INTRODUÇÃO: Aproximadamente 170 milhões de pessoas são portadores de hepatite C crônica, sendo esta atualmente a principal causa de transplantes hepáticos no mundo. Os pacientes com hepatite crônica C são atualmente tratados com interferon e ribavirina (IFN/RBV). Estudos de associação do genoma associaram à resposta ao tratamento com IFN/RBV a um polimorfismo de nucleotídeo único (SNP) nas proximidades do gene da Interleucina 28B, que codifica a interferona-?. OBJETIVOS: Padronizar nova metodologia de baixo custo e menor tempo de execução para a genotipagem do polimorfismo rs12979860. Investigar a frequência do polimorfismo rs12979860, em uma coorte de pacientes com hepatite crônica C e sua associação com a resposta ao tratamento no Hospital das Clínicas da Universidade de São Paulo. MÉTODOS: A genotipagem foi realizada, por novo método diagnóstico, PCR multiplex CTPP (confronto de dois pares de iniciadores) e validado através de sequenciamento direto e PCR em tempo real. Um estudo retrospectivo foi realizado em 248 portadores de hepatite C crônica, tratados com interferon e ribavirina; 138 portadores de hepatite C crônica, virgens de tratamento e 240 doadores de sangue. Foi analisado o DNA, dados clínicos e demográficos, juntamente com dados sobre a resposta ao tratamento. RESULTADOS: O método de PCR CTPP foi padronizado e mostrou-se mais rápido e de menor custo comparado ao sequenciamento e PCR em tempo real. Pacientes com resposta virológica sustentada (RVS) apresentaram uma frequência de 33/61 (54,1%) para o genótipo C/C, de 21/61 (34,4%) para o genótipo C/T e 7/61 (11,5%) para o genótipo T/T. Pacientes que não tiveram RVS (Não RVS) apresentam uma frequência de 44/185 (23,8%) para o genótipo C/C, de 102/185 (55,1%) para o genótipo C/T e de 39/185 (21,1%) para o genótipo T/T. Os Não RVS estão associados ao genótipo C/T (p=0,002) e ao genótipo T/T (p=0,001) quanto comparados com o grupo de RVS. CONCLUSÕES: Esta dissertação descreve um método inovador, rápido e de baixo custo, o PCR CTPP, que detecta o polimorfismo rs12979860. O ensaio é internamente controlado e não requer a utilização de endonucleases de restrição ou equipamento especial. O polimorfismo rs12979860 é um preditor significativo da resposta ao tratamento com IFN/RBV em pacientes com infecção crônica pelo vírus da hepatite C. A genotipagem deste, em conjunto com os indicadores já existentes, pode identificar prováveis não respondedores ao tratamento / INTRODUCTION: Approximately 170 million people are chronic carriers of hepatitis C virus (HCV). Chronic HCV patients are currently treated with pegylated interferon and ribavirin (PEG- IFN/RBV). A genome-wide association with PEG-IFN/RBV treatment response and a single nucleotide polymorphism (rs12979860) has been identified near the interleukin 28B gene that encodes interferon-?-3. AIM: Describe an innovative, fast, and low-cost multiplex polymerase chain reaction with confronting two-pair primers that detects the rs12979860 polymorphism. Investigate the frequency of polymorphism rs12979860, among patients with chronic hepatitis C and association with to response treatment at the Hospital das Clínicas da Universidade de São Paulo. METHODS: Genotyping was performed by new diagnostic method, multiplex PCR CTPP (confronting two-pairprimers) and validated by direct sequencing and real time PCR. Retrospective study was conductedin 248 patients with hepatitis C chronic treated with interferon and ribavirin, 138 patients with chronic hepatitis C treatment-naïve and 240 blood donors. We analyzed DNA, clinical and demographic data, along with data onthe response to treatment. RESULTS AND CONCLUSIONS: The CTPP method was standardized and proved faster and lower cost compared to sequencing andreal time PCR. Patients with sustained virologic response (SVR) showed a frequency of 33/61 (54.1%) for the genotype C/C of 21/61 (34.4%) for the genotype C/T and 7/61 (11.5%) for genotype T/T. Patients with out sustained virologic response (Non SVR) have a frequency of 44/185 (23.8%) for the genotype C/C,102/185 (55.1%) for the genotype C/T and 39/185 (21.1%) for genotype T/T.The Non SVR are associated with genotype C/T (p = 0.002) and T/T genotype (p= 0.001) as compared with the group of SVR. Today, the IL28B genotyping is recomended by in the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver guidelines. As a result, physicians should consider testing IL28B in patients with hepatitis C; however, the implementation of routine genotyping has been halted in tertiary care hospitals because of the need for molecular biology tools that are expensive and highly complex. The CTPP multiplex assay described here detects in a single reaction the genotypes C/C, C/T, and T/T. This method allows rapid genotyping of the polymorphism rs12979860, which is reproducible in minimally equipped laboratories; it does not require any special equipment and is a relatively low-cost procedure. The PCR-CTPP method can be used for large testing arrays and is also suitable for genotyping a small number of samples

Democracy has been encountering an increasing number of critics. Whether it comes from a sympathy for autocrats, free-markets, or the more knowledgeable, this increasing democratic scepticism often takes an epistemic form. Democracy's critics argue that democratic procedures and institutions are unlikely to make good decisions or produce good outcomes in terms of justice or the common good, and should, therefore, be restricted if not completely rejected in favour of its more able alternatives. In the face of such scepticism, this thesis develops an epistemic theory of deliberative democracy. This theory has two principal aims. The first is to analyse and define the epistemic properties of deliberative democracy, and the second is to clarify the possible role epistemic values can play in a wider justification of democratic rule. In accordance with the first, the thesis analyses the ability of deliberative democratic institutions to make good or correct decisions in comparison to a broad range of prominent alternatives. These include traditional rivals such as autocracy and aristocracy, but also more modern and less considered alternatives such as free-markets, limited epistocracy and forms of technical calculation. Through these comparisons, it is argued that we have no good or clear epistemic reason to reject democracy. Deliberative democracy is found to be epistemically superior to many of its alternatives and epistemically equivalent to even its best competitors. The thesis, therefore, mounts a strong reply to democracy's epistemic sceptics. The analysis, however, also helps clarify which form of deliberative democracy is epistemically most valuable, pointing to the value systems approaches which give a prominent role to direct citizen deliberation. The epistemic theory of deliberative democracy also aims to clarify what role epistemic values can play in a wider justification of democratic rule. The thesis argues that deliberative democracy is epistemically superior to many of its rivals and no worse epistemically than even its best alternatives. This suggests that although epistemic values cannot mount a stand-alone defence of democracy, democrats would only be required to defend very weak non-epistemic values to produce a mixed justification. Far from being 'rule by the incompetent many' and therefore highly reliant on procedural values, the thesis will demonstrate that epistemic values can carry significant weight in an argument for democratic rule.

Introdução O Transtorno de Déficit de Atenção/hiperatividade (TDAH) tem sido muito estudado, mas informações econômicas referentes ao seu tratamento com o metilfenidato de liberação imediata (MFD-LI) ainda necessitam ser exploradas. Grande parte da população mundial, principalmente aqueles que vivem em países em desenvolvimento, utiliza essa formulação como principal escolha para o tratamento do TDAH. Esses países, por sua condição financeira, necessitam informações de análises econômicas para administrar de forma eficiente os recursos públicos destinados aos setores da saúde. Objetivos Avaliar a eficácia do MFD-LI através de estudos com tempo superior a 12 semanas, e realizar uma análise econômica para o tratamento do TDAH com MFD-LI para crianças e adolescentes brasileiros. Método O estudo foi planejado em cinco etapas: 1) estimativa de custo do não tratamento do TDAH para o Brasil, e estimativa de economia com tratamento com MFD-LI; 2) revisão sistemática da literatura nas principais bases de dados internacionais onde se buscaram estudos abertos com tratamento do TDAH com MFD-LI por tempo igual ou superior a 12 semanas; também foram feitas metanálises e uma metaregressão 3) estudo naturalístico para obterem-se dados de uma amostra brasileira referentes a probabilidades de uso e sucesso com tratamento com MFD-LI por 12 semanas, e estimar os utilities desses indivíduos; 4) painel Delphi com especialistas em TDAH no Brasil; 5) estudo de custo-efetividade para o tratamento do TDAH com MFD-LI no Brasil, utilizando um Modelo de Markov. A perspectiva adotada será a do sistema público de saúde brasileiro como pagador. Resultados Os resultados principais encontrados para cada uma das etapas foram: 1) a estimativa de custos anuais com o TDAH não tratado no Brasil foi de R$ 1.594 bilhões/ano, e da quantia que poderia ser economizada se tratado, R$ 1 bilhão/ano. 2) na revisão sistemática da literatura, de 4.498 resumos, sete foram incluídos para compor a metanálise. O tempo de tratamento variou entre 13 e 104 semanas. O efeito agregado para desatenção e hiperatividade medida pelos pais, respectivamente, foi 0.96 (95%CI 0.60 - 1.32) e 1.12 (95%CI 0.85 - 1.39), e pelos professores 0.98 (95%CI 0.09 - 1.86) e 1.25 (95% CI 0.7 - 1.81). A metaregressão não mostrou associação entre as variáveis idade, qualidade do artigo e tempo de tratamento com heterogeneidade. 3) no estudo naturalístico, de 171 pacientes avaliados, 73 forneceram informações para o baseline, e 56 para a 12a semana de tratamento com MFD-LI. Os utilities para um paciente com TDAH não tratado (baseline) foram 0.69 (crianças) e 0.66 (adolescentes), e estimaram-se ganhos entre 0.09 a 0.10 utilities/mês, se tratados adequadamente. 4) no painel Delphi, de 26 especialistas, 14 responderam o questionário online, e foi estimado que a probabilidade dos pacientes não tratados se manterem sintomáticos na 12a semana seria de 91%, e 9% a probabilidade de melhora espontânea; 5) no estudo de custo-efetividade, para o caso base, estimou-se que o Incremental Cost Effectiveness Ratio (ICER) seja I$9,103/QALY (Quality Adjusted Life Years) para crianças e I$11,883/QALY para adolescentes em um horizonte temporal de 06 anos. Para os cenários mais desfavoráveis, os ICERS mais elevados foram I$95,164/QALY para 50% de sucesso com o tratamento, e I$15,000/QALY para 70% de adesão em um horizonte temporal de 06 anos. Conclusões O MFD-LI é um tratamento eficaz para crianças e adolescentes, por um período superior a 12 semanas. Entretanto, o Brasil pode estar aumentando os custos referentes à saúde por não estar fornecendo um tratamento eficaz e economicamente acessível para o TDAH. O tratamento mostrou ser uma opção custo-efetiva para crianças e adolescentes brasileiros, mesmo em cenários desfavoráveis para o tratamento. / Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a well-known psychiatric disorder, but some economical aspects of the treatment with Methylphenidate Immediate-release (MPH -IR) still need to be explored. A large number of people around the world, most living in Low-Middle Income Countries (LMIC), use this formulation as the first choice for ADHD treatment. These countries, due to their financial condition, need information from health economic analyzes to efficiently manage the public resources allocated to the health sector. Objective To study the efficacy of MPH-IR reviewing studies conducted for more than 12 weeks long, and to perform an economic analysis for the treatment of ADHD with MPH-IR for Brazilian children. Method The study was planned in a five stages process: 1) to estimate the cost of untreated ADHD for Brazil, and to estimate the savings if MPH-IR were adequately provided; 2) systematic review of the literature to identify papers published where young patients with ADHD were treated with MPH-IR for more than 12 weeks, and to perform a meta-analysis and a meta-regression; 3) to conduct a naturalistic study with a Brazilian sample to collect the probabilities of use and success with the MPH-IR treatment for 12 weeks, and to estimate the utilities; 4) to perform a Delphi panel with ADHD Brazilian experts; 5) to conduct a cost-effectiveness analysis for the treatment of ADHD with MPH-IR in Brazil, using a Markov model. The perspective is the one of the Brazilian public health system as the payer. Results The main findings for each step were: 1) the estimated annual expenditures with untreated ADHD in Brazil were R$1.594billon/year, and the estimated amount that could be saved was R$1billion/year; 2) in the systematic review, from 4,498 abstracts, 7 studies were selected. The length of treatment ranged from 13 to 104 weeks. The aggregate effects for inattention and hyperactivity, according to parents evaluations were respectively 0.96 (95%CI 0.60 - 1.32) and 1.12 (95%CI 0.85 - 1.39), and for teachers 0.98 (95%CI 0.09 - 1.86) e 1.25 (95% CI 0.7 - 1.81). There was no evidence of association between heterogeneity and the variables, age, paper quality and length of treatment; 3) in the naturalistic study, from 171 patients assessed, 73 provided information in the baseline, and 56 in the 12th week of MPH-IR treatment. Utilities for an untreated ADHD patient (baseline) were 0.69 (children) and 0.66 (adolescents), and it was estimated a gain ranging from 0.09 to 0.10 utilities/month if subjects were properly treated; 4) in the Delphi Panel, 26 experts were addressed and 14 filled in the online questionnaire. It was estimated the probability of untreated patients to remain symptomatic on the 12th week to be 91%, and the probability of spontaneous improvement, 9%; 5) in the cost-effectiveness analysis, for the base case, it was estimated an Incremental Cost Effectiveness Ratio (ICER) of I$9,103/QALY (Quality Adjusted Life Years) for children and I$11,883/QALY for adolescents, in a time horizon of 6 years. The worst case scenarios were also tested, and the highest ICER were I$95,164/QALY when patient reached 50 % of success with the treatment, and I$15,000/QALY if only 70% of use was observed in a time horizon of 6 years. Conclusions MPH-IR is an efficacious treatment for ADHD children and adolescents for periods longer than 12 weeks. However, Brazil may be probably wasting money due to not provide an efficient and affordable treatment for ADHD such as the MPH-IR. The treatment proved to be cost-effective for children and adolescents living in Brazil, even when the worst case scenarios were tested.

The challenge in most developing countries is lack of funding in education. This leaves no option for most learners except to drop out of school. Even when safety nets are provided for by governments, this does not fully address the issues of access, equity and retention in secondary education. Education for All, as pronounced in the Dakar Declaration (2000) calls on governments to address access, retention and equity in basic education, overlooking the provision of secondary education. Many policies were adopted by governments in post-colonial rule in Africa and Asia to address the colonial disparities in education. This had a tendency of drowning the budgets in educational matters, notwithstanding the issues of fully addressing access, equity and retention in secondary education. In the developing world, the bulk of the population lives in rural areas where infrastructure for teaching and learning still has to catch up with the urban setting. In view of the global economic meltdown in the 1980s, 1990s and mid-2008, education has seen a squeeze on its budget. It is in this context that funding for secondary education has to be analysed in order to establish policies and programmes which are most suitable and sustainable to enable access, equity and retention of learners in secondary education. Models of funding in various countries are carefully examined in this study, in order to draw on the best practices in funding secondary education as applicable to the Zimbabwean case, and possibly to other countries in a similar situation. The research was carried out in three administrative districts of the Manicaland province of Zimbabwe. Using a mixed methods approach, this study examines the safety nets for the provision of secondary school education in Zimbabwe and proposes better ways to finance secondary school education. / Educational Leadership and Management / D. Ed. (Education Management)

Esta dissertação busca analisar a eficiência econômica da forma de classificação das usinas geradoras nos leilões de contratação de energia elétrica por disponibilidade. Historicamente, o Brasil tem apresentado uma matriz de geração de energia elétrica predominantemente hídrica, que, embora mais econômica do que as matrizes de geração prevalentemente térmicas, pode resultar em déficits de geração em períodos de escassez hidrológica. O ano de 2001 evidenciou tal perigo. Nele, uma série de baixas afluências hidrológicas, sem o prévio incremento adequado do parque gerador, resultou no Programa de Redução do Consumo e, através desse, num decréscimo de 20% na demanda por energia elétrica à época, acentuando a preocupação pela incorporação de empreendimentos termelétricos para diversificar a matriz de geração do País. Entre as modificações realizadas, destaca-se a alteração da estrutura de comercialização de energia elétrica no Brasil visando a favorecer à expansão da oferta termelétrica, concebendo-se a modalidade de contratação por disponibilidade. Tal modalidade transfere o risco da operação e do preço do combustível dos ombros do gerador para os do consumidor. Contudo, fez-se necessário, para viabilizar tal modalidade de contratação, o uso de ferramental diferenciado para classificação dessa nova oferta de energia nos leilões, e a ferramenta adotada foi o Índice de Custo Benefício (ICB). Nesse contexto, o objetivo deste trabalho é analisar os resultados econômicos decorrentes do uso do ICB na contratação de usinas termelétricas por disponibilidade, verificando se ele se mostrou ou não adequado a tal fim. Para isso, analisam-se os resultados dos leilões para a contratação da energia de novos empreendimentos, destacando a participação de cada fonte energia e os valores financeiros exercidos por meio dos preços, das receitas fixas e dos respectivos ICBs. Além disso, é feita uma análise das operações das usinas termelétricas após a contratação. Dessa forma, são utilizados os anos operativos de 2014 e 2015, nos quais foi registrada uma profunda escassez hidrológica, como base na comparação de cenários de geração de energia elétrica com diferentes participações entre empreendimentos termelétricos a óleos derivados do petróleo e a gás natural. Os cenários utilizados são quatro: dois com composição real entre as dessas duas fontes termelétricas (óleos derivados do petróleo e a gás natural) para os anos de 2014 e 2015; e dois simulados, com 100% da geração termelétrica sendo realizada apenas a gás natural para os mesmos anos. Os resultados financeiros encontrados indicam que a potencial economia no custo da energia elétrica gerada no cenário simulado comparado ao cenário real seria da ordem de 6 bilhões de reais nos anos de 2014 e 2015. Assim, considerando as 59 usinas que integraram o universo da análise, o resultado que indica ineficiência no uso ICB, o qual apontou vantagem econômica de certos empreendimentos no momento de suas contratações que não se concretizaram nos cenários testados de baixa hidrologia. Ademais, fica clara a necessidade de aprimorar a metodologia de classificação de empreendimentos de geração de modo que tal metodologia leve em conta os efeitos de eventuais anos de baixa hidrologia, buscando tornar a contratação de energia elétrica no Brasil mais econômica e mais aderente à volatilidade hidrológica do País. / This thesis seeks to analyze the economic efficiency of the classification method for power plants in power availability contracts. Historically Brazil has presented a predominantly hydroelectric power generation matrix, which, though more economical than predominantly thermal generation matrix, can result in the generation deficits in hydrological scarcity periods. The year 2001 showed such danger. In it a number of low hydrological inflows, without adequate prior increase in generating capacity, resulted in rationing of 20% in demand for electricity at the time, stressing the concern by incorporating thermal power projects to diversify the country generation matrix. Among the changes made, it altered the electricity market structure in Brazil in order to favor the expansion of the thermoelectric supply, creating the availability contracts modality. This mode transfers the risk of the operation and the price of fuel from generator to the consumer. However, it was necessary to enable this type of contract, the use of different tools for classification in the auctions, and the tool adopted was the Cost Benefit Index (CBI). The objective of this study is to analyze the economic results from the use of CBI in hiring thermoelectric plants using availability contracts, checking if was or not suitable for this purpose. In this sense, we analyze the results of the auctions for new energy projects, highlighting the contribution of each energy source and the financial figures exercised through prices, the fixed income and ICBS. Moreover, it is also made an analysis of the operations of power plants after hiring. Thus, operating years used were 2014 and 2015, in which it was registered a profound hydrological shortage, based on the comparison of electricity generation scenarios with different interests between thermal power projects to petroleum oils and natural gas. The scenarios used were four: two with real composition between these two thermal sources for the years 2014 and 2015, petroleum oils and natural gas; and two simulated, with 100% of thermal generation with natural gas for the same years. The financial results indicate that the potential savings in the cost of the electricity generated in the simulated scenario compared to the real scenario would be around 6,1 billion reais in the years 2014 and 2015. Thus, considering the 59 plants that integrated the universe of analysis, the result indicates the inefficiency of the use ICB, which pointed out the economic advantage contracts that were not hired in low hydrology scenario tested. In addition, it is a clear the need to improve the classification methodology for generation projects in a way that takes into account the effects low hydrology year, trying to make the electricity contracts more economical to Brazil and more adherent to hydrological volatility of the country.

O objetivo principal da presente pesquisa foi estimar o valor monetário de visitação do Parque "PHILLIPE WESTIN CABRAL DE VASCONCELOS" e adjacências da ESALQ/ USP localizado no Município de Piracicaba do Estado de São Paulo. Para tanto, foi aplicado o método de valoração contingente, adotando-se o modelo de referendo com distribuição de probabilidade logística. O levantamento de dados foi efetuado no período de agosto a setembro de 2004, realizando-se 207 entrevistas, extraindo-se uma amostra para aproveitamento de 202 observações. O valor médio da disposição a pagar foi estimado em R$ 14,53 por mês. O beneficio econômico total foi estimado em R$ 37.487,40 por mês, considerando o numero total estimado de 2.580 visitantes mensais. Tais valores demonstram o considerável beneficio econômico que os atributos do Parque da ESALQ/ USP geram para toda a população local. Tais resultados podem ser utilizados para auxiliar no planejamento de políticas de visitação ordenada do lugar, além de auxiliar na justificativa do investimento na manutenção e preservação do lugar. O estudo constatou os motivos para não aceitação do valor de pagamento mensal. O valor sugerido, a restrição orçamentária e a imputação de que a manutenção e preservação de áreas naturais publicas é responsabilidade do governo, são algumas das principais razões. / The main objective of the present research was to estimate the monetary value of visitation of Park "PHILLIPE WESTIN CABRAL OF VASCONCELOS" and adjacencies of ESALQ/USP located in the City of Piracicaba, State of São Paulo. For which, the method of contingent valuation was applied, adopting the model countersignature with distribution of logistic probability. The data-collected was over the period between August and September 2004. The sample totaled 207 interviews, out of which, 202 were used in the estimation procedures. The average value of the willingness to pay was estimated to be R$ 14,53 per month. The total economic benefit was calculated to be R$ 37.487,40 per month considering a total monthly visitation of 2.580. Such values demonstrate a considerable economic benefit that Park of ESALQ/USP generates for all its visitors. Such results can be used to assist in the planning of visitation policies and to justify the investment in the Park’s maintenance and preservation. Also, the main reasons for payment refusal were: suggested value; the income restriction; and the perception that the maintenance and preservation of public natural areas are responsibility of the government.

Aufgabenstellung: Die Europäische Kommission strebt an, die Zahl der Getöteten im Straßenverkehr in der EU bis zum Jahr 2010 zu halbieren, unter anderem durch Einsatz von Telemedizin in der präklinischen Notfallrettung. Ziel dieser Arbeit ist die Untersuchung der Kosten-Wirksamkeit von Telemedizinsystemen für die präklinische Notfallrettung bei Verkehrsunfällen in Deutschland. Methodik: Aus Sicht der Gesellschaft und der Krankenkassen werden drei Varianten eines Telemedizinsystems mit dem Status Quo in Deutschland, das heißt dem "Nicht-Einsatz von Telemedizin" in der präklinischen Notfallrettung, verglichen. Die Analyse erfolgt auf Basis retrospektiv erhobener Daten für einen Zeithorizont von zehn Jahren. Berücksichtigt werden Systemkosten, Kosten der Personenschäden und Strukturkosten des Rettungsdienstes. Diese werden diskontiert und nicht inflationsbereinigt. Der Nutzen wird mittels gewonnener Lebensjahre durch die Verkürzung des therapiefreien Intervalls und die Verbesserung der Laienhilfe gemessen. Aufgrund der Uneinheitlichkeit der Daten werden Annahmen und Abschätzungen getroffen. Ergebnis: Im Basisergebnis ist der Kosten-Wirksamkeits-Quotient für die Variante "Telemedizin für Laienhelfer" (299.366 Euro pro gewonnenes Lebensjahr) höher als für die Variante "Automatische Unfallmeldung" (247.977 Euro pro gewonnenes Lebensjahr). Den besten Kosten-Wirksamkeits-Quotient erzielt die Vollausstattung mit 239.524 Euro pro gewonnenem Lebensjahr. Im Rahmen von multivariaten Sensitivitätsanalysen (best und worst case scenario) wird festgestellt, dass eine Senkung der Systemkosten die Gesamtkosten überproportional reduziert und dass durch eine schnelle Marktdurchdringung der Kosten-Wirksamkeits-Quotient des Telemedizinsystems deutlich verbessert werden kann. Fazit: Für alle drei Varianten des Telemedizinsystems werden hohe Kosten pro gewonnenes Lebensjahr erwartet. Eine Einführung dieser Systeme erscheint nur in einer abgestimmten europäischen Vorgehensweise realistisch. / Objective: Since the European Commission set a goal of reducing the number of road accident deaths across the EU by 2010 to one half, the use of telemedicine for pre-clinical traffic accident emergency rescue is very high on the agenda. The purpose of this study is to assess the cost-effectiveness of telemedical devices for pre-clinical traffic accident emergency rescue in Germany. Methods: Three telemedical devices are compared from the perspective of society and health insurance with baseline assumptions in Germany, i.e. the non-application of telemedicine in pre-clinical emergency rescues. The analysis is based on retrospective statistical data covering a period of ten years. Costs resulting from telemedical device, personal injury, wasted journeys and erroneous dispatching of rescue services are discounted and not adjusted for inflation. The outcome is measured in terms of "life years gained" by reducing therapy-free intervals and improvements in first-aid provided by laypersons. Due to the uncertainty of data, certain assumptions and estimates are necessary. Results: In the base case scenario the cost-effectiveness ratio of the device "Telemedicine for laypersons" (Euro 299,366 per life year gained) would be higher than of the "Automatic Accident Alert" (Euro 247,977 per life year gained). The full equipment device has the best cost-effectiveness ratio (Euro 239,524 per life year gained). Multi-way sensitivity-analysis with best and worst case scenarios show that decreasing costs of telemedical device would disproportionately reduce total costs, and that rapid market penetration would largely increase the cost-effectiveness ratio of the devices. Conclusion: The net costs per life year gained in the application of the three telemedical devices are estimated as quite high. The implementation of the devices seems only realistic as part of a larger European co-ordinated initiative.

The objective of this thesis is to develop an ecological economic framework for the assessment and establishment of protected areas (PAs) that are aimed at conserving forests and biodiversity. The framework is intended to be both rigorous and relevant to the decision-making process. Constructivism is adopted as the paradigm guiding the research process of the thesis, after firstly examining also positivist philosophy and ???post-normal??? scientific methodology. The tenets of both ecological and environmental economics are then discussed. An expanded model of human behaviour, which includes facets derived from institutional economics and socioeconomics as well as aspects of neoclassical economics, is outlined. The framework is further developed by considering, from a contractarian view point, the implications of intergenerational equity for biodiversity conservation policies. The issues of intragenerational distribution and allocation are then considered. In this regard, cost-benefit analysis (CBA), as applied to the valuation of forests, PAs, and biodiversity, is critically reviewed. A participatory approach to decision-making, which may also include CBA, is then proposed. The resulting ecological economic framework may be thus summarised: (a) ecosystem use patterns should be chosen on the basis of their sustainability, distributional, and efficiency aspects; (b) systems of PAs should be established in order to achieve minimal intergenerational equity; (c) intragenerational equity requires the correction of the asymmetrical distribution of the costs and benefits arising from the establishment of PAs; (d) the institutional features relevant to the environmental-economic issues being analysed should be considered; and (e) the decision-making process should be participatory and action oriented. The framework is applied to two case studies in Vanuatu. These applications detail (a) stakeholders??? views and trade-offs faced in relation to forest management (b) modes of participatory research and decision-making, (c) forms of compensation that may be adopted in correcting asymmetrical distributions of the costs and benefits of PAs, and (d) institutional influences on ecosystems use and implications for conservation projects. The institutional arrangements developed for the establishment of the PAs are presented. The application of this ecological economic framework has resulted in the formal establishment of one PA and the identification and assessment of five other PAs.

台灣為海島型國家，因自有能源貧乏，99%以上的能源仰賴國外進口。為確保能源供給之穩定與安全，除發展再生能源之外，提高能源終端使用效率為重要之解決手段。熱泵系統因其獨特之節能減碳效果，在歐美先進國家備受重視，極力推廣。基此，考量台灣氣候類型及居住型態，評估熱泵熱水系統的適用性及成本效益分析，爰為本研究之動機與目的。 為了彰顯應用熱泵系統在不同地區氣候條件與能源價格之差異，本研究將台灣劃分為12個地區，並且以電能、LPG桶裝瓦斯、NG管線瓦斯三種現有之住宅用熱水系統作為可供替代之選項，利用迴避成本(Avoided Cost)推估台灣各地區住宅部門改採熱泵熱水系統之成本效益。此外，參考歐美先進國家熱泵系統補助政策，以及台灣現有「太陽能熱水系統推廣獎勵措施」之政府政策補助方案，設定各相關參數，俾模擬政府補貼方案情境下之成本效益分析。 分析結果以淨現值(Net Present Value)、益本比(Benefit-Cost Ratio)及折現回收期(Discounted Payback Period )呈現，結論可從兩個觀點之檢定加以評估。其一、以「參與者檢定」評估是否有足夠的經濟誘因，促使住宅用戶裝設熱泵熱水系統。其二、以「總資源成本檢定」，評估推廣熱泵系統對於整體社會是否具有淨效益。 本研究中全台12個地區，若以熱泵系統取代電能熱水系統、LPG瓦斯熱水系統、NG瓦斯熱水系統三種既有設備，交叉比對之33個替代方案，由「參與者檢定」之結果顯示，所有替代方案之益本比均大於1.1；折現回收期最長達11.3年，最短僅3.2年。若模擬政府補助18,000名用戶採用熱泵系統，則「總資源成本檢定」之結果中，所有替代方案之益本比介乎1至1.73之間；折現回收期最長達14.9年，最短僅5.4年；住宅部門以熱泵替代現有電能、LPG瓦斯、NG瓦斯熱水系統至少可降低碳排放量每年2,707公噸。三種替代類別中以電能熱水系統替代方案益本比最高(介乎1.55至1.73)；LPG瓦斯替代方案之益本比居次(介乎1.19至1.28)；NG瓦斯替代方案益本比最低(介乎1.0至1.06)。全台12個地區考量環境溫度差異之影響以南投分區改採熱泵系統的益本比最高(電能替代1.73、LPG瓦斯替代1.28、NG瓦斯替代1.06)，屏東分區的益本比為最低(電能替代1.55、LPG瓦斯替代1.19、NG瓦斯替代1.0)。 若考量熱泵系統市場滲透率，以熱泵取代NG瓦斯熱水系統之市佔率達5%、20%、50%時，台灣整體社會的淨現值分別為251百萬元、1,006百萬元與2,514百萬元，且每年可減少碳排放量27,169公噸、108,675公噸以及271,687公噸。 / As an island country, 99% energy supply in Taiwan depends on importation due to the very limited endogenous energy. In order to maintain both energy security and stability, improving energy efficiency of consumer end-use is an important government policy. Heat pump systems have been widely applied and strongly promoted in Europe and United State for its uniquely energy saving and CO2 reducing capability. Therefore, the motivation of this study is to access the regional applicability of heat pump water heating system for Taiwan’s climate and residential building types by cost-benefit analysis method. To demonstrate the regional difference of climatic conditions and energy prices heat pump application, Taiwan is divided in twelve regions with three kinds of alternative residential water heating systems (i.e. electric heating, LPG tank heating, and NG pipe heating). Under these conditions, we utilize the avoided cost method to access itemized costs and benefits of heat pump water heating systems in various regional families in Taiwan. In addition, referring to heat pump incentive scheme in advanced European countries and North America while considering solar water heating systems incentive policy in Taiwan, we also simulate variation of parameters (such as cash rebate subside, total residential heat pump user numbers )of heat pump system subsidy program. The outcome of cost-benefit analysis is presented in a form as net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DP). The results could be analyzed by test from two different perspectives including Participant Test (PCT) from participant perspective and Total Resource Cost Test (TRC) from overall sociality perspective. All of the 33 alternative programs constituted by 12 regions with electric , LPG and NG systems, for PCT, BCR, all 33 alternative programs are greater than 1.1; DP are between 3.2 to 11.3 years. For TRC, BCR, all 33 alternative programs are greater than 1 but less than 1.73; DP are between 5.4 to 14.9 years. Residential building adopting heat pump could reduce 2,707 tons carbon emissions annually. For the three types of alternative system, BCR of electric heating alternative program is the largest and NG alternative program being the least. For all of the 12 regions, BCR of Nantou region is the largest for adopting heat pump while BCR of Pingtung region is the smallest. NPV of overall Taiwan with market penetration reaching 5%, 20% and 50% substitution rate from heat pump system to NG water heating system are 251 million NT$, 1,006 million NT$, and 2,514 million NT$ respectively. Carbon emissions reduce 27,169 tons, 108,675 tons and 271,687 tons annually.

<p>This thesis addresses the issue of weighted cost-benefit analysis (WCBA). WCBA is a welfare evaluation model where income distribution effects are valued by distributional weighting. The method was developed already in the 1970s. The interest in and applications of this method have increased in the past decade, e.g. when evaluating of global environmental problems. There are, however, still unsolved problems regarding the application of this method. One such issue is the choice of the approach to the means of estimating of the distributional weights. The literature on WCBA suggests a couple of approaches, but gives no clues as to which one is the most appropriate one to use, either from a theoretical or from an empirical point of view. Accordingly, the choice of distributional weights may be an arbitrary one. In the first paper in this thesis, the consequences of the choice of distributional weights on project decisions have been studied. Different sets of distributional weights have been compared across a variety of strategically chosen income distribution effects. The distributional weights examined are those that correspond to the WCBA approaches commonly suggested in literature on the topic. The results indicate that the choice of distributional weights is of importance for the rank of projects only when the income distribution effects concern target populations with low incomes. The results also show that not only the mean income but also the span of incomes, of the target population of the income distribution effect, affects the result of the distributional weighting when applying very progressive non-linear distributional weights. This may cause the distributional weighting to indicate an income distribution effect even though the project effect is evenly distributed across the population.</p><p>One rational for distributional weighting, commonly referred to when applying WCBA, is that marginal utility of income is decreasing with income. In the second paper, this hypothesis is tested. My study contributes to this literature by employing stated preference data on compensated variation (CV) in a model flexible as to the functional form of the marginal utility. The results indicate that the marginal utility of income decreases linearly with income.</p><p>Under certain conditions, a decreasing marginal utility of income corresponds to risk aversion. Thus the hypothesis that marginal utility of income is decreasing with income can be tested by analyses of individuals’ behaviour in gambling situations. The third paper examines of the role of risk aversion, defined by the von Neumann-Morgenstern expected utility function, for people’s concern about the problem of ‘sick’ buildings. The analysis is based on data on the willingness to pay (WTP) for having the indoor air quality (IAQ) at home examined and diagnosed by experts and the WTP for acquiring an IAQ at home that is guaranteed to be good. The results indicate that some of the households are willing to pay for an elimination of the uncertainty of the IAQ at home, even though they are not willing to pay for an elimination of the risks for building related ill health. The probability to pay, for an elimination of the uncertainty of the indoor air quality at home, only because of risk aversion is estimated to 0.3-0.4. Risk aversion seems to be a more common motive, for the decision to pay for a diagnosis of the IAQ at home, among young people.</p><p>Another rationale for distributional weighting, commonly referred to, is the existence of unselfish motives for economic behaviour, such as social inequality aversion or altruism. In the fourth paper the hypothesis that people have altruistic preferences, i.e. that they care about other people’s well being, is tested. The WTP for a public project, that ensures good indoor air quality in all buildings, have been measured in three different ways for three randomly drawn sub-samples, capturing different motives for economic behaviour (pure altruism, paternalism and selfishness). The significance of different questions, and different motives, is analysed using an independent samples test of the mean WTPs of the sub-samples, a chi-square test of the association between the WTP and the sample group membership and an econometric analysis of the decision to pay to the public project. No evidence for altruism, either pure altruism or paternalism, is found in this study.</p>