Klimatförändringar till följd av den ökande halten koldioxid i atmosfären är en växande utmaning. Som följd av detta har Uppsala kommun ökat sina hållbarhetsinsatser, varav biokol har visat sig vara ett lovande alternativ. Biokol fungerar som en kolsänka genom att lagra kol långsiktigt i marken, samtidigt som det förbättrar jordens struktur och näringsinnehåll. Denna rapport syftar till att utforska möjligheterna till att upprätta en biokolsanläggning inom Uppsala kommun. För att utreda möjligheterna till en sådan anläggning utförs analys av tillgängligt biomassaflöde, utvärdering av pyrolysteknik samt identifiering av platsspecifika begränsningar. Därtill har tillstånd och krav på en anläggning identifierats och sammanställts.  Metoden bygger på ett teoretiskt ramverk, som appliceras för att utvärdera och sedan maximera lönsamheten vid rekommendation av plats. Intervjuer har genomförts, för att skapa en förståelse för teknik och drift samt för att fastställa diverse kostnadsposter. En budgetkalkyl har sedan skapats utifrån kartlagda kostnader, för vilken en finansiell analys sedan utförts. Med utgångspunkt i den analysen har lämpliga platser valts ut, vilka kompletterats med en rekommendation av optimal teknik och resurshantering. Miljörelaterade externaliteter för rekommenderade platser har tilldelats ett monetärt värde, för att sedan sammanvägas med det finansiella resultatet i en kostnads- och nyttoanalys Utifrån avgränsningen att det finns en stabil marknad och efterfrågan på biokol, har analysen resulterat i en hög avkastning på de rekommenderade investeringarna, samt en märkbar förbättring då externaliteterna inkluderas. Resulterande slutsatser har varit klimatnyttor skulle utgöra en stor del av lönsamheten för Uppsala kommun, men att avgränsningen riskerar att ge missvisande finansiella resultat. Framtida arbeten bör med fördel kartlägga marknaden för biokolsproduktion, samt analysera och utvärdera pris och efterfrågan för avsättningar. / Climate change due to the increasing levels of carbon dioxide in the atmosphere, is a growing challenge. As a result, Uppsala Municipality has increased its sustainability efforts, among which biochar has proven to be a promising alternative. Biochar acts as a carbon sink by storing carbon long-term in the soil, while also improving soil structure and nutrient content. This report aims to explore the possibilities for establishing a biochar facility within Uppsala Municipality. To investigate the feasibility of such a facility, an analysis of available biomass flow, evaluation of pyrolysis technology, and identification of site-specific constraints are conducted. Additionally, the permits and requirements for a facility have been identified and compiled. The methodology is based on a theoretical framework, applied to evaluate and then maximize profitability when recommending a site. Interviews have been conducted to understand technology and operations, and to determine various cost items. A budget calculation has been created based on identified costs, for which a financial analysis has then been performed. Based on this analysis, suitable sites have been selected, complemented with a recommendation of optimal technology and resource management. Environmental externalities for recommended sites have been assigned a monetary value, which is then combined with the financial result in a cost-benefit analysis. Assuming a stable market and demand for biochar, the analysis has resulted in a high return on the recommended investments, along with a noticeable improvement when externalities are included. The resulting conclusions indicate that climate benefits would constitute a significant part of the profitability for Uppsala Municipality, but that the assumption risks providing misleading financial results. Future work would benefit from mapping out the market for biochar production, as well as analyzing and evaluating the price and demand for biochar outputs.

I dagens samhälle är det viktigt att använda sig av optimerade transportförbindelser där det är samhällsekonomiskt lönsamt. Optimala beräkningar och värderingar är viktiga för att inse vilka projekt som kommer att bli lönsamma. Syftet med denna kvantitativa studie är att undersöka de effekterna som påverkar ett infrastrukturprojekt där nyttan och kostnaden av en färjeled jämförs med en bro i ett mindre samhälle. Detta för att se om en broförbindelse mellan Hemsön och Strinningen är samhällsekonomisk lönsam.  Data samlades in från den nuvarande färjeleden mellan Strinningen och Hemsön. Metoden som valdes var en samhällsekonomisk nyttoanalys som utgick från ramverket från ASEK 8, där de påverkande effekterna togs fram och de beräkningsbara effekterna beräknades. Konsumentprisindex tillämpades för att vikta upp de beräkningsbara effekterna till projektets startdatum. Därefter användes nuvärdesmetoden för att vikta kostnader och nyttor över projektets diskonteringsperiod. En Monte Carlo-simulering tillämpades för att beräkna osäkra kostnader och nyttor. Detta gjordes genom att slumpmässigt generera värden i intervallet där de osäkra nyttorna låg med ett stort antal iterationer. Resultatet av de beräkningsbara effekterna visade på en genomsnittlig förlust med en låg sannolikhet för att projektet skulle bli samhällsekonomiskt lönsamt. De ej beräkningsbara effekterna var främst positiva men var med störst sannolikhet inte tillräckligt stora för att göra medelvärdet för nettovinsten positiv. Detta betydde att en ny broförbindelse mellan Strinningen och Hemsön över den ekonomiska livslängden inte skulle bli samhällsekonomiskt lönsam. / In today’s society, it is important to make use of optimized transport links where it is economically viable. Optimal calculations and valuations are important to understand which projects will be profitable. The purpose of this quantitative study is to examine the effects affecting an infrastructure project where the benefit and cost of a ferry link is compared to a bridge in a small city. This is to see if a bridge connection between Hemsön and Strinningen is economically viable.   Data was collected from the current ferry route between Strinningen and Hemsön. The method chosen was a cost benefit analysis that was based on the framework form ASEK 8, where the effects were drawn up and the calculable effects were calculated. The consumer price index was applied to weight up the calculable effects to the projects start date. The present value method was used to weight costs and benefits over the projects discount period. A Monte Carlo simulation was applied to calculate uncertain costs and benefits. This was done by randomly generating values in the range where the uncertain benefits lay with a large number of iterations. The result of the calculable effects showed an average loss with a low probability that the project would be economically viable. The non-calculabe effects were mainly positive but were most likely not large enough to make the average value of the net profit positive. This meant that a new bridge connection between Strinningen and Hemsön over the economic lifespan would not be economically viable.

This study aims to explore the ability of a multi-criteria decision making with analytical hierarchy process (MCDM-AHP) model to emulate the results of a cost benefit analysis (CBA) model in the context of offshore wind farm siting within the Swedish exclusive economic zone (EEZ). The research question addressed is whether the MCDM-AHP analysis produces similar results to the CBA analysis. In addition to this, the strengths and weaknesses of each model is explored. The MCDM-AHP model employs the spatial criteria in a more basic manner compared to the CBA model, simplifying the evaluation process while still explaining 89.5% of the variation in the CBA model and defining similar areas as suitable. Thus, it can be concluded that the MCDM-AHP model adequately emulates the CBA model within the context of offshore wind farm siting within the Swedish EEZ. However, it is crucial to note that the two models produce outputs on different scales. While the CBA model provides levelized cost of energy (LCOE) values that can be thresholded for investment viability comparisons, the suitability score generated by the MCDM-AHP model remains a relative and arbitrary score within the model. Both models entail uncertainties, limiting their usage beyond making general assumptions or identifying areas of interest. The findings reveal that the CBA model demonstrates greater robustness when confronted with changes in spatial input parameters compared to the MCDM-AHP model. This discrepancy is attributed to the iterative computation process and consideration of flat cost inputs in the CBA model, whereas the MCDM-AHP model represents a linear combination of various spatial parameters. However, the calculated LCOE values in the CBA model are highly sensitive to changes in modeling assumptions regarding external parameters, resulting in significant linear variations. The LCOE values obtained from the CBA model baseline case fall within a range of 52.1 - 98.9 EUR/MWh, which aligns with similar studies, validating the CBA model. Nonetheless, caution should be exercised when considering these results as an accurate representation of the real world due to inherent uncertainties in cost inputs and the LCOE measure. The strengths of the MCDM-AHP model lie in its robustness when the order of relative importance remains stable for key spatial evaluators. It is sensitive to significant changes in water depth and wind speed, which heavily influence its output. The model's simplicity allows for a quick overview of the problem, but it requires assumptions that introduce uncertainties. Validation of the MCDM-AHP model using existing and planned offshore wind farms within the Swedish EEZ was possible but limited by the arbitrary scale and limited validation areas. The comparison between the two models could be enhanced with more comprehensive spatial and economic data for an in-depth CBA model, which could serve as a ground truth for the MCDM-AHP model. Nevertheless, the comparison made in this study considers the CBA model to be closer to the truth, acknowledging the underlying assumptions that should be considered during evaluation. In conclusion, within the context of offshore wind farm siting, the MCDM-AHP model produces outputs that are similar to the CBA model.

Genetically modified (GM) white and yellow maize, Zea mays, has been commercially released and cultivated in South Africa since 1997/1998. The traits expressed are insect resistance and herbicide tolerance conferred by the bacteria Bacillus thuringiensis (Bt) Cry genes and Agrobacterium 5-enolpyruvylshikimate-3-phosphate (EPSP) synthase gene, respectively. The Cry genes have been used widely to control lepidopteran insect pests but insect resistance to GM Bt crops has been a concern since the introduction of this technology. A management strategy includes refugia planting of 5% non-Bt plants, with no insecticide application, and 20%, where insecticide application is allowed. These refugia are designed to allow the survival of insect pests within restricted planted zones. However, in South Africa there are reports of Bt-resistant stem borer (Busseola fusca) (Fuller) (Lepidoptera: Noctuidae) and non-compliance with refuge planting. The aims of this study were two-fold: 1. To conduct a survey among KwaZulu-Natal (KZN) GM maize growers to ascertain information such as level of compliance with refuge planting and to determine which refugia were predominantly planted and reasons thereof; 2. To conduct a replicated field trial to determine yield, insect borer damage and economic benefit of the 5% unsprayed and 20% sprayed refuge options (including three configurations namely strip, perimeter and block and a 5 and 20% ‘refuge-in-a-bag’ option). The survey indicated that 28 out of 29 (96.6%) KZN Bt maize growers plant the 5% non-sprayed refuge with 27 (96.4%) of those respondents planting the strip configuration for the purpose of insect management (75%) and ease of planting (32.2%). The survey also showed that 7 (seven) i.e. 21.9% of KZN Bt maize growers observed borer damage and although growers are now fully compliant with refugia planting requirements, initially 7 respondents (24.1%) did not comply with or plant refugia correctly. Furthermore, 7 respondents reported insect borer damage in their maize with 4 of the 7 instances (57.1%) likely stemming from incorrectly planted refugia. vii No significant differences in yield or insect damage were observed between the 5 and 20% refugia for any of the planting configurations in the field trial. However due to costs involved with insecticide application and labour required for the operation in the 20% option, these treatments were less economically advantageous than the non-Bt control. The 20% block and strip configurations had a cost benefit ratio of ZAR 7.21 and ZAR 6.67 respectively, earned per R1 spent by the grower compared with ZAR 7.76 in the sprayed control. The cost-benefit comparison for the 5% block and strip configurations was ZAR 8.48 and ZAR 7.71, respectively compared with ZAR 9.44 in the unsprayed control. In addition, the 20% seed mixture limited borer damage to 4.95% when compared with 15.77% damage in the sprayed control (ANOVA, F pr = 0.124). The seed mixtures are not available commercially and the results from the survey indicated that some education and marketing by the seed companies would be advisable prior to their release to the farming community. In order to determine which of the refuge options between 5 and 20% would be more advantageous for growers overall, regardless of the planting configuration; data were grouped and analysed. There were no significant differences in either the yield or insect damage for the 5 and 20% refugia, but the cost-benefit calculations indicated that the 5% option was more cost effective – for the 5 and 20% refugia, ZAR 7.97 and ZAR 7.15 respectively, earned per ZAR 1 spent by the grower (ANOVA, F pr. = 0.03). This is because no insecticide was used in the 5% treatments. Mean ear damage comparisons between the 5 and 20% refugia showed that the 20% refuge in the perimeter configuration incurred the least damage (2.65% ear damage) compared with 5% perimeter (10.86% ear damage), although the reasons for this are not clear. While the results of the field trials showed no significant differences in insect damage and yield with regard to choice of refuge configuration, monitoring insect resistance management remains an integral part of Bt maize crops in South Africa, in order to delay further resistance development and to prolong the viability of Bt technology. / Agriculture and  Animal Health / M. Sc. (Agriculture)

在數位內容下載市場蓬勃發展的同時，非法傳輸的流量亦不惶多讓，是以DRM機制成為了著作權利人進入網路世界的絕佳後盾，以DRM提高複製的門檻，並據以實施其商業模式，故於各數位內容核心產業皆可見DRM應用之蹤跡，卻同時引發了究竟DRM是Digital “Rights” Management 亦或Digital “Restriction” Management的爭議。是天使？或是惡魔？便形成了人們對於DRM的不同觀感。 本研究係從技術、法律以及管理三個面向分別切入，由技術面看DRM保護著作物之極限何在，由法律面看相關科技保護措施之立法造成何種影響，合理使用的空間是否因DRM之實施而造成限縮，接著由管理面向看DRM在數位內容產業價值鏈中所扮演之角色及其與價值鏈上各端權力角力衝突之關係，最後由標準面看目前DRM相關標準的運作以及互通性標準的發展趨勢。並從個案研究觀察DRM在不同產業情境中的應用。 本研究認為，DRM技術本身是中性的，其關鍵在於商業設計運用。而在盜版問題無法完全根絕之情況下，以DRM作為因應之道將使得受限內容之經濟價值不若自由流通之內容，因為內容產業的發展關鍵在於「人氣」，而盜版永遠無法取代創意與使用者對於內容之需求。因此，既然無法防堵非法傳輸之現象，則不妨與之直接面對面進行作戰，權利人既掌握了關鍵的內容，則可以針對盜版的弱點提供更優質的服務。就我國目前數位內容產業發展之情境來看，現階段或許有採取DRM進行保護的必要性，以便在推動合法消費市場之際，平衡兼顧保護著作權人以及著作利用人之權益。然而，在虛擬世界中欲全面防堵非法散佈有其技術上之侷限性，消費者亦多半養成了免費取得之使用模式與心態，因此長期而言，或許應設法從創新的商業模式來扭轉此態勢。 / Though the use of digital rights management (DRM) has been controversial, it is still widely used in the digital world. Advocates think of DRM as an indispensable way to prevent unauthorized duplication and dissemination of copyrighted works while opponents often suggest that the term “rights” should be replaced by “restriction” to best describe how DRM works. This thesis aims to analyze the issues of DRM from three perspectives. First starting with the technical point of view to see how DRM works and found out that DRM technology does have its limitation for copyright protection. That’s the reason why treaties and legislations such as the WCT, WPPT, and DMCA are needed to build the last ditch in the war with piracy. However, the attempt backfired as companies other than rights holders used it as a way to prevent market competition. As the rights holders can effectively control the access of their work with DRM, there comes another dispute about the “Paracopyright” effect. Most important of all, the use of DRM divests the users of the rights they had in the analog world, such as simply lending a book to a friend. From the perspective of management, a cost benefit analysis indicates that the benefit of using DRM to prevent unauthorized duplication obviously overwhelms by its cost and risk. In the context where the content providers, service providers, and device manufacturers all attempt to dominate the whole value chain, DRM also became one of the most powerful instruments for that purpose. Closed ecosystems are built one after another especially in the online music industry in order to bundle the consumers with specific players and music services and thus caused the antitrust issue. The online music industry and the e-book industry were chosen as case studies in the fourth chapter of the thesis. Based on different industry context, DRM strategy and its impact would differ and therefore results in a variety of business models. For example, the consumers in the US are relatively more aware of the use of DRM and are more willing to pay for authorized content. In contrast, the awareness of DRM of consumers in Taiwan is much lower and the price they are willing to pay is also far lower than what the music labels can accept. As a result, the streaming model prevails over pay-per-download model in the online music market of Taiwan. And the feasibility and necessity of DRM also varies in different industries. Before the digitalization of books, authors already had libraries providing free copies as piracy do today, and the prevalence of scanning machines and copy machines makes it even harder to prevent illegal file sharing. Accordingly, there is far less reason to use DRM in the e-book industry than in the online music industry. DRM technology is neutral in itself, and the key point is how it is designed based on different business models. The defect of DRM is neither a technical nor a legal issue, but rather a business issue. As piracy can never be eradicated, coping it with DRM would only make the value of restricted contents much less than freely distributed contents. Popularity is what really matters in the content industry. DRM has its technical limit and causes so many legal issues accompanied with the cost and risk of maintaining such fragile systems. What rights holders have in hand are the creativity and the market’s need for new content, which could never be replaced by piracy. So why not fight it face to face? Digital content industry is considered one of the most promising industries in Taiwan. However, local consumers have entrenched mindset of “free” contents. In present context, DRM is somehow needed while promoting the growth of legal market, in order to provide sufficient incentive to enrich the society with more and more creativity, and fairly protect both the rights of content providers and content users. But in the long run, a more creative or even subversive business model should be the solution to meet the trend of digital convergence.

Les nouvelles technologies médicales contribuent aux dépenses en santé qui ne cessent de croître, alors que les budgets se trouvent limités. L’évaluation économique des technologies devraient permettre d’identifier quelles sont celles qui sont les plus rentables. Malgré cela, plusieurs technologies dont le rapport coût-efficacité reste plutôt limite ou défavorable sont utilisées en médecine moderne et remboursées par notre système public de santé. Ce mémoire se concentre sur deux technologies en santé cardiovasculaire dont le rapport coût-efficacité est plutôt limite mais qui sont fréquemment utilisées au Canada; les tuteurs médicamentés ou pharmaco-actifs et les défibrillateurs cardiaques implantables (DCI). Nous avons fait une évaluation contingente de ces technologies dans le but d’examiner si ce type d’évaluation économique complémentaire pouvait procurer un point de vue nouveau sur la valeur économique et sociétaire des ces technologies. Les résultats de ces deux évaluations indiquent que les patients accordent une grande importance aux bénéfices que procurent ces deux technologies. Nos résultats soutiennent les politiques de santé actuelles de rembourser de façon libérale ces deux technologies. / Technological innovations have greatly contributed to the rising costs in healthcare, while budgets have remained limited. Economic evaluations of technologies should identify which technologies are cost-effective. However, several technologies used in modern medicine are either borderline cost-effective or even not cost-effective according to many studies. This thesis focuses on two technologies in cardiovascular medicine which are considered borderline cost-effective; drug-eluting stents and implantable cardioverter defibrillators. We conducted a contingent valuation of these technologies in hopes of determining if this alternative type of economic evaluation could give a novel point of view on the economic and societal value of these technologies. Results indicated that patients greatly valued benefits provided by these two technologies. Our result support our public healthcare system policies’ of liberal reimbursement of these two technologies.

Cette thèse a été réalisée, entre autres, grâce à une subvention reçue du Fonds de recherche du Québec – Société et culture et de son partenaire le ministère de l’Éducation, du Loisir et du Sport (MELS) Les analyses contenues dans cette thèse ont été réalisées au Centre interuniversitaire québécois de statistiques sociales (CIQSS), membre du Réseau canadien des centres de données de recherche (RCCDR). Les activités du CIQSS sont rendues possibles grâce à l’appui financier du CRSHC, des IRSC, de la FCI, de Statistique Canada, du FRQSC ainsi que de l’ensemble des universités québécoises qui participent à leur financement. Les idées exprimées dans ce texte sont celles des auteurs et non celles des partenaires financiers. / Ce travail explore le phénomène social que sont l’élaboration et la variation des aspirations scolaires réalistes chez les finissants du secondaire tout au long de leurs études, soit sur une période de huit années. L’idée est de faire ressortir les fac-teurs en jeu, en se référant aux deux concepts sociologiques d’importance dans le milieu de l’éducation que sont l’habitus de Pierre Bourdieu et la rationalité de Ray-mond Boudon. En somme, cette thèse explore dans quelle mesure les facteurs liés à au parcours de l’élève (base de référence pour un calcul rationnel) et à l’héritage so-cioculturel (habitus) peuvent intervenir sur l’élaboration des aspirations scolaires dites réalistes et la variation des aspirations. Les analyses ont été effectuées en deux temps. La première consiste en une régression logistique pour l’analyse transversale selon les données de l’enquête au-près des jeunes en transition (EJET). Analyse qui avait pour intention de faire ressor-tir les principaux facteurs qui interviennent lors de l’élaboration d’une aspiration sco-laire chez les élèves canadiens qui sont à la fin de leurs études secondaires. Par la suite, une seconde analyse a été faite, toujours avec les données d’EJET, afin de poser un regard longitudinal sur ce phénomène afin de prendre connaissance des facteurs qui interviennent tout au long de leur parcours; pour ce faire une régression d’estimation d’équation généralisée a été effectuée. Les résultats tendent à suggérer que l’élève exécute bel et bien un calcul ra-tionnel pour l’élaboration et la variation des aspirations scolaires réalistes, mais un calcul qui est, avant tout, influencé par l’habitus, surtout selon le niveau d’études des parents (capital culturel institutionnalisé). Par ailleurs, ce calcul rationnel serait da-vantage influencé par la moyenne générale déclarée lors des études au secondaire et lors des premières années à la suite des études secondaires. Ainsi peut-on dire que l’élaboration et la variation d’une aspiration scolaire réaliste se conçoivent sur la base d’un héritage culturel et d’un parcours scolaire constitués d’un ensemble d’expériences scolaires récentes, qui pourrait se conceptualiser sous « la rationalité en habitus ». / This thesis investigates the social phenomenon of the elaboration and adjustment of realistic educational aspirations for high school graduates during the ten-year period preceding graduation. Its aim is to determine which factors most affect realistic edu-cational aspirations in the light of two major sociological concepts: Pierre Bourdieu’s concept of habitus and Raymond Boudon’s concept of rationality. In short, this thesis explores the manner in which factors linked to educational experience (the baseline for rational calculating) and to sociocultural heritage (habitus) may affect the cons-truction of so-called realistic educational aspirations and their adjustment The analyses are done in two distinct parts. The first part consists of logistic regres-sion analysis using cross-sectional data drawn from the Youth in Transition Survey (YITS). The aim of this analysis is to identify the main factors that enter into consid-eration during the construction of educational aspirations for Canadian students ap-proaching high school graduation. The second part, also using YITS data, examines this phenomenon with a longitudinal perspective in order to identify which factors affect aspirations throughout Canadian students’ educational experience. This is done using generalized estimating equations (GEE) regression. The results show that young students, predictably, use rational calculation when con-structing and adjusting realistic educational aspirations, but also that such a calcula-tion is highly influenced by the habitus, especially by the parents’ education level (institutionalized cultural capital). Moreover, the students’ calculation proves to be significantly constrained, when assessing the risks of following different educational aspirations, by the self-reported overall high school average and additional grades in the first years of a postsecondary studies.

Para avaliar os benefícios da comunicação rápida ao clínico do diagnóstico de vírus respiratórios, foi analisado a viabilidade econômica de 2 testes, com o tempo de entrega de resultado em 2 horas para teste rápido e 48 horas para Biologia Molecular. As amostras coletadas foram processadas utilizando técnicas convencionais e os testes disponíveis no mercado local. Foram escolhidos dois testes rápidos pelo método de imunocromatografia para quatro parâmetros analíticos: Influenza A, Influenza H1N1, Influenza B e Vírus Sincicial Respiratório (RSV) e em Biologia Molecular um teste de RT-PCR multiplex com 25 patógenos entre vírus e bactérias. O tipo de amostra utilizada foi swab e lavado de nasofaringe. A população escolhida para o estudo foi paciente adulto, em tratamento de câncer, que necessita de uma resposta rápida já que a maioria se encontra com comprometimento do sistema imune por doença ou por tratamento. O estudo foi transversal, realizado entre os anos de 2012 e 2013, para avaliar a viabilidade econômica da introdução de testes de diagnóstico da infecção respiratória aguda de etiologia viral a partir de amostras de nasofaringe em pacientes com câncer atendidos no Centro de Atendimento de Oncologia Intercorrência (CAIO ), do Instituto do Câncer do Estado de São Paulo (ICESP), hospital público que atende exclusivamente Sistema Único de Saúde (SUS) e Hospital A.C. Camargo, que atende tanto a pacientes do SUS como da rede privada. O estudo incluiu 152 pacientes em tratamento para qualquer tipo de câncer, predominantemente do sexo feminino (81 mulheres e 70 homens) com idades entre 18-86 anos. Para participar do estudo o paciente era consultado e o critério para escolha do paciente foi ser portador de câncer, com história de febre (ainda que referida) acompanhada de tosse ou dor de garganta, tosse e sintomas respiratórios agudos, atendidos por protocolo padronizado que inclui avaliação na admissão, seguimento e manejo antimicrobiano. Para a avaliação econômica os pacientes foram classificados de acordo com o estado geral de saúde, se apresentavam bom estado de estado de saúde poderiam receber alta e faziam uso da medicação em casa evitando 5 dias de internação se recebessem algum resultado para Influenza ou RSV, no entanto os pacientes que apresentavam outro vírus, resultado negativo ou o estado geral era ruim permaneciam internados por 7 dias em observação e cuidados com medicação adequada. Foram realizadas análises econômicas em dois âmbitos: o sistema de saúde publico e o privado considerando o fator diminuição de dias de internação. A analise de Custo-benefício foi eficiente no Sistema privado mas inadequada para o SUS assim como, qualquer outra medida monetária já que os valores de reembolso do SUS estão defasados do custo de qualquer internação. A análise de Custo-efetividade que olha para outros fatores além do monetário foi efetiva nos dois sistemas que enfrentam falta de leitos além da condição de saúde do paciente de evitar a ingestão desnecessária de antibióticos, evitar os gastos do acompanhante, perda de dias de trabalho e estudo. Não houve correspondência de resultados dos testes rápidos com o multiplex de Biologia Molecular / To evaluate the benefits of the rapid communication of the respiratory viruses\' diagnosis to the doctor, the economic feasibility of two tests was analyzed, with the result delivery time within 2-hours for the rapid test and 48 hours for Molecular Biology. The samples were processed using conventional techniques and the available tests in the local market. Two rapid tests were selected by the immunochromatography method for four analytical parameters: Influenza A, Influenza A H1N1, Influenza B, and Respiratory Syncytial Virus (RSV) and in Molecular Biology a multiplex RT-PCR assay with 25 pathogens between viruses and bacteria. The type of sample used was swab and nasopharyngeal wash. The population chosen for the study was of adult patients undergoing cancer treatment, which requires a rapid response since most have a compromised immune system due to the disease or treatment. The study, conducted between 2012 and 2013, was cross-sectional to evaluate the economic feasibility of introducing diagnostic tests for acute respiratory infection of viral etiology from nasopharyngeal samples of patients with cancer attended at the Oncology Intercurrence Care Center (CAIO), at the Cancer Institute of the São Paulo State (ICESP), at public hospital that attends exclusively the Unified Health System (SUS) and at AC Camargo hospital, which attends SUS patients as well as the private health system. The study included 152 patients undergoing treatment for any type of cancer, predominantly female (81 women and 70 men) between 18 and 86 years. To participate in the study, the patients were consulted and the criteria for choosing a patient was to be a cancer patient with a history of fever (even if referred) accompanied by cough or sore throat, coughing and acute respiratory symptoms, attended by standardized protocol that includes an evaluation at the admission, tracking and antimicrobial management. For the economic evaluation, patients were classified according to the general health condition. If they were in a good health condition, they could receive medical discharge and make use of the medication at home avoiding five days of hospitalization when receiving a result for influenza or RSV. However, the patients with other viruses, negative results or with bad general condition remained hospitalized for seven days under observation and care with proper medication. Economic analyzes were carried out in two areas: the public health system and private health system considering the factor decreased length of hospital stay. The cost-benefit analysis was efficient in the private system but inadequate for the NHS as well as any other monetary measure since the SUS reimbursement values are too low when compared to the cost of any other hospital. The cost-effectiveness analysis that looks at other factors besides money was effective in both systems that were facing lack of beds in addition to the health condition of the patient to avoid unnecessary intake of antibiotics, avoid the costs of the accompanying person, loss of working and study days. There were no results correspondences of the rapid tests with the Molecular Biology multiplex

Chan Siu-Wah. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 173-200). / Abstracts in English and Chinese; appendix in Chinese. / Table of Contents --- p.i / Abstract --- p.v / 論文摘要 --- p.ix / Acknowledgments --- p.xii / Table of Figures --- p.xiii / Table of Tables --- p.xvii / Chapter Chapter 1. --- Introduction --- p.1 / Chapter Chapter 2. --- Literature Review --- p.3 / Chapter 2.1 --- Diabetes Mellitus (DM)： Overview --- p.3 / Chapter 2.1.1 --- Diagnosis and Diagnostic Criteria --- p.4 / Chapter 2.1.2 --- Classifications of Diabetes Mellitus --- p.8 / Chapter 2.1.3 --- Management of Type 2 Diabetes Mellitus --- p.15 / Chapter 2.2 --- Diabetes Mellitus Complications： Overview --- p.25 / Chapter 2.2.1 --- Microvascular Complications --- p.26 / Chapter 2.2.2 --- Macrovascular Complications --- p.31 / Chapter 2.3 --- Type 2 Diabetes Mellitus - A Rising Global Burden --- p.32 / Chapter 2.3.1 --- Prevalence of Type 2 Diabetes Mellitus --- p.32 / Chapter 2.3.2 --- Prevalence of Type 2 Diabetes Mellitus in Hong Kong --- p.36 / Chapter 2.3.3 --- Mortality and Morbidity of Type 2 Diabetes Mellitus in Hong Kong --- p.40 / Chapter 2.4 --- cost of Type 2 Diabetes Mellitus - Under-explored Area in Hong Kong and Asia --- p.46 / Chapter 2.4.1 --- Cost of Type 2 Diabetes Mellitus in the USA --- p.48 / Chapter 2.4.2 --- Cost of Type 2 Diabetes Mellitus in Europe --- p.57 / Chapter 2.4.3 --- Cost of Type 2 Diabetes Mellitus in Asia-Pacific --- p.61 / Chapter 2.5 --- Hong Kong Healthcare System --- p.65 / Chapter 2.5.1 --- Hospital Authority in Hong Kong (Public Healthcare Sector) --- p.67 / Chapter 2.5.2 --- Hong Kong Healthcare Financing System --- p.73 / Chapter 2.6 --- New Emerging Drug Treatment for Type 2 DM in Hong Kong Chinese - Rosiglitazone --- p.77 / Chapter 2.6.1 --- Clinical Efficacy and Tolerability of Rosiglitazone --- p.77 / Chapter 2.6.2 --- Cost-effectiveness of Rosiglitazone --- p.78 / Chapter Chapter 3. --- Hypothesis and Objectives --- p.81 / Chapter 3.1 --- Cost of Type 2 Diabetes Mellitus in Hong Kong Chinese --- p.81 / Chapter 3.1.1 --- Hypothesis --- p.81 / Chapter 3.1.2 --- Objectives --- p.81 / Chapter 3.2 --- Cost-effectiveness Analysis of Metformin + Rosiglitazone vs. Metformin + Glibenclamide for Type 2 DM Patient Whose Diabetes is not Adequately Controlled by Metformin Alone from a Payer's Perspective --- p.82 / Chapter 3.2.1 --- Hypothesis --- p.82 / Chapter 3.2.2 --- Objectives --- p.83 / Chapter Chapter 4. --- Cost of Type 2 Diabetes Mellitus in Hong Kong Chinese --- p.84 / Chapter 4.1 --- Subjects and Methods --- p.84 / Chapter 4.1.1 --- Subjects --- p.84 / Chapter 4.1.2 --- Methods --- p.85 / Chapter 4.1.3 --- Validity and Reliability of the Chinese Questionnaire --- p.96 / Chapter 4.2 --- Results --- p.96 / Chapter 4.2.1 --- Subjects' Characteristics --- p.96 / Chapter 4.2.3 --- Comorbidity --- p.102 / Chapter 4.2.4 --- Complications --- p.102 / Chapter 4.2.5 --- Costs of Type 2 DM --- p.104 / Chapter 4.3 --- Discussions --- p.123 / Chapter Chapter 5 --- Cost-effectiveness Analysis of Metformin + Rosiglitazone vs. Metformin + Glibenclamide for Type 2 DM Patient Whose Diabetes is not Adequately Controlled by Metformin Alone from a Payer's Perspective --- p.134 / Chapter 5.1 --- Methods --- p.134 / Chapter 5.1.1 --- Model Overview --- p.134 / Chapter 5.1.2 --- "Success, Failure and Discontinuation Rates" --- p.138 / Chapter 5.1.3 --- Resources Use and Costs --- p.142 / Chapter 5.1.4 --- Health-Related Quality of Life (HRQOL) --- p.148 / Chapter 5.1.5 --- Base Case Analysis --- p.149 / Chapter 5.1.6 --- Sensitivity Analyses --- p.149 / Chapter 5.2 --- Results --- p.150 / Chapter 5.2.1 --- Base Case Model - CE Analysis: cost per controlled Type 2 DM patient --- p.150 / Chapter 5.2.2 --- Sensitivity Analysis- CE Analysis: cost per controlled Type 2 DM patient --- p.151 / Chapter 5.2.3 --- Base Case Model - CE Analysis: cost per EQ5D utility score --- p.154 / Chapter 5.2.4 --- Sensitivity Analysis- CE Analysis: cost per EQ5D utility score --- p.155 / Chapter 5.3 --- Discussions --- p.158 / Chapter Chapter 6. --- Conclusions --- p.163 / Appendix --- p.165 / References

Para avaliar os benefícios da comunicação rápida ao clínico do diagnóstico de vírus respiratórios, foi analisado a viabilidade econômica de 2 testes, com o tempo de entrega de resultado em 2 horas para teste rápido e 48 horas para Biologia Molecular. As amostras coletadas foram processadas utilizando técnicas convencionais e os testes disponíveis no mercado local. Foram escolhidos dois testes rápidos pelo método de imunocromatografia para quatro parâmetros analíticos: Influenza A, Influenza H1N1, Influenza B e Vírus Sincicial Respiratório (RSV) e em Biologia Molecular um teste de RT-PCR multiplex com 25 patógenos entre vírus e bactérias. O tipo de amostra utilizada foi swab e lavado de nasofaringe. A população escolhida para o estudo foi paciente adulto, em tratamento de câncer, que necessita de uma resposta rápida já que a maioria se encontra com comprometimento do sistema imune por doença ou por tratamento. O estudo foi transversal, realizado entre os anos de 2012 e 2013, para avaliar a viabilidade econômica da introdução de testes de diagnóstico da infecção respiratória aguda de etiologia viral a partir de amostras de nasofaringe em pacientes com câncer atendidos no Centro de Atendimento de Oncologia Intercorrência (CAIO ), do Instituto do Câncer do Estado de São Paulo (ICESP), hospital público que atende exclusivamente Sistema Único de Saúde (SUS) e Hospital A.C. Camargo, que atende tanto a pacientes do SUS como da rede privada. O estudo incluiu 152 pacientes em tratamento para qualquer tipo de câncer, predominantemente do sexo feminino (81 mulheres e 70 homens) com idades entre 18-86 anos. Para participar do estudo o paciente era consultado e o critério para escolha do paciente foi ser portador de câncer, com história de febre (ainda que referida) acompanhada de tosse ou dor de garganta, tosse e sintomas respiratórios agudos, atendidos por protocolo padronizado que inclui avaliação na admissão, seguimento e manejo antimicrobiano. Para a avaliação econômica os pacientes foram classificados de acordo com o estado geral de saúde, se apresentavam bom estado de estado de saúde poderiam receber alta e faziam uso da medicação em casa evitando 5 dias de internação se recebessem algum resultado para Influenza ou RSV, no entanto os pacientes que apresentavam outro vírus, resultado negativo ou o estado geral era ruim permaneciam internados por 7 dias em observação e cuidados com medicação adequada. Foram realizadas análises econômicas em dois âmbitos: o sistema de saúde publico e o privado considerando o fator diminuição de dias de internação. A analise de Custo-benefício foi eficiente no Sistema privado mas inadequada para o SUS assim como, qualquer outra medida monetária já que os valores de reembolso do SUS estão defasados do custo de qualquer internação. A análise de Custo-efetividade que olha para outros fatores além do monetário foi efetiva nos dois sistemas que enfrentam falta de leitos além da condição de saúde do paciente de evitar a ingestão desnecessária de antibióticos, evitar os gastos do acompanhante, perda de dias de trabalho e estudo. Não houve correspondência de resultados dos testes rápidos com o multiplex de Biologia Molecular / To evaluate the benefits of the rapid communication of the respiratory viruses\' diagnosis to the doctor, the economic feasibility of two tests was analyzed, with the result delivery time within 2-hours for the rapid test and 48 hours for Molecular Biology. The samples were processed using conventional techniques and the available tests in the local market. Two rapid tests were selected by the immunochromatography method for four analytical parameters: Influenza A, Influenza A H1N1, Influenza B, and Respiratory Syncytial Virus (RSV) and in Molecular Biology a multiplex RT-PCR assay with 25 pathogens between viruses and bacteria. The type of sample used was swab and nasopharyngeal wash. The population chosen for the study was of adult patients undergoing cancer treatment, which requires a rapid response since most have a compromised immune system due to the disease or treatment. The study, conducted between 2012 and 2013, was cross-sectional to evaluate the economic feasibility of introducing diagnostic tests for acute respiratory infection of viral etiology from nasopharyngeal samples of patients with cancer attended at the Oncology Intercurrence Care Center (CAIO), at the Cancer Institute of the São Paulo State (ICESP), at public hospital that attends exclusively the Unified Health System (SUS) and at AC Camargo hospital, which attends SUS patients as well as the private health system. The study included 152 patients undergoing treatment for any type of cancer, predominantly female (81 women and 70 men) between 18 and 86 years. To participate in the study, the patients were consulted and the criteria for choosing a patient was to be a cancer patient with a history of fever (even if referred) accompanied by cough or sore throat, coughing and acute respiratory symptoms, attended by standardized protocol that includes an evaluation at the admission, tracking and antimicrobial management. For the economic evaluation, patients were classified according to the general health condition. If they were in a good health condition, they could receive medical discharge and make use of the medication at home avoiding five days of hospitalization when receiving a result for influenza or RSV. However, the patients with other viruses, negative results or with bad general condition remained hospitalized for seven days under observation and care with proper medication. Economic analyzes were carried out in two areas: the public health system and private health system considering the factor decreased length of hospital stay. The cost-benefit analysis was efficient in the private system but inadequate for the NHS as well as any other monetary measure since the SUS reimbursement values are too low when compared to the cost of any other hospital. The cost-effectiveness analysis that looks at other factors besides money was effective in both systems that were facing lack of beds in addition to the health condition of the patient to avoid unnecessary intake of antibiotics, avoid the costs of the accompanying person, loss of working and study days. There were no results correspondences of the rapid tests with the Molecular Biology multiplex