The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

Objective To summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer. Design Cost-effectiveness modelling using the information from a randomised controlled trial. Participants Two hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy. Outcome measures Surgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits. Results For 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were $509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery. Conclusions The adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero.

Family to Family: Child Welfare for the 21st Century

Child welfare services have undergone many revisions and transformations since their initiation. Some scholars trace the beginning of child welfare in the United States to events such as a 1655 Massachusetts conviction for maltreatment leading to the death of a 12-year-old boy (Watkins, 1990). The predominant philosophy of child welfare has shifted over time from an early emphasis on child saving, to child protection, to family preservation. Building on family preservation, one of the current transformations in child welfare that is taking place in isolated pockets to whole states, is family-centered, neighborhood-based services. One force behind implementation of this transformation is the Family to Family Initiative of the Annie E. Casey Foundation. This paper places family-centered, neighborhood-based child welfare services within the historical context of development of child welfare and within the recent move to reinvent human services (Adams & Nelson, 1995). Against this backdrop, a locality-based implementation of the Family to Family Initiative is described.

Position, privacy and personnel : concerns for the (digital) future

Firms are moving away from decentralized regional offices. Last year the author spoke with a valuer working on the Sunshine Coast for a Brisbane firm. In years past this valuer would have left home in the morning to go to the office, as well as travelling during the day to client sites. Now they get up, have breakfast, change out of their pyjamas (if they have meetings!) and walk into their employer set-up home office to ‘punch-in’. Apart from travel for essential meetings at head office, or for the purpose of on-site inspections, they can attend work, engage with colleagues and clients and never leave home. While this practice may be a cost saving to the firm and a commuter-friendly way of working, it raises a range of issues to be managed.

Design considerations and economics of different shaped surface aeration tanks

This paper deals with the design considerations of surface aeration tanks on two basic issues of oxygen transfer coefficient and power requirements for the surface aeration system. Earlier developed simulation equations for simulating the oxygen transfer coefficient with theoretical power per unit volume have been verified by conducting experiments in geometrically similar but differently shaped and sized square tanks, rectangular tanks of length to width ratio (L/W) of 1.5 and 2 as well as circular tanks. Based on the experimental investigations, new simulation criteria to simulate actual power per unit volume have been proposed. Based on such design considerations, it has been demonstrated that it is economical (in terms of energy saving) to use smaller tanks rather than using a bigger tank to aerate the same volume of water for any shape of tanks. Among the various shapes studied, it has been found that circular tanks are more energy efficient than any other shape.

Estudo da implementação de medidas de eficência energética num hotel

Tese de mestrado integrado em Engenharia da Energia e do Ambiente, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2016

The Brazilian 1994 stabilization plan: an analytical view

The Real Plan has succeeded in stabilizing the Brazilian inflation. The consumer price inflation has been reduced from 11260 percent per year, in June 1994, to an estimate of 8 percent in 1997. The lower inflation resulted in a remarkable income distribution, and in an increased private consumption. The plan managed to control the inflationary effects of the increased demand with some traditional measures: A more liberalized economy, a moving (and overvalued) exchange rate band, high interest rate differentials, and a tight domestic credit policy. The government has, so far failed to accomplish the fiscal adjustment. The price stabilization has largely depended on the current account deficit. However, macroeconomic indicators do not present reasons for concern about the current account sustainability, in the medium-run. The economy may be trapped in a low-growth vicious cycle, represented by a stop-and-go trend, due to the two-way endogencity between domestic saving and growth. Economic growth depends on policies in increase the public sector saving, to secure the privatization of the State enterprises, and to promote investments. The major problem for the government action is, as always, in the political sphere. Approximately 80 percent of the Central Government net revenue are allocated to the social sectors. Consequently, the fiscal reform will hue to deal with the problem of re-designing the public sector’s intervention in the social area. Most probably, it will be inevitable to cut the social area budget. This is politically unpleasant.

Geometria analítica plana: praxeologias matemáticas no ensino médio

O objetivo desta pesquisa é a construção e a aplicação de uma organização didática para a Geometria Analítica Plana, a partir do estudo dos Vetores, no 3º ano do ensino médio, à luz da Teoria Antropológica do Didático de Yves Chevallard e da teoria da Aprendizagem Significativa de David Ausubel. A pesquisa é de natureza qualitativa do tipo etnográfica na educação, de acordo com Marli André, e foi desenvolvido com um grupo de alunos em um contexto específico que é a preparação para o vestibular. A manipulação de objetos ostensivos para compreensão dos objetos não-ostensivos da Matemática serviu de categorias para análise das praxeologias vivenciadas em sala de aula. Concluímos que os alunos ao manipular as representações de objetos ostensivos resgatam conhecimentos matemáticos de forma articulada e integrada para a ancoragem de novos conhecimentos matemáticos. Observou-se também que a organização didática permite “economia de tempo”, no que diz respeito ao estudo destes conteúdos nesta etapa da vida escolar.

Estimativa da produção anual de serapilheira dos bosques de mangue no Furo Grande, Bragança-Pará

As condições ambientais de determinado local podem influenciar a produtividade dos manguezais. Assim, este estudo estimou a produção total e dos componentes da serapilheira no Furo Grande, Bragança, PA. Este estudo compreendeu quatro ciclos anuais (julho/2000 a agosto/2004) em três sítios. Foram instaladas sete cestas em cada sítio ao longo de uma transecção de 140 m, com intervalos de 20 m. Cada cesta possuía uma área útil de 1 m², com tela de 1 mm², suspensa acima do nível das marés de sizígia. O material acumulado nas cestas foi coletado mensalmente, separado em folha, flor, fruto, estípula, galho e miscelânea, sendo posteriormente secado a 70 ºC até alcançar peso constante. A produção média dos quatro anos foi de 9,85 t.ha^-1.ano^-1 no sítio 1, 6,41 t.ha^-1.ano^-1 no sítio 2 e 5,99 t.ha^-1.ano^-1 no sítio 3, cuja comparação apresenta diferença significativa entre os sítios 1 e 3 (H=7,53; gl=2; p<0,05). Em suma, os resultados apontaram que a folha foi o componente de maior produtividade e, juntamente com a flor, teve pico na estação seca, o que parece favorecer uma economia de energia para o investimento em reprodução, enquanto a maior produção de fruto foi na estação chuvosa, promovendo a dispersão de propágulos e, conseqüentemente, a renovação e manutenção dessas florestas.

Sharing services, saving money? Five risks to cost saving when organizations share administrative services

Shared services are a popular reform for governments under financial pressure. The hope is to reduce overheads and increase efficiency by providing support services like HR, finance and procurement once to multiple agencies. Drawing on insights from organization theory and political science, we identify five risks that shared services won’t live up to current expectations. We illustrate each with empirical evidence from the UK, Ireland and further afield, and conclude with suggestions on how to manage these risks.

Saving Energy by Delegating Network Activity to Home Gateways

Today, an ever-increasing number of devices has networking capability. The main implication of this fact is that such devices are often left fully powered yet idle just to maintain their network presence, hence leading to large energy waste. This ultimately results in higher electricity cost for consumers. This paper tackles an effective mechanism to reduce energy waste of consumer electronics, by boosting the usage of lowpower states available in most devices. The main concept is to delegate background networking routines to home gateways, which are today available in most homes and offices. The paper describes the functionality and the software architecture to be implemented by home gateways and consumer electronics, reports performance evaluation on a working prototype, and provides estimation of potential benefits for consumers.

Race-to-halt energy saving strategies

Energy consumption is one of the major issues for modern embedded systems. Early, power saving approaches mainly focused on dynamic power dissipation, while neglecting the static (leakage) energy consumption. However, technology improvements resulted in a case where static power dissipation increasingly dominates. Addressing this issue, hardware vendors have equipped modern processors with several sleep states. We propose a set of leakage-aware energy management approaches that reduce the energy consumption of embedded real-time systems while respecting the real-time constraints. Our algorithms are based on the race-to-halt strategy that tends to run the system at top speed with an aim to create long idle intervals, which are used to deploy a sleep state. The effectiveness of our algorithms is illustrated with an extensive set of simulations that show an improvement of up to 8% reduction in energy consumption over existing work at high utilization. The complexity of our algorithms is smaller when compared to state-of-the-art algorithms. We also eliminate assumptions made in the related work that restrict the practical application of the respective algorithms. Moreover, a novel study about the relation between the use of sleep intervals and the number of pre-emptions is also presented utilizing a large set of simulation results, where our algorithms reduce the experienced number of pre-emptions in all cases. Our results show that sleep states in general can save up to 30% of the overall number of pre-emptions when compared to the sleep-agnostic earliest-deadline-first algorithm.

Lighting energy saving due to the use of direct sunlight

This paper describe a simulation program, which uses Trengenza’s average room illuminance method in conjunction with hourly solar irradiance and luminous efficacy, to predict the potential lighting energy saving for a side-lit room. Two lighting control algorithms of photoelectric switching (on/off) and photoelectric dimming (top-up) have been coded in the program. A simulation for a typical UK office room has been conducted and the results show that energy saving due to the sunlight dependent on the various factors such as orientation, control methods, building depth, glazing area and shading types, etc. This simple tool can be used for estimating the potential lighting energy saving of the windows with various shading devices at the early design stage.