistä. Investointipotentiaali saatiin laskemalla nykyarvo vuotuisista tulevaisuuden energiankulutuksen käyttökustannussäästöistä. Työn tuloksina esitettiin energiatehokkuutta parantavia ratkaisuja sekä kolme erisuuruisten energiankulutuksen vähennysyhdistelmien aikaansaamaa käyttökustannus-säästöistä syntyvää investointipotentiaaliratkaisua. Tutkimustietoa voidaan hyödyntää alkavassa sairaalan rakennus- ja saneerausinvestoinnin suunnittelutyössä.