This diploma thesis deals with design of a new production facility for the manufacture of blasting machines in company Kovo Staněk Ltd. The thesis includes analysis and capacity calculations of individual production technologies, design of a building arrangement and economical evaluation of the whole investment.

L’évaluation économique de la mise en œuvre du développement durable se heurte à de multiples difficultés : la diversité des conceptions de la soutenabilité, l’hétérogénéité et le déficit de définition unitaire de ses dispositifs, ou encore le caractère immatériel des valeurs engendrées ou protégées par un développement réellement soutenable. Nous mobilisons tout d’abord une analyse en termes de référentiels, inspirée des sciences politiques, pour tenir compte conjointement des référentiels d’action et des référentiels d’évaluation du développement durable. Cette première analyse sous-tend notre approche « par les capitaux » de la soutenabilité ainsi que le choix de notre objet d’étude, l’Agenda 21 Local. Sous les hypothèses de la soutenabilité faible (substituabilité des capitaux), nous réalisons ensuite une évaluation de l’Agenda 21 Local au niveau communal français en ayant recours à l’indicateur de richesse totale (développé par la Banque Mondiale) ainsi qu’à un estimateur d’impact de l’adoption de l’Agenda 21 Local sur le revenu par tête des communes. Cette évaluation est donc réalisée au sein d’un découplage (entre un indicateur de stocks et un indicateur de flux) qui interroge la relation entre la mise en œuvre du développement durable et la croissance du revenu. En même temps, un travail analytique nous permet de proposer une requalification des dispositifs de mise en œuvre du développement durable en termes de savoirs au sens économique de Machlup. Enfin, les hypothèses de la soutenabilité faible ne garantissant pas nécessairement des flux de revenu ou un bien-être inchangés à travers le temps, nous appliquons à notre problématique les hypothèses de la soutenabilité forte (complémentarité des capitaux, phénomènes d’irréversibilité), traduites empiriquement par la recherche d’effets de seuils pour les capitaux composant la richesse totale. Dans le cadre de notre étude empirique et sous ses hypothèses, nous montrons ainsi que la mise en œuvre du développement durable ne s’est pas faite au détriment de la croissance. Au contraire, l’adoption de l’Agenda 21 Local a eu un impact positif sur le revenu par habitant au niveau local français. Parmi les composantes de la richesse totale, nous trouvons enfin des effets de seuil pour les capitaux naturel et humain. / The economic evaluation of the implementation of sustainable development encounters many difficulties including the diversity of conceptions of sustainability, the heterogeneity and the lack of single definition of its initiatives, but also the intangible nature of both generated and protected values provided by a truly sustainable development. We first develop an analysis in terms of reference frames, inspired by political science, so as to take both reference frames of action addressed to a sustainable development and reference frames for evaluating it into account. This first analysis underlies our "capital" approach to sustainability as well as the choice of our study object, Local Agenda 21. Under the assumptions of weak sustainability (capital substitutability), we then perform an evaluation of Local Agenda 21 at the French municipal level using, on the one hand, the total wealth indicator (developed by the World Bank) and on the other hand an impact estimate of the adoption of Local Agenda 21 within municipalities on per capita income. This assessment is thus performed within a decoupling (between a stock indicator and a flow indicator) that questions the relationship between the implementation of sustainable development and income growth. At the same time, an analytical work enables us to propose a requalification of the sustainable development initiatives in terms of knowledge in the economic sense of Machlup. Finally, since the hypotheses of weak sustainability do not necessarily keep income flows or well-being unchanged over time, we alternatively consider strong sustainability assumptions (capital complementarity, irreversibility). Empirically, it implies searching for threshold effects for the different assets being part of total wealth. In the context of our empirical study and under its assumptions, we demonstrate that the implementation of sustainable development has not been at the expense of growth. On the contrary, the adoption of Local Agenda 21 is shown to translate into an improvement in per capita income at the local French level. Among the components of total wealth, we find threshold effects for natural and human capital.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第18255号 / 工博第3847号 / 新制||工||1590(附属図書館) / 31113 / 京都大学大学院工学研究科都市社会工学専攻 / (主査)教授 小林 潔司, 准教授 宇野 伸宏, 准教授 松島 格也 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

To mitigate the global greenhouse gases (GHGs) emissions, carbon dioxide (CO2) capture and storage (CCS) has the potential to play a significant role for reaching mitigation target. Oxy-fuel combustion is a promising technology for CO2 capture in power plants. Advantages compared to CCS with the conventional combustion technology are: high combustion efficiency, flue gas volume reduction, low fuel consumption, near zero CO2 emission, and less nitrogen oxides (NOx) formation can be reached simultaneously by using the oxy-fuel combustion technology. However, knowledge gaps relating to large scale coal based and natural gas based power plants with CO2 capture still exist, such as combustors and boilers operating at higher temperatures and design of CO2 turbines and compressors. To apply the oxy-fuel combustion technology on power plants, much work is focused on the fundamental and feasibility study regarding combustion characterization, process and system analysis, and economic evaluation etc. Further studies from system perspective point of view are highlighted, such as the impact of operating conditions on system performance and on advanced cycle integrated with oxy-fuel combustion for CO2 capture. In this thesis, the characterization for flue gas recycle (FGR) was theoretically derived based on mass balance of combustion reactions, and system modeling was conducted by using a process simulator, Aspen Plus. Important parameters such as FGR rate and ratio, flue gas composition, and electrical efficiency etc. were analyzed and discussed based on different operational conditions. An advanced evaporative gas turbine (EvGT) cycle with oxy-fuel combustion for CO2 capture was also studied. Based on economic indicators such as specific investment cost (SIC), cost of electricity (COE), and cost of CO2avoidance (COA), economic performance was evaluated and compared among various system configurations. The system configurations include an EvGT cycle power plant without CO2 capture, an EvGT cycle power plant with chemical absorption for CO2 capture, and a combined cycle power plant. The study shows that FGR ratio is of importance, which has impact not only on heat transfer but also on mass transfer in the oxy-coal combustion process. Significant reduction in the amount of flue gas can be achieved due to the flue gas recycling, particularly for the system with more prior upstream recycle options. Although the recycle options have almost no effect on FGR ratio, flue gas flow rate, and system electrical efficiency, FGR options have significant effects on flue gas compositions, especially the concentrations of CO2 and H2O, and heat exchanger duties. In addition, oxygen purity and water/gas ratio, respectively, have an optimum value for an EvGT cycle power plant with oxy-fuel combustion. Oxygen purity of 97 mol% and water/gas ratio of 0.133 can be considered as the optimum values for the studied system. For optional operating conditions of flue gas recycling, the exhaust gas recycled after condensing (dry recycle) results in about 5 percentage points higher electrical efficiency and about 45 % more cooling water consumption comparing with the exhaust gas recycled before condensing (wet recycle). The direct costs of EvGT cycle with oxy-fuel combustion are a little higher than the direct costs of EvGT cycle with chemical absorption. However, as plant size is larger than 60 MW, even though the EvGT cycle with oxy-fuel combustion has a higher COE than the EvGT cycle with chemical absorption, the EvGT cycle with oxy-fuel combustion has a lower COA. Further, compared with others studies of natural gas combined cycle (NGCC), the EvGT system has a lower COE and COA than the NGCC system no matter which CO2 capture technology is integrated. / QC 20111123

<p>Introduction: Globally, more than 200 million patients undergo major non-cardiac surgery each year and more than 10 million patients will be exposed to postoperative myocardial ischemia, a condition strongly associated with 30-day mortality. The majority of these events go undetected without postoperative Troponin screening. Methods: We conducted a model-based cost-consequence analysis comparing a postoperative Troponin T screening vs. standard care in patients undergoing noncardiac surgery. In a first model, we evaluated the incremental number of detected perioperative myocardial infarctions and the incremental costs. A second model assessed the effect of the screening and consequent treatment on 1-year survival and the related cost. Model inputs based on the Vascular events In Non-cardiac Surgery patIents cOhort evaluatioN (VISION) Study, a large international cohort. We run probability sensitivity analyses with 5,000 iterations. We conducted extensive sensitivity analyses.</p> <p>Results: The cost to avoid missing an event amounted to CAD$ 5,184 for PMI and CAD$ 2,983 for isolated Troponin T. The cost-effectiveness of the postoperative Troponin screening was higher in patients’ subgroups at higher risk for PMI, e.g. patients undergoing urgent surgery. The incremental costs at 1 year of a postoperative PMI screening by 4 Troponin T measurements were CAD$ 169.20 per screened patient. The cost to prevent a death at 1 year amounted to CAD$ 96,314; however, there was relevant model uncertainty associated with the efficacy of the treatment in the 1-year model.</p> <p>Conclusion: Based on the estimated incremental cost per health gain, the implementation of a postoperative Troponin T screening after noncardiac surgery seems appealing, in particular in patients at high risk for perioperative myocardial infarction. However, decision-makers will have to consider it in terms of opportunity costs, i.e. in relation to the cost-effectiveness of other potential programs within the broader health care context.</p> / Master of Science (MSc)

Increased needs for health and social services, along with limits to financial resources, force public sector managers to optimize the allocation of financial resources. In this perspective, this research project is aimed at developing tools to evaluate rehabilitation programs dealing with physical disabilities. More specifically, the objectives are first, to examine relationships between the progression of a physically disabled person's functional profile and the rehabilitation services received, and second, to develop a tool to measure the efficiency of the rehabilitation programs offered. In accordance with the disability creation process conceptual framework, clinical results have been measured by measuring the progression of rehabilitation and efficiency has been defined as the relationship between clinical results obtained and the resources or means employed. A prospective cohort study was done on a sample of 100 users 65 years of age or older enrolled in the visual impairment program. The results of the study tend to show that the hours of service delivery allocated to a user contribute positively to the progress of his or her overall functional profile. They also show that a user's overall functional profile at intake is very strongly related to the consumption of financial resources. This relationship has allowed us to establish a system of classification of homogenous typical functional groups that makes relatively reliable predictions based on a unique measurement. Finally, the efficiency measurement tool developed represents a major innovation in evaluating the performance of rehabilitation programs in that it constitutes a benchmark toward attaining quality objectives for care and services while respecting financial constraints.

Rationale Epilepsy is a common, chronic, neurological condition that disproportionately affects individuals living in low- and middle- income countries, including much of sub-Saharan Africa. Epilepsy is treatable, with the majority of individuals who take anti-epileptic drugs experiencing a reduction, or elimination, of seizures. Yet the number of individuals taking and adhering to medication in Africa is low and interventions aimed at improving treatment are lacking. Aims To define the epidemiology of convulsive epilepsy in rural South Africa in terms of incidence, mortality and disability-adjusted life years; to determine outpatient, out-of-pocket costs resulting from epilepsy treatment; to establish the level of adherence to anti-epileptic drugs amongst people with epilepsy; and, to determine whether the introduction of routine visits to people with epilepsy by community health workers is a cost-effective intervention for improving adherence to anti-epileptic drugs. Methods Nested within the Agincourt Health and Demographic Surveillance System, this work utilized a cohort of individuals diagnosed with convulsive epilepsy in 2008 to determine health care utilization and out-of-pocket costs due to care sought for epilepsy. Additionally, using blood samples from the cohort, anti-epileptic drug adherence was measured and, following the cohort, mortality rates were determined. Using these collected epidemiological parameters, disability-adjusted life years due to convulsive epilepsy were determined. Finally, combining the epidemiological and cost parameters, a community health worker intervention was modeled to determine its incremental cost-effectiveness ratio. Key Findings The burden of convulsive epilepsy is lower in rural South Africa than other parts of Africa, likely due to lower levels of known risk factors. Yet the burden, especially in terms of mortality, remains high, as does the treatment gap and health care utilization. Findings from the economic evaluation found the introduction of a community health worker to be highly cost-effective and would likely lower the burden of epilepsy in rural South Africa. Implications Epilepsy contributes to the burden of disease in rural South Africa, with high levels of mortality and a substantial treatment gap. The introduction of a community-health worker is likely to be one cost-effective, community based intervention that would lower the burden of epilepsy by improving adherence to anti-epileptic drugs. Implementing this intervention, based on these findings, is a justified and important next step.

Transport infrastructure investment decision making is typically based on a range of inputs such as social, environmental and economic factors. The benefit cost ratio (BCR), a measure of economic efficiency (“value for money”) determined through cost benefit analysis (CBA), is dependent on accurate estimates of the various option costs and net social benefits such as reductions in travel time, accidents, and vehicle operating costs. However, most evaluations are deterministic procedures using point estimates for the inputs and producing point estimates for the outputs. Transport planners have primarily focused on the cost risks and treat risk through sensitivity testing. Probabilistic risk analysis techniques are available which could provide more information about the statistical confidence of the economic evaluation outputs. This research project report investigated how risk and uncertainty are dealt with in the literature and guidelines. The treatment of uncertainty in the Nelson Arterial Traffic Study (ATS) was reviewed and an opportunity to apply risk analysis to develop probabilities of sea level rise impacting on the coastal road options was identified. A simplified transport model and economic evaluation case study based on the ATS was developed in Excel to enable the application of @RISK Monte Carlo simulation software. The simplifications mean that the results are not comparable with the ATS. Seven input variables and their likely distributions were defined for simulation based on the literature review. The simulation of seven variables, five worksheets, and 10,000 iterations takes about 30 seconds of computation time. The input variables in rank order of influence on the BCR were capital cost, car mode share, unit vehicle operating cost, basic employment forecast growth rate, and unit value of time cost. The deterministically derived BCR of 0.75 is associated with a 50% chance that the BCR will be less than 0.6, although this probability is partly based on some statistical parameters without an empirical basis. In practice, probability distribution fitting to appropriate datasets should be undertaken to better support probabilistic risk analysis conclusions. Probabilities for different confidence levels can be reported to suit the risk tolerance of the decision makers. It was determined that the risk analysis approach is feasible and can produce useful outputs, given a clear understanding of the data inputs and their associated distributions.

Introduction: Cerebrovascular events are a major cause of mortality, disability and healthcare resource use. Despite this, there is a lack of reliable information on their costs and outcomes, particularly related to transient ischaemic attacks (TIA) and minor stroke. Such information is vital to inform decisions about local and national service provision, and to provide reliable estimates for use in cost-effectiveness analyses. Aims This thesis estimates the costs and outcomes of stroke and TIA using data from a population-based study undertaken in a population of over 91,000 individuals in Oxfordshire (the Oxford Vascular Study – OXVASC). In addition, the thesis aims to estimate the short-term cost-effectiveness of two secondary stroke prevention programmes evaluated in a study nested within OXVASC. Methods: Using multiple methods of case ascertainment, 1,282 patients were identified as having suffered a stroke or TIA, of which 1,199 (723 stroke and 476 TIA) patients consented to the study. Follow-up of patients took place at 1, 6, 12 and 24 months, with data collected on patients’ disability, medication usage, living arrangements, and quality of life. Healthcare resource use information was derived from hospital and primary care records, and priced using published unit costs. Findings: Stroke patients had higher case-fatality rates than TIA patients (15% vs. 1%; p<0.001), with 5-year life expectancy being one year longer for TIA patients. For stroke and TIA survivors, the risk of disability remained higher, at around 30% at each of the four follow-ups, than at baseline (17%; p<0.001 for all follow-ups). After standardising for age and gender, average quality of life for stroke and TIA patients combined was significantly lower than English population norms (p<0.001 for all follow-ups). However, when quality of life was compared to population norms by event type, quality of life differences between TIA patients and English population norms no longer remained statistically significant. Important predictors of quality of life included event severity, baseline disability and recurrent vascular events. Total costs were considerably higher 1-year after the initial stroke or TIA than for the year preceding it and, except for day cases, increases were observed for all resource-use categories. Five years after the index event, stroke patients incurred costs of £16,923 (95% CI: 15,149 to 18,858) per patient, significantly higher than those incurred by TIA patients, at £13,904 (95% CI: 11,488 to 16,657; p=0.019). In multivariate analyses, event severity was found to be a significant predictor of inpatient care resource use and costs, as were the presence of recurrent vascular events, especially stroke and coronary events. For non-hospitalised patients, results showed that urgent outpatient specialist assessment and treatment reduced the 90-day risk of fatal or disabling stroke (0.4% vs. 5%, p<0.001) compared with less urgent assessment and treatment. In terms of resource usage, patients who were assessed and treated urgently had lower recurrent stroke hospitalisation (2% vs. 8%; p=0.001), and reduced overall number of days in hospital (average reduction of 4 days; p=0.017). These reductions in hospital resource usage generated savings of £643 per patient assessed and treated urgently in an outpatient clinic (p=0.028). Conclusion: Despite the impact of stroke on death, disability and healthcare resource use, there is a lack of reliable information on costs and outcomes, especially for TIA and minor stroke. Through the use of a population-based study, the gold-standard study design when assessing the incidence and outcomes of TIA and stroke, this thesis provides healthcare decision makers and researchers with a wealth of data on the resource use patterns, costs and outcomes of TIA and stroke patients, and their main predictors.

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