Abstract The aim of this study was to assess a series of caries risk indicators to find a suitable model for screening adolescents for risk cases, and to evaluate the long-term efficacy and cost-effectiveness of an one-year intervention programme provided for the resulting risk groups. To reduce the spread of infectious diseases at 20 day-care centres, risk factors for the occurrence of salivary mutans streptococci were surveyed in 345 children before and after 8 months of intervention, i.e. withdrawal of tooth brushing in 10 centres. Dental health habits were evaluated by means of questionnaires. Four clinical and six salivary tests were related to 11-month caries increment in 181 adolescents. The 109 high-risk subjects presenting four or more risk factors were provided either with chlorhexidine or fluoride treatment, the low-risk group receiving basic prevention. An age and sex-matched control group was chosen. Life-long data on all 390 subjects were collected from their dental records. Survival analysis was applied, taking as the starting point the time of tooth eruption and as the event the first filling due to caries. The costs of the intervention and the number of fillings were compared between the groups. The dental health of the risk groups tended to approach the average level for the control group. One tooth surface per subject was saved from filling. The costs of fillings for the control group were twice as great as those for the risk groups at the end of the intervention, but only slightly more after the five-year follow-up period. The model (DFS, Candida and sucrase) offers additive information for finding adolescents at risk of caries, and for targeting preventive measures at the individual level and for the motivation of patients. The results stress the importance of dental age and of providing preventive procedures at the time of tooth eruption. The present risk-based strategy proved to be of moderate benefit to dental health by comparison with the costs of normal preventive and restorative care and cannot be recommended as such for a target population with a high risk of caries.

<p> A review ·of the basic purposes for, and research work conducted on, estimates of running costs of motor vehicles is presented. An attempt at using available running cost data at the Ministry of Transportation and Communications (Ontario) to obtain acceptable estimates of running costs is also presented. The purpose of this report was to study, in detail, the purpose and research methods advocated for obtaining running cost estimates with inherent advantages and disadvantages, and includes an attempt at using available data in obtaining such estimates and the problems associated with it. </p> <p> Several of the principal purposes and uses of running cost estimates are addressed. Each purpose is presented and discussed in detail and examples of data obtained to satisfy that purpose are given. In addition, the deficiencies of each data type are identified. Examples of use and application of different data types in obtaining economic assessment for individual organizational and governmental uses are included. </p> <p> A review of literature on running costs for motor vehicles is given. The different data collection and research methods adopted by researchers all over the world are discussed. A discussion of the advantages and disadvantages of each method with respect to variables included, data collection method, level of data aggregation, impact of time-dependence, techniques and results is presented. </p> <p> An investigation of running cost records available at the Ontario Ministry of Transportation and Communications was conducted. An effort at using such records to obtain reliable estimates of running costs was attempted but no conclusive results were obtained. The limitations of using these records to obtain running costs estimates are indicated. </p> <p> The concluding chapter includes recommendations for future research efforts for both short term and long term consideration. </p> / Thesis / Master of Engineering (MEngr)

Atualmente, a obesidade constitui significativo problema de saúde pública em vários países, associando-se positivamente ao incremento na prevalência de doenças crônicas não transmissíveis. Isso impõe encargos substanciais à população, resultando em redução da qualidade de vida e produtividade, além de elevação dos custos dos sistemas de saúde. Assim, o presente estudo propôs avaliação econômica das estratégias terapêuticas medicamentosas para tratamento da obesidade disponíveis no Brasil, a partir de revisão sistemática de literatura direcionada para identificação de desfechos em saúde associada à estimativa de custos diretos de tratamento das alternativas disponíveis no país. A revisão sistemática de literatura identificou 17 estudos sobre perda de peso para tratamento medicamentoso baseado em sibutramina, orlistat e liraglutida. Em termos de avaliação econômica, verificou-se razão custo-efetividade (RCE) de R$506,75; R$3.116,08 e R$2.176,45 por ponto percentual de peso reduzido para sibutramina, orlistat e liraglutida, respectivamente; indicando melhor efetividade por custo para tratamento medicamentoso com sibutramina. Destaca-se que tratamento medicamentoso da obesidade requer avaliação individual da terapia recomendável, assim como acompanhamento da aderência do paciente. Adicionalmente, ressalta-se necessidade de condução de estudos sobre tratamentos com base em outros medicamentos isolados ou combinações de medicamentos, além de análise da manutenção ou reganho de peso em médio e longo prazo após término do tratamento. / Nowadays, obesity represents a significant public health problem in diverse countries, being positively associated to increased prevalence of chronic noncommunicable diseases. It imposes substantial burden to the population, resulting in losses regarding quality of life and productivity, in addition to increases in health system costs. Thus, the presente study proposed economic assessment of therapeutic strategies based on medication available in Brazilian market for treatment of obesity, using systematic literature review to identify health outcomes associated with direct costs estimation of the treatment alternatives. Systematic review of literature identified 17 studies on weight loss during obesity treatment with sibutramine, orlistat and liraglutide. Regarding economic assessment, cost-effectiveness ratios (RCE) of R$506.75; R$3,116.08 e R$2,176.45 per percentage point of weight loss for treatments with sibutramine, orlistat and liraglutide, respectively; indicating better effectiveness per cost for adoption of treatment with sibutramine. It is important highlight that medication for treatment of obesity requires individual assessment of the recommended therapy and monitoring of the patient\'s adherence to treatment. Additionally, it is advisable to perform further research on other medication available, including monotherapy or combination therapy, along with analysis of maintenance of weight or weight regain after finishing treatment in the long run.

Atualmente, a obesidade constitui significativo problema de saúde pública em vários países, associando-se positivamente ao incremento na prevalência de doenças crônicas não transmissíveis. Isso impõe encargos substanciais à população, resultando em redução da qualidade de vida e produtividade, além de elevação dos custos dos sistemas de saúde. Assim, o presente estudo propôs avaliação econômica das estratégias terapêuticas medicamentosas para tratamento da obesidade disponíveis no Brasil, a partir de revisão sistemática de literatura direcionada para identificação de desfechos em saúde associada à estimativa de custos diretos de tratamento das alternativas disponíveis no país. A revisão sistemática de literatura identificou 17 estudos sobre perda de peso para tratamento medicamentoso baseado em sibutramina, orlistat e liraglutida. Em termos de avaliação econômica, verificou-se razão custo-efetividade (RCE) de R$506,75; R$3.116,08 e R$2.176,45 por ponto percentual de peso reduzido para sibutramina, orlistat e liraglutida, respectivamente; indicando melhor efetividade por custo para tratamento medicamentoso com sibutramina. Destaca-se que tratamento medicamentoso da obesidade requer avaliação individual da terapia recomendável, assim como acompanhamento da aderência do paciente. Adicionalmente, ressalta-se necessidade de condução de estudos sobre tratamentos com base em outros medicamentos isolados ou combinações de medicamentos, além de análise da manutenção ou reganho de peso em médio e longo prazo após término do tratamento. / Nowadays, obesity represents a significant public health problem in diverse countries, being positively associated to increased prevalence of chronic noncommunicable diseases. It imposes substantial burden to the population, resulting in losses regarding quality of life and productivity, in addition to increases in health system costs. Thus, the presente study proposed economic assessment of therapeutic strategies based on medication available in Brazilian market for treatment of obesity, using systematic literature review to identify health outcomes associated with direct costs estimation of the treatment alternatives. Systematic review of literature identified 17 studies on weight loss during obesity treatment with sibutramine, orlistat and liraglutide. Regarding economic assessment, cost-effectiveness ratios (RCE) of R$506.75; R$3,116.08 e R$2,176.45 per percentage point of weight loss for treatments with sibutramine, orlistat and liraglutide, respectively; indicating better effectiveness per cost for adoption of treatment with sibutramine. It is important highlight that medication for treatment of obesity requires individual assessment of the recommended therapy and monitoring of the patient\'s adherence to treatment. Additionally, it is advisable to perform further research on other medication available, including monotherapy or combination therapy, along with analysis of maintenance of weight or weight regain after finishing treatment in the long run.

Current practices of power quality mitigation in the industry are characterized by sub-optimal investment decisions where over compensation is often the norm such causing huge wastage in financial resources. Providing power quality management services to industrial customers in the form of power quality contracts could yield substantial return for the network operator. With better understanding of network parameters, and the option of installing network level mitigation devices, network operators could employ wider range of cost effective mitigation solutions. Tapping into the market however, entails bearing the risks for the customers which network operators are not always willing or encouraged to do. With potentially millions at stake, extensive risk assessments are crucial for any proposed power quality management scheme. This thesis investigates the voltage sag aspect of the problem as part of a larger power quality management scheme. The aim is to develop general framework for technical and financial assessments of voltage sags prior to the introduction of power quality management service. The thesis focuses on five major aspects of voltage sag assessment: identification of customer requirement, financial loss assessment, network sag performance estimation, sag mitigation, and financial appraisal of mitigating solutions. The first part of the thesis gives a comprehensive overview of current power quality problems faced by industrial customers and provides ranges of typical financial losses incurred by different types of industries around the world. It then proposes robust methodology for assessment of typical financial loss, i.e., customized customer damage function (CCDF), for a given industry based on available survey data and taking into account characteristics of the assessed customer plant. For failure and financial risk assessments, the thesis introduces new customer models employing probabilistic methods to quantify risks induced by voltage sags and proposes generic models that incorporate full flexibility in failure risk assessment, taking into account the effect of unbalanced sags on equipment behavior. It further quantifies the error introduced by sag performance estimation using limited monitoring data with a case study on actual sag profile. It demonstrates how different estimation methods and different durations of monitoring period affect accuracy of estimation of voltage sag profile and associated risk of industrial process failure. Following this, the thesis presents new models for plant and network level sag mitigation devices. They include power injecting mitigation devices, devices that reduce number of faults in the network and devices that reduce the severity of faults. Developed models are then used to investigate the cost-effectiveness of sag mitigation at different levels. Finally, the thesis presents Genetic Algorithm based methodology for deciding on optimal investment scheme in voltage sag mitigation in the network. The sensitivity of the solution to various influential parameters, including plant type and size, sensitive equipment type, process characteristics, financial loss resulting from process interruption, cost and effectiveness of mitigating solution and network fault rates is also established.

As part of the UK’s effort to combat climate change, deep reductions in carbon emissions will be required from existing social housing. This thesis explores the viability of achieving such a goal through a case-study approach, focusing on Peabody, a large housing association operating in London. A model was developed for Peabody’s existing housing stock that quantifies the impacts of technical carbon reduction interventions on stock carbon emissions, Peabody’s expenditure and residents’ fuel bills for the period up to 2030. A participant observation study, conducted from 2006 to 2009, explored the impact of contextual factors influencing the viability of Peabody carrying out the considered technical interventions. The model study found that the Greater London Authority’s target of achieving 60% emission cuts by 2025 could be achieved, but only through extensive stock refurbishment, including a widespread use of solid wall insulation. An external context of substantial reductions in the carbon intensity of the national grid and constrained resident demand for energy is also required. Even where considerable financial support for refurbishment from Government was assumed, the model provided evidence of a funding gap of tens of millions of pounds which would need to be bridged if the required measures were to be carried out. The participant observation study found that the prohibitive cost of carrying out carbon reduction measures is the key barrier currently holding back progress. Other significant issues are related to Government policy, including the inability to raise income from residents to offset refurbishment spending, and the lack of a long term framework to drive action to reduce emissions from existing UK housing. By coupling an analysis of technical interventions with analysis of their financial and political viability, this thesis demonstrates that the achievement of deep emission cuts from Peabody’s existing stock is certainly possible, but requires changes in Government policy and increased efforts from all stakeholders concerned if it is to come to pass.

Disertacijoje vertinamos regiono unikalių išteklių panaudojimo galimybės regiono ekonominei socialinei raidai gerinti, įgyvendinant Europos Sąjungos regioninę politiką. Pagrindinis tyrimo objektas yra regioninės politikos sprendimų rengimo ir pagrindimo procesai, reikalaujantys adekvataus regionų unikalumo vertinimo, tame tarpe siekiant efektyviai panaudoti unikalius išteklius regiono socialinei ekonominei raidai. Pagrindinis disertacijos tikslas – sukurti teorinę koncepciją, skirtą kompleksiniams regionų unikalumo ekonominiams vertinimams bei parengti regionų unikalumo ekonominio vertinimo instrumentarijų, panaudotiną regioninės politikos sprendimams. Sukurto instrumentarijaus taikymo sritis – Europos Sąjungos ir nacionalinės regioninės politikos įgyvendinimas. / The dissertation investigates the issues of regional development and region possibilities to increase value added by using unique resources of the regions in the context of EU integration processes. The main object of research is regional policy decision-making processes requiring adequate economic assessment of regional uniqueness aiming effective use of unique resources of the region for social and economic development. This object is important not only to the state or regional level but also at the EU level with the aim to exploit regions basic skills and resources that can be unique from the perspective of other regions and to use competitive advantage. The primary purpose of this dissertation is building the theoretical concept that would serve as a base for the methodology creation of complex economic assessment of regional uniqueness that in the next stage would serve as an instrument for the implementation of EU regional policy.

Introdução: O aumento na prevalência de doenças crônicas não transmissíveis (DCNT) tem resultado em mudança nos padrões de mortalidade em vários países, inclusive no Brasil. Considerando associação entre transição demográfica, nutricional e epidemiológica, há necessidade de ações em saúde direcionadas à prevenção de doenças e agravos, aliada a estratégias de promoção da saúde da população, de forma a proporcionar maior qualidade de vida aos indivíduos. Objetivo: Conduzir análise custo-efetividade da dieta de uma amostra de pacientes com idade igual ou superior a 50 anos, usuários de Unidades Básicas de Saúde (UBS) do município de Bauru (SP), comparando-se com um padrão de alimentação saudável dentro de parâmetros nutricionais recomendados, preferências alimentares locais e custo similar à alimentação usual dos pacientes. Metodologia: Tratou-se de estudo transversal com caráter retrospectivo, originado de projeto de pesquisa de maior abrangência intitulado \"Relação entre atividade física habitual e desenvolvimento de síndrome metabólica e comorbidades associadas em usuários do sistema público de saúde: Um estudo de coorte de 8 anos\", incluindo aplicação de recordatório 24 horas para registro do consumo alimentar. Adicionalmente, foi realizada pesquisa de preços no varejo para estimativa dos custos da alimentação rotineira e calculada qualidade da dieta por meio do Índice Qualidade da Dieta Revisado adaptado para população brasileira para avaliação da razão custo-efetividade da alimentação dos pacientes da amostra. Resultados: Identificou-se influência positiva da classe econômica, consumo de bebidas alcoólicas e escore de qualidade nutricional da dieta sobre custos da alimentação dos pacientes; assim como incremento da RCE em relação à idade, à escolaridade e ao consumo de bebidas alcoólicas dos indivíduos. Conclusão: A partir da estimativa do custo diário da alimentação, verificou-se possibilidade de mudança na dieta a baixo custo, de forma a reduzir o impacto do fator renda na tomada de decisão pela melhoria da qualidade nutricional da alimentação da população. / Introduction: The increase in the prevalence of non-communicable diseases (NCDs) has resulted in a change in mortality patterns in several countries, including Brazil. Considering the association between demographic, nutritional and epidemiological transition, there is a need for health actions directed to the prevention of diseases and conditions, allied with strategies to promote the health of the population, in order to provide a better quality of life for individuals. Objective: To conduct a cost-effectiveness analysis of the diet of a sample of patients aged 50 years or older, users of Basic Health Units (UBS) in the city of Bauru (SP), comparing them with a healthy eating pattern inside of recommended nutritional parameters, local food preferences and cost similar to the usual diet of the patients. Methodology: This is a retrospective cross-sectional study from a larger research project entitled \"Relationship between habitual physical activity and the development of metabolic syndrome and associated co-morbidities in users of the public health system: An 8-year cohort study \", including application of a 24-hour recall to record food consumption. In addition, a retail price survey was conducted to estimate the costs of routine feeding and calculated diet quality using the Revised Diet Quality Index adapted for the Brazilian population to evaluate the cost-effectiveness ratio of the sample patients\' feed intake. Results: We identified a positive influence of the economic class, consumption of alcoholic beverages and score of nutritional quality of the diet on costs of the patients\' diet; as well as increase of the RCE in relation to the age, the schooling and the consumption of alcoholic beverages of the individuals. Conclusion: From the estimated daily cost of food, was checked a possibility to change the low cost diet, in order to reduce the impact of the income factor in decision making in favor of improving the nutritional quality of the population\'s diet.

Concerns over both environmental issues and about the depletion of fossil fuels have acted as twin driving forces to the development of renewable energy and its integration into existing electricity grids. The variable nature of RE generators assessment affects the ability to balance supply and demand across electricity networks; however, the use of energy storage and demand-side response techniques is expected to help relieve this situation. One possibility in this regard might be the use of water electrolysis to produce hydrogen while producing industrial-scale DSR services. This would be facilitated by the use of tariff structures that incentive the operation of electrolysers as dispatchable loads. This research has been carried out to answer the following question: What is the feasibility of using electrolysers to provide industrial-scale of Demand-side Response for grid balancing while producing hydrogen at a competitive price? The hydrogen thus produced can then be used, and indeed sold, as a clean automotive fuel. To these ends, two common types of electrolyser, alkaline and PEM, are examined in considerable detail. In particular, two cost scenarios for system components are considered, namely those for 2015 and 2030. The coastal city of Darnah in Libya was chosen as the basis for this case study, where renewable energy can be produced via wind turbines and photovoltaics (PVs), and where there are currently six petrol stations serving the city that can be converted to hydrogen refuelling stations (HRSs). In 2015 all scenarios for both PEM and alkaline electrolysers were considered and were found to be able to partly meet the project aims but with high cost of hydrogen due to the high cost of system capital costs, low price of social carbon cost and less government support. However, by 2030 the price of hydrogen price will make it a good option as energy storage and clean fuel for many reasons such as the expected drop in capital cost, improvement in the efficiency of the equipment, and the expectation of high price of social carbon cost. Penetration of hydrogen into the energy sector requires strong governmental support by either establishing or modifying policies and energy laws to increasingly support renewable energy usage. Government support could effectively bring forward the date at which hydrogen becomes techno-economically viable (i.e. sooner than 2030).

Introdução: O aumento na prevalência de doenças crônicas não transmissíveis (DCNT) tem resultado em mudança nos padrões de mortalidade em vários países, inclusive no Brasil. Considerando associação entre transição demográfica, nutricional e epidemiológica, há necessidade de ações em saúde direcionadas à prevenção de doenças e agravos, aliada a estratégias de promoção da saúde da população, de forma a proporcionar maior qualidade de vida aos indivíduos. Objetivo: Conduzir análise custo-efetividade da dieta de uma amostra de pacientes com idade igual ou superior a 50 anos, usuários de Unidades Básicas de Saúde (UBS) do município de Bauru (SP), comparando-se com um padrão de alimentação saudável dentro de parâmetros nutricionais recomendados, preferências alimentares locais e custo similar à alimentação usual dos pacientes. Metodologia: Tratou-se de estudo transversal com caráter retrospectivo, originado de projeto de pesquisa de maior abrangência intitulado \"Relação entre atividade física habitual e desenvolvimento de síndrome metabólica e comorbidades associadas em usuários do sistema público de saúde: Um estudo de coorte de 8 anos\", incluindo aplicação de recordatório 24 horas para registro do consumo alimentar. Adicionalmente, foi realizada pesquisa de preços no varejo para estimativa dos custos da alimentação rotineira e calculada qualidade da dieta por meio do Índice Qualidade da Dieta Revisado adaptado para população brasileira para avaliação da razão custo-efetividade da alimentação dos pacientes da amostra. Resultados: Identificou-se influência positiva da classe econômica, consumo de bebidas alcoólicas e escore de qualidade nutricional da dieta sobre custos da alimentação dos pacientes; assim como incremento da RCE em relação à idade, à escolaridade e ao consumo de bebidas alcoólicas dos indivíduos. Conclusão: A partir da estimativa do custo diário da alimentação, verificou-se possibilidade de mudança na dieta a baixo custo, de forma a reduzir o impacto do fator renda na tomada de decisão pela melhoria da qualidade nutricional da alimentação da população. / Introduction: The increase in the prevalence of non-communicable diseases (NCDs) has resulted in a change in mortality patterns in several countries, including Brazil. Considering the association between demographic, nutritional and epidemiological transition, there is a need for health actions directed to the prevention of diseases and conditions, allied with strategies to promote the health of the population, in order to provide a better quality of life for individuals. Objective: To conduct a cost-effectiveness analysis of the diet of a sample of patients aged 50 years or older, users of Basic Health Units (UBS) in the city of Bauru (SP), comparing them with a healthy eating pattern inside of recommended nutritional parameters, local food preferences and cost similar to the usual diet of the patients. Methodology: This is a retrospective cross-sectional study from a larger research project entitled \"Relationship between habitual physical activity and the development of metabolic syndrome and associated co-morbidities in users of the public health system: An 8-year cohort study \", including application of a 24-hour recall to record food consumption. In addition, a retail price survey was conducted to estimate the costs of routine feeding and calculated diet quality using the Revised Diet Quality Index adapted for the Brazilian population to evaluate the cost-effectiveness ratio of the sample patients\' feed intake. Results: We identified a positive influence of the economic class, consumption of alcoholic beverages and score of nutritional quality of the diet on costs of the patients\' diet; as well as increase of the RCE in relation to the age, the schooling and the consumption of alcoholic beverages of the individuals. Conclusion: From the estimated daily cost of food, was checked a possibility to change the low cost diet, in order to reduce the impact of the income factor in decision making in favor of improving the nutritional quality of the population\'s diet.