Cumulative costs for the prosthetic reconstructions and maintenance in young adult patients with birth defects affecting the formation of teeth

OBJECTIVES: To assess retrospectively the cumulative costs for the long-term oral rehabilitation of patients with birth defects affecting the development of teeth. METHODS: Patients with birth defects who had received fixed reconstructions on teeth and/or implants > or =5 years ago were asked to participate in a comprehensive clinical, radiographic and economic evaluation. RESULTS: From the 45 patients included, 18 were cases with a cleft lip and palate, five had amelogenesis/dentinogenesis imperfecta and 22 were cases with hypodontia/oligodontia. The initial costs for the first oral rehabilitation (before the age of 20) had been covered by the Swiss Insurance for Disability. The costs for the initial rehabilitation of the 45 cases amounted to 407,584 CHF (39% for laboratory fees). Linear regression analyses for the initial treatment costs per replaced tooth revealed the formula 731 CHF+(811 CHF x units) on teeth and 3369 CHF+(1183 CHF x units) for reconstructions on implants (P<.001). Fifty-eight percent of the patients with tooth-supported reconstructions remained free from failures/complications (median observation 15.7 years). Forty-seven percent of the patients with implant-supported reconstructions remained free from failures/complications (median observation 8 years). The long-term cumulative treatment costs for implant cases, however, were not statistically significantly different compared with cases reconstructed with tooth-supported fixed reconstructions. Twenty-seven percent of the initial treatment costs were needed to cover supportive periodontal therapy as well as the treatment of technical/biological complications and failures. CONCLUSION: Insurance companies should accept to cover implant-supported reconstructions because there is no need to prepare healthy teeth, fewer tooth units need to be replaced and the cumulative long-term costs seem to be similar compared with cases restored on teeth.

Green buildings for greying people : a case study of a retirement village in Australia

Purpose With an increasingly ageing population and widespread acceptance of the need for sustainable development in Australia, the demand for green retirement villages is increasing. This paper aims to identify the critical issues to be considered by developers and practitioners when embarking on their first green residential retirement project in Australia. Design/methodology/approach In view of the lack of adequate historical data for quantitative analysis, a case study approach is employed to examine the successful delivery of green retirement villages. Face-to-face interviews and document analysis were conducted for data collection. Findings The findings of the study indicate that one of the major obstacles to the provision of affordable green retirement villages is the higher initial costs involved. However, positive aspects were identified, the most significant of which relate to: the innovative design of site and floor plans; adoption of thermally efficient building materials; orientation of windows; installation of water harvesting and recycling systems, water conservation fittings and appliances; and waste management during the construction stage. With the adoption of these measures, it is believed that sustainable retirement development can be achieved without significant additional capital costs. Practical implications The research findings serve as a guide for developers in decision making throughout the project life-cycle when introducing green features into the provision of affordable retirement accommodation. Originality/value This paper provides insights into the means by which affordable green residential retirement projects for aged people can be successfully completed.

Information programs for technology adoption: The case of energy-efficiency audits

We analyze technology adoption decisions of manufacturing plants in response to government-sponsored energy audits. Overall, plants adopt about half of the recommended energy-efficiency projects. Using fixed effects logit estimation, we find that adoption rates are higher for projects with shorter paybacks, lower costs, greater annual savings, higher energy prices, and greater energy conservation. Plants are 40% more responsive to initial costs than annual savings, suggesting that subsidies may be more effective at promoting energy-efficient technologies than energy price increases. Adoption decisions imply hurdle rates of 50-100%, which is consistent with the investment criteria small and medium-size firms state they use. © 2003 Elsevier B.V. All rights reserved.

Conversão de veículos diesel para tração elétrica

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica

HFCs e soluções alternativas viáveis

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica

Service provider switching: a study on the switching process in retail banking

In a business environment that is characterized by intense competition, building customer loyalty has become a key area of focus for most financial institutions. The explosion of the services sector, changing customer demographics and deregulation and emergence of new technology in the financial services industry have had a critical impact on consumers’ financial services buying behaviour. The changes have forced banks to modify their service offerings to customers so as to ensure high levels of customer satisfaction and also high levels of customer retention. Banks have historically had difficulty distinguishing their products from one another because of their relative homogeneity; with increasing competition,the problem has only intensified with no coherent distinguishing theme. Rising wealth, product proliferation, regulatory changes and newer technologies are together making bank switching easier for customers. In order to remain competitive, it is important for banks to retain their customer base. The financial services sector is the foundation for any economy and plays the role of mobilization of resources and their allocation. The retail banking sector in India has emerged as one of the major drivers of the overall banking industry and has witnessed enormous growth. Switching behaviour has a negative impact on the banks’ market share and profitability as the costs of acquiring customers are much higher than the costs of retaining. When customers switch, the business loses the potential for additional profits from the customer the initial costs invested in the customer by the business get . The Objective of the thesis was to examine the relationship among triggers that customers experience, their perceptions of service quality, consumers’ commitment and behavioral intentions in the contemporary India retail banking context through the eyes of the customer. To understand customers’ perception of these aspects, data were collected from retail banking customers alone for the purpose of analysis, though the banks’ views were considered during the qualitative work carried out prior to the main study. No respondent who is an employee of a banking organization was considered for the final study to avoid the possibility of any bias that could affect the results adversely. The data for the study were collected from customers who have switched banks and from those who were non switchers. The study attempted to develop and validate a multidimensional construct of service quality for retail banking from the consumer’s perspective. A major conclusion from the empirical research was the confirmation of the multidimensional construct for perceived service quality in the banking context. Switching can be viewed as an optimization problem for customers; customers review the potential gains of switching to another service provider against the costs of leaving the service provider. As banks do not provide tangible products, their service quality is usually assessed through service provider’s relationship with customers. Thus, banks should pay attention towards their employees’ skills and knowledge; assessing customers’ needs and offering fast and efficient services.

Critical reliability issues for building services systems

This paper addresses two critical issues associated with reliability and maintenance of building services systems. The first is the ratio of operating and/or maintenance costs to initial costs for building services systems. It is an important parameter for life cycle costing and maintenance policy development. The second is the proportion of items among building services systems that need preventive maintenance. In this paper, we estimate the ratios based on a cost dataset. It suggests that correctly estimating the ratio be important but using a constant ratio in life cycle costing may result in wrong decisions. It also estimates the proportion of preventive maintenance for building services systems on the basis of the distribution of failure patterns.

Cost-effectiveness of adult circumcision in a resource-rich setting for HIV prevention among men who have sex with men

Background.  We examined the effects and cost‐effectiveness of 4 strategies of circumcision in a resource‐rich setting (Australia) in a population of men who have sex with men (MSM).

Method.  We created a dynamic mathematical transmission model and performed an economic analysis to estimate the costs, outcomes, and cost‐effectiveness of different strategies, compared with those of the status quo. Strategies included circumcision of all MSM at age 18 years, circumcision of all MSM aged 35–44 years, circumcision of all insertive MSM aged 18 years, and circumcision of all MSM aged 18 years . All costs are reported in US dollars, with a cost‐effectiveness threshold of $42,000 per quality‐adjusted life‐year.

Results.  We find that 2%–5% of human immunodeficiency virus (HIV) infections would be averted per year, with initial costs ranging from $3.6 million to $95.1 million, depending on the strategy. The number of circumcisions needed to prevent 1 HIV infection would range from 118 through 338. Circumcision of predominately insertive MSM would save $21.7 million over 25 years with a $62.2 million investment. Strategies to circumcise 100% of all MSM and to circumcise MSM aged 35–44 years would be cost‐effective; the latter would require a smaller investment. The least cost‐effective approach is circumcision of young MSM close to their sexual debut. Results are very sensitive to assumptions about the cost of circumcision, the efficacy of circumcision, sexual preferences, and behavioral disinhibition.

Conclusions.  Circumcision of adult MSM may be cost‐effective in this resource‐rich setting. However, the intervention costs are high relative to the costs spent on other HIV prevention programs.

Avaliação das principais t́cnicas para obtenção de MPPT de paińis fotovoltaicos

Electrical energy from photovoltaic panels (PV) has became an increasing viable alternative because of the great concern for environmental preservation and the possibility of the reduction of the conventional fuels, and this natural energy source is free, abundant and clean. In addition, Brazil is a privileged country because of the high levels of irradiation throughout its territory all over the year. Thus the exploitation of the energy from PV is one of the best alternatives to overcome the supply electrical energy issues. However, nowadays the energy conversion efficiency is low and the initial costs are high for these energy systems. Therefore, in order to increase the efficiency of these systems the extraction of the maximum power point (MPP) from PV is extremely necessary, and it is done using the maximum power point tracking (MPPT) techniques. The MPP of the PV varies non linearly with the environmental conditions and several MPPT techniques are available in literature, and this paper presents a careful comparison among the most usual techniques, doing meaningful comparisons with respect to the amount of energy extracted, PV voltage ripple, dynamic response and use of sensors, considering that the models are implemented via MatLab/Simulink®. © 2010 IEEE.

Model to increase the lateral line length of drip irrigation systems

Non-pressure compensating drip hose is widely used for irrigation of vegetables and orchards. One limitation is that the lateral line length must be short to maintain uniformity due to head loss and slope. Any procedure to increase the length is appropriate because it represents low initial cost of the irrigation system. The hypothesis of this research is that it is possible to increase the lateral line length combining two points: using a larger spacing between emitters at the beginning of the lateral line and a smaller one after a certain distance; and allowing a higher pressure variation along the lateral line under an acceptable value of distribution uniformity. To evaluate this hypothesis, a nonlinear programming model (NLP) was developed. The input data are: diameter, roughness coefficient, pressure variation, emitter operational pressure, relationship between emitter discharge and pressure. The output data are: line length, discharge and length of the each section with different spacing between drippers, total discharge in the lateral line, multiple outlet adjustment coefficient, head losses, localized head loss, pressure variation, number of emitters, spacing between emitters, discharge in each emitter, and discharge per linear meter. The mathematical model developed was compared with the lateral line length obtained with the algebraic solution generated by the Darcy-Weisbach equation. The NLP model showed the best results since it generated the greater gain in the lateral line length, maintaining the uniformity and the flow variation under acceptable standards. It had also the lower flow variation, so its adoption is feasible and recommended.

Dimensionamento da linha lateral utilizando dois espaçamentos entre gotejadores

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sistemi per la climatizzazione mediante pompe di calore geotermiche e pali energetici

We need a large amount of energy to make our homes pleasantly warm in winter and cool in summer. If we also consider the energy losses that occur through roofs, perimeter walls and windows, it would be more appropriate to speak of waste than consumption. The solution would be to build passive houses, i.e. buildings more efficient and environmentally friendly, able to ensure a drastic reduction of electricity and heating bills. Recently, the increase of public awareness about global warming and environmental pollution problems have “finally” opened wide possibility in the field of sustainable construction by encouraging new renewable methods for heating and cooling space. Shallow geothermal allows to exploit the renewable heat reservoir, present in the soil at depths between 15 and 20 m, for air-conditioning of buildings, using a ground source heat pump. This thesis focuses on the design of an air-conditioning system with geothermal heat pump coupled to energy piles, i.e. piles with internal heat exchangers, for a typical Italian-family building, on the basis of a geological-technical report about a plot of Bologna’s plain provided by Geo-Net s.r.l. The study has involved a preliminary static sizing of the piles in order to calculate their length and number, then the project was completed making the energy sizing, where it has been verified if the building energy needs were met with the static solution obtained. Finally the attention was focused on the technical and economical validity compared to a traditional system (cost-benefit analysis) and on the problem of the uncertainty data design and their effects on the operating and initial costs of the system (sensitivity analysis). To evaluate the performance of the thermal system and the potential use of the piles was also used the PILESIM2 software, designed by Dr. Pahud of the SUPSI’s school.

Clinical evaluation of 3 overdenture concepts with tooth roots and implants: 2-year results

PURPOSE: In the present cohort study, overdentures with a combined root and implant support were evaluated and compared with either exclusively root- or implant-supported overdentures. Results of a 2-year follow-up period are reported, namely survival of implants, root copings, and prostheses, plus prosthetic complications, maintenance service, and patient satisfaction. MATERIALS AND METHODS: Fourteen patients were selected for the combined overdenture therapy and were compared with 2 patient groups in which either roots or implants provided overdenture support. Altogether, 14, 17, and 15 patients (in groups 1, 2, and 3, respectively) were matched with regard to age, sex, treatment time, and observation period. The mean age was around 67 years. Periodontal parameters were recorded, radiographs were taken, and all complications and failures were registered during the entire observation time. The patients answered a 9-item questionnaire by means of a visual analogue scale (VAS). RESULTS: One implant failed and 1 tooth root was removed following longitudinal root fracture. Periodontal/peri-implant parameters gave evidence of good oral hygiene for roots and implants, and slight crestal bone resorption was measured for both. Technical complications and service performed were significantly higher in the first year (P < .04) in all 3 groups and significantly higher in the tooth root group (P < .03). The results of the VAS indicated significantly lower scores for satisfaction, speaking ability, wearing comfort, and denture stability with combined or exclusive root support (P < .05 and .02, respectively). Initial costs of overdentures with combined or root support were 10% lower than for implant overdentures. CONCLUSION: The concept of combined root and implant support can be integrated into treatment planning and overdenture design for patients with a highly reduced dentition.

Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve

BACKGROUND The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) 2 trial demonstrated a significant reduction in subsequent coronary revascularization among patients with stable angina and at least 1 coronary lesion with a fractional flow reserve ≤0.80 who were randomized to percutaneous coronary intervention (PCI) compared with best medical therapy. The economic and quality-of-life implications of PCI in the setting of an abnormal fractional flow reserve are unknown. METHODS AND RESULTS We calculated the cost of the index hospitalization based on initial resource use and follow-up costs based on Medicare reimbursements. We assessed patient utility using the EQ-5D health survey with US weights at baseline and 1 month and projected quality-adjusted life-years assuming a linear decline over 3 years in the 1-month utility improvements. We calculated the incremental cost-effectiveness ratio based on cumulative costs over 12 months. Initial costs were significantly higher for PCI in the setting of an abnormal fractional flow reserve than with medical therapy ($9927 versus $3900, P<0.001), but the $6027 difference narrowed over 1-year follow-up to $2883 (P<0.001), mostly because of the cost of subsequent revascularization procedures. Patient utility was improved more at 1 month with PCI than with medical therapy (0.054 versus 0.001 units, P<0.001). The incremental cost-effectiveness ratio of PCI was $36 000 per quality-adjusted life-year, which was robust in bootstrap replications and in sensitivity analyses. CONCLUSIONS PCI of coronary lesions with reduced fractional flow reserve improves outcomes and appears economically attractive compared with best medical therapy among patients with stable angina.

Adaptation to Changes in the Coffee Value Chain and the Price of Coiffee among Coffee Producers in Two Villages in Kilimanjaro, Tanzania

Market liberalization in Tanzania has eroded the monopoly of the cooperative unions by allowing private coffee buyers (PCBs) to compete with them on equal footing. Similarly, farmers groups and primary societies are now allowed to sell coffee at auction. Thus, farmers have various options for selling their coffee. Similarly, the coffee industry has experienced large fluctuations in prices and stagnation in production. How do farmers react to these changes? Can and do farmers profit from different market conditions and sell to different traders at the lower end of the value chain, or do they remain with cooperatives or farmers groups? This study was conducted in Mruwia and Mshiri villages in Moshi Rural district. Whereas Mshiri village remains attached to the Kilimanjaro Native Cooperative Union (KNCU), Mruwia has detached from this organization and sells coffee independently. The sample (103) was randomly selected from the coffee farmers in the two villages. Data were collected through surveys, focus group discussions (FGDs), and socio-anthropological methods (participant-observation, biographies, and thematic interviews). Results indicate that the selection of whom to sell coffee depends largely on farmers’ dependence on coffee and prices, other benefits accrued, and whether the initial costs are covered by buyers. Additionally, most respondents did not sell coffee to PCBs. Thus, prices, the institutional infrastructure, and the structure of local communities were important when making decisions about how and with whom to trade.