Right to Maintenance Under Criminal Law - A Critical Study

Some study has been made earlier, but no attempt has ever been made to make the study comprehensive and comparative. There exists also no information as to the working of the system. Hence the work is undertaken to provide first hand knowledge of the legal institutions that had handled and now handles annually large masses of deprived and neglected population. An investigation is also necessary to know the legal and social characteristics of the jurisdiction enjoined on the court so that this will help compare the law in the statute with the law and practice. The evaluation of the working system in the changed social atmosphere is also an urgent need of the hour

Integrating TPM and QFD for improving quality in maintenance engineering

To provide maintenance engineering community with a model named “Maintenance quality function deployment” (MQFD) for nourishing the synergy of quality function deployment (QFD) and total productive maintenance (TPM) and enhancing maintenance quality of products and equipment.The principles of QFD and TPM were studied. MQFD model was designed by coupling these two principles. The practical implementation feasibility of MQFD model was checked in an automobile service station.Both QFD and TPM are popular approaches and several benefits of implementing them have been reported worldwide. Yet the world has not nourished the synergic power of integrating them. The MQFD implementation study reported in this paper has revealed its practical validity

A New Model For Reliability Centered Maintenance In Petroleum Refineries

Refiners today operate their equipment for prolonged periods without shutdown. This is primarily due to the increased pressures of the market resulting in extended shutdown-to-shutdown intervals. This places extreme demands on the reliability of the plant equipment. The traditional methods of reliability assurance, like Preventive Maintenance, Predictive Maintenance and Condition Based Maintenance become inadequate in the face of such demands. The alternate approaches to reliability improvement, being adopted the world over are implementation of RCFA programs and Reliability Centered Maintenance. However refiners and process plants find it difficult to adopt this standardized methodology of RCM mainly due to the complexity and the large amount of analysis that needs to be done, resulting in a long drawn out implementation, requiring the services of a number of skilled people. These results in either an implementation restricted to only few equipment or alternately, one that is non-standard. The paper presents the current models in use, the core requirements of a standard RCM model, the alternatives to classical RCM, limitations in the existing model, classical RCM and available alternatives to RCM and will then go on to present an ‗Accelerated‘ approach to RCM implementation, that, while ensuring close conformance to the standard, does not place a large burden on the implementers

Corrosion Health Monitoring System for Steel Ship Structures

Corrosion represents one of the largest through life cost component of ships. Ship owners and operators recognize that combating corrosion significantly impacts the vessels’ reliability, availability and through life costs. Primary objective of this paper is to review various inspections, monitoring systems and life cycle management with respect to corrosion control of ships and to develop the concept of “Corrosion Health” (CH) which would quantify the extent of corrosion at any point of ships’ operational life. A system approach in which the ship structure is considered as a corrosion system and divided into several corrosion zones, with distinct characteristics, is presented. Various corrosion assessment criteria for assessment of corrosion condition are listed. A CH rating system for representation of complex corrosion condition with a numeric number along with recommendations for repair/maintenance action is also discussed

A study on the performance of flexible pavements on mature soil subgrades

The country has witnessed tremendous increase in the vehicle population and increased axle loading pattern during the last decade, leaving its road network overstressed and leading to premature failure. The type of deterioration present in the pavement should be considered for determining whether it has a functional or structural deficiency, so that appropriate overlay type and design can be developed. Structural failure arises from the conditions that adversely affect the load carrying capability of the pavement structure. Inadequate thickness, cracking, distortion and disintegration cause structural deficiency. Functional deficiency arises when the pavement does not provide a smooth riding surface and comfort to the user. This can be due to poor surface friction and texture, hydro planning and splash from wheel path, rutting and excess surface distortion such as potholes, corrugation, faulting, blow up, settlement, heaves etc. Functional condition determines the level of service provided by the facility to its users at a particular time and also the Vehicle Operating Costs (VOC), thus influencing the national economy. Prediction of the pavement deterioration is helpful to assess the remaining effective service life (RSL) of the pavement structure on the basis of reduction in performance levels, and apply various alternative designs and rehabilitation strategies with a long range funding requirement for pavement preservation. In addition, they can predict the impact of treatment on the condition of the sections. The infrastructure prediction models can thus be classified into four groups, namely primary response models, structural performance models, functional performance models and damage models. The factors affecting the deterioration of the roads are very complex in nature and vary from place to place. Hence there is need to have a thorough study of the deterioration mechanism under varied climatic zones and soil conditions before arriving at a definite strategy of road improvement. Realizing the need for a detailed study involving all types of roads in the state with varying traffic and soil conditions, the present study has been attempted. This study attempts to identify the parameters that affect the performance of roads and to develop performance models suitable to Kerala conditions. A critical review of the various factors that contribute to the pavement performance has been presented based on the data collected from selected road stretches and also from five corporations of Kerala. These roads represent the urban conditions as well as National Highways, State Highways and Major District Roads in the sub urban and rural conditions. This research work is a pursuit towards a study of the road condition of Kerala with respect to varying soil, traffic and climatic conditions, periodic performance evaluation of selected roads of representative types and development of distress prediction models for roads of Kerala. In order to achieve this aim, the study is focused into 2 parts. The first part deals with the study of the pavement condition and subgrade soil properties of urban roads distributed in 5 Corporations of Kerala; namely Thiruvananthapuram, Kollam, Kochi, Thrissur and Kozhikode. From selected 44 roads, 68 homogeneous sections were studied. The data collected on the functional and structural condition of the surface include pavement distress in terms of cracks, potholes, rutting, raveling and pothole patching. The structural strength of the pavement was measured as rebound deflection using Benkelman Beam deflection studies. In order to collect the details of the pavement layers and find out the subgrade soil properties, trial pits were dug and the in-situ field density was found using the Sand Replacement Method. Laboratory investigations were carried out to find out the subgrade soil properties, soil classification, Atterberg limits, Optimum Moisture Content, Field Moisture Content and 4 days soaked CBR. The relative compaction in the field was also determined. The traffic details were also collected by conducting traffic volume count survey and axle load survey. From the data thus collected, the strength of the pavement was calculated which is a function of the layer coefficient and thickness and is represented as Structural Number (SN). This was further related to the CBR value of the soil and the Modified Structural Number (MSN) was found out. The condition of the pavement was represented in terms of the Pavement Condition Index (PCI) which is a function of the distress of the surface at the time of the investigation and calculated in the present study using deduct value method developed by U S Army Corps of Engineers. The influence of subgrade soil type and pavement condition on the relationship between MSN and rebound deflection was studied using appropriate plots for predominant types of soil and for classified value of Pavement Condition Index. The relationship will be helpful for practicing engineers to design the overlay thickness required for the pavement, without conducting the BBD test. Regression analysis using SPSS was done with various trials to find out the best fit relationship between the rebound deflection and CBR, and other soil properties for Gravel, Sand, Silt & Clay fractions. The second part of the study deals with periodic performance evaluation of selected road stretches representing National Highway (NH), State Highway (SH) and Major District Road (MDR), located in different geographical conditions and with varying traffic. 8 road sections divided into 15 homogeneous sections were selected for the study and 6 sets of continuous periodic data were collected. The periodic data collected include the functional and structural condition in terms of distress (pothole, pothole patch, cracks, rutting and raveling), skid resistance using a portable skid resistance pendulum, surface unevenness using Bump Integrator, texture depth using sand patch method and rebound deflection using Benkelman Beam. Baseline data of the study stretches were collected as one time data. Pavement history was obtained as secondary data. Pavement drainage characteristics were collected in terms of camber or cross slope using camber board (slope meter) for the carriage way and shoulders, availability of longitudinal side drain, presence of valley, terrain condition, soil moisture content, water table data, High Flood Level, rainfall data, land use and cross slope of the adjoining land. These data were used for finding out the drainage condition of the study stretches. Traffic studies were conducted, including classified volume count and axle load studies. From the field data thus collected, the progression of each parameter was plotted for all the study roads; and validated for their accuracy. Structural Number (SN) and Modified Structural Number (MSN) were calculated for the study stretches. Progression of the deflection, distress, unevenness, skid resistance and macro texture of the study roads were evaluated. Since the deterioration of the pavement is a complex phenomena contributed by all the above factors, pavement deterioration models were developed as non linear regression models, using SPSS with the periodic data collected for all the above road stretches. General models were developed for cracking progression, raveling progression, pothole progression and roughness progression using SPSS. A model for construction quality was also developed. Calibration of HDM–4 pavement deterioration models for local conditions was done using the data for Cracking, Raveling, Pothole and Roughness. Validation was done using the data collected in 2013. The application of HDM-4 to compare different maintenance and rehabilitation options were studied considering the deterioration parameters like cracking, pothole and raveling. The alternatives considered for analysis were base alternative with crack sealing and patching, overlay with 40 mm BC using ordinary bitumen, overlay with 40 mm BC using Natural Rubber Modified Bitumen and an overlay of Ultra Thin White Topping. Economic analysis of these options was done considering the Life Cycle Cost (LCC). The average speed that can be obtained by applying these options were also compared. The results were in favour of Ultra Thin White Topping over flexible pavements. Hence, Design Charts were also plotted for estimation of maximum wheel load stresses for different slab thickness under different soil conditions. The design charts showed the maximum stress for a particular slab thickness and different soil conditions incorporating different k values. These charts can be handy for a design engineer. Fuzzy rule based models developed for site specific conditions were compared with regression models developed using SPSS. The Riding Comfort Index (RCI) was calculated and correlated with unevenness to develop a relationship. Relationships were developed between Skid Number and Macro Texture of the pavement. The effort made through this research work will be helpful to highway engineers in understanding the behaviour of flexible pavements in Kerala conditions and for arriving at suitable maintenance and rehabilitation strategies. Key Words: Flexible Pavements – Performance Evaluation – Urban Roads – NH – SH and other roads – Performance Models – Deflection – Riding Comfort Index – Skid Resistance – Texture Depth – Unevenness – Ultra Thin White Topping

Die Privatisierung der Öffentlichen Personennahverkehrs (ÖPNV) und die damit verbundene Problematik des marktwirtschaftlichen und interventionistischen Dualismus am Beispiel des Schienenpersonennahverkehrs (SPNV) in der Fläche

Der SPNV als Bestandteil des ÖPNV bildet einen integralen Bestandteil der öffentlichen Daseinsvorsorge. Insbesondere Flächenregionen abseits urbaner Ballungszentren erhalten durch den SPNV sowohl ökonomisch als auch soziokulturell wichtige Impulse, so dass die Zukunftsfähigkeit dieser Verkehrsart durch geeignete Gestaltungsmaßnahmen zu sichern ist. ZIELE: Die Arbeit verfolgte das Ziel, derartige Gestaltungsmaßnahmen sowohl grundlagentheoretisch herzuleiten als auch in ihrer konkreten Ausformung für die verkehrswirtschaftliche Praxis zu beschreiben. Abgezielt wurde insofern auf strukturelle Konzepte als auch praktische Einzelmaßnahmen. Der Schwerpunkt der Analyse erstreckte sich dabei auf Deutschland, wobei jedoch auch verkehrsbezogene Privatisierungserfahrungen aus anderen europäischen Staaten und den USA berücksichtigt wurden. METHODEN: Ausgewertet wurden deutschsprachige als auch internationale Literatur primär verkehrswissenschaftlicher Ausrichtung sowie Fallbeispiele verkehrswirtschaftlicher Privatisierung. Darüber hinaus wurden Entscheidungsträger der Deutschen Bahn (DB) und DB-externe Eisenbahnexperten interviewt. Eine Gruppe 5 DB-interner und 5 DB-externer Probanden nahm zusätzlich an einer standardisierten Erhebung zur Einschätzung struktureller und spezifischer Gestaltungsmaßnahmen für den SPNV teil. ERGEBNISSE: In struktureller Hinsicht ist die Eigentums- und Verfügungsregelung für das gesamte deutsche Bahnwesen und den SPNV kritisch zu bewerten, da der dominante Eisenbahninfrastrukturbetreiber (EIU) in Form der DB Netz AG und die das Netz nutzenden Eisenbahnverkehrs-Unternehmen (EVUs, nach wie vor zumeist DB-Bahnen) innerhalb der DB-Holding konfundiert sind. Hieraus ergeben sich Diskriminierungspotenziale vor allem gegenüber DB-externen EVUs. Diese Situation entspricht keiner echten Netz-Betriebs-Trennung, die wettbewerbstheoretisch sinnvoll wäre und nachhaltige Konkurrenz verschiedener EVUs ermöglichen würde. Die seitens der DB zur Festigung bestehender Strukturen vertretene Argumentation, wonach Netz und Betrieb eine untrennbare Einheit (Synergie) bilden sollten, ist weder wettbewerbstheoretisch noch auf der Ebene technischer Aspekte akzeptabel. Vielmehr werden durch die gegenwärtige Verquickung der als Quasimonopol fungierenden Netzebene mit der Ebene der EVU-Leistungen Innovationspotenziale eingeschränkt. Abgesehen von der grundsätzlichen Notwendigkeit einer konsequenten Netz-Betriebs-Trennung und dezentraler Strukturen sind Ausschreibungen (faktisch öffentliches Verfahren) für den Betrieb der SPNV-Strecken als Handlungsansatz zu berücksichtigen. Wettbewerb kann auf diese Weise gleichsam an der Quelle einer EVU-Leistung ansetzen, wobei politische und administrative Widerstände gegen dieses Konzept derzeit noch unverkennbar sind. Hinsichtlich infrastruktureller Maßnahmen für den SPNV ist insbesondere das sog. "Betreibermodell" sinnvoll, bei dem sich das übernehmende EIU im Sinne seiner Kernkompetenzen auf den Betrieb konzentriert. Die Verantwortung für bauliche Maßnahmen sowie die Instandhaltung der Strecken liegt beim Betreiber, welcher derartige Leistungen am Markt einkaufen kann (Kostensenkungspotenzial). Bei Abgabeplanungen der DB Netz AG für eine Strecke ist mithin für die Auswahl eines Betreibers auf den genannten Ausschreibungsmodus zurückzugreifen. Als kostensenkende Einzelmaßnahmen zur Zukunftssicherung des SPNV werden abschließend insbesondere die Optimierung des Fahrzeugumlaufes sowie der Einsatz von Triebwagen anstatt lokbespannter Züge und die weiter forcierte Ausrichtung auf die kundenorientierte Attraktivitätssteigerung des SPNV empfohlen. SCHLUSSFOLGERUNGEN: Handlungsansätze für eine langfristige Sicherung des SPNV können nicht aus der Realisierung von Extrempositionen (staatlicher Interventionismus versus Liberalismus) resultieren, sondern nur aus einem pragmatischen Ausgleich zwischen beiden Polen. Dabei erscheint eine Verschiebung hin zum marktwirtschaftlichen Pol sinnvoll, um durch die Nutzung wettbewerbsbezogener Impulse Kostensenkungen und Effizienzsteigerungen für den SPNV herbeizuführen.

Transaction costs of farmers’ participation in forest management: Policy implications of payments for environmental services schemes in Vietnam

Recent research on payments for environmental services (PES) has observed that high transaction costs (TCs) are incurred through the implementation of PES schemes and farmer participation. TCs incurred by households are considered to be an obstacle to the participation in and efficiency of PES policies. This study aims to understand transactions related to previous forest plantation programmes and to estimate the actual TCs incurred by farmers who participated in these programmes in a mountainous area of northwestern Vietnam. In addition, this study examines determinants of households’ TCs to test the hypothesis of whether the amount of TCs varies according to household characteristics. Results show that average TCs are not likely to be a constraint for participation since they are about 200,000 VND (USD 10) per household per contract, which is equivalent to one person’s average earnings for about two days of labour. However, TCs amount to more than one-third of the programmes’ benefits, which is relatively high compared to PES programmes in developed countries. This implies that rather than aiming to reduce TCs, an appropriate agenda for policy improvement is to balance the level of TCs with PES programme benefits to enhance the overall attractiveness of afforestation programmes for smallholder farmers. Regression analysis reveals that education, gender and perception towards PES programmes have significant effects on the magnitude of TCs. The analyses also points out the importance of local conditions on the level of TCs, with some unexpected results.

On-the-Fly Maintenance of Series-Parallel Relationships in Fork-Join Multithreaded Programs

A key capability of data-race detectors is to determine whether one thread executes logically in parallel with another or whether the threads must operate in series. This paper provides two algorithms, one serial and one parallel, to maintain series-parallel (SP) relationships "on the fly" for fork-join multithreaded programs. The serial SP-order algorithm runs in O(1) amortized time per operation. In contrast, the previously best algorithm requires a time per operation that is proportional to Tarjan’s functional inverse of Ackermann’s function. SP-order employs an order-maintenance data structure that allows us to implement a more efficient "English-Hebrew" labeling scheme than was used in earlier race detectors, which immediately yields an improved determinacy-race detector. In particular, any fork-join program running in T₁ time on a single processor can be checked on the fly for determinacy races in O(T₁) time. Corresponding improved bounds can also be obtained for more sophisticated data-race detectors, for example, those that use locks. By combining SP-order with Feng and Leiserson’s serial SP-bags algorithm, we obtain a parallel SP-maintenance algorithm, called SP-hybrid. Suppose that a fork-join program has n threads, T₁ work, and a critical-path length of T[subscript ∞]. When executed on P processors, we prove that SP-hybrid runs in O((T₁/P + PT[subscript ∞]) lg n) expected time. To understand this bound, consider that the original program obtains linear speed-up over a 1-processor execution when P = O(T₁/T[subscript ∞]). In contrast, SP-hybrid obtains linear speed-up when P = O(√T₁/T[subscript ∞]), but the work is increased by a factor of O(lg n).

Intraovarian sperm storage in Helicolenus dactylopterus dactylopterus fertilitzation, crypt formation and maintenance of stored sperm

The females of the bluemouth rockfish, Helicolenus dactylopterus dactylopterus (DelaRoche, 1809), store sperm within their ovaries for periods of up to 10 months. Twenty six females with standard lengths between 152 and 257 mm and six males with standard lengths between 253 and 209 mm were caught storage crypts with stored spermatozoa and to describe their evolution over the year. After internal fertilization and once sperm reaches the ovary, a crypt forms probably by an epithelial inclusion at the base of the lamellae of one or several spermatozoa groups that are floating freely in the interlamellar space of the ovarian lumen. Stored spermatozoa have a large cytoplasm bag surrounding their heads. This bag could serve as a nutritive reservoir during the long storage period. Many desmosonal and tight junctions between the crypt cells ensure tha male sex cells are protected against the female immune system

Probabilistic models to assist maintenance of multiple instruments

The paper discusses maintenance challenges of organisations with a huge number of devices and proposes the use of probabilistic models to assist monitoring and maintenance planning. The proposal assumes connectivity of instruments to report relevant features for monitoring. Also, the existence of enough historical registers with diagnosed breakdowns is required to make probabilistic models reliable and useful for predictive maintenance strategies based on them. Regular Markov models based on estimated failure and repair rates are proposed to calculate the availability of the instruments and Dynamic Bayesian Networks are proposed to model cause-effect relationships to trigger predictive maintenance services based on the influence between observed features and previously documented diagnostics

Efecto de una intervención sobre la carga física durante el proceso de coquización en una empresa de Colombia

Se realizó estudio cuasi experimental con el fin de comparar el efecto sobre la carga física de una intervención tecnológica y en la organización del trabajo en trabajadores en el cargo de horneros en la tarea de extracción de coque en Colombia. Se midió la carga física mediante frecuencia cardiaca e índice de costo cardiaco relativo en una población de trabajadores expuestos (37) y no expuestos (66) a una intervención tecnológica. La monitorización de la frecuencia cardiaca se realizó con 7 pulsímetros Polar RS 800cx debidamente calibrados. Las variables numéricas se describieron con base en la media aritmética, su desviación estándar, y el rango. Para evaluar la diferencia entre las medias de los grupos con respecto a la frecuencia cardiaca en reposo, media, máxima, índice de costo cardiaco relativo, gasto energético de trabajo se aplicó análisis de varianza de una vía. Se estableció a priori un nivel de significación estadística α = 0,05. Se encontraron diferencias estadísticamente significativas en el comportamiento de la frecuencia cardiaca media, frecuencia cardiaca máxima e índice de costo cardiaco relativo, entre los grupos de estudio. Se concluyó que este estudio valida la frecuencia cardiaca como una variable sensible para la medición del riesgo por carga física y a su utilidad en la evaluación intervenciones ergonómica. El estudio demostró que la intervención ergonómica logró controlar la carga física con una disminución significativa la frecuencia cardiaca, en el grupo de intervención.

El Outsourcing en la dinámica de sistemas hacia mercados extranjeros

Este trabajo recopila literatura académica relevante sobre estrategias de entrada y metodologías para la toma de decisión sobre la contratación de servicios de Outsourcing para el caso de empresas que planean expandirse hacia mercados extranjeros. La manera en que una empresa planifica su entrada a un mercado extranjero, y realiza la consideración y evaluación de información relevante y el diseño de la estrategia, determina el éxito o no de la misma. De otro lado, las metodologías consideradas se concentran en el nivel estratégico de la pirámide organizacional. Se parte de métodos simples para llegar a aquellos basados en la Teoría de Decisión Multicriterio, tanto individuales como híbridos. Finalmente, se presenta la Dinámica de Sistemas como herramienta valiosa en el proceso, por cuanto puede combinarse con métodos multicriterio.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Accesos vasculares para hemodiálisis, cuál es el más costo efectivo?

Marco conceptual: La enfermedad renal crónica es un serio problema de salud pública en nuestro país por la gran cantidad de recursos económicos que requiere su atención. La hemodiálisis es el tratamiento más usado en nuestro medio; el acceso vascular y sus complicaciones derivadas son el principal aspecto que incrementa los costos de atención en éstos pacientes. Materiales y métodos: Se realizó un estudio económico de los accesos vasculares en pacientes incidentes de hemodiálisis en el año 2012 en la agencia RTS-Fundación Cardio Infantil. Se estableció el costo de creación y mantenimiento del acceso con catéter central, fístula arteriovenosa nativa, fístula arteriovenosa con injerto; y el costo de atención de las complicaciones para cada acceso. Se determinó la probabilidad de ocurrencia de complicaciones. Mediante un árbol de decisiones se trazó el comportamiento de cada acceso en un período de 5 años. Se establecieron los años de vida ajustados por calidad (QALY) en cada acceso y el costo para cada uno de éstos QALY. Resultados: de 36 pacientes incidentes de hemodiálisis en 2012 el 100% inició con catéter central, 16 pacientes cambiaron a fístula arteriovenosa nativa, 1 a fístula arteriovenosa con injerto que posteriormente pasó a CAPD, 15 continuaron su acceso con catéter y 4 pacientes fallecieron. En 5 años se obtuvieron 2,36 QALY para los pacientes con catéter central que costarían $ 24.813.036,39/QALY y 2,535 QALY para los pacientes con fístula nativa que costarían $ 6.634.870,64/QALY. Conclusiones: el presente estudio muestra que el acceso vascular mediante fístula arteriovenosa nativa es el más costo-efectivo que mediante catéter