Impact of hormonal therapy on survival and racial disparities in a large community-based cohort of older men with local/regional prostate cancer

Prostate cancer (CaP) is the most diagnosed non-cutaneous malignancy and the second leading cause of cancer mortality among United States males. Major racial disparities in incidence, survival, as well as treatment persist. The mortality is three times higher among African Americans (AAs) compared with Caucasians. Androgen carcinogenesis has been persistently implicated but results are inconsistent; and hormone manipulation has been the main stay of treatment for metastatic disease, supportive of the androgen carcinogenesis. The survival disadvantage of AAs has been attributed to the differences in socioeconomic factors (SES), tumor stage, and treatment. We hypostasized that HT prolongs survival in CaP and that the racial disparities in survival is influenced by variation in HT and primary therapies as well as SES. To address these overall hypothesis, we first utilized a random-effect meta-analytic design to examine evidence from randomized trials on the efficacy of androgen deprivation therapy in localized and metastatic disease, and assessed, using Cox proportional hazards models, the effectiveness of HT in prolonging survival in a large community-based cohort of older males diagnosed with local/regional CaP. Further we examined the role of HT and primary therapies on the racial disparities in CaP survival. The results indicated that adjuvant HT compared with standard care alone is efficacious in improving overall survival, whereas HT has no significant benefit in the real world experience in increasing the overall survival of older males in the community treated for local/regional disease. Further, racial differences in survival persist and were explained to some extent by the differences in the primary therapies (radical prostatectomy, radiation and watchful waiting) and largely by SES. Therefore, given the increased used of hormonal therapy and the cost-effectiveness today, more RCTs are needed to assess whether or not survival prolongation translates to improved quality of life, and to answer the research question on whether or not the decreased use of radical prostatectomy by AAs is driven by the Clinicians bias or AAs's preference of conservative therapy and to encourage AAs to seek curative therapies, thus narrowing to some degree the persistent mortality disparities between AAs and Caucasians. ^

Specialized managed care for children with cystic fibrosis: Resource use patterns and rate design for a high cost Medicaid population

Objective. This research study had two goals: (1) to describe resource consumption patterns for Medi-Cal children with cystic fibrosis, and (2) to explore the feasibility from a rate design perspective of developing specialized managed care plans for such a special needs population.^ Background. Children with special health care needs (CSHN) comprise about 2% of the California Medicaid pediatric population. CSHN have rare but serious health problems, such as cystic fibrosis. Medicaid programs, including Medi-Cal, are enrolling more and more beneficiaries in managed care to control costs. CSHN, however, do not fit the wellness model underlying most managed care plans. Child health advocates believe that both efficiency and quality will suffer if CSHN are removed from regionalized special care centers and scattered among general purpose plans. They believe that CSHN should be "carved out" from enrollment in general plans. One alternative is the Specialized Managed Care Plan, tailored for CSHN.^ Methods. The study population consisted of children under age 21 with CF who were eligible for Medi-Cal and California Children's Services program (CCS) during 1991. Health Care Financing Administration (HCFA) Medicaid Tape-to-Tape data were analyzed as part of a California Children's Hospital Association (CCHA) project.^ Results. Mean Medi-Cal expenditures per month enrolled were $2,302 for 457 CF children, compared to about \$1,270 for all 47,000 CCS special needs children and roughly $60 for almost 2.6 million ``regular needs'' children. For CF children, inpatient care (80\%) and outpatient drugs (9\%) were the major cost drivers, with {\it all\/} outpatient visits comprising only 2\% of expenditures. About one-third of CF children were eligible due to AFDC (Aid to Families with Dependent Children). Age group explained about 17\% of all expenditure variation. Regression analysis was used to select the best capitation rate structure (rate cells by age and eligibility group). Sensitivity analysis estimated moderate financial risk for a statewide plan (360 enrollees), but severe risk for single county implementation due to small numbers of children.^ Conclusions. Study results support the carve out of CSHN due to unique expenditure patterns. The Specialized Managed Care Plan concept appears feasible from a rate design perspective given sufficient enrollees. ^

THE EFFECTS OF COST-SHARING ON USE OF SERVICES AND CONSUMER CHARACTERISTICS IN A STATE'S CRIPPLED CHILDREN'S DIVISION

The present study analyzed some of the effects of imposing a cost-sharing requirement on users of a state's health service program. The study population consisted of people who were in diagnosed medical need and included, but was not limited to, people in financial need.^ The purpose of the study was to determine if the cost-sharing requirement had any detrimental effects on the service population. Changes in the characteristics of service consumers and in utilization patterns were analyzed using time-series techniques and pre-post policy comparisons.^ The study hypotheses stated that the distribution of service provided, diagnoses serviced, and consumer income levels would change following the cost-sharing policy.^ Analysis of data revealed that neither the characteristics of service users (income, race, sex, etc.) nor services provided by the program changed significantly following the policy. The results were explainable in part by the fact that all of the program participants were in diagnosed medical need. Therefore, their use of "discretionary" or "less necessary" services was limited.^ The study's findings supported the work of Joseph Newhouse, Charles Phelps, and others who have contended that necessary service use would not be detrimentally affected by reasonable cost-sharing provisions. These contentions raise the prospect of incorporating cost-sharing into programs such as Medicaid, which, at this writing, do not demand any consumer payment for services.^ The study concluded with a discussion of the cost-containment problem in health services. The efficacy of cost-sharing was considered relative to other financing and reimbursement strategies such as HMO's, self-funding, and reimbursement for less costly services and places of service. ^

Adaptación del modelo leader en el territorio huejotzingo, puebla: una nueva propuesta de desarrollo rural local

Free people association constructed from button to above to get better conditions of people using local resources, are among others, elements of local development. LEADER (Liaisons HQWUH DFWLYLWpV GH 'HYHORSHPHQW GH /¶(FRQRPLH 5XUDO) is the Europe Union model of rural development. The LEADER method is conformed in seven features which are factors of success in the approach of applying in different territories . The actions held in the municipal council of rural development of San Andres C a l p a n during 2010 showed some elements of LEADER for it´s adjustment: 1).- territory definition , 2).- local association , 3).- financing. It´s used a methodology consists of reviewing documents about the financing and association in the territory studied, survey applying t define the model of agricultural production and development along with mayors of different municipalities, the economical and social actors. The definition performance field with territory integration of citizen councils as groups of local action and a financing strategy are part of the results of this process of adapting in this territory

Evolución y crisis de la región metropolitana de Madrid 1985-2007. Análisis de las diversas perspectivas para la transformación del gobierno urbano: una revisión crítica del planeamiento

La Región Metropolitana de Madrid (RMM) ha sufrido una gran transformación urbana en el periodo 1985-2007, en el cual ha crecido la población, ha crecido fuertemente el cuerpo físico, pero sobre todo han crecido su coste y su consumo, lo que supone que se ha vuelto más insostenible. Para tratar de comprender esta evolución asimétrica se ensayan sucesivos modelos que tratan de explicar la transformación de la realidad a través de la articulación de las formas de poder y sus políticas asociadas dentro del contexto local-metropolitano. Si se compara la transformación urbana en el periodo 1985-2007 respecto a la registrada durante el desarrollismo previo al presente periodo democrático, se encuentran similitudes, como el amplio consumo de suelo, pero el modelo desarrollista se inscribe en otras lógicas y tiene otros parámetros de contexto y es congruente ya que las últimas décadas del Régimen Franquista se caracterizan por un importantísimo aumento poblacional que se correspondía con el fuerte crecimiento industrial de la RMM. Esa congruencia relativa se pierde en el periodo estudiado, a pesar de que en 1985, se aprueba el Plan General de Ordenación Urbana de Madrid centrado en la ciudad existente y con un crecimiento contenido, y que puede considerarse un modelo abortado. Tras numerosas transformaciones políticas, económicas, sociales y urbanísticas se llega a una situación opuesta a la prevista en el citado Plan. Más de veinte años después, en 2007, se presentan no solo síntomas de agotamiento del modelo finalmente adoptado, sino su quiebra dramática tanto en su dimensión inmobiliario-financiera como del espacio del bienestar. Es precisamente la supresión de los mecanismos de regulación lo que ha caracterizado la evolución de los modelos urbanos, en correspondencia con la desregulación de las actividades económicas y de los flujos de capital propios del modelo "neoliberal". La actual crisis financiera internacional, en especial en algunos países periféricos europeos como España, ha demostrado cómo las políticas económicas que se han llevado a cabo, fuera de toda regulación, han resultado insostenibles. Pero no se trata solo de una crisis económica. En el caso español, de todas las dimensiones de la crisis, destaca la dimensión urbana, o el auge y caída del ciclo inmobiliario, debido a la urbanización intensiva del territorio en relación con el circuito secundario de la acumulación capitalista, habiendo tenido especial incidencia en algunos territorios como la RMM. En la Región Metropolitana de Madrid la situación actual es de crisis urbana, causada principalmente por el divorcio entre las necesidades y la producción de ciudad, pues no se ha basado el crecimiento en la creación de nuevos hogares, u otras cuestiones demográficas, sino en la acumulación de capital a través del crecimiento de la ciudad. Además, dicho crecimiento está conformado por una expansión urbana descontrolada, con mayores requerimientos energéticos que el modelo compacto y complejo tradicional, lo que unido a la escala de los procesos, supone un sistema urbano progresivamente ineficiente. El caso de la RMM resulta paradigmático, ya que la región ha desempeñado un papel como laboratorio de nuevas formas de gobierno y planificación que han dado un mayor protagonismo al espacio, que ha entrado en las dinámicas centrales principalmente por el apoyo al crecimiento físico, a la vez que han confluido circunstancias específicas, como un nuevo impulso al centralismo, lo que ha potenciado ciertas políticas, como considerar la ciudad como motor de crecimiento económico y de competitividad en el concierto europeo y mundial de ciudades. El estudio del papel de la planificación y sus crisis en la sucesión de los modelos, muestra su función nuclear en la propia constitución de estos —es parte fundamental de su aparato de regulación— y su valor no solo para poder entender el periodo, sino para poder proyectar otro futuro urbano. Este enfoque conduce a establecer la relación del planeamiento con las diferentes crisis económicas en el periodo de estudio lo que permite diferenciar tres momentos de dicha relación: la planificación urbanística austera bajo la influencia de la crisis fordista, la salida de la crisis a través de la imposición de un modelo urbano basado en el sobreproducción de espacio urbano, y la entrada en una crisis inmobiliaria y de financiarización en relación a la adopción de un modelo multidimensionalmente insostenible. El análisis de este periodo es la base para apuntar perspectivas que permitan transformar el gobierno urbano hacia un modelo urbano más deseable, o mejor aún, otros futuros posibles, que se enmarcan dentro de la alternativa principal que supone la sostenibilidad. Madrid's Metropolitan Region (MMR) has undergone a major urban transformation in the period 1985-2007, where the population has grown up, the built environment has grown strongly, but mostly its cost and consumption have grown, which means that it has become unsustainable. To try to understand this evolution successive asymmetric models are tested in order to explain the transformation of reality through the articulation of forms of power and its associated policies in that localmetropolitan context. Comparing the urban transformation in the period 1985-2007 to the existing during developmentalism in the current predemocratic period, both have similarities in terms of land consumption, but the previous developmentalism model is part of another logics and has got other context parameters. It is consistent since the last decades of the Franco Regime was characterized by an important population increase that corresponded to strong industrial growth of the MMR. This relative consistency is lost during the study period, although in 1985, with the approval of the Master Plan of Madrid that was focused on the existing city, with a limited growth, and it may be considered an interrupted model. After numerous political, economic, social and urban changes, there is the opposite situation to that foresight under that Plan. Over twenty years later, in 2007, there are not only signs of exhaustion of the model which was finally adopted, but also its dramatic collapse in both real estate and financial dimension of space as well. The urban transformation under analysis has relaunched the hegemony of the sectors that rule the growth of the Madrid's Metropolitan Region and it is supported by decision making and financing of the different administrations with the passivity of the social stakeholders and citizens. This has meant the removal of regulatory mechanisms that have characterized the evolution of urban models, corresponding to the deregulation of economic activities and capital flows according to "neoliberal" model. The current international financial crisis, especially in some European peripheral countries like Spain, has shown how economic policies that have been carried out, without any regulation, have proven unsustainable. But it is not only an economic crisis. In the Spanish case, of all the dimensions of the crisis, it is the urban dimension that is highlighted, or the rise and fall of real estate cycle, due to intensive urbanization of the territory in relation to the secondary circuit of capital accumulation, having had a particular impact in some territories such as the Madrid's Metropolitan Region. In Madrid's Metropolitan Region there is the current situation of urban crisis, mainly caused by the divorce between needs and the city (space) production, because no growth has been based on creating new homes, or other demographic issues, but in the capital accumulation through growth of the city. Furthermore, this growth is made up of urban sprawl, with higher energy requirements than the traditional compact and complex one, which together with the scale of processes, is increasingly an inefficient urban system. The case of Madrid's Metropolitan Region is paradigmatic, since the region has played a role as a laboratory for new forms of governance and planning have given a greater role to space, which has entered the core dynamics supported mainly by physical growth, while specific circumstances have come together as a new impulse to centralization. This has promoted policies such as considering the city as an engine of economic growth and competitiveness in the international and the European hierarchy of cities. The study of the role of planning and crisis in the succession of models, shows its nuclear role in the constitution of these models is a fundamental part of its regulatory apparatus- and also its value not only to understand the period, but to anticipate to other urban future. This approach leads to establish the relationship of planning with the various crises in the study period, allowing three different moments of that relationship: the austere urban planning under the influence of Fordist crisis, the output of the crisis through imposition of an urban model based on the overproduction of urban space, and entry into a housing crisis and financialisation in relation to the adoption of a multi-dimensionally unsustainable model. The analysis of this period is the basis for targeting prospects that translate urban governance towards a more desirable urban model, or better yet, other possible futures, which are part of the main alternative that is sustainability.

Construction cost and energy consumption resulting from energy retrofitting in an apartment building in Madrid (Spain).

This theoretical study analyzes the relation between the measures necessesary for the energy retrofitting of a residential building constructed in Madrid, their cost and the improvement of the energy rating of the dwellings. The aim of this work is to establish an evaluation methodology that allows developers and architects to obtain conclusions and orientates therm in the decisioin-making process. It will allow finding the most suitable cost-effective solutions in each case. This paper describes the methodology and the findings obtained. Energy retrofitting and the improvement of the energy behaviour of the building depend on the selection of the retrofitting solutions and also on the investment. In this case study to achieve the best energy rates it is necessary to improve the thermal performance of the envelope as well as the energy systems. Energy retrofitting means an increase in property value but it can't only be considered in economic terms. It is necessary to take into account unquantifiable aspects as increased comfort, improved sound insulation, livability, health, or the elimination of energy poverty situations.

Caracterización de la agitación local y la respuesta oscilatoria de un buque mediante el uso de técnicas de visión artificial : aplicación al análisis de los umbrales operativos en líneas de atraque y amarre

El desarrollo de actividades de carga y descarga son parte de la esencia de la naturaleza funcional de un puerto, de las cuales derivan en gran medida los ingresos del mismo y la eficiencia de la cadena logística en su conjunto. Las oscilaciones en el interior de una dársena y en un línea de atraque disminuyen la calidad de la estancia de las embarcaciones en puerto, reducen el rendimiento de la estiba de los buques y solicitan y fatigan las estructuras y los cuerpos flotantes amarrados. Si los parámetros que definen la agitación local se aproximan a regiones de fallo 0 parada, el subsistema pierde rendimiento, fiabilidad y finalmente se paralizan las operaciones, produciéndose de este modo tiempos de inactividad. Estas paradas operativas conllevan pérdidas económicas para la terminal y, consecuentemente, para el puerto. Hoy día se dispone vastas redes de monitorización destinadas a la caracterización del medio físico en el entorno de los puertos. Paralelamente, las operaciones de manipulación de cargas en las terminales se están dirigiendo hacia modelos de automatización o semi automatización, que permiten no sólo la sistematización de procesos, sino también un profundo conocimiento del flujo de tareas. En este contexto hay un déficit de información sobre cómo afectan los diferentes forzadores del medio físico al rendimiento, la seguridad funcionalidad del proceso de manipulación de carga y descarga. Esto se debe en gran medida a la falta de registros dilatados en el tiempo que permitan correlacionar todos los aspectos mencionados de un modo particularizado para cada línea de atraque y amarre de un puerto. En esta tesis se desarrolla una metodología de vídeo monitorización no intrusiva y de bajo coste basada en la aplicación de técnicas "pixel tool' y la obtención de los parámetros extrínsecos de una observación monofocal. Con ello pretende poner en valor las infraestructuras de vídeo vigilancia de los puertos y de los laboratorios de experimentación a escala reducida, con el objeto de facilitar el estudio los umbrales operativos de las áreas de atraque y amarre. The development of loading and unloading activities is an essential part of he functional nature of a port, which derive largely from he same income and the efficiency of he supply chain as a whole. The oscillations inside a dock and a mooring line diminish he quality of the stay of vessels in port reducing the performance of the stowage of ship and asking and fatigued structures and moored floating bodies. If the parameters defining the local al agitation regions are close to areas of failure or shutdown, he subsystem looses performance, reliability and eventually paralyzes the operations, thereby producing downtime. These operational stops entail economic 1osses to the terminal and, consequently for the port. Today vast networks of monitoring, aimed at he characterization of the physical environment in the vicinity of he ports, are available. In parallel, the cargo handling operations at terminals are moving towards automation or semi-automation models that allow not only the systematization of processes, but also a deep understanding of he workflow. In this context, there is a lack of information about how the different forcing agents of the physical environment affect the performance and he functional safety of the loading and unloading process. This is due largely to the lack of spread-over-time records which would allow to correlate all aspects mentioned, specifically, for each berthing and mooring of a port. This thesis develops a methodology for non-intrusive and low cost monitoring video based on the application of "pixel tool" techniques and on obtaining the extrinsic parameters of a monofocal observation. It seeks an enhancement of the video monitoring infrastructure at ports and at experimental laboratories of reduced scale, in order to facilitate the study of operational thresholds berthing and mooring areas.

COST Action Urban Agriculture Europe Training School «Urban agriculture inside the city:alternatives for vacant lots and public space»

The third Training School of the Action took place in Vitoria-Gasteiz (Basque country, Spain) from 24th to 26th September 2014. Vitoria-Gateiz has experimented an important urban outgrowth in the last decade, mainly through the planning and development of two new neighborhoods, Zabalgana and Salburúa, situated at the eastern and western border of the city, by the Greenbelt. These new development are well-equipped and designed according to sustainability principles. Nevertheless, among the main problems they present is their over-dimensioned public space, which creates some areas lacking enough density and mix of uses. On the other hand it is very expensive for the municipality to maintain these public space with the high Vitorian urban standards for public space. The proposed solution for this problem is a strategy of "re-densification" through the insertion of new uses The debate has arisen about which are the most adequate uses to insert in order to get an increasing of urban vitality, specially considering that housing has reached its peak and that Vitoria-Gasteiz is well served with social and sport amenities. The main goal of the TS was to offer an opportunity for the reflection about how urban agriculture might be an optimal alternative for the re-qualifying of this over-dimensioned public space in the new neighbourhoods, especially considering it synergic potential as a tool for production, leisure and landscaping, including the possibility of energy crops within the limits of urban space. Continuity with rural and natural surrounding area through alternatives for urban fringe at the small scale is a relevant issue to be considered as well within the reflection. Taking Zabalgana neighbourhood as a practical field for experiment, the Training School is conceived as a practical and intensive design charrette to be held during a whole day after two days of local knowledge-deepening through field visits and presentations.

Determinación de la amplificación sísmica local en el Campus Sur UPM mediante la técnica de sismología de microtremores ReMi.

En el Campus Sur de la Universidad Politécnica de Madrid se ha llevado a cabo un proyecto para obtener una caracterización del subsuelo mediante ensayos ReMi, en colaboración con el departamento de Geofísica del Instituto Geográfico Nacional. La técnica ReMi (Refraction Microtremor) permite, mediante ensayos geofísicos realizados localmente sobre el terreno,obtener los parámetros físicos del mismo, que resultan de especial interés en el ámbito de la ingeniería civil. Esta técnica se caracteriza por englobarse dentro de la sísmica pasiva, muy empleada en prospección geofísica y basada en la obtención del modelo subyacente de distribución de velocidades de propagación de la onda S en función de la profundidad, con la ventaja de aprovechar el ruido sísmico ambiental como fuente de energía. Fue desarrollada en el Laboratorio Sismológico de Nevada (EEUU) por Louie (2001), con el objetivo de presentar una técnica innovadora en la obtención de las velocidades de propagación de manera experimental. Presenta ciertas ventajas, como la observación directa de la dispersión de ondas superficiales,que da un buen resultado de la velocidad de onda S, siendo un método no invasivo, de bajo coste y buena resolución, aplicable en entornos urbanos o sensibles en los que tanto otras técnicas sismológicas como otras variedades de prospección presentan dificultades. La velocidad de propagación de la onda S en los 30 primeros metros VS30, es ampliamente reconocida como un parámetro equivalente válido para caracterizar geotécnicamente el subsuelo y se halla matemáticamente relacionada con la velocidad de propagación de las ondas superficiales a observar mediante la técnica ReMi. Su observación permite el análisis espectral de los registros adquiridos, obteniéndose un modelo representado por la curva de dispersión de cada emplazamiento, de modo que mediante una inversión se obtiene el modelo de velocidad de propagación en función de la profundidad. A través de estos modelos, pueden obtenerse otros parámetros de interés sismológico. Estos resultados se representan sobre mapas isométricos para obtener una relación espacial de los mismos, particularmente conocido como zonación sísmica. De este análisis se extrae que la VS30 promedio del Campus no es baja en exceso, correspondiéndose a posteriori con los resultados de amplificación sísmica, período fundamental de resonancia del lugar y profundidad del sustrato rocoso. En última instancia se comprueba que los valores de amplificación sísmica máxima y el período al cual se produce posiblemente coincidan con los períodos fundamentales de resonancia de algunos edificios del Campus. ABSTRACT In South Campus at Polytechnic University of Madrid, a project has been carried out to obtain a proper subsoil description by applying ReMi tests, in collaboration with the Department of Geophysics of the National Geographic Institute. Through geophysical tests conducted locally, the ReMi (Refraction Microtremor) technique allows to establish the physical parameters of soil, which are of special interest in the field of civil engineering. This technique is part of passive seismic methods, often used in geophysical prospecting. It focuses in obtaining the underlying model of propagation velocity distribution of the shear wave according to depth and has the advantage of being able to use seismic ambient noise as a source of energy. It was developed in the Nevada Seismological Laboratory (USA) by Louie (2001) as an innovative technique for obtaining propagation velocities experimentally. It has several other advantages, including the direct observation of the dispersion of surface waves, which allows to reliably measure S wave velocity. This is a non-invasive, low cost and good resolution method, which can be applied in urban or sensitive environments where other prospection methods present difficulties. The propagation velocity of shear waves in the first 30 meters Vs30 is widely recognized as a valid equivalent parameter to geotechnically characterize the subsurface. It is mathematically related to surface wave's velocity of propagation, which are to observe using REMI technique. Spectral analysis of acquired data sets up a model represented by the dispersion curve at each site, so that, using an inversion process, propagation velocity model in relation to depth is obtained. Through this models, other seismologically interesting parameters can be obtained. These results are represented on isometric maps in order to obtain a spatial relationship between them, a process which is known as seismic zonation. This analysis infers that Vs30 at South Campus is not alarmingly low , corresponding with subsequent results of seismic amplification, fundamental period of resonance of soil and depth of bedrock. Ultimately, it's found that calculated values of soil's fundamental periods at which maximum seismic amplification occurs, may possibly match fundamental periods of some Campus buildings.

Human-computer interaction based on visual hand-gesture recognition using volumetric spatiograms of local binary patterns

A more natural, intuitive, user-friendly, and less intrusive Human–Computer interface for controlling an application by executing hand gestures is presented. For this purpose, a robust vision-based hand-gesture recognition system has been developed, and a new database has been created to test it. The system is divided into three stages: detection, tracking, and recognition. The detection stage searches in every frame of a video sequence potential hand poses using a binary Support Vector Machine classifier and Local Binary Patterns as feature vectors. These detections are employed as input of a tracker to generate a spatio-temporal trajectory of hand poses. Finally, the recognition stage segments a spatio-temporal volume of data using the obtained trajectories, and compute a video descriptor called Volumetric Spatiograms of Local Binary Patterns (VS-LBP), which is delivered to a bank of SVM classifiers to perform the gesture recognition. The VS-LBP is a novel video descriptor that constitutes one of the most important contributions of the paper, which is able to provide much richer spatio-temporal information than other existing approaches in the state of the art with a manageable computational cost. Excellent results have been obtained outperforming other approaches of the state of the art.

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost

Objective: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic.

Creating local bibliographic databases: new tools for evidence-based health care*

The Internet has created new opportunities for librarians to present literature search results to clinicians. In order to take full advantage of these opportunities, libraries need to create locally maintained bibliographic databases. A simple method of creating a local bibliographic database and publishing it on the Web is described. The method uses off-the-shelf software and requires minimal programming. A hedge search strategy for outcome studies of clinical process interventions is created, and Ovid is used to search MEDLINE. The search results are saved and imported into EndNote libraries. The citations are modified, exported to a Microsoft Access database, and published on the Web. Clinicians can use a Web browser to search the database. The bibliographic database contains 13,803 MEDLINE citations of outcome studies. Most searches take between four and ten seconds and retrieve between ten and 100 citations. The entire cost of the software is under $900. Locally maintained bibliographic databases can be created easily and inexpensively. They significantly extend the evidence-based health care services that libraries can offer to clinicians.

Policy Development at a Local Level to Mitigate Depositing Endocrine Disruptors into Aquatic Ecosystems

Endocrine disruptors are suspected to cause disruption to organisms in aquatic environments. Intersex fish and skewed populations of females outnumbering males have been found where effluents from municipal wastewater treatment plants enter into receiving waters. The science needed to substantiate a link of these suspected pollutants as the cause of problems to human health or the environmental is in its infancy. Empirical research was used to identify suspected endocrine disruptors, their sources, and the difficulties involved in regulating these emerging contaminants. This project examined entities that are addressing endocrine disruption and provides cost-effective recommendations for municipalities to develop policies to mitigate the amount of endocrine disruptors entering into receiving waters and limiting the effects caused by endocrine disruption.

Solar Photovoltaic Energy Project Development on Brownfields: Leveraging Policy Incentives and Project Financing Mechanisms

This study evaluates the practice of redeveloping Brownfields with solar photovoltaic renewable energy technology. Utilizing renewable energy as a strategy to reuse contaminated or potentially contaminated property is a relatively new convention. While the benefits of redeveloping Brownfields are well established, ongoing challenges and limited literature on the subject complicate the practice. Challenges, opportunities, and benefits related to renewable energy development on Brownfields are identified and analyzed. Strategic leveraging of federal, state, local, and utility incentives for renewable energy and Brownfield revitalization, and gap finance tools is explored and evaluated. A comparison of three photovoltaic Brownfield projects is analyzed for critical success and failure factors, and lessons learned. A recommendation of best practices is made based on findings and results.

Low-cost batteries will not disrupt (all) energy utilities. CEPS Commentary, 5 October 2015

With the launch last April of an affordable lithium-ion home battery – the Powerwall – Tesla’s CEO Elon Musk is betting that batteries are going to become a mass market. This may very well become reality, but this commentary argues that one should not jump to the conclusion that this is the end of energy utilities. Similar to solar panels, batteries have high upfront costs. The massive deployment of solar was driven by dedicated policy support, in many cases without any kind of cost or volume control. There is no such thing for batteries. In the absence of financing programmes, the author finds that high upfront costs provide an unfavourable starting point for a disruptive development. But he notes that the fact that self-consumption of stored solar energy will soon pay for consumers represents a paradigm shift in the power industry, which should be seen as an opportunity, at least for first-movers.