The UK domestic building sector accounts for a substantial amount of the final energy demand and greenhouse gas (GHG) emissions. To this extent, the sector can play an important role in GHG abatement and energy demand reduction, essential objectives of a more ‘sustainable energy system’. Microgeneration, or production of electricity or heat from small-scale sources, have been advocated by some, including the Supergen ‘Highly Distributed Power Systems Consortium’ to which this thesis contributes, as important means towards achieving these objectives. In this thesis, three assessed microgenerators; specifically a 600W microwind system, 2.1 kWp photovoltaic (PV) and building-integrated photovoltaic (BIPV) systems, and a 2.8m2 solar hot water (SHW) system have been analysed through an ‘integrated appraisal toolkit’ in order to assess their respective economic and financial performance in current UK context. A cost-benefit analysis (CBA) is applied, based on outputs and results from energy analysis and life-cycle assessment (LCA), and other tools such as financial appraisal, cost-effective analysis (CEA), and simple multi-attribute ranking technique (SMART) are also performed in order to asses how these systems perform on an individual household level or when compared to other energy technologies. The CBA, which included environmental impacts quantified through the LCA, obtained negative net present values (NPVs) for all the assessed microgenerators with the exception of microwind in a high-wind resourced ‘open’ area with lower end capital costs. The NPVs in the financial appraisal, which excluded environmental impacts, yielded relatively poorer results still. Only with the proposed feed-in tariffs would the systems all achieve positive NPVs. Given that the CBA included a substantial qualitative part, alternative tools, such as CEA and multi-criteria evaluation were applied (in brief) in order to place the assessed systems in the context of other energy generating sources in the UK, and to enable a more confident decision with respect to whether these systems should be advocated or rejected.

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The Limited English Proficiency (LEP) population in the United States requires interpreters in order to receive appropriate medical care. However, interpreters are not used consistently in clinical encounters. This study aims to identify the barriers that interfere with providing this service, as well as to propose some possible ways of overcoming these barriers. A systematic review of the literature was conducted using Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. Twenty articles that presented barriers to interpreter use were identified. These barriers referred to either professional interpreters or ad hoc interpreters, or were general barriers. The barriers to professional interpreter use most frequently identified related to cost. Most of the cost-related barrier citations were found in studies conducted in the U.S. The barriers to ad hoc interpreter use most frequently identified related to concern about the interpreters ability to interpret. I determined that appropriate provision of interpreters to the LEP community would require four elements: 1) The consistent use of professional interpreters, and the elimination of ad hoc interpreter use. 2) Research into the possible financial benefits that may arise from increased interpreter use, and how the cost of providing interpreters may be offset by the widespread benefits of using them. 3) Professionalization of interpreter services, with quality assurance and standardized training and evaluation of interpreters. 4) Increased education and training for patients and providers about the language services that are available and how to access them, and about how to work with an interpreter efficiently and effectively. One possible solution that would allow the implementation of all of the above elements is a national interpretation service.

The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.

The purpose of this study was to perform a cost-benefit analysis of an intervention to treat all the children in Bolivia (under 15 years of age) who are infected with Chagas disease. This research was carried out in La Paz, Bolivia where the author lived for a year collecting data in collaboration with the National Chagas Control Program, Bolivian Ministry of Health. Operational costs were based on current prices for laboratory testing and pharmaceuticals, average hourly wages for health care workers, and the number of children who would be treated. The benefit of the program was estimated as the sum of direct and indirect costs associated with chronic cardiac disease caused by Chagas infection. Direct costs were calculated as the minimum amount needed for adequate medical treatment summed over the patients life span. Indirect costs were measured in Disability-Adjusted Life Years (DALYs) multiplied by average yearly salary to more fully account for the true burden of disease. Implementation cost was estimated to be approximately $35 million. This intervention would prevent over 279,000 DALYs and alleviate $123 million in direct and $632 million in indirect costs. Clearly, such a program would be extremely cost-effective. Thus, with an initial investment of less than $135 per infected child, approximately $2,900 worth of future costs would be prevented, in addition to improvements in quality of life not captured by DALYs. A sensitivity analysis showed that even while assuming a high variability of the data, the cost and benefit of this intervention were significantly different (p-value < 0.001).

Due to the interdisciplinary nature of eco-labelling, the sense of the phenomenon itself is lost when studied in isolation. With this consideration, a balance of research between practical and theoretical approaches, between environmental sociology, environmental economics, international trade relations, consumer society, sustainability and marketing theory was explored. Eco-labelling has far-reaching ramifications in society, not just in the commercial relationship between producer and consumer, but in socio-cultural norms and values. It combines economic and social forces via the marketplace. The research of this paper focuses on 1) the socio-cultural aspects of eco-labelling, 2) the economic incentive which drives eco-labelling and 3) the global institutional structures which influence the eco-labelling dimension. Chapter 1 provides an overview of eco-labelling and introduces ecological modernization, the theoretical foundation of this paper. Chapter 2 is a summary of interviews which were conducted with eco-labelling managers around the world. Chapter 3 analyses the economic impact of eco-labelling, the effects on international trade and the environment, and how eco-labelling affects consumers and producers. Chapter 4 deals with the social context of eco-labelling, and the social paradigms of consumer society and sustainability, merging in the case of ecological modernization. Chapter 5 looks at opportunities and challenges to eco-labelling, and concrete recommendations with respect to the design of eco-labelling programmes are made. Eco-labelling is the only tool which functions within the conflicting social forces of consumer society and sustainability. As a market-based instrument for environmental management that functions within the producer - consumer relationship, eco-labelling can be seen as the ecological marketisation of consumer society. Best practices in eco-labelling rely on accepting the fundamental market principles combined with social trends. (author´s abstract)

Many countries, including Nepal, have been affected with highly pathogenic avian influenza (HPAI) outbreaks. There have been human mortalities in some countries and large numbers of poultry either died or were culled due to HPAI. The overall objective of this thesis was to improve our understanding of the epidemiology and economics of avian influenza (AI), and particularly HPAI, in Nepal. We determined the seroprevalence of and risk factors for AI virus antibodies presence in ducks in Kathmandu, Nepal. The estimated true prevalence of AI viruses (AIV) antibodies was 27.2% [95% Confidence Interval (CI): 24.6- 29.5]. Age of the ducks was identified as the only risk factor for AIV seropositivity. Ducks older than one year were more likely to be seropositive compared to ducks less than six months of age [Odds Ratio= 2.17 (95% CI: 1.07- 4.39)]. This study provided baseline information about seroprevalence of AIVs in Kathmandu that will benefit further research to differentiate the subtypes of AIVs circulating in Kathmandu. We also evaluated alternatives to the current control program (CCP) for HPAI in Nepal. The considered alternatives were: (i) absence of control measures (ACM) and (ii) vaccinating 60% of the domestic poultry flock twice per year. Cost-benefit analysis approach was used to evaluate the economic feasibility of the programs. In terms of the benefit-cost ratio, our findings indicated that there is a return of 1.96 dollars for every dollar spent in the CCP compared to ACM. The net present value of the CCP versus ACM was US$ 989,918. The vaccination program yielded a return of 2.41 dollars for every dollar spent when compared to the CCP. The net present value of vaccination versus implementing the CCP was US$ 13,745,454. These results support a continued investment into the CCP rather than ceasing to implement government regulated control measures and suggest that vaccination may be an even better control alternative. In summary, our studies have highlighted the value of epidemiologic and economic analysis in research of AI. Our results are expected to lead to an improved understanding and awareness of AI in Nepal and to formulation of better control strategies.

Risk management is composed of three major elements viz., hazard identification, risk estimation and risk evaluation. The aim of hazard identification and risk estimation is to identify the outcomes from risk, the magnitude of the associated con&quences from risk, and the estimation of the probabilities of these outcomes. Previous work focused on hazard identification and risk estimation and identified the relatively high risks associated with playing professional football. By adhering to the risk management process, the aim of this thesis was to determine the significance of these high risks to football clubs and their players. A theoretical framework was designed to evaluate the influence of player injury on the financial and playing performance of professional football clubs. This framework was also used to assess, through use of cost benefit analysis, the practicalities of investing in suitable injury prevention strategies, to reduce the risks to football clubs and their players. Former professional footballers were surveyed to investigate the long-term medical and socioeconomic consequences associated with the high risks of playing professional football. The results identified the high financial costs associated with player injury on professional football clubs. Although the high risks of player injury have a relatively minor effect on teamperformance of the Premier League clubs, this effect still has a relatively major influence on the financial performance of the club. In contrast, the influence of player injury to teamperformance was relatively major for Division I and Division 2 clubs, but this had a relatively minor effect on financial performance. The application of cost benefit analysis to the investment of specialist personnel to reduce the risks of injury demonstrated that the proposals were practicable for Premier League and Division I clubs only. In addition, it was also demonstrated that the high risks associated with playing professional football have a significant influence on the long-term well-being of foriner players. One-third of former players had been medically diagnosed osteoarthritic in a lower limb joint. The majority of players also perceived that injury had a negative influence on their present and future welfare. The results demonstrate that the consequences associated with the relatively high acute injury risk also have a significant effect on the financial and playing performance of football clubs and the future welfare of their players.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Sveriges lantbruksuniv. / Härtill 3 uppsatser.