The diploma thesis deals with the design of a new production hall for sheet metal processing in KOVOT Invest s.r.o. The content of the thesis is the analysis of the current state, the capacity calculations of individual technologies and warehouse management. Further design of the layout solution in the hall and economic evaluation of the investment.

CONTEXTE : Les critères de jugement prenant en compte le ressenti des patients, tels que la qualité de vie, deviennent des éléments déterminants pour l’évaluation des prises en charge et l’aide à la décision. Bien que les troubles mentaux représentent un fardeau considérable tant en termes de prévalence que de conséquences économiques, les connaissances sur la qualité de vie des patients pris en charge par les services de psychiatrie sont limitées, ce qui complexifie la prise de décisions éclairées dans le champ de la santé mentale.OBJECTIFS : Nos objectifs étaient d’évaluer la qualité de vie, mesurée par des scores d’utilité, des patients souffrant de troubles mentaux en France, de mesurer la perte de qualité de vie attribuable à ces troubles et d’identifier les facteurs qui y sont associés.MATERIEL ET METHODES : Après une revue de la littérature décrivant les instruments de mesure de la qualité de vie utilisés en santé mentale, nous avons évalué la qualité de vie des patients pris en charge par le secteur de psychiatrie générale en mobilisant deux instruments permettant le calcul de scores d’utilité : le SF-36, permettant le calcul de scores d’utilité via le SF-6D, et l’EQ-5D. Nous avons comparé leurs performances et avons évalué leur concordance. Nous avons confronté la qualité de vie des patients souffrant de troubles mentaux à celle de la population générale en mobilisant les données du volet « ménages » de l’enquête Handicap-Santé. Enfin, nous avons recouru à des outils de modélisation adaptés aux spécificités des distributions des scores d’utilité pour étudier les caractéristiques sociodémographiques, cliniques et les prises en charge psychiatriques des patients qui y sont associées.RESULTATS : Notre enquête a inclus 212 patients. Leurs scores d’utilité moyens s’élevaient à 0,684 dans le cas d’une mesure par le SF-6D et à 0,624 dans le cas de l’EQ-5D et étaient inférieurs de 11% à ceux de la population générale. Le fait d’être une femme et le fait d’être sévèrement malade étaient associés à des scores d’utilité plus faibles. Les patients ayant été librement hospitalisés à temps plein, par rapport à ceux ne l’ayant pas été, avaient tendance à avoir des scores SF-6D plus faibles tandis que les patients pris en charge à temps partiel présentaient des scores SF-6D plus élevés. Les scores d’utilité SF-6D et EQ-5D n’étaient pas concordants. Si les deux instruments étaient comparables en termes d’acceptabilité et de validité discriminante et convergente, l’EQ-5D était moins sensible, présentant un effet plafond, et les modèles mis en œuvre pour identifier les facteurs associés à ce score présentaient des performances modestes.CONCLUSION : Nos travaux ont permis d’objectiver l’impact négatif des troubles mentaux sur la qualité de vie des personnes atteintes. Les différences importantes identifiées entre les scores d’utilité SF-6D et EQ-5D font du choix de l’instrument le plus adapté un enjeu majeur. Le manque de sensibilité du score d’utilité EQ-5D et les difficultés rencontrées pour trouver un modèle statistique adapté aux spécificités de ce score suggèrent une meilleure adéquation du SF-6D au champ de la santé mentale. Cependant, des travaux menés sur des échantillons de taille plus conséquente seront mis en œuvre pour préciser nos résultats. / BACKGROUND: Assessment criteria which take patients’ perceptions into account, such as quality of life, are becoming increasingly important in health services assessment and policy and clinical decision-making. Despite the fact that mental disorders represent a significant burden in terms of prevalence and economic consequences, there is a lack of knowledge regarding quality of life of patients cared for by mental health care services which impedes informed decision-making in the field of psychiatry.OBJECTIVES: Our objectives were to measure quality of life using utility scores of people cared for by mental health care services in France; to assess the loss of quality of life attributable to mental disorders; and to identify factors associated with quality of life.MATERIAL AND METHODS: After a literature review describing quality of life tools used in the field of mental health, we undertook a survey to measure the quality of life of people suffering from mental disorders who were treated in the general psychiatric sector using two tools and the corresponding utility scores: the SF-36, allowing calculation of utility scores by the SF-6D, and the EQ-5D. We compared them in terms of performance, and we assessed their consistency. We evaluated the quality of life loss attributable to mental disorders considering data from the French general population-based survey on health and disabilities as a reference. Finally, we used several models adapted to the specificities of the utility score distributions to identify socio-demographic, clinical and mental health care utilization characteristics associated with quality of life.RESULTS: 212 patients were included. The mean utility score was 0.684 when assessed by the SF-6D, and 0.624 when assessed by the EQ-5D. Utility scores of patients suffering from mental disorders were 11% lower than those of the general population. Being a woman and being severely ill were factors associated with lower utility scores using both tools. In comparison with no hospitalization, voluntary hospitalization within the past 12 months was associated with lower SF-6D utility scores, whereas part-time hospitalization was linked with higher SF-6D utility scores. SF-6D and EQ-5D utility scores showed poor agreement in measuring quality of life. These instruments were similar in terms of acceptability as well as discriminant and convergent validity; however, the EQ-5D showed lower sensitivity, illustrated by a ceiling effect, and the models used to study factors associated with this score showed poor performances.CONCLUSION: We objectivized the negative impact of mental disorders on quality of life. Considering the significant differences identified between the SF-6D and EQ-5D utility scores, the choice of the most adapted instrument constitutes a major issue. The lack of sensitivity of the EQ-5D and the difficulties experienced in finding a model adapted to the specificities of this score would suggest that the SF-6D is better suited to the field of mental health. However, our results must be confirmed by analysis on larger samples.

A feasibility study is a technical-economic study, an essential tool for investment decisions. The study aims to provide technical, economic, financial and management information qualified for investment decisions. The theoretical section summarizes the purpose, process and structure of individual chapters of the feasibility study including cost-benefit analysis. In the practical part of the feasibility study is designed public project model and its alternative financing option by the grant program of the European Union.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第18256号 / 工博第3848号 / 新制||工||1590(附属図書館) / 31114 / 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, 教授 谷口 栄一, 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

<p>In the Central Hardwood Region, the quantity and quality of hardwood timber critically depend on forest management decisions made by private landowners, since they hold the largest share of woodlands, some of which are plantations. These plantations are in a unique and critical position to provide much-needed hardwood resources. However, there is a lack of research and tools enabling rigorous assessments of profitability of long-term investments in hardwood plantations. Partially due to this, the majority of these privately held plantations remain unmanaged.</p> <p>This study aims at providing scientific evidence and tools to help promote forest management on hardwood plantations held by private landowners. To this end, I demonstrate in Chapter 1 an economic-modeling approach that minimizes establishment costs while ensuring free-to-grow status by year 5, and crown closure by year 10. Using temperate hardwoods such as black walnut and red oak as focal species, I find a black walnut plantation can attain crown closure in year six at the lowest cost ($4,540/ha) with 6 feet x 7 feet spacing, herbicide application for the first year, and fencing. For red oak, the minimum-cost option ($5,371/ ha) which achieves crown closure in year 10 requires a planting density of 6 feet x 7 feet, herbicide application for the first three years, and fencing. Modelling uncertainty in growth and mortality in a stochastic counterpart shifts optimal solutions to denser plantings for black walnut; planting more trees is, thus, risk mitigative. Based upon these research outcomes, I identify the tradeoffs between efficacy of treatments towards establishment success viz a viz their relative costs which serve as a solid foundation for the assessment of subsequent management strategies.</p> <p>Next, in chapter 2, I first calibrate growth, yield, and crown-width models for black walnut trees with existing and new tree measurements on selected Hardwood Tree Improvement and Regeneration Center (HTIRC) plots. Using spatial information on trees, I develop an individual tree level thinning model and simulate their post-thinning growth and yield. Significant predictors of annual diameter growth between years 10 to 18 include the initial tree DBH, forest edge effects, distance-dependent neighborhood competition, and tree age. Significant edge effects exist up to 3 rows and 3 trees from the non-forested edge. A tree on the perimeter rows grows 0.30 cm (0.12in.) in DBH more per year than the interior trees, between years 10 to 18. Next, I dovetail my results from the spatially explicit thinning model with the USFS Forest Vegetation Simulator (FVS) to understand the impacts of different scenarios of planting densities, site productivities, thinning treatments, and expected yields (as percentage of the total volume) of veneer sawlogs to quantify the growth and profitability from the mid-rotation until the final harvest. To support the attendant financial analyses, I incorporate risk into these projections by simulating stochastic windthrows based on certain assumptions. My projections suggest that, without the threat of windthrow damage, the net present day value (NPV) could exceed $4,900 per acre on the highest quality sites (SI =100) and high densities at planting (6 feet x 6 feet), assuming 10% or more of final volume was veneer and using a 3% discount rate. In contrast, under simulations of probable windthrow disturbances from mid-rotation to final harvest, the chances that standing timber value at harvest exceeds $5,000 per acre are 43.13% for a 96- and 90-year rotation and increase to 45.48% for 75 and further to 56.04% for 60.</p>

This master thesis aimed to design a permanent magnet assisted synchronous reluctancemachine (PMaSynRM) rotor for pump applications which were to be implemented inan existing Induction Machine stator. The machine were to be compared with a similarpermanent magnet synchronous machine (PMSM) with similar torque production in termsof cost and performance.This thesis goes through the theory of the Synchronous Reluctance Machine andthe Permanent Magnet assistance. A rotor was designed by utilizing existing design approachesand simulation of performance by use of finite element analysis. A demagnetizationstudy was conducted on the added permanent magnets in order to investigate thefeasiblity of the design.The final design of the PMaSynRM was thereafter compared to the equivalentsurface-mounted PMSM in terms of performance and cost. The performance parameterswas torque production, torque ripple, efficiency and power factor. Due to the lower torquedensity of the PMaSynRM, for equal torque production the PMSM had a 40% shorterlamination stack than the PMaSynRM.The economic evaluation resulted in that when utilizing ferrite magnets in the PMa-SynRM it became slightly cheaper than the PMSM, up to 20%. However, due to the fluctuatingprices of NdFeB magnets, there exist breakpoints below which the PMaSynRM isin fact more expensive than the PMSM or where the price reduction of the PMaSynRMis not worth the extra length of the motor. However, it was shown that the PMaSynRMis very insensitive to magnet price fluctuations and thereby proved to be a more securechoice than the PMSM / Detta examensarbete avsåg att designa en rotor till en permanentmagnetsassisteradsynkron reluktansmaskin (PMaSynRM) för pumpapplikationer, vilken skulle implementeras i en befintlig asynkronmaskin (IM) stator. Maskinen jämfördes ekonomiskt och prestandamässigt med en liknande synkronmaskin med permanentmagneter (PMSM) med jämförbar vridmomentsproduktion.Uppsatsen avhandlar teorin bakom synkrona reluktansmaskiner och konceptet kring permanentmagnetassistans. Rotorn designades genom användandet av befintliga designmetoder och simulering genom finit elementanalys (FEA). En avmagnetiseringsstudie utfördes på de adderade magneterna för att undersöka rimligheten kring designenDen slutgiltiga designen av PMaSynRMen jämfördes därefter mot den jämlika PMSMen i termer om prestanda och kostnad. De undersökta prestandaparameterarna var vridmoment, vridmomentsrippel, verkningsgrad och effektfaktor. Eftersom vridmomentsdensiteten i en PMaSynRM är lägre än hos en PMSM så visade sig PMSMen ha en 40% kortare lamineringskropp än PMaSynRMen vid jämnlik vridmomentsproduktion.Den ekonomiska utvärderingen resulterade i att vid användandet av ferritmagneter i PMaSynRMen så blev den något billigare än PMSMen, upp till 20%. På grund av fluktuerande priser hos NdFeB magneter, så finns det brytpunkter där PMaSynRMen faktiskt blir dyrare än PMSMen eller då kostnadsreduktionen för PMaSynRMen kan bedömas att vara för låg med tanke på den ökade längden och vridmomentsrippel. Däremot visades det att PMaSynRMen är väldigt okänslig för prisvariationer och därför visades vara ettkostnadsmässigt tryggare val än PMSMen

Целью работы является разработка методических подходов к экономической оценке развития компаний в условиях санкционного давления. В исследовании рассматривалось усовершенствование инструментов экономической оценки предприятий, находящихся под санкционным давлением. В нем подчеркивалась необходимость разработки компаниями стратегий переключения на экспорт, импортозамещения и снижения внутреннего рынка. Предлагаемый подход позволяет компаниям оценивать экономические последствия этих стратегий и принимать обоснованные решения в поддержку технологического суверенитета, операционной эффективности и управления человеческими ресурсами. / The aim of the work is to develop methodological approaches to the economic assessment of the development of companies under sanctions pressure. The study examined the improvement of tools for the economic assessment of enterprises under sanctions pressure. It emphasized the need for companies to develop strategies for switching to exports, import substitution and reducing the domestic market. The proposed approach allows companies to assess the economic impact of these strategies and make informed decisions in support of technological sovereignty, operational efficiency and human resource management.

Rökning är ett utbrett samhällsproblem världen över och sjukdomar relaterade till rökning leder till mer än åtta miljoner dödsfall årligen. Effektiva rökavvänjningsmetoder spelar därför en viktig roll i samhället då de besparar samhället sjukvårdskostnader och främjar folkhälsan. I detta arbete genomförs en hälsoekonomisk utvärdering av ett SMS-baserat stöd för rökavvänjning. Syftet med arbetet är att fylla en kunskapslucka vad det gäller kostnadseffektivitet av digitala rökavvänjningsinsatser och samtidigt ge ett underlag tillbeslutsfattare som ansvarar för att prioritera folkhälsofrämjande insatser. Den hälsoekonomiska utvärderingen använder sig av kostnadseffektivitetsanalys som metod och baseras på en klinisk studie, där långsiktiga kostnader och hälsoeffekter skattas med hjälpav en beslutsanalytisk modell primärt baserad på en Markovmodell. De tre vanligaste följdsjukdomarna av rökning; KOL (kronisk obstruktiv lungsjukdom), lungcancer och hjärt- och kärlsjukdom modelleras mot bakgrund av hur många som slutar röka med hjälp av SMS-stödet. Data från olika källor används i modellen och i de fall data saknas görs antaganden baserade på tidigare studier för att kunna skatta kostnader och hälsoeffekter. Arbetet påvisar att en implementering av ett SMS-baserat stöd skulle generera ökade hälsoeffekter till lägre kostnader i jämförelse med att inte implementera ett sådant stöd. Resultatet från grundscenariot visar att interventionen skulle leda till kostnadsbesparingar på 63 539 kr per individ som tar del av interventionen och 0,30 vunna år i perfekt hälsa, sett över ett livstidsperspektiv. Resultaten bör tolkas med viss försiktighet då de är förknippade med osäkerheter, men kan användas som en del av det underlag beslutsfattare behöver för att fattabeslut om hur hälso- och sjukvårdens resurser ska prioriteras. Trots osäkerheterna i underlagetförefaller ett SMS-baserat stöd för rökavvänjning ha positiva hälsoeffekter och samtidigt spara resurser och därmed framstår metoden som en potentiellt viktig insats i framtida folkhälsoarbete. / Smoking is a globally widespread societal problem and diseases related to smoking account for more than eight million deaths annually. Effective smoking cessation methods therefore play an important role in society as they save society´s healthcare resources and promote public health. In this work, a health economic evaluation of an SMS-based smoking cessation is performed. The purpose of the work is to fill a knowledge gap in terms of cost-effectiveness of digital smoking cessation initiatives and at the same time provide a basis for decision-makers who are responsible for prioritizing public health promotion initiatives. The health economic evaluation uses cost-effectiveness analysis as a method and is based on a clinical study, where long-term costs and health effects are estimated using a decision-analytical model with a Markov structure. The three most common sequelae of smoking; COPD (chronic obstructive pulmonary disease), lung cancer and cardiovascular disease are modeled based on how many people stop smoking with the help of the SMS support. Data from different sources are used in the model and required assumptions based on previous studies are used to be able to estimate costs and health effects. The work shows that the implementation of an SMS-based support would generate increased health effects at lower costs in comparison with not implementing such support. The results from the basic scenario show that the intervention would lead to cost savings of SEK 63,539 per individual who takes part in the intervention and a gain in 0.30 years in full health, seen over a lifetime perspective. The results should be interpreted with some caution as they are associated with uncertainties but can be used as part of the basis on which decision-makers need to make decisions about how health care resources should be prioritized. Despite these uncertainties the SMS-based support for smoking cessation appears to save resources and lead to positive health effects and the method should be considered a potentially important addition in future public health policy.

Syfte: Syftet med studien var att undersöka ekonomiska utvärderingar av preventiva metoder som används inom tandvården genom att göra en systematisk litteraturöversikt och besvara frågor om vilka preventiva metoder som analyserats avseende kostnad och effekt samt vilka typer av ekonomiska utvärderingar som analyserats. Material och metod: En sökningsstrategi genomfördes och PubMed, The Cochrane Library och Web of Science utgjorde databaser för litteratursökningen. Inklusions- och exklusionskriterier fastställdes och ett protokoll utgjorde grunden för läsningen av de inkluderade studierna i fulltext. En kritisk granskning av de inkluderade studierna genomfördes genom att använda ett andra protokoll. Resultat: Totalt 38 publikationer om ekonomiska utvärderingar av preventiva metoder som används inom tandvården inkluderades. Studier om kariespreventiva metoder var av övervägande majoritet (n=35) och endast ett fåtal studier utvärderade preventiva metoder för andra sjukdomar (n=3). Den vanligaste preventiva metoden som utvärderades var fissurförsegling (n=8) följt av fluorlackning (n=6) och vattenfluoridering (n=3). Många studier utvärderade kombinerade preventiva metoder (n=12). Typerna av ekonomiska utvärderingar var CEA (n=16) följt av CA/Cost-minimization analysis (n=10), CBA (n=3), en kombination av CEA och CBA (n=5), CUA (n=1) och en kombination av CEA och CA (n=1). Konklusion: Även om studierna om ekonomiska utvärderingar av preventiva metoder som används inom tandvården är betydligt fler än när SBU-rapporterna publicerades så kan ingen generell slutsats beträffande kostnadseffektiviteten dras på grund heterogenitet i design och sätt att analysera. Fler välgjorda studier rekommenderas. / Aims: The aim of this study was to examine economic evaluations of preventive methods used in dentistry by using a systematic review approach and answering questions about which preventive methods used in dentistry that have been analysed regarding costs and effects and what types of economic evaluations that have been conducted. Material and method: A search strategy were conducted and PubMed, The Cochrane Library and Web of Science formed the basis of the literature search. Inclusion- and exclusion criteria were defined and a protocol was made for full-text reading of the included publications. A critical appraisal of the included publications was made using a second protocol. Results: A total of 38 publications on economic evaluations of preventive methods used in dentistry were included. Publications on caries preventive methods were of overwhelming majority (n=35) and only a few publications evaluated preventive methods for other diseases (n=3). The most common evaluated preventive method was pit and fissure sealant (n=8) followed by fluoride varnish (n=6) and water fluoridation (n=3). Most publications evaluated combined preventive methods (n=11). Types of economic evaluations were CEA (n=16) followed by CA/Cost-minimization analysis (n=10), CBA (n=3), a combination of CEA and CBA (n=5), CUA (n=1) and a combination of CEA and CA (n=1). Conclusions: Publications on economic evaluations of preventive methods used in dentistry were considerably more than when the SBU reports were published. Yet, no general conclusions could be drawn regarding cost-effectiveness due to heterogeneity in design and way of analyses. Future well-designed studies are recommended.

Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in the intensive care unit, resulting in a high burden of illness, mortality and increased cost. The literature around the cost-effectiveness of probiotics in prevention of health-care associated infections has not been previously well-described, and a definitive health economic evaluation alongside a well-designed randomized control trial assessing probiotic prophylaxis has not been previously performed. This thesis consists of 3 separate manuscripts (with 2 published in peer-reviewed journals and 1 pending). The theme of this thesis was to: (1) describe the literature about the cost-effectiveness of probiotics in hospitalized patients in preventing healthcare-associated infections; (2) design a protocol for an economic evaluation alongside a randomized control trial (RCT) examining probiotic prophylaxis of VAP; and then (3) perform and analyze the health economic evaluation presented in the protocol. The first component of this thesis is a systematic review of probiotic prophylaxis of healthcare-associated infections in hospitalized patients. We performed an extensive search including multiple databases which found 7 studies. Probiotics demonstrated favourable cost-effectiveness in 6 of 7 (86%) economic evaluations, with 3 studies being manufacturer-supported, all suggesting cost-effectiveness. Certainty of cost-effectiveness evidence was very low due to risk of bias, imprecision and inconsistency using the GRADE approach. Hence further RCTs with economic evaluations were stated as a solution. The second component of this thesis is a study protocol for an economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT), which assessed the efficacy of probiotic prophylaxis in the prevention of healthcare-associated infections (specifically VAP). The third component of this thesis is the cost-effectiveness analysis performed utilizing the individual patient data from PROSPECT to produce the economic evaluation (E-PROSPECT). As of the date of thesis submission, PROSPECT is still pending publication, and hence E-PROSPECT is also pending analysis and publication. However, I have prepared a draft manuscript (along with figures and tables) that will be produced at the conclusion of E-PROSPECT for thesis committee review. / Thesis / Master of Health Sciences (MSc) / Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in the intensive care unit, resulting in a high burden of illness, mortality and increased cost. The literature around the cost-effectiveness of probiotics in prevention of health-care associated infections has not been previously well-described, and a definitive health economic evaluation alongside a well-designed randomized control trial assessing probiotic prophylaxis has not been previously performed. This thesis consists of 3 separate manuscripts (with 2 published in peer-reviewed journals and 1 pending). The theme of this thesis was to: (1) describe the literature about the cost-effectiveness of probiotics in hospitalized patients in preventing healthcare-associated infections; (2) design a protocol for an economic evaluation alongside a randomized control trial (RCT) examining probiotic prophylaxis of VAP; and then (3) perform and analyze the health economic evaluation presented in the protocol. The first component of this thesis is a systematic review of probiotic prophylaxis of healthcare-associated infections in hospitalized patients. We performed an extensive search including multiple databases which found 7 studies. Probiotics demonstrated favourable cost-effectiveness in 6 of 7 (86%) economic evaluations, with 3 studies being manufacturer-supported, all suggesting cost-effectiveness. Certainty of cost-effectiveness evidence was very low due to risk of bias, imprecision and inconsistency using the GRADE approach. Hence further RCTs with economic evaluations were stated as a solution. The second component of this thesis is a study protocol for an economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT), which assessed the efficacy of probiotic prophylaxis in the prevention of healthcare-associated infections (specifically VAP). The third component of this thesis is the cost-effectiveness analysis performed utilizing the individual patient data from PROSPECT to produce the economic evaluation (E-PROSPECT). As of the date of thesis submission, PROSPECT is still pending publication, and hence E-PROSPECT is also pending analysis and publication. However, I have prepared a draft manuscript (along with figures and tables) that will be produced at the conclusion of E-PROSPECT for thesis committee review.