Human interference with the Earth’s climate, through the release of greenhouse gasses (GHGs), is estimated to have already increased average statewide temperatures in California by 1.7° Fahrenheit (F), with a further 2.7°F of warming expected by mid-century. The negative impacts of increased temperatures may be especially acute in mid-latitude cities that currently enjoy a mild climate, such as Los Angeles (LA), which are projected to warm to a point that will significantly affect human health and well being. The built environment increases urban temperatures through building materials that readily absorb heat from the sun, a lack of vegetation, a lack of pervious surface area, and anthropogenic heat. Local governments can take action to help their cities adapt to future temperatures through changes to building materials, urban design and infrastructure. This study evaluates six urban design strategies for reducing temperatures and therefore adapting to increased heat in LA: cool roofs, cool pavements, solar panels, tree planting, structural shading and green roofs. The methods used in this analysis include a cost-effectiveness analysis, key stakeholder interviews, and case studies from other cities in the US. Findings indicate that cool roofs are the most cost-effective strategy for urban heat island mitigation, with cool pavements and tree planting also cost-effective. Findings from stakeholder interviews indicate that political feasibility is high for all strategies except structural shading, which was thought to be costly and difficult to implement. However, significant political barriers were also identified for tree planting and green roofs. Findings from four case studies indicate that climate adaptation policies should emphasize co-benefits, include flexible design standards, and provide financial or performance-based incentives for property owners or developers. Specific recommendations for implementing climate adaptation measures are provided for urban planners, policy makers, urban designers and architects in Los Angeles.

Bakgrund – Essity, en framstående aktör inom hygien- och hälsobranschen, står inför utmaningar gällande logistikflödet för konsumentprodukter från produktionsanläggningen i Lilla Edet till kunder i Danmark. Den nuvarande logistikprocessen involverar intern transport med egna lastbilar till externa lager. I detta sammanhang är det av yttersta vikt att säkerställa snabba och kostnadseffektiva leveranser, samtidigt som kundtillfredsställelse upprätthålls. Syfte – Projektet syftar till att analysera och optimera Essitys nuvarande logistikflöde för konsumentprodukter. Fokus ligger på att identifiera potentiella förbättringar för att säkerställa smidiga och effektiva leveranser till den danska marknaden. En central del av studien innefattar även övervägandet av att integrera en tredjepartslogistikpartner (3PL) för att ytterligare förbättra logistikstrukturen. Metod – En omfattande metodik har använts, där både kvalitativa och kvantitativa aspekter har analyserats. Genom intervjuer och observationer har data samlats in för att skapa en holistisk förståelse för nuvarande logistikflöde och eventuella alternativa lösningar. Resultat och diskussion – Den omfattande analysen av Essitys nuvarande logistikflöde avslöjar viktiga insikter. Den befintliga metoden, med intern transport till externa lager, visar sig vara ekonomiskt gynnsam, särskilt när kontrakterade kostnader för externa lager och andra projektrelaterade utgifter för år 2023 beaktas. Det är värt att notera att de ekonomiska data för en alternativ lösning från en potentiell 3PL-leverantör gäller för år 2025. För att förstå möjliga förändringar i kostnader över tid har hänsyn tagits till den potentiella ökningen av kostnaderna för den befintliga metoden. Diskussionen inkluderar också miljöaspekter, där olika lösningar övervägs för att identifiera den mest hållbara och lönsamma strategin för Essitys logistik. Lösning 2, som involverar byggandet av ett nytt lager (green warehouse) och användning av elfordon och HVO-drivna lastbilar, presenterar sig som en hållbar inriktning som kan minska CO2-utsläppen och bidra till Essitys övergripande mål att minska miljöpåverkan. Rekommendationer för Essity – Baserat på resultaten av analysen rekommenderas Essity att genomföra en benchmarking för att undersöka erbjudanden från andra potentiella 3PL- leverantörer. Förhandlingar med det nuvarande externa lagret för att förbättra prisstrukturen bör övervägas, särskilt med tanke på de betydande totala kostnaderna för båda lösningarna. Slutligen bör Essity överväga att göra en strategisk investering i att bygga ett utökat manuellt lager nära det befintliga, vilket kan möjliggöra ökad flexibilitet och kostnadseffektivitet över tiden. / Background – Essity, a prominent player in the hygiene and health industry, faces challenges regarding the logistics flow for consumer products from its production facility in Lilla Edet to customers in Denmark. The current logistics process involves internal transportation with company-owned trucks to external warehouses. In this context, ensuring swift and cost- effective deliveries while maintaining customer satisfaction is of utmost importance. Purpose – The project aims to analyze and optimize Essity's current logistics flow for consumer products. The focus is on identifying potential improvements to ensure smooth and efficient deliveries to the Danish market. A central part of the investigation also involves considering the integration of a third-party logistics partner (3PL) to further enhance the logistics structure. Method – A comprehensive methodology has been employed, analyzing both qualitative and quantitative aspects. Through interviews and observations, data has been collected to gain a holistic understanding of the current logistics flow and potential alternative solutions. Results and Discussion – The extensive analysis of Essity's current logistics flow reveals crucial insights. The existing method, involving internal transport to external warehouses, proves to be economically advantageous, especially when considering contracted costs for external warehouses and other project-related expenses for the year 2023. It is worth noting that the economic data for an alternative solution from a potential 3PL provider applies to the year 2025. To understand possible changes in costs over time, considerations have been made for the potential increase in costs for the existing method. The discussion also includes environmental aspects, where different solutions are considered to identify the most sustainable and profitable strategy for Essity's logistics. Solution 2, involving the construction of a new warehouse (green warehouse) and the use of electric vehicles and HVO-driven trucks, presents itself as a sustainable approach that can reduce CO2 emissions and contribute to Essity's overall goal of reducing environmental impact. Recommendations for Essity – Based on the results of the analysis, Essity is recommended to conduct a more in-depth benchmarking to explore offerings from other potential 3PL providers. Negotiations with the current external warehouse to improve the price structure should be considered, especially considering the significant total costs for both solutions. Finally, Essity should contemplate making a strategic investment in building an expanded manual warehouse near the existing one, enabling increased flexibility and cost-effectiveness over time.

Energianvändningen har ökat markant globalt sedan 1971, vilket har påverkat klimatet och orsakat global uppvärmning. För att minska energiförbrukningen och dess påverkan på klimatet har Sverige fastställt energi- och klimatmål fram till år 2030. Sektorn för bygg- och fastigheter har en stor roll att spela i att minska utsläppen av växthusgaser eftersom den stod för 15,9 miljoner ton koldioxidekvivalenter år 2020. Syftet med denna studie är att undersöka möjliga alternativa lösningar och åtgärder som kan minska både energiförbrukningen och kostnaderna samtidigt som klimatpåverkan från byggnader minskas. Fokus ligger på att tillämpa dessa åtgärder på ett småhus i Markaryd. I studien användes litteraturstudier, intervjuer och beräkningsprogram som Bidcon, energiberäkning.se och pay off-metoden. Resultaten visar att renoveringsåtgärder, såsom fönster- och dörrbyte, tilläggsisolering av vinden och installation av ett mekaniskt ventilationssystem, minskade energiförbrukningen och var ekonomiskt fördelaktiga när de kombinerades med andra åtgärder. Undersökningen visar att trä och cellulosa hade lägre klimatpåverkan än aluminium och glasull i skedena A1-A5. Renoveringsåtgärder, med rätt val av material, kan således minska energiförbrukningen och klimatpåverkan samtidigt som de är ekonomiskt fördelaktiga, vilket leder till positiva effekter för både miljön och ekonomin. / Studies indicate that renovation projects have significantly lower environmental impact compared to new constructions, with emissions reduced by up to 50 % due to the reuse of existing materials. The purpose of this study is to explore alternative solutions and strategies that can effectively reduce both energy consumption and costs, while mitigating the climate impact of buildings. The focus is specifically on applying these measures to a small house in Markaryd. The research methodology involved a combination of literature reviews, interviews, and the utilization of calculation tools such as Bidcon, energiberäkning.se, and the pay-off method. The results demonstrate that renovation measures such as window and door replacement, additional insulation in the attic, and the installation of a mechanical ventilation system effectively reduced energy consumption and proved economically viable. The investigation also revealed that wood and cellulose materials had lower climate impact compared to aluminum and glass wool in stages A1-A5. Therefore, renovating buildings with careful material selection can simultaneously achieve reduced energy consumption and climate impact, while also offering economic benefits, thereby contributing positively to both the environment and the economy.

Background: Tuberculosis (TB) is a major global health threat that results not only in health consequences but also economic consequences. Since 2015 the World Health Organization (WHO) has developed a strategy with the aim of ending the global burden of TB by reducing TB-related deaths, reducing TB incidence, and eliminating the burden of TB-related catastrophic costs for patients and their families. In order to reach these targets, we need to implement effective TB diagnostic and care strategies that are feasible for both patients as well as the health care system. -- Methods: This study consists of two manuscripts which assess the economic burden of TB - one from the patient perspective and the other from the health system perspective. The first manuscript is a systematic review aimed to determine the costs incurred by patients and their households while receiving TB care with direct (medical and non-medical) as well as indirect costs being examined for the pre-diagnostic, post-diagnostic and total phase of care. It analyzed studies with varying patient populations from low-, middle-, and high-income settings to help estimate key factors that drive patient costs. Furthermore, it assessed the proportion of patients that incurred catastrophic costs and the coping strategies that they resorted to in order to offset the costs of TB care. The second manuscript is a modelling study which aimed to develop, parameterize and analyze a decision analytic model to determine the cost, health outcomes as measured by disability-adjusted life years (DALYs) averted and the cost-effectiveness of second-generation lateral flow lipoarabinomannan assay (SG LF-LAM) diagnostic algorithms in people living with HIV (PLHIV) per DALY averted. This model examined four different strategies - 1) the standard of care (SOC) Gene Xpert MTB/RIF only, 2) Gene Xpert MTB/RIF plus LF-LAM for all patients, 3) Gene Xpert MTB/RIF plus LF-LAM for patients with a negative Xpert result, and 4) Gene Xpert MTB/RIF plus LF-LAM for patients who are symptom negative. -- Results: A systematic review showed that total patient costs related to TB care ranged from a mean of $2.80 to $19,153.80 (2019 USD) with costs largely dependent on geographic location as well as patient population, Direct medical and indirect cost components were the largest source of costs for patients and their families while receiving TB care. Direct medical costs included the cost of medication, consultations, diagnostics, follow-up testing, and hospitalization while indirect costs mainly consisted of loss of income. The costs of TB care were considered catastrophic for the majority of patients resulting in them using coping strategies to offset the burden of costs. In the second manuscript, the cost-effectiveness analysis Xpert only was found to be dominated by Xpert + FujiLAM conditional on a negative Xpert with an ICER of 1,000 USD/per DALY averted compared to the standard of care (SOC) Xpert only. Sensitivity analysis found that variations in the key model parameters had an impact on the cost and effectiveness calculations obtained through the model. -- Conclusions: The burden of TB-related costs impact both patients and the health care system at all stages of TB care. Novel diagnostic strategies like the inclusion of FujiLAM for TB diagnosis in PLHIV are cost-effective tools that can aid in case detection and reduce severe outcomes of TB. In order to reduce the TB burden and achieve the "End TB" strategy goals, studies need to work to understand the key components involved in these costs as well as work to develop and implement effective, feasible interventions for TB diagnostics and care.

Background Of the 464 million patients diagnosed with diabetes mellitus globally, type 2 diabetes accounts for 90%. Type 2 diabetes contributes to other conditions such as hypertension, dyslipidaemia and cardiovascular diseases. Glycaemic haemoglobin control is essential in reducing long-term macrovascular and microvascular complications. Pharmacist interventions have been documented to have a positive role in diabetes management. In Kuwait, type 2 diabetes prevalence is increasing and found in a young population. Aims To evaluate the influence of the pharmacist-led intervention on diabetes knowledge, medication adherence and HbA1c, and hypertension. In addition, to estimate the 10-years risk of developing cardiovascular events and assess the cost of diabetes-related complications. Method The study was a randomised controlled trial with control and intervention arms conducted at the military hospital in Kuwait. Participants (n=177) were randomly allocated to the intervention group (n=88) and control group (n=89), using a 4-block randomisation procedure. The intervention group received face-to-face education and counselling from the pharmacist with a monthly follow-up for six months. The primary outcome was glycaemic control, and secondary measures were hypertension, lipid profiles, medication adherence, diabetes knowledge, 10-year estimated cardiovascular events and cost. QRISK3 and UKPDS-OM2 were used to estimate the risk of CVD events and cost comparison analysis. ii Results Compared with baseline, the mean reduction of HbA1c, blood pressure, and lipid profiles showed significant improvement in the intervention group. Additionally, improvement in medication adherence, diabetes knowledge, 10-years estimated cardiovascular events were reported with the intervention group. Also, the pharmacist-led intervention was cost-saving. Conclusion The study highlighted that adult type 2 diabetes patients who received the pharmacist-led intervention experienced a reduction in adverse clinical outcomes, improved non-clinical outcomes, and assisted in lifestyle modification.

No description available.

No description available.

Blood products are essential components of any healthcare system, and their safety, in terms of being free of transfusion-transmittable infections, is crucial. While the Food and Drug Administration (FDA) in the United States requires all blood donations to be tested for a set of infections, it does not dictate which particular tests should be used by blood collection centers. Multiple FDA-licensed blood screening tests are available for each infection, but all screening tests are imperfectly reliable and have different costs. In addition, infection prevalence rates and several donor characteristics are uncertain, while surveillance methods are highly resource- and time-intensive. Therefore, only limited information is available to budget-constrained blood collection centers that need to devise a post-donation blood screening scheme so as to minimize the risk of an infectious donation being released into the blood supply. Our focus is on "robust" screening schemes under limited information. Toward this goal, we consider various objectives, and characterize structural properties of the optimal solutions under each objective. This allows us to gain insight and to develop efficient algorithms. Our research shows that using the proposed optimization-based approaches provides robust solutions with significantly lower expected infection risk compared to other testing schemes that satisfy the FDA requirements. Our findings have important public policy implications. / Ph. D.

This paper's objective is to determine the best approaches for clean-up of an underground oil leak using cost-benefit analysis. The background aspects of the leak, including a description and history of the oil plume, aspects of the site, and applicable Federal and local regulations, are discussed. Several remediation methods are chosen for examination. The costs associated with each method are estimated. An analysis of the area's property value data using the hedonic approach to benefits estimation is also conducted. Costs of the clean-up of the oil plume are compared to the benefits. It was determined that the amount of estimated benefits from restoration programs is $7.6 million. Based on this information and the cost data, the microbial fence / hydraulic containment method and the enhanced groundwater extraction / hydraulic containment method should be considered as remediation approaches. / Master of Arts

Thesis (M. Tech. (Information Technology)) -- Central University of technology, Free State, 2013 / The aim of this study was to create a dynamic software system that captures all information related to a student and delivers it to the educators, principal, higher authorities and parents. In order to achieve this aim, an investigation was launched as to the development of a cost-effective school management system for disadvantaged schools in the Free State Province using the Software as a Service (SaaS) delivery model. Although a variety of other school management systems exist in the market, they are often expensive and difficult to maintain. Details such as previous academic performances, disciplinary actions taken against a student in the current school, ailments the student suffers from and parental details are some of the information that will help an educator to better understand a student. The software that is currently in use fails to deliver this information. Designing the software as a multitenant system, helps accommodate different schools under the same database, while the shared database, shared schema reduces back-end costs. Database design was carried out in such a way that tenant data is logically isolated and that data integrity is maintained throughout. What makes the software explained in this study cost effective is the method of delivery that was employed, which is SaaS. Here, software is not purchased, there is no upfront capital and the yearly license fee is eliminated, as schools need only pay a monthly rental fee for the services they use. Since all services are provided through the Internet, there is no need for system space; the only requirement is a high-speed Internet network.