Objective: To complete a cost-minimization analysis (CMA) of the cost of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) in the management of early-stage breast cancer (ESBC) in a hypothetical Ontario hospital setting. Methods: Decision-analysis modeling, with a decision-tree and Markov states, was used to estimate hospital costs for the two treatment options. The model was populated with data from the literature and costs from the Ontario Case Costing Initiative, a publicly accessible, government-sponsored, costing database. Model variability and parameter uncertainty were quantified by probabilistic sensitivity analysis (PSA). Results: The SLNB treatment algorithm was cost-minimizing compared to the ALND-only treatment option. The costs of treating postoperative complications did not contribute to the incremental average cost. Conclusion: A treatment algorithm that involves SLNB as the initial axillary-staging procedure in the setting of ESBC offers a cost-savings over the ALND-only option. This result is generalizable to all Ontario hospitals.

Objective: To complete a cost-minimization analysis (CMA) of the cost of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) in the management of early-stage breast cancer (ESBC) in a hypothetical Ontario hospital setting. Methods: Decision-analysis modeling, with a decision-tree and Markov states, was used to estimate hospital costs for the two treatment options. The model was populated with data from the literature and costs from the Ontario Case Costing Initiative, a publicly accessible, government-sponsored, costing database. Model variability and parameter uncertainty were quantified by probabilistic sensitivity analysis (PSA). Results: The SLNB treatment algorithm was cost-minimizing compared to the ALND-only treatment option. The costs of treating postoperative complications did not contribute to the incremental average cost. Conclusion: A treatment algorithm that involves SLNB as the initial axillary-staging procedure in the setting of ESBC offers a cost-savings over the ALND-only option. This result is generalizable to all Ontario hospitals.

Objetivo: Comparar as relações de custo-efetividade de duas terapias, Imunoglubulina Intravenosa (IgIV) e Plasmaferese (PE), no tratamento da Síndrome de Guillain-Barré sob a perspectiva do sistema público (SUS). O objetivo secundário foi avaliar a adesão às recomendações da Comissão de Medicamentos do HCPA Métodos: estudo transversal com análise econômica de pacientes tratados por Síndrome de Guillain-Barré no período de junho de 2003 a junho de 2008 no Hospital de Clínicas de Porto Alegre (HCPA). Foi realizada análise de custo-efetividade do emprego de IgIV e de PE nestes pacientes, pelo método de minimização de custos, considerando-se somente os custos diretos sanitários, fornecidos pelo sistema gerencial da instituição . Foram excluídos os pacientes que usaram outro tipo de tratamento associado ou isolado. Coletaram-se os dados através da revisão dos prontuários. A gravidade da doença na internação foi classificada como: doença leve, quando caminhar foi possível; doença moderada, quando caminhar foi impossível; doença grave, quando os pacientes necessitaram de ventilação assistida. A incapacidade na alta foi estabelecida pela escala de sete pontos de Hughes. A adesão às recomendações da Comissão de Medicamentos do HCPA, objetivo secundário, foi avaliada através da dose e o esquema de prescrição da IgIV. Resultados: Vinte e cinco participantes (2 a 70 anos) foram incluídos no estudo, cinco tratados com PE, empregando-se Albumina Humana como substituto do plasma, e 20 tratados com IgIV. O custo total do tratamento de um paciente com PE foi R$10.603,88 (± 2.978,12) e o de um que recebeu IgIV foi R$ 32.103,00 (± 21.454,24). O custo total da internação foi de R$45.027,14 (± 32.750,45) para os tratados com PE e de R$ 60.844,28 (±48.590,52) para os que receberam IgIV. Em relação ao desfecho clínico principal, melhora na escala de incapacidade de sete pontos, após o tratamento com uma das alternativas escolhida, a mediana dos pacientes que internaram com grau de gravidade 3 e que foram tratados com PE foi igual a dos que receberam IgIV. Em relação à permanência hospitalar, permanência em UTI e dias de Ventilação Mecânica, não houve diferença estatisticamente significativa entre os dois tratamentos. Conclusões: Quando comparados os custos médios das duas opções terapêuticas, uma delas aparece claramente com menor custo. Quando comparados os desfechos, após o emprego de cada opção terapêutica, estes não revelam diferença. Concluímos que, no HCPA, a opção pelo procedimento Plasmaferese é mais custo efetiva do que o emprego da IgIV. / Objectives: To compare the cost-effectiveness of two distinct therapies, Intravenous Immunoglobulin (IVIg) and Plasma Exchange (PE) in the treatment of Guillain-Barré Syndrome, concerning the public health care system. Compliance to the guidelines of the Pharmacy and Therapeutics Committee of the Hospital de Clínicas de Porto Alegre was a secondary objective. Methods: A cross-sectional, economical analysis was conducted, including patients treated for GBS in the period from June, 2003 through June, 2008 in Hospital de Clínicas de Porto Alegre (HCPA). The cost-effectiveness of the use of IVIg and PE in such patients was studied through the cost minimization method, considering direct medical costs only (2008 currency), yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by chart reviews. Severity of disease on admittance was classified as follows: mild disease, when the patient was able to walk; moderate disease, when the patient was unable to walk, and severe disease, when assisted ventilation was required. Disability on discharge was established by the 7-point scale of Hughes. Compliance to the guidelines of the Pharmacy and Therapeutics Committee was evaluated through the dose and prescription scheme of IVIg. Results: Twenty-five participants (2 to 70 years of age) were included in the study, 5 were submitted to treatment with PE, using human albumin as replacement for plasma, and 20 were treated with IVIg. The total treatment cost for PE in a single patient was US$6,058.85 (±1,701.78 SD), and the same expense for IVIg was US$18,344.57 (± 12,259.56 SD) (p = 0.035). Total inpatient cost was US$25,729.79 (± 18,714.54 SD) in the PE group, and US$34,768.16 (±27,766.01 SD) (p=0.530) in the IVIg group. The main clinical outcome was improvement in the 7-point disability grade scale. The median of that measure in patients admitted with a severity grade 3 treated either with PE and IVIg was the same. Secondary outcomes, such as in-hospital stay, ICU stay, and number of days on mechanical ventilation revealed no statistically significant difference between treatments. Conclusions: As the mean expenses of both therapeutic options are compared, one clearly stands-out as less onerous. Clinical outcomes, when compared, reveal no statistical difference after each treatment. We concluded that, in HCPA, plasma exchange is more cost-effective than intravenous immunoglobulin.

Objetivo: Comparar as relações de custo-efetividade de duas terapias, Imunoglubulina Intravenosa (IgIV) e Plasmaferese (PE), no tratamento da Síndrome de Guillain-Barré sob a perspectiva do sistema público (SUS). O objetivo secundário foi avaliar a adesão às recomendações da Comissão de Medicamentos do HCPA Métodos: estudo transversal com análise econômica de pacientes tratados por Síndrome de Guillain-Barré no período de junho de 2003 a junho de 2008 no Hospital de Clínicas de Porto Alegre (HCPA). Foi realizada análise de custo-efetividade do emprego de IgIV e de PE nestes pacientes, pelo método de minimização de custos, considerando-se somente os custos diretos sanitários, fornecidos pelo sistema gerencial da instituição . Foram excluídos os pacientes que usaram outro tipo de tratamento associado ou isolado. Coletaram-se os dados através da revisão dos prontuários. A gravidade da doença na internação foi classificada como: doença leve, quando caminhar foi possível; doença moderada, quando caminhar foi impossível; doença grave, quando os pacientes necessitaram de ventilação assistida. A incapacidade na alta foi estabelecida pela escala de sete pontos de Hughes. A adesão às recomendações da Comissão de Medicamentos do HCPA, objetivo secundário, foi avaliada através da dose e o esquema de prescrição da IgIV. Resultados: Vinte e cinco participantes (2 a 70 anos) foram incluídos no estudo, cinco tratados com PE, empregando-se Albumina Humana como substituto do plasma, e 20 tratados com IgIV. O custo total do tratamento de um paciente com PE foi R$10.603,88 (± 2.978,12) e o de um que recebeu IgIV foi R$ 32.103,00 (± 21.454,24). O custo total da internação foi de R$45.027,14 (± 32.750,45) para os tratados com PE e de R$ 60.844,28 (±48.590,52) para os que receberam IgIV. Em relação ao desfecho clínico principal, melhora na escala de incapacidade de sete pontos, após o tratamento com uma das alternativas escolhida, a mediana dos pacientes que internaram com grau de gravidade 3 e que foram tratados com PE foi igual a dos que receberam IgIV. Em relação à permanência hospitalar, permanência em UTI e dias de Ventilação Mecânica, não houve diferença estatisticamente significativa entre os dois tratamentos. Conclusões: Quando comparados os custos médios das duas opções terapêuticas, uma delas aparece claramente com menor custo. Quando comparados os desfechos, após o emprego de cada opção terapêutica, estes não revelam diferença. Concluímos que, no HCPA, a opção pelo procedimento Plasmaferese é mais custo efetiva do que o emprego da IgIV. / Objectives: To compare the cost-effectiveness of two distinct therapies, Intravenous Immunoglobulin (IVIg) and Plasma Exchange (PE) in the treatment of Guillain-Barré Syndrome, concerning the public health care system. Compliance to the guidelines of the Pharmacy and Therapeutics Committee of the Hospital de Clínicas de Porto Alegre was a secondary objective. Methods: A cross-sectional, economical analysis was conducted, including patients treated for GBS in the period from June, 2003 through June, 2008 in Hospital de Clínicas de Porto Alegre (HCPA). The cost-effectiveness of the use of IVIg and PE in such patients was studied through the cost minimization method, considering direct medical costs only (2008 currency), yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by chart reviews. Severity of disease on admittance was classified as follows: mild disease, when the patient was able to walk; moderate disease, when the patient was unable to walk, and severe disease, when assisted ventilation was required. Disability on discharge was established by the 7-point scale of Hughes. Compliance to the guidelines of the Pharmacy and Therapeutics Committee was evaluated through the dose and prescription scheme of IVIg. Results: Twenty-five participants (2 to 70 years of age) were included in the study, 5 were submitted to treatment with PE, using human albumin as replacement for plasma, and 20 were treated with IVIg. The total treatment cost for PE in a single patient was US$6,058.85 (±1,701.78 SD), and the same expense for IVIg was US$18,344.57 (± 12,259.56 SD) (p = 0.035). Total inpatient cost was US$25,729.79 (± 18,714.54 SD) in the PE group, and US$34,768.16 (±27,766.01 SD) (p=0.530) in the IVIg group. The main clinical outcome was improvement in the 7-point disability grade scale. The median of that measure in patients admitted with a severity grade 3 treated either with PE and IVIg was the same. Secondary outcomes, such as in-hospital stay, ICU stay, and number of days on mechanical ventilation revealed no statistically significant difference between treatments. Conclusions: As the mean expenses of both therapeutic options are compared, one clearly stands-out as less onerous. Clinical outcomes, when compared, reveal no statistical difference after each treatment. We concluded that, in HCPA, plasma exchange is more cost-effective than intravenous immunoglobulin.

Distribution system plays a significant role in the overall electrical power system due to its impact on electricity costs, reliability as well as security of supplied energy. Optimal development planning of modern distribution system is mainly required to satisfy continuous change in customer demands and generations in a cost-effective manner, utilizing the available smart solutions. All these aspects need to be addressed in modern distribution planning methodology that can be applied today in real-life. Review has shown that there are no distributions planning models that adequately model security of supply of radially operated networks. Moreover, the optimal development planning models still do not consider multiple operating regimes, which has become a necessity due to connection of low carbon technologies. Numerous techniques published on this subject tend to ignore the regulations and planning standards that must be complied during system development, resulting in methodology that is not in-tuned with business practices. Furthermore, a comprehensive model that integrates all major components of today’s real-life distribution planning is still lacking, even though many of them have been addressed individually. In this thesis, integrated planning methodology for development of distribution system is proposed, incorporating utility practices in the UK. The overall methodology built on two independent stages, investment stage and operation stage. The operation stage is further cast into two sub-stages, quality of supply planning and minimization of operation costs planning. The overall planning methodology incorporates the novel probabilistic decision tree concept for distribution system planning to consider probable network uncertainties. The first model which is the investment stage determines the new construction and reinforcement of circuits and switchgear, along with circuit decommissioning. Multiple operating regimes due to fluctuation in generation and load profiles are considered, in addition to explicit modelling of N-1 security constraint according to P2/6 planning standards. The quality of supply planning determines the allocation of switchgear and its automation to maximise the reliability benefits from the regulatory incentive regime. Finally, the operation model determines the optimal network configuration that minimises the total operation costs of distribution system. The final outputs are list of cables and switchgear for construction, reinforcement, and decommission, benefits harvested due to quality of supply investments on switchgear, optimal network running arrangement, etc. These studies have proven to be important in formulating effective strategies for development of distribution system, in compliance to the planning standards and resulted in higher network operation capabilities.

This thesis (1) reports the development of simulation tools and control strategies for optimizing hybrid electric vehicle (HEV) energy management, and (2) reports the design and testing of a hydraulic hybrid school bus (HHB) prototype. A hybrid vehicle is one that combines two or more energy sources for use in vehicle propulsion. Hybrid electric vehicles have become popular in the consumer market due to their greatly improved fuel economy over conventional vehicles. The control strategy of an HEV has a paramount effect on its fuel economy performance. In this thesis, backward-looking and forward-looking simulations of three HEV architectures (parallel, power-split and 2-mode power-split) are developed. The Equivalent Cost Minimization Strategy (ECMS), which weights electrical power as an equivalent fuel usage, is then studied in great detail and improvements are suggested. Specifically, the robustness of an ECMS controller is improved by linking the equivalence factor to dynamic programming and then further tailoring its functional form. High-fidelity vehicle simulations over multiple drive-cycles are performed to measure the improved performance of the new ECMS controller, and to show its potential for online application. While HEVs are prominent in the consumer market and studied extensively in current literature, hydraulic hybrid vehicles (HHVs) only exist as heavy utility vehicle prototypes. The second half of this thesis reports design, construction, and testing of a hydraulic hybrid school bus prototype. Design considerations, simulation results, and preliminary testing results are reported, which indicate the strong potential for hydraulic hybrids to improve fuel economy in the school bus vehicle segment.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-04-19T12:22:32Z No. of bitstreams: 1 arquivo total.pdf: 1708178 bytes, checksum: 7e11088ace9db25472a51ec593b21f75 (MD5) / Made available in DSpace on 2016-04-19T12:22:32Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 1708178 bytes, checksum: 7e11088ace9db25472a51ec593b21f75 (MD5) Previous issue date: 2015-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research examines the history of mathematical models that deal with resource allocation problems involving mass moving – specifically earth moving in construction of highways - which involves analysis of the evolution of models used for solving this type of problem - its applicability, advantages and disadvantages. The historical analysis of the models generates the foundation for creating a new model that includes two pertinent aspects of daily life of Brazilian companies involved in road construction: time and obstacle. Then, the new formulation is applied in a real life situation, seeking to measure its effectiveness and representativeness; for this purpose, a computational algorithm of the model is created and then used in VBA in order to facilitate the applicability of the model to both scholars of this field as to entrepreneurs and engineers who deal with the problem of mass moving in their daily professional activities. / Esta pesquisa examina o histórico dos modelos matemáticos que lidam com problemas de alocação de recursos envolvendo a movimentação de massas – mais especificamente a movimentação de terra em obras de rodovias - o que envolve a análise da evolução dos modelos usados para a resolução deste tipo de problema – sua aplicabilidade, vantagens e desvantagens. A análise histórica dos modelos usados para tanto permite caminhar no sentido de criar um novo modelo que inclua dois aspectos pertinentes do cotidiano de empresas brasileiras envolvidas com construção de rodovias: tempo e obstáculo. Em seguida, aplica-se a nova formulação em um caso real do país, buscando-se medir sua efetividade e representatividade; para tanto, cria-se e utiliza-se o código computacional do modelo em VBA visando facilitar a aplicabilidade do mesmo tanto para os estudiosos da área quanto para empresários e engenheiros que lidem com o problema da movimentação de massas em seu cotidiano profissional.

The relevance of the research topic is that in modern conditions of economic development it is necessary to pay special attention to reducing production costs and selling products. The purpose of this work is to study the methods of cost management, the analysis of the structure of costs for production and sales of products at the enterprise NPP "DVM", the identification of problems and the development of ways to solve them. In this paper, the essence, the structure of costs for production and sales of products are analyzed, the influence of the cost structure on the financial performance of the NPP "DVM" is analyzed, the problems of cost management of the enterprise are revealed and cost minimization measures are proposed to increase the profitability and profitability of the enterprise. / Актуальность темы исследования заключается в том, что в современных условиях развития экономики необходимо уделять особое внимание снижению затрат на производство и реализацию продукции. Целью данной работы является исследование методов управления затратами, анализ структуры затрат на производство и реализацию продукции на предприятии ООО НПП «ДВМ», выявление проблем и разработка путей их решения. В данной работе исследованы сущность, структуру затрат на производство и реализацию продукции, проанализировано влияние структуры затрат на финансовые показатели деятельности ООО НПП «ДВМ», выявлены проблемы управления затратами предприятия и предложены мероприятия по минимизации затрат, с целью увеличения прибыльности и рентабельности предприятия.

The relevance of the chosen topic is due to the current market situation, which obliges enterprises to conduct a continuous search for ways to improve the efficiency of economic activity. As a result, the study of both theoretical and practical methods of cost management, depending on the industry of the subject, is of particular importance in solving this issue. The purpose of the master's thesis is to improve the cost management system for the production and sales of the enterprise as a result of the study of the theoretical foundations of this issue and a detailed analysis of the cost structure on the example of a large Russian manufacturing company. In this paper we investigate the essence, the structure of expenses for production and sales, analyzed the impact of cost structure on the production and sale of products on financial performance of OJSC "Zhirovoy Kombinat" identified the problems of cost management of OJSC "Zhirovoy Kombinat" and proposed measures to minimise costs, to increase profitability and plant profitability. / Актуальность выбранной темы обусловлена настоящей рыночной ситуацией, которая обязывает предприятия вести непрерывный поиск путей повышения эффективности экономической деятельности. В результате чего особую значимость при решении этого вопроса приобретает исследование как теоретических, так и практических методов управления затратами в зависимости от отраслевой принадлежности субъекта. Цель магистерской диссертации заключается в совершенствовании системы управления затратами на производство и реализацию продукции предприятия в результате изучения теоретических основ данного вопроса и детального анализа структуры затрат на примере крупной российской производственной компании. В данной работе исследованы сущность, структуру затрат на производство и реализацию продукции, проанализировано влияние структуры затрат на производство и реализацию продукции на финансовые показатели деятельности ОАО «Жировой комбинат», выявлены проблемы управления затратами ОАО «Жировой комбинат» и предложены мероприятия по минимизации затрат, с целью увеличения прибыльности и рентабельности предприятия.

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