Avaliação da matriz nutricional da enzima fitase em rações contendo sorgo para poedeiras comerciais

Avaliaram-se os efeitos da inclusão de fitase e de sua matriz nutricional em rações contendo sorgo sobre o desempenho das aves, a qualidade dos ovos, a ingestão e a excreção e retenção de fósforo e nitrogênio em poedeiras comerciais. Utilizaram-se 180 poedeiras comerciais, distribuídas em delineamento inteiramente ao acaso em esquema fatorial 2 × 2 + 1, com dois níveis de fitase (0 e 500 FTU/kg de ração) e dois níveis de substituição do milho pelo sorgo (50 e 100%) e uma ração testemunha (isenta de sorgo e fitase), constituindo cinco tratamentos com seis repetições de seis aves. As rações foram à base de milho e farelo de soja, sem fitase e sorgo, considerando a matriz nutricional da fitase. O desempenho e a qualidade dos ovos foram avaliados em quatro períodos de 28 dias. Ao final do experimento, um ensaio de metabolismo foi realizado para quantificar a ingestão, excreção e retenção aparente de fósforo e nitrogênio e avaliar a viabilidade econômica das rações. Ao considerar a matriz nutricional da fitase, as exigências em energia, cálcio, fósforo, proteína e aminoácidos foram atendidas, mesmo com a redução dos níveis nutricionais da dieta, e o desempenho e a qualidade dos ovos não foram comprometidos. A adição de fitase nas rações possibilitou reduzir todos os parâmetros econômicos avaliados. O sorgo pode substituir totalmente o milho e ser o único grão energético da dieta.

Extração supercrítica do óleo de linhaça: construção do extrator, estudo de parâmetros de processo, avaliação química e antioxidante do produto

The aim of the present study was to extract vegetable oil from brown linseed (Linum usitatissimum L.), determine fatty acid levels, the antioxidant capacity of the extracted oil and perform a rapid economic assessment of the SFE process in the manufacture of oil. The experiments were conducted in a test bench extractor capable of operating with carbon dioxide and co-solvents, obeying 23 factorial planning with central point in triplicate, and having process yield as response variable and pressure, temperature and percentage of cosolvent as independent variables. The yield (mass of extracted oil/mass of raw material used) ranged from 2.2% to 28.8%, with the best results obtained at 250 bar and 50ºC, using 5% (v/v) ethanol co-solvent. The influence of the variables on extraction kinetics and on the composition of the linseed oil obtained was investigated. The extraction kinetic curves obtained were based on different mathematical models available in the literature. The Martínez et al. (2003) model and the Simple Single Plate (SSP) model discussed by Gaspar et al. (2003) represented the experimental data with the lowest mean square errors (MSE). A manufacturing cost of US$17.85/kgoil was estimated for the production of linseed oil using TECANALYSIS software and the Rosa and Meireles method (2005). To establish comparisons with SFE, conventional extraction tests were conducted with a Soxhlet device using petroleum ether. These tests obtained mean yields of 35.2% for an extraction time of 5h. All the oil samples were sterilized and characterized in terms of their composition in fatty acids (FA) using gas chromatography. The main fatty acids detected were: palmitic (C16:0), stearic (C18:0), oleic (C18:1), linoleic (C18:2n-6) and α-linolenic (C18:3n-3). The FA contents obtained with Soxhlet dif ered from those obtained with SFE, with higher percentages of saturated and monounsaturated FA with the Soxhlet technique using petroleum ether. With respect to α-linolenic content (main component of linseed oil) in the samples, SFE performed better than Soxhlet extraction, obtaining percentages between 51.18% and 52.71%, whereas with Soxhlet extraction it was 47.84%. The antioxidant activity of the oil was assessed in the β-carotene/linoleic acid system. The percentages of inhibition of the oxidative process reached 22.11% for the SFE oil, but only 6.09% for commercial oil (cold pressing), suggesting that the SFE technique better preserves the phenolic compounds present in the seed, which are likely responsible for the antioxidant nature of the oil. In vitro tests with the sample displaying the best antioxidant response were conducted in rat liver homogenate to investigate the inhibition of spontaneous lipid peroxidation or autooxidation of biological tissue. Linseed oil proved to be more efficient than fish oil (used as standard) in decreasing lipid peroxidation in the liver tissue of Wistar rats, yielding similar results to those obtained with the use of BHT (synthetic antioxidant). Inhibitory capacity may be explained by the presence of phenolic compounds with antioxidant activity in the linseed oil. The results obtained indicate the need for more detailed studies, given the importance of linseed oil as one of the greatest sources of ω3 among vegetable oils

Avaliação da viabilidade econômica da implantação de uma usina de triagem e compostagem na cidade de Rio Claro-SP

The question of the solid waste is without a doubt one of the biggest problems faced for the world-wide population in the present time, resulting in the call “collapse of the garbage”. In this direction that appears the composting, in the scope of the treatment of organic waste origin, that in Brazil, approximately correspond 50% of the generated volume. However, the rare plants of selection and composting (UTC) existing at least do not obtain auto-to support themselves, increasing to each day the number of deactivations, almost always related the financial questions. In this direction, the present research brings the analysis of the economic viability of the implantation of a UTC for the city of Rio Claro-SP, relating it with the thick organic composition sales, for the cultures of vegetables cultivated in a ray of 30 km of the study area. For in such a way, they had been carried through, calculations concerning the regional demand for organic composition, and the verification of the implantation costs and operation of the plant. The reached results had been the flow of box for the first year of functioning of the UTC, as well as the break-even point between the gotten expenditures and prescriptions. From this relation investment profitability, it was verified that the UTC is presented impracticable under the economic point of view.

The Probe, Issue 174 – March 1997

Outwitting Urban Beaver, by C. E. "Ki" Faulkner, Regional Director, Region 0, NADCA Bear Gets Attention in Southeast Chinese disease Threatens Rabbits Product Announcements: BEAR BE GONE™ -- a device designed to deter bears from foraging in trash cans. Booklet: "Using Guard Animals to Protect Livestock" Abstracts Published at the 3rd Annual Conference of The Wildlife Society: A case study of black bear movements and survival after landfill closure in the central Adirondacks, by Ann M. Russell and S.L. Simek Ecology of coyotes in a sheep ranching environment, by Ben N. Sacks, J.C.C. Neale, M. Jaeger, and D. R. McCullough Design and analysis of carnivore scent-station surveys, by Glen Sargeant, Douglas H. Johnson, and William Berg Public attitudes toward wildlife damage management, by Robert H. Schmidt, M.W. Brunson, andD. Reiter Human dimensions of wildlife contraception, by Robert H. Schmidt and D. E. Mclvor Economic assessment of rabies control efforts in Texas, by Randy M. Smith Methyl salicylate: a naturally occurring avian repellent, by Shirley Wager-Page A brief historical perspective on wildlife contraception research, by Robert J. Warren Wildlife-caused losses to agriculture in 1994, by Alice P. Wywialowski

El Paisaje como Servicio Ambiental que otorgan las zonas agrícolas de la provincia de Mendoza, Argentina

Los ecosistemas proveen de servicios ambientales necesarios para la satisfacción de las necesidades tanto materiales, como no materiales de los seres humanos. Aportan al crecimiento económico y también a otros aspectos intangibles, que hacen al bienestar humano. Este flujo de bienes y servicios es vital para la economía. Los ecosistemas rurales, satisfacen las necesidades humanas y generan bienestar, incidiendo directamente sobre calidad de vida de las personas. En Argentina, existen conflictos sociales, económicos y ecológicos estrechamente relacionados. Por ello, no es correcto separar la sociedad de la naturaleza y tratar los problemas como si existieran escindidos. Por este motivo se recurre a la valoración de los ecosistemas y del medio ambiente, como instrumento preventivo ante posibles amenazas que vienen alterando el funcionamiento y la estructura de los ecosistemas rurales, por medio de estrategias y políticas sostenidas para el tratamiento y corrección de esta situación. Mendoza es considerada actualmente en un lugar destacado a nivel turístico. Teniendo en cuenta los caminos del vino y la Fiesta Nacional de la Vendimia. Actividades distintivas de la identidad provincial y de sus pobladores. En la última década, el departamento de Maipú ha sufrido una notoria pérdida de tierras agrícolas que se destinaron a la urbanización. Los problemas típicos de la ciudad ya han alcanzado a las zonas rurales. La inseguridad alcanzada, es un claro ejemplo de ésta situación. La elección del territorio de estudio, surgió al analizar el avance urbano en los censos 2001 y 2010, en zonas agrícolas representativas de Mendoza. Se observó que el departamento de Maipú obtuvo un incremento poblacional del 93%. Siendo el mismo, el departamento del Gran Mendoza, con mayor crecimiento de la última década. Además se tuvo en cuenta que Maipú es uno de los departamentos más importantes en el aspecto agrícola de la provincia, conocido como la cuna del vino y del olivo. Se toma como referencia la opinión de habitantes de un departamento que ha sufrido este cambio más recientemente para calificar el avance urbano y pérdida de servicios ambientales en zonas agrícolas de toda la provincia de Mendoza. La presente investigación se centra en el estudio de la provisión de servicios ambientales, por parte de los ecosistemas rurales de la provincia de Mendoza, Argentina. Se estudia la valoración social de los beneficios ambientales y sociales que la sociedad maipucina, le otorga a las zonas agrícolas de Mendoza. Se realiza a través de entrevistas enmarcadas en una técnica de Valoración Contingente en la que se obtienen resultados para el análisis de la Valoración Social de los servicios ambientales, sin llegar al análisis de una Valoración Económica. Los resultados obtenidos muestran que existe una preferencia de los habitantes de Maipú hacia paisajes naturales y agrícolas. Se sienten beneficiados y atraídos por la sensación de bienestar, otorgándoles valor social de existencia. Sin embrago, se percibe que están siendo afectados por problemas típicos de un paisaje urbanizado como lo son la contaminación visual, sonora y la pérdida de servicios ambientales como lo son la belleza escénica y la cultura mendocina. Los datos obtenidos de las encuestas quedan a disposición como herramienta para la toma de decisiones y para la correcta aplicación de la Ley 8051 de Ordenamiento Territorial y Uso del Suelo en Mendoza.

Cadastro do Património Arbóreo da Cidade de Portalegre – Conceção de um Sistema de Informação Geográfico

Os meios urbanos são espaços cada vez mais edificados, compactos e com solos impermeabilizados, onde a ausência ou reduzida presença de espaços verdes é uma realidade. Os elementos arbóreos, qualquer que seja a sua disposição, ganham cada vez mais significado enquanto representantes do meio natural na conservação da qualidade e conforto de vida nas cidades. Este trabalho desenvolveu-se a partir do tema das árvores em meio urbano, tendo por base os benefícios das árvores nas cidades, a sua distribuição espacial e o estado de conservação deste tipo de património. O principal fio condutor passou pela concepção do inventário do Património Arbóreo da cidade de Portalegre, com recurso às novas tecnologias da informação, nomeadamente os Sistemas de Informação Geográfica, capaz de se integrar nos sistemas homólogos do Município de Portalegre. O inventário à escala do perímetro urbano da cidade de Portalegre contabilizou 2087 elementos arbóreos localizados em áreas públicas, dos quais 1500 são árvores de folha caduca e 587 são perenifólias. Registou-se um elevado índice de diversidade para aquela área, cerca de 705 árvores/km2, embora as árvores estejam distribuídas de forma heterogénea pelo território considerado, percebendo-se com isso as zonas de carência de arborização. Com este inventário foi ainda possível conceber uma avaliação económica segundo a Norma de Granada, de 13 árvores isoladas e uma alameda com 38 indivíduos, assim como propor a classificação destes elementos a Árvores de Interesse Público. Anseia-se que este trabalho seja um documento informativo e sensibilizador de todo o público em geral, mas principalmente que se assuma como uma ferramenta útil aos responsáveis pelos espaços verdes da cidade de Portalegre.

The pre-treatment and pyrolysis of biomass for the production of liquids for fuels and speciality chemicals

Fast pyrolysis of biomass is a significant technology for producing pyrolysis liquids [also known as bio-oil], which contain a number of chemicals. The pyrolysis liquid can be used as a fuel, can be produced solely as a source of chemicals or can have some of the chemicals extracted and the residue used as a fuel. There were two primary objectives of this work. The first was to determine the fast pyrolysis conditions required to maximise the pyrolysis liquid yield from a number of biomass feedstocks. The second objective was to selectively increase the yield of certain chemicals in the pyrolysis liquid by pre-treatment of the feedstock prior to pyrolysis. For a particular biomass feedstock the pyrolysis liquid yield is affected by the reactor process parameters. It has been found that, providing the other process parameters are restricted to the values shown below, reactor temperature is the controlling parameter. The maximum pyrolysis liquid yield and the temperature at which it occurs has been found by a series of pyrolysis experiments over the temperature range 400-600°C. high heating rates > 1000°C/s; pyrolysis vapour residence times <2 seconds; pyrolysis vapour temperatures >400 but <500°C; rapid quenching of the product vapours. Pre-treatment techniques have been devised to modify the chemical composition and/or structure of the biomass in such a way as to influence the chemical composition of the pyrolysis liquid product. The pre-treatments were divided into two groups, those that remove material from the biomass and those which add material to the biomass. Component removal techniques have selectively increased the yield of levoglucosan from 2.45 to 18.58 mf wt.% [dry feedstock basis]. Additive techniques have selectively increased the yield of hydroxyacetaldehyde from 7.26 to 11.63 mf w.% [dry feedstock basis]. Techno-economic assessment has been carried out on an integrated levoglucosan production process [incorporating pre-treatment, pyrolysis and chemical extraction stages] to assess which method of chemical production is the more cost effective. It has been found that it is better to pre-treat the biomass in order to increase the yield of specific chemicals in the pyrolysis liquid and hence improve subsequent chemicals extraction.

Technoeconomic modelling of coal conversion processes for liquid fuel production

Since the oil crisis of 1973 considerable interest has been shown in the production of liquid fuels from alternative sources. In particular processes utilizing coal as the feedstock have received considerable interest. These processes can be divided into direct and indirect liquefaction and pyrolysis. This thesis describes the modelling of indirect coal liquefaction processes for the purpose of performing technical and economic assessment of the production of liquid fuels from coal and lignite, using a variety of gasification and synthesis gas liquefaction technologies. The technologies were modeled on a 'step model' basis where a step is defined as a combination of individual unit operations which together perform a significant function on the process streams, such as a methanol synthesis step or a gasification and physical gas cleaning step. Sample results of the modelling, covering a wide range of gasifiers, liquid synthesis processes and products are presented in this thesis. Due to the large number of combinations of gasifier, liquid synthesis processes, products and economic sensitivity cases, a complete set of results is impractical to present in a single publication. The main results show that methanol is the cheapest fuel to produce from coal followed by fuel alcohol, diesel from the Shell Middle Distillate Synthesis process,gasoline from Mobil Methanol to Gasoline (MTG) process, diesel from the Mobil Methanol Olefins Gasoline Diesel (MOGD) process and finally gasoline from the same process. Some variation in production costs of all the products was shown depending on type of gasifier chosen and feedstock.

The use of solar colletor for heating and electricity for a single family house

The presented work is related to the use of solar energy for the needs of heating and electricity for a single house located in Poland. Electricity will provided by energy conversion in the turbine by means of Organic Rankine Cycle (ORC), in which the operating medium (water heated in solar collector) is heating refrigerator in the heating exchanger. The solar installation is integrated with heat accumulator and wood boiler, which is used in the situation that collector is not enough to fill requirements of thermal comfort. There are chosen also all the necessary components of the system. In the work is also performed the economic assessment, by F chart method, to evaluate the profitability of the project, taking into total costs and savings.

Sistemas de avaliação de tecnologias de saúde: dispositivos médicos

As tecnologias de saúde, nomeadamente medicamentos, dispositivos médicos (DM), procedimentos médicos ou cirúrgicos, entre outros, têm ocupado uma posição de destaque no setor da saúde, e na vida dos seus utilizadores. A inovação e utilização de tecnologias de saúde, e consequente aumento das despesas fizeram emergir a necessidade de avaliação das tecnologias de saúde. Surge assim, a avaliação de tecnologias de saúde (ATS), que tem por objetivo abordar os impactos clínicos, económicos, organizacionais, sociais, legais e éticos de uma tecnologia de saúde, considerando o seu contexto médico específico, bem como as alternativas disponíveis. A ATS pretende que os processos sejam feitos de forma rigorosa, transparente, valorizando e garantindo a sustentabilidade do acesso aos cuidados em saúde. Seguindo a tendência europeia de implementação de políticas e modelos de ATS, Portugal criou o seu próprio sistema de avaliação de tecnologias. O Decreto-Lei nº 97/2015, de 1 de junho veio oficializar a criação do Sistema Nacional de Avaliação de Tecnologias de Saúde (SiNATS). O SiNATS vai permitir uma avaliação não só de medicamentos, mas também de DM e outras tecnologias tendo em consideração a avaliação técnica, terapêutica e económica das tecnologias de saúde com base em fatores sociais, políticos, éticos e a participação de entidades, como, a indústria, as instituições de ensino, as instituições de saúde, os investigadores, os profissionais de saúde, os doentes e as associações dos doentes. O SiNATS vai emitir recomendações e decisões sobre o uso das tecnologias de saúde e possibilitar o ganho em saúde e contribuir para a sustentabilidade do Serviço Nacional de Saúde (SNS). O SiNATS vem permitir a avaliação de DM. O sector dos DM é um sector caracterizado pela inovação, crescimento e também competitividade. A complexidade e especificidade deste sector devem por isso ser tidas em consideração aquando da sua análise. A implementação do SiNATS permitirá avaliar e reavaliar preços, comparticipações, recomendações, contratos ao longo do ciclo de vida de cada DM. No presente momento, ainda é difícil expor os processos através dos quais esta avaliação vai ser processada, uma vez que se aguarda a publicação de despachos e portarias referidos no Decreto-Lei nº 97/2015, de 1 de junho. Tendo em consideração a partilha de informação sobre políticas, métodos, procedimentos de ATS aplicada aos DM na Europa, foram analisados os casos de França e do Reino Unido com o objetivo de alargar o conhecimento acerca do que já é feito a nível Europeu e explorar se os mesmos poderiam ser adaptados à realidade portuguesa. Em França, a ATS está diretamente relacionada com a comparticipação de DM, já no Reino Unido, o National Institute and Centre of Excellence (NICE) tem a responsabilidade de avaliar os DM segundo procedimentos de ATS, mas não está diretamente relacionado com comparticipação. O NICE publica normas de orientação que auxiliam a decisão de aquisição ou não de um DM. Tendo em consideração a informação reunida e descrita, este trabalho também propõe um modelo hipotético sobre o sistema português de avaliação de DM. Este modelo aborda, ainda que não de forma exaustiva, os possíveis processos e procedimentos para a avaliação de DM. Este sistema caracteriza-se pela importância dada ao envolvimento dos stakeholders e partilha de informação com os mesmos, mas também na agilização dos processos, isto é, uma redução e simplificação dos processos de avaliação de DM. A reavaliação de DM durante a sua comercialização também ganha destaque, apontando que cada grupo genérico de dispositivos ou DM inovador dever ser reavaliado a cada cinco anos, ou sempre que informação emergente o justifique. Este modelo representa uma abordagem experimental sobre o futuro do SiNATS aplicado aos DM. A partilha de informação, os fóruns de discussão e o envolvimento da sociedade serão uma mais-valia para que a implementação do SiNATS aos DM seja feita de forma gradual e com a máxima transparência possível.

Effects of exposure to Bovine viral diarrhoea virus 1 on risk of bovine respiratory disease in Australian feedlot cattle

Viruses play a key role in the complex aetiology of bovine respiratory disease (BRD). Bovine viral diarrhoea virus 1 (BVDV-1) is widespread in Australia and has been shown to contribute to BRD occurrence. As part of a prospective longitudinal study on BRD, effects of exposure to BVDV-1 on risk of BRD in Australian feedlot cattle were investigated. A total of 35,160 animals were enrolled at induction (when animals were identified and characteristics recorded), held in feedlot pens with other cattle (cohorts) and monitored for occurrence of BRD over the first 50 days following induction. Biological samples collected from all animals were tested to determine which animals were persistently infected (PI) with BVDV-1. Data obtained from the Australian National Livestock Identification System database were used to determine which groups of animals that were together at the farm of origin and at 28 days prior to induction (and were enrolled in the study) contained a PI animal and hence to identify animals that had probably been exposed to a PI animal prior to induction. Multi-level Bayesian logistic regression models were fitted to estimate the effects of exposure to BVDV-1 on the risk of occurrence of BRD.Although only a total of 85 study animals (0.24%) were identified as being PI with BVDV-1, BVDV-1 was detected on quantitative polymerase chain reaction in 59% of cohorts. The PI animals were at moderately increased risk of BRD (OR 1.9; 95% credible interval 1.0-3.2). Exposure to BVDV-1 in the cohort was also associated with a moderately increased risk of BRD (OR 1.7; 95% credible interval 1.1-2.5) regardless of whether or not a PI animal was identified within the cohort. Additional analyses indicated that a single quantitative real-time PCR test is useful for distinguishing PI animals from transiently infected animals.The results of the study suggest that removal of PI animals and/or vaccination, both before feedlot entry, would reduce the impact of BVDV-1 on BRD risk in cattle in Australian feedlots. Economic assessment of these strategies under Australian conditions is required. © 2016 Elsevier B.V.

Medizinische und gesundheitsökonomische Bewertung der Radiochirurgie zur Behandlung von Hirnmetastasen

Hintergrund: Für die Therapie maligner Neubildungen stellt die Strahlentherapie wichtige Behandlungsmöglichkeiten dar, die sich in den vergangenen Jahrzehnten deutlich weiterentwickelt haben. Hierzu gehört unter anderem die stereotaktische Radiochirurgie (SRS), die durch eine einmalige Applikation fokussierter hoher Strahlendosen in einem klar definierten Zeitraum gekennzeichnet ist. Von besonderer Bedeutung ist die SRS für die Behandlung von Hirnmetastasen. Fragestellung: Ziel dieses HTA-Berichts ist die Erstellung einer umfassenden Übersicht der aktuellen Literatur der Behandlung von Hirnmetastasen, um die Radiochirurgie als alleinige Therapie oder in Kombination mit Therapiealternativen bezüglich der medizinischen Wirksamkeit, Sicherheit und Wirtschaftlichkeit sowie ethischer, sozialer und juristischer Aspekte zu vergleichen. Methodik: Relevante Publikationen deutscher und englischer Sprache werden über eine strukturierte Datenbank- sowie mittels Handrecherche zwischen Januar 2002 und August 2007 identifiziert. Die Zielpopulation bilden Patienten mit einer oder mehreren Hirnmetastasen. Eine Beurteilung der methodischen Qualität wird unter Beachtung von Kriterien der evidenzbasierten Medizin (EbM) durchgeführt. Ergebnisse: Von insgesamt 1.495 Treffern erfüllen 15 Studien die medizinischen Einschlusskriterien. Insgesamt ist die Studienqualität stark eingeschränkt und mit Ausnahme von zwei randomisierte kontrollierte Studien (RCT) und zwei Metaanalysen werden ausschließlich historische Kohortenstudien identifiziert. Die Untersuchung relevanter Endpunkte ist uneinheitlich. Qualitativ hochwertige Studien zeigen, dass die Ergänzung der Ganzhirnbestrahlung (WBRT) zur SRS sowie der SRS zur WBRT mit einer verbesserten lokalen Tumorkontrolle und Funktionsfähigkeit einhergeht. Nur im Vergleich zur alleinigen WBRT resultiert die Kombination von SRS und WBRT jedoch bei Patienten mit singulären Hirnmetastasen, RPA-Klasse 1 (RPA = Rekursive Partitionierungsanalyse) und bestimmten Primärtumoren in verbesserter Überlebenszeit. Die Therapiesicherheit zeigt in beiden Fällen keine deutlichen Unterschiede zwischen den Interventionsgruppen. Methodisch weniger hochwertige Studien finden keine eindeutigen Unterschiede zwischen SRS und WBRT, SRS und Neurochirurgie (NC) sowie SRS und hypofraktionierter Strahlentherapie (HCSRT). Die Lebensqualität wird in keiner Studie untersucht. Durch die Datenbankrecherche werden 320 Publikationen für den ökonomischen Bereich identifiziert. Insgesamt werden fünf davon für den vorliegenden Health Technology Assessment (HTA)-Bericht verwendet. Die Qualität der Publikationen ist dabei unterschiedlich. Bezüglich der Wirtschaftlichkeit verschiedener Gerätealternativen ergibt sich, unter der Annahme gleicher Wirksamkeit, eine starke Abhängigkeit von der Anzahl der behandelten Patienten. Im Fall, dass die beiden Gerätealternativen nur für die SRS verwandt werden, liegen Hinweise vor, dass das Gamma Knife kostengünstiger sein kann. Andernfalls ist es sehr wahrscheinlich, dass der flexiblere modifizierte Linearbeschleuniger kostengünstiger ist. Nach einem HTA sind die Gesamtkosten für ein Gamma Knife und einen dedizierten Linearbeschleuniger ungefähr gleich, während ein modifizierter Linearbeschleuniger günstiger ist. Für ethische, juristische und soziale Fragestellungen werden keine relevanten Publikationen identifiziert. Diskussion: Insgesamt sind sowohl die Qualität als auch die Quantität identifizierter Studien stark reduziert. Es zeigt sich jedoch, dass die Prognose von Patienten mit Hirnmetastasen auch unter modernsten therapeutischen Möglichkeiten schlecht ist. Ausreichend starke Evidenz gibt es lediglich für die Untersuchung ergänzender WBRT zur SRS und der ergänzenden SRS zur WBRT. Ein direkter Vergleich von SRS und WBRT, SRS und NC sowie SRS und HCSRT ist hingegen nicht möglich. Die Wirtschaftlichkeit verschiedener Gerätealternativen hängt von der Patientenzahl und den behandelten Indikationen ab. Für ausgelastete dedizierte Systeme, liegen Hinweise vor, dass sie kostengünstiger sein können. Bei flexibler Nutzung scheinen modifizierte Systeme wirtschaftlich vorteilhafter. Diese Aussagen erfolgen unter der nicht gesicherten Annahme gleicher Wirksamkeit der Alternativen. Die Behandlungspräzision der Geräte kann Einfluss auf die Gerätewahl haben. Zu neueren Gerätealternativen wie z. B. dem CyberKnife liegen bisher keine Untersuchungen vor. Aus der wirtschaftlich vorteilhaften hohen Auslastung folgt aber eine begrenzte Geräteanzahl in einem vorgegebenen Gebiet, was evtl. einen gleichberechtigten, wohnortnahen Zugang zu dieser Technik erschwert. Schlussfolgerungen: Die Kombination SRS und WBRT geht mit einer verbesserten lokalen Tumorkontrolle und Funktionsfähigkeit gegenüber der jeweils alleinigen Therapie einher. Nur für Patienten mit singulärer Metastase resultiert dies in Vorteilen der Überlebenszeit. Qualitativ hochwertige Studien sind notwendig um die SRS direkt mit WBRT und NC zu vergleichen. Weiterhin sollte besonders die Lebensqualität in zukünftigen Studien mitberücksichtigt werden. Bei der Art des verwendeten Gerätes zeichnet sich eine deutliche Abhängigkeit der Wirtschaftlichkeit der Geräte von der erreichbaren Auslastung ab. Hohe Patientenzahlen bieten Vorteile für spezialisierte Systeme und bei geringeren Patientenzahlen ist die Flexibilität modifizierter System vorteilhaft. Weitere Studien z. B. zum CyberKnife sind wünschenswert. Insgesamt ist die Studienlage insbesondere für das deutsche Gesundheitssystem sehr mangelhaft.

The Role of decision-analytic modelling in German health technology assessments

BACKGROUND: Decision-analytic modelling (DAM) has become a widespread method in health technology assessments (HTA), but the extent to which modelling is used differs among international HTA institutions. In Germany, the use of DAM is optional within HTAs of the German Institute of Medical Documentation and Information (DIMDI). Our study examines the use of DAM in DIMDI HTA reports and its effect on the quality of information provided for health policies. METHODS: A review of all DIMDI HTA reports (from 1998 to September 2012) incorporating an economic assessment was performed. All included reports were divided into two groups: HTAs with DAM and HTAs without DAM. In both groups, reports were categorized according to the quality of information provided for healthcare decision making. RESULTS: Of the sample of 107 DIMDI HTA reports, 17 (15.9%) used DAM for economic assessment. In the group without DAM, conclusions were limited by the quality of economic information in 51.1% of the reports, whereas we did not find limited conclusions in the group with DAM. Furthermore, 24 reports without DAM (26.7%) stated that using DAM would likely improve the quality of information of the economic assessment. CONCLUSION: The use of DAM techniques can improve the quality of HTAs in Germany. When, after a systematic review of existing literature within a HTA, it is clear that DAM is likely to positively affect the quality of the economic assessment DAM should be used.

Evaluación de costo efectividad de la profilaxis versus tratamiento a demanda en pacientes con Hemofilia A moderada y severa para prevenir sangrado articular de una aseguradora en Colombia

Introducción: En Colombia existe un protocolo de manejo para pacientes con hemofilia A severa sin inhibidores que recomienda el manejo de profilaxis primaria y secundaria con FVIII. Objetivos: Estimar la relación incremental de costo-efectividad (RICE) de la profilaxis con Factor VIII vs tratamiento a demanda para prevenir sangrados articulares en pacientes con hemofilia A moderada y severa de una aseguradora en Colombia. Materiales y Métodos: Se adaptó un modelo de Markov desde la perspectiva del tercer pagador. Las probabilidades de transición se ajustaron mediante un modelo de regresión logística multinomial explicadas por la edad y el peso. Las tasas de eventos son anuales. Las efectividades se extrajeron de la cohorte de la aseguradora y de la literatura. Los costos incluyeron el FVIII, medicamentos, hospitalización, procedimientos quirúrgicos, apoyo diagnóstico y consultas médicas. La tasa de descuento fue del 3%. Resultados: En pacientes con hemofilia A moderada y severa la profilaxis con FVIII evitará en promedio 7 sangrados articulares, el RICE para el sangrado articular es de $303.457. Conclusiones: La profilaxis con Factor VIII es una estrategia costo-efectiva en el manejo de pacientes con hemofilia A moderada y severa para la aseguradora, disminuyendo el número de sangrados articulares al año.

Incorporating an economic model in the health impact assessment approach

The current policy decision making in Australia regarding non-health public investments (for example, transport/housing/social welfare programmes) does not quantify health benefits and costs systematically. To address this knowledge gap, this study proposes an economic model for quantifying health impacts of public policies in terms of dollar value. The intention is to enable policy-makers in conducting economic evaluation of health effects of non-health policies and in implementing policies those reduce health inequalities as well as enhance positive health gains of the target population. Health Impact Assessment (HIA) provides an appropriate framework for this study since HIA assesses the beneficial and adverse effects of a programme/policy on public health and on health inequalities through the distribution of those effects. However, HIA usually tries to influence the decision making process using its scientific findings, mostly epidemiological and toxicological evidence. In reality, this evidence can not establish causal links between policy and health impacts since it can not explain how an individual or a community reacts to changing circumstances. The proposed economic model addresses this health-policy linkage using a consumer choice approach that can explain changes in group and individual behaviour in a given economic set up. The economic model suggested in this paper links epidemiological findings with economic analysis to estimate the health costs and benefits of public investment policies. That is, estimating dollar impacts when health status of the exposed population group changes by public programmes – for example, transport initiatives to reduce congestion by building new roads/ highways/ tunnels etc. or by imposing congestion taxes. For policy evaluation purposes, the model is incorporated in the HIA framework by establishing association among identified factors, which drive changes in the behaviour of target population group and in turn, in the health outcomes. The economic variables identified to estimate the health inequality and health costs are levels of income, unemployment, education, age groups, disadvantaged population groups, mortality/morbidity etc. However, though the model validation using case studies and/or available database from Australian non-health policy (say, transport) arena is in the future tasks agenda, it is beyond the scope of this current paper.