O acirramento da competição entre as empresas produtoras de tratores agrícolas tem levado ao aumento da exportação de produtos e a consequente necessidade da manutenção dos níveis de qualidade destes produtos. Os custos relativos ao retrabalho em tratores exportados para os mercados externos é um dos problemas enfrentados pelas empresas manufatureiras de máquinas agrícolas. Dentre as principais causas geradoras de retrabalho estão os problemas gerados pelo manuseio destes tratores quando transportados de um país para outro. No caso das máquinas exportadas para o mercado norte-americano este problema se torna ainda mais oneroso, uma vez que os custos de mão-de-obra naquele mercado são bastante elevados. Tendo em vista reduzir a níveis mínimos os custos com retrabalho, o presente trabalho teve como objetivo analisar comparativamente duas propostas para o processo logístico de processamento de tratores nos portos norteamericanos. Desta forma decidiu-se comparar a proposta atual com uma proposta alternativa adotada pela indústria automobilística. Esta proposta envolve a utilização de VPC (vehicle processing center) que são centros de processamento de veículos com preparação completa das unidades para serem entregues às revendas. Desse modo a solução adotada pelo mercado automobilístico foi analisada para efeito de utilização na indústria de tratores através da consideração dos ganhos relativos à eliminação da perda de qualidade quando em comparação ao processo atual. De posse dos resultados desta análise foi concluído que a utilização da solução alternativa gera ganhos de qualidade, os quais foram quantificados em valores monetários. / The increasing competition among companies that produce agricultural tractors, has led to the increase in the export of products and the consequent need for maintenance of quality levels for these products Costs due to rework in exported tractors for foreign markets is one of the problems faced by agricultural machinery manufacturers. Problems generated by tractor handling when shipped from one country to another are among the main causes that produce rework. In the case of machines exported to the North American market the problem becomes even more costly, once labor costs are extremely high in that market. In order to reduce the cost of rework to a minimum level, this study had the target of analyzing comparatively two proposals for the logistic process of handling tractors at North American ports. Therefore, it was decided to compare the current proposal to an alternate proposal in use by the automobile industry. This solution involves the use of VPC (Vehicle Processing Center), with a complete preparation of units so as to be delivered to dealers. Therefore the solution adopted by the automobile industry was analyzed so as to be used by the tractor industry, by means of taking in consideration the gains related to the elimination of quality loss when compared to the current process in use. By use of the results it was inferred that the use of the alternative solution generates quality advantages, which were quantified in monetary values.

This diploma thesis aids to analyze the economic viability of public health care in the Czech Republic specifically on obstetrics. The theoretical part of the thesis deals with the definition of basic concepts in health care, describes the history of obstetrics and health care, and specific the differences between traditional market and medical market. Further work is focused on indivudual models of health systems and explore the main principles of financing the public health system and reimbursement mechanisms fot health care in the Czech Republic. In the current healthcare system are guaranteed by the wide availibility of health care in corporated liberal elements strongly decentralized system. Despite efforts to privatization and decentralization of heath care remains the most important role of the state. It is clear from the Constitution of the Czech Republic and its components -- The Charter of Fundamental Rights and Freedoms. The practical part contains the implementation of cost- analysis of direct and indirect cost of labor and spontaneous birth by Caesarean section in an examination of medical device. In the Czech Republic the level of neonatal care is high. Infant mortality is almoust minimal and our country is ranked in the direction of of the leading positions in Europe and worldwide. This part is focused on the hospitál in general, number of hospitals in the Czech Republic and limit number of births under which the hospitál should be concluded. In the Czech Republic, every year go from hospitál to home care about 400 children with weight under one kilogram and the subsequent care of the newborn is not so good. That is why the final part of my thesis devoted to the issue of premature infants and care for them.

Os progressos na terapêutica medicamentosa têm sido notáveis, porém estudos da sua utilização e dos efeitos desejáveis ou indesejáveis necessitam ser amplamente desenvolvidos. O presente estudo averiguou a utilização de medicamentos, descrevendo o perfil de prescrição e dispensação de antimicrobianos com foco em custos no HCFMRP-USP, revelando a topografia dos gastos conforme sua utilização nos diversos setores e ao longo de um período. Objetivo: Estudar o perfil de utilização de medicamentos antimicrobianos através da análise de dados provenientes de sistema informatizado de prescrição e dispensação do HCFMRP-USP. Metodologia: A partir de banco de dados geral de prescrição e dispensação de itens de medicamentos no HCFMRP-USP, foi criado um banco de dados específico de itens de antimicrobianos (antibacterianos, antifúngicos, antivirais e antiparasitários) prescritos individualmente aos pacientes internados e a eles dispensados, no período de 2013 a 2015. As análises foram realizadas através do programa Excel®, versão 2007, pacote Office, Microsoft. Resultados: Os antimicrobianos representaram, em média, 12% dos itens prescritos totais e 16%, em média, dos itens dispensados. 30 itens antimicrobianos de maior custo do hospital correspondem a 97,48% dos custos e a 20,54% da dispensação; o item que mais custa ao hospital, dentre todas as classes analisadas é a Anfotericina B lipossomal (42,55%); Dos antibióticos, a classe que mais custa ao hospital são os cabapenens (22,94%), seguidos das tetraciclinas (21,69%) e polimixinas (15,85%) e as classes mais dispensadas são as cefalosporinas (30,03%), penicilinas (16,72%) e carbapenens (16,59%). CIDs mais registrados: Z380, I120 e Z383. Em média, 33,5 pacientes são responsáveis pelos gastos com antimicrobianos. Os centros de custos que mais gastam são Enf. Hematologia, pediatria e CTI. Já os que mais dispensam são UETDI, Ortopedia e moléstias infecciosas. Conclusões: O HCFMRP-USP tem como um dos seus maiores custos variáveis os medicamentos, em especial os antimicrobianos. Assim, a geração de informações através de EUM auxilia a tomadas de decisões estratégicas e gerenciais. Este trabalho só foi possível devido à prescrição informatizada, que possibilita o registro de todos os dados de prescrição e dispensação. / Advances in drug therapy have been remarkable, but studies of their use and the desirable or undesirable effects need to be fully developed. The present study investigated the use of drugs, describing the prescription profile and dispensing antimicrobials focusing on costs, at HCFMRP- USP, revealing the topography spending as their use in the various sectors and over a period. Objectives: To study the profile of use of antimicrobial drugs through analysis of data from the computerized system of prescribing and dispensing of HCFMRP- USP. Methodology: From general database of prescription and dispensing of medicines items in HCFMRP- USP, a specific database of antimicrobials items (antibacterial, antifungal, antiviral and antiparasitic) was created, individually prescribed to hospitalized patients and they exempt, from 2013 to 2015. Analyses were performed using Excel®, version 2007, Office suite, Microsoft. Results: The antimicrobial represented, on average, 12% of the total prescribed items and 16% on average of dispensed items. 30 antimicrobials items of higher cost of hospital correspond to 97.48% of the costs and 20.54% of the dispensation; the item that costs more to the hospital, among all analyzed classes is the liposomal amphotericin B (42.55%); From antibiotics, the class that more costs the hospital are cabapenens (22.94%), followed by tetracyclines (21.69%) and polymyxins (15.85%) and the most dispensed classes are cephalosporins (30.03%), penicillins (16.72%) and carbapenems (16.59%). ICDs (International Code Diseases) more registered: Z380, Z383 and I120. On average, 33.5 patients are responsible for spending on antimicrobials. Cost centers that spend more are Enf. Hematology, pediatrics and CTI. But those who dispense more are UETDI, orthopedics and infectious diseases. Conclusions: HCFMRP- USP has as one of its major cost variables medicines, especially antibiotics. Thus, the generation of information and through the use of these medications study aids taken strategic and management decisions. This work was only possible because of the computerized prescription, which allows the registration of all prescription and dispensing data in the system.

Este trabalho apresenta parâmetros de custos para implantação de redes de infra-estrutura urbana (drenagem, pavimentação, água, esgoto, energia elétrica e arborização) em parcelamentos de solo realizados em uma cidade média do interior do estado de São Paulo. Realiza-se a análise dos sistemas de infra-estrutura, dos métodos para estimativas de custos e do processo para aprovação de projetos, decompondo e caracterizando as diversas partes constituintes. Através dos estudos de caso são apresentados os custos dos diferentes subsistemas e a incidência desses no sistema de infra-estrutura urbana como um todo. Espera-se contribuir para o entendimento dos fatores que condicionam os custos dos sistemas utilizados em cidades médias. / This paper presents cost parameters for deployment of networks of urban infrastructure (drainage, paving, water, sewage, electricity and tree planting) in a city of Sao Paulo. It performs the analysis of infrastructure systems, methods for estimating costs and the process for approving projects, decomposing and characterizing the different parts. The case studies present the costs of various subsystems and the incidence of the system of urban infrastructure as a whole. It is expected to contribute to the understanding of factors that influence the cost of the systems used in medium sized cities.

Os progressos na terapêutica medicamentosa têm sido notáveis, porém estudos da sua utilização e dos efeitos desejáveis ou indesejáveis necessitam ser amplamente desenvolvidos. O presente estudo averiguou a utilização de medicamentos, descrevendo o perfil de prescrição e dispensação de antimicrobianos com foco em custos no HCFMRP-USP, revelando a topografia dos gastos conforme sua utilização nos diversos setores e ao longo de um período. Objetivo: Estudar o perfil de utilização de medicamentos antimicrobianos através da análise de dados provenientes de sistema informatizado de prescrição e dispensação do HCFMRP-USP. Metodologia: A partir de banco de dados geral de prescrição e dispensação de itens de medicamentos no HCFMRP-USP, foi criado um banco de dados específico de itens de antimicrobianos (antibacterianos, antifúngicos, antivirais e antiparasitários) prescritos individualmente aos pacientes internados e a eles dispensados, no período de 2013 a 2015. As análises foram realizadas através do programa Excel®, versão 2007, pacote Office, Microsoft. Resultados: Os antimicrobianos representaram, em média, 12% dos itens prescritos totais e 16%, em média, dos itens dispensados. 30 itens antimicrobianos de maior custo do hospital correspondem a 97,48% dos custos e a 20,54% da dispensação; o item que mais custa ao hospital, dentre todas as classes analisadas é a Anfotericina B lipossomal (42,55%); Dos antibióticos, a classe que mais custa ao hospital são os cabapenens (22,94%), seguidos das tetraciclinas (21,69%) e polimixinas (15,85%) e as classes mais dispensadas são as cefalosporinas (30,03%), penicilinas (16,72%) e carbapenens (16,59%). CIDs mais registrados: Z380, I120 e Z383. Em média, 33,5 pacientes são responsáveis pelos gastos com antimicrobianos. Os centros de custos que mais gastam são Enf. Hematologia, pediatria e CTI. Já os que mais dispensam são UETDI, Ortopedia e moléstias infecciosas. Conclusões: O HCFMRP-USP tem como um dos seus maiores custos variáveis os medicamentos, em especial os antimicrobianos. Assim, a geração de informações através de EUM auxilia a tomadas de decisões estratégicas e gerenciais. Este trabalho só foi possível devido à prescrição informatizada, que possibilita o registro de todos os dados de prescrição e dispensação. / Advances in drug therapy have been remarkable, but studies of their use and the desirable or undesirable effects need to be fully developed. The present study investigated the use of drugs, describing the prescription profile and dispensing antimicrobials focusing on costs, at HCFMRP- USP, revealing the topography spending as their use in the various sectors and over a period. Objectives: To study the profile of use of antimicrobial drugs through analysis of data from the computerized system of prescribing and dispensing of HCFMRP- USP. Methodology: From general database of prescription and dispensing of medicines items in HCFMRP- USP, a specific database of antimicrobials items (antibacterial, antifungal, antiviral and antiparasitic) was created, individually prescribed to hospitalized patients and they exempt, from 2013 to 2015. Analyses were performed using Excel®, version 2007, Office suite, Microsoft. Results: The antimicrobial represented, on average, 12% of the total prescribed items and 16% on average of dispensed items. 30 antimicrobials items of higher cost of hospital correspond to 97.48% of the costs and 20.54% of the dispensation; the item that costs more to the hospital, among all analyzed classes is the liposomal amphotericin B (42.55%); From antibiotics, the class that more costs the hospital are cabapenens (22.94%), followed by tetracyclines (21.69%) and polymyxins (15.85%) and the most dispensed classes are cephalosporins (30.03%), penicillins (16.72%) and carbapenems (16.59%). ICDs (International Code Diseases) more registered: Z380, Z383 and I120. On average, 33.5 patients are responsible for spending on antimicrobials. Cost centers that spend more are Enf. Hematology, pediatrics and CTI. But those who dispense more are UETDI, orthopedics and infectious diseases. Conclusions: HCFMRP- USP has as one of its major cost variables medicines, especially antibiotics. Thus, the generation of information and through the use of these medications study aids taken strategic and management decisions. This work was only possible because of the computerized prescription, which allows the registration of all prescription and dispensing data in the system.

The Utah Department of Transportation developed life-cycle benefit-cost analysis spreadsheets that allow engineers and analysts to evaluate multiple safety countermeasures. The spreadsheets have included the functionality to evaluate a roadway based on the 11 facility types from the Highway Safety Manual (HSM) with the use of crash severity distributions. The HSM suggests that local agencies develop crash severity distributions based on their local crash data. The Department of Civil and Environmental Engineering at Brigham Young University worked with the Statistics Department to develop crash severity distributions for the facility types from the HSM.The primary objective of this research was to utilize available roadway characteristic and crash data to develop crash severity distributions for the 11 facility types in the HSM. These objectives were accomplished by segmenting the roadway data based on homogeneity and developing statistical models to determine the distributions. Due to insufficient data, the facility types of freeway speed change lanes and freeway ramps were excluded from the scope of this research. In order to accommodate more roadways within the research, the facility type definitions were expanded to include more through lanes.The statistical models that were developed for this research include multivariate regression, frequentist binomial regression, frequentist multinomial, and Bayesian multinomial regression models. A cross-validation study was conducted to determine the models that best described the data. Bayesian Information Criterion, Deviance Information Criterion, and Root-Mean-Square Error values were compared to conduct the comparison. Based on the cross-validation study, it was determined that the Bayesian multinomial regression model is the most effective model to describe the crash severity distributions for the nine facility types evaluated.

Water resources in Florida have been severely degraded by eutrophic conditions, resulting toxic algae blooms, which negatively affect health and tourism. Eutrophication, or excessive amount of phosphorus (P) and nitrogen (N) in water, overstimulates the production of aquatic plants, depletes dissolved oxygen, and deteriorates the aquatic environment. However, phosphorus is a non-renewable resource essential for all living organisms. In fact, more than half of the total demand for P globally is to supply the food industry, which has concerningly accelerated the depletion rates of phosphate reserves. In many wastewater treatment plants (WWTPs), the enhanced biological phosphorus removal (EBPR) approach has been employed to achieve high phosphorus removals from wastewater through phosphate-accumulating organisms (PAOs). However, during either anaerobic or aerobic digestion of EBPR sludge, stored polyphosphates are released and carried into the sidestream, which is typically returned to the headworks of the main treatment facility, thereby recycling phosphorus back into the system. This treatment train is highly inefficient because nutrients rather are recirculated rather than recovered. Struvite (MgNH4PO4•6H2O) is precipitated in oversaturated aqueous solutions with equal molar concentrations of magnesium, ammonium, and phosphate. The controlled crystallization of struvite may be applied to remove phosphorus and some ammonium from sidestreams, which is the liquid portion of the digester effluent. Struvite can be employed as a sustainable slow-release fertilizer due to its low solubility in water. This offers the opportunity of marketing the struvite produced under controlled conditions and creating a revenue for the utility. The specific research objectives of this thesis are (1) to investigate different possible operating conditions under which anaerobically digested sludge from EBPR facilities might be treated through struvite precipitation; (2) to quantify the removal of N and P from sidestreams from anaerobically digested EBPR sludge via struvite precipitation and assess the composition of the precipitate obtained; and (3) to generate a cost analysis to assess the trade-offs between the capital and operation and maintenance (O&M) costs of struvite production and the benefits such as reduced chemical use and production of a slow-release fertilizer. The main parameters affecting struvite precipitation are the Mg2+ to PO43- molar ratio, pH, temperature, mixing speed, hydraulic retention time (HRT), and the seed quantity added to promote nucleation. Different operating conditions within these parameters were batch-tested as part of this study using sidestream from the pilot-scale anaerobic digester (AD) fed from Falkenburg Advanced Wastewater Treatment Plant (FAWWTP) EBPR sludge. Additionally, the effect of temperature and pH were investigated using Visual MINTEQ simulations. Analysis of Variance (ANOVA) was employed to investigate the variance within the removals from the centrate obtained for phosphate, ammonium, magnesium, and calcium. The chemical composition of the solids collected after employing the selected operating conditions was analyzed by powder X-ray diffraction (PXRD). The results for the batch tests performed as part of this thesis were quantified in terms of the removals of phosphate, ammonium, magnesium, and calcium from the centrate. The greatest amount of phosphate removal was achieved by operating the struvite reactor at 4.0 mmol of Mg2+ per mmole of PO43-. The other molar ratios tested were 1.0, 2.0, and 3.0. Visual inspection of the data showed significant variability in removals of ammonium, calcium, and magnesium, which are likely to be correlated with the highly variable influent concentrations into the struvite reactor. In this case, ANOVA will require larger data sets to accurately analyze variance in the results. The statistical results given by ANOVA for the pH suggests that the main species to contribute with struvite being precipitated are statistically stable within the tested pH values of 8.5, 9.0, and 9.5. The results obtained by the simulation using Visual MINTEQ indicated that maximum saturation as function of pH takes place at a pH between 9.5 and 10.0. The ANOVA for the mixing speed showed that significant amounts of ammonium were removed at higher mixing speeds. This is likely due ammonium being volatilized, which is enhanced by turbulence. Magnesium and phosphate showed lower removals at higher mixing speeds, suggesting that too high mixing speeds will promote struvite seed dissolution. ANOVA identified NH4+ and Ca2+ as the species significantly impacted by modifying the HRT from 8 to 20 minutes. This suggests that prolonged HRT promotes inorganic nitrogen species to volatilize. It is likely that at higher HRT, tricalcium phosphates (TCP) or other favored calcium species coprecipitated together with struvite. Regarding the added struvite seed for nucleation, the greatest removals of ammonium, magnesium, and, phosphate were observed when 1g/L of struvite seed was added. The results also indicated that adding 5 and 10 g/L was an excessive amount of seed, which ended up contributing significantly to more nutrients into the centrate rather than precipitating them. The results also suggested that the struvite crystals formed in the sidestream by secondary nucleation, since removals close to zero were reached after adding no seed. The optimum temperature identified by the simulation in Visual MINTEQ was 21°C. Operating the struvite reactor under the optimal conditions identified in the batch tests, resulted in an average of 99% total P (TP) and 17% total N (TN) removals. The precipitate molar composition for [Mg2+:NH4+:PO43-] was equal to [2:2:1] based on the concentrations that disappeared from the aqueous solution, suggesting that other minerals coprecipitated with struvite. Visual MINTEQ predicted that together with struvite, CaHPO4 and CaHPO4•2H2O will also precipitate under the tested conditions. However, given the obtained ratio it is likely that other unpredicted species by Visual MINTEQ, such as magnesium carbonates or magnesium hydroxide coprecipitated with struvite. PXRD analysis also revealed that the sample was likely contaminated struvite, although the specific contaminants were not identified. A cost analysis was performed to distinguish the economic feasibility of incorporating a struvite harvesting system to treat the anaerobically digested sidestream from the Biosolids Management Facility (BMF) within the Northwest Regional Water Reclamation Facility (NWRWRF). Three different scenarios were evaluated; in Scenario (1) Ostara® Nutrient Recovery Technologies Inc. (Ostara®) evaluated the production of struvite from anaerobically digested EBPR sidestream using a fluidized reactor. In Scenario (2), Ostara® evaluated the production of struvite in a fluidized bed reactor by employing Waste Activated Sludge Stripping to Remove Internal Phosphorus (WASSTRIP™) in a mixture of post-anaerobic digestion centrate and pre-digester thickener liquor. Scenario (3) was addressed by Schwing Bioset Inc. (SBI) for a continuously-stirred reactor followed by a struvite harvesting system. Scenario (2) offers the highest TP and TN recoveries through WASSTRIP™ release due to the additional mass of phosphorus that is sent to the phosphorus recovery process. Therefore, although Scenario (2) has the highest total capital costs ($5M) it also has the shortest payback period (18 years). Scenarios (1) and Scenario (3) have similar payback periods (22-23 years) but very different total capital costs. The annual savings by producing struvite in Scenario (3) is $40K, which is about 30% less than producing struvite in Scenario (1). This is probably because the only savings considered under Scenario (3) were the lower alum usage and the fertilizer revenue; however, the savings by producing class A biosolids, were not accounted for. Consequently, the reduced total capital cost of $960K and the annual payment amount per interest period close to $80K, positioned Scenario (3) as the more feasible one, considering 20 years as the expected life of the asset at a 5% interest rate.

This thesis aims to provide a general overview of a cost and benefit analysis of incorporating a battery energy storage system within unit commitment model. The deregulation of the electricity market in the U.S. has only been around for the last two decades. With renewable energy and energy storage systems becoming less expensive, a decentralized market scheme is becoming more popular and plausible. The scope of this work is to provide a fundamental understanding of unit commitment and a cost analysis of applying a battery energy storage system to an already established power system. A battery energy storage system (BESS) was placed within a unit commitment schematic and modeled for a 7 day/168 hour forecast. Three models were generated, two with and one without the battery energy storage device (BESS). The comparison between the three systems was conducted to produce a visual economic justification to the feasibility of a BESS.

This thesis describes the impact of contact lens-related microbial keratitis in terms of incidence and severity. Disease outcome is defined by visual outcome, costs to the healthcare system, costs to the individual and duration of disease. A successful 12-month surveillance study was conducted of the populations of Australia and New Zealand to detect all cases of contact lens-related microbial keratitis. A random telephone survey of 32,000 households in Australia and 7,500 in New Zealand accurately determined the level of use of various contact lenses in the community. The impact of new contact lens types: silicone hydrogels and daily disposables were investigated. Increased risk persisted in overnight wear with silicone hydrogel materials. Microbial keratitis associated with silicone hydrogel materials had slightly shorter disease duration however other factors had a stronger influence on severity. Rigid gas permeable and frequent replacement soft lenses when used for daily wear constitute the lowest risk. Cost analysis was developed in a hospital case series of microbial keratitis. This analysis was applied in the surveillance study including cases managed in the private health care sector. Disease duration and associated costs are novel indices of severity for contact lens-related disease. The most dramatic effects on disease severity were seen with the type of organism involved. Keratitis attributed to environmental organisms (Gram-negative bacteria, Acanthamoeba, fungi and Nocardia species) were 10x more likely to cause loss of visual acuity, had longer duration of symptoms and incurred higher costs. Importantly, delays in receiving treatment increased disease duration and associated costs. Greater awareness of the need for specialist healthcare is indicated amongst health care providers and contact lens wearers. The hypothesis that overnight wear in silicone hydrogel lenses would not increase the risk of infection has been disproven. This information is of value to practitioners who are responsible for informing contact lens wearers about the risk of contact lens-related infections and should be weighed against the benefits of continuous wear. The identification of factors which contribute to the outcomes of disease will be used in education campaigns amongst health care providers and contact lens wearers to minimise the impact of disease.

Reliability based life cycle cost analysis is becoming an important consideration for decision-making in relation to bridge design, maintenance and rehabilitation. An optimal solution should ensure reliability during service life while minimizing the life cycle cost. Risk of failure is an important component in whole of life cycle cost for both new and existing structures. Research work presented here aimed to develop a methodology for evaluation of the risk of failure of reinforced concrete bridges to assist in decision making on rehabilitation. Methodology proposed here combines fault tree analysis and probabilistic time-dependent reliability analysis to achieve qualitative and quantitative assessment of the risk of failure. Various uncertainties are considered including the degradation of resistance due to initiation of a particular distress mechanism, increasing load effects, changes in resistance as a result of rehabilitation, environmental variables, material properties and model errors. It was shown that the proposed methodology has the ability to provide users two alternative approaches for qualitative or quantitative assessment of the risk of failure depending on availability of detailed data. This work will assist the managers of bridge infrastructures in making decisions in relation to optimization of rehabilitation options for aging bridges.