The aim of this master´s thesis was design of rehabilitation of selected parts of the sewer network in Valašské Meziříčí. The work is divided into several parts. The first part is a description of the preliminary research based on appointments with the operator of the sewer network. The second section describes the basic information on the assessment of the sewer network. In the third part, the evaluation of technical and operational conditions according to ČSN EN 13 508. This section was supplemented by creation of supportive software program in Microsoft Office Excel, which is based on the proposed TNV 756905. In the next part the environmental assessment was performed digging and trenchless technology and then selected a possibility representative to design of selected parts. The fifth and sixth section contains technical and economic evaluation designed technology. A final section deals with the choosing optimal rehabilitation technologies for the design of selected parts of the sewer network.

No description available.

L'analyse des transferts hydriques inter-bassins massifs a fait l'objet de très peu de travaux en économie. Pourtant ce type d'intervention hydraulique est amené à prendre une place croissante dans la gestion de l'eau au 21ème siècle, dans les pays en développement et émergents notamment. Nous proposons une analyse du point de vue de l'économie écologique d'un projet de transfert hydrique dans le Nordeste du Brésil, en nous penchant particulièrement sur les conflits socio-environnementaux qui ont lieu autour de ce mégaprojet. Dans un premier temps, nous caractérisons le style de développement économique adopté par le Brésil au tournant du siècle ainsi que la dynamique des réformes de la gestion de l'eau. Nous tirons de cette analyse une présentation stylisée du complexe eau-économie nécessaire à la compréhension du projet étudié. Nous discutons ensuite les apports et limites des approches économiques (économie du bien-être, économie de la soutenabilité) de l'évaluation des grands projets hydrauliques. Nous mettons en exergue la spécificité des transferts inter-bassins massifs et proposons une grille d'analyse économique adaptée. Dans une troisième partie, nous approfondissons les conflits socio-environnementaux qui ont eu lieu autour du projet de transfert. Nous proposons une analyse en termes de justice environnementale ainsi qu'une modélisation de type institutionnaliste du conflit et de ses répercussions. / The analysis of massive inter-basin water transfers has been scarcely developed within the discipline of economics. Though, this kind of hydraulic engineering is bound to be ever more widepsread in the 21st century, in particular in developing and emerging economies. We propose an analysis of a water transfer project in Norhteastern Brazil from an ecological economic point of view. We especially investigate the socio-environmental conflicts that take place around this megaproject. In the first place, we characterise Brazil's current style of economic development at the turn of the century, as well as the dynamics of water sector reforms. From such an analysis, we draw a stylised presentation of the water-economy nexus which we deem necessary for the understanding of the project. We then discuss the scope and limits of economic approaches (welfare economics, sustainability economics) to the assessment of large scale water projects. We put an emphasis on the specific features of massive inter-basin water transfers and we propose a suitable economic framework. In a third part, we analyse the socio-environmental conflicts that took place in relation with the transfer project. We propose an environmental justice analysis as well as an institutionalist modeling of the conflict and its impacts.

[pt] No atual ciclo de expansão do setor elétrico brasileiro está previsto um forte crescimento de fontes renováveis não despacháveis, por exemplo, as fontes eólica e solar fotovoltaica. Neste contexto, o conceito de usinas híbridas tem surgido como uma alternativa para que os riscos dos empreendimentos de geração de energia possam ser melhor gerenciados, além de proporcionar alternativas mais rentáveis no desenvolvimento de projetos desta natureza. A combinação de diferentes tecnologias tem o potencial de propiciar efeitos sinérgicos no desenvolvimento e na operação das usinas e, consequentemente, provocar redução de despesas e custos. O objetivo desta dissertação é apresentar uma abordagem metodológica para avaliar uma usina híbrida composta pelas tecnologias eólica e solar fotovoltaica, considerando dois dos principais fatores de riscos associados, ou seja, a aleatoriedade da geração do empreendimento e do preço da energia no mercado de curto prazo. Para o estudo de caso considerado, a aplicação da metodologia foi capaz de mensurar o ganho sinérgico com o desenvolvimento do arranjo híbrido. As análises de fluxo de caixa foram feitas em base mensal e horária, cujos resultados se mostraram próximos para a maior parte das situações estudadas. Foram realizadas análises de sensibilidade acerca do Montante de Uso do Sistema de Transmissão contratado, as quais indicaram a viabilidade de se contratar 30 por cento a 40 por cento menos do que hoje é obrigatório no setor elétrico brasileiro. Estas análises vieram acompanhadas do dimensionamento do quanto de sua produção o empreendimento deixa de injetar na rede básica em função de diferentes valores do MUST contratado. / [en] In the current expansion cycle of the Brazilian electricity sector, a strong growth of non-dispatchable renewable sources is expected, for example, wind and solar energy. In this context, the concept of hybrid power plants (HPP) has emerged as an alternative so that the risks of energy generation projects can be better managed, in addition to providing more profitable alternatives in the development of projects of this kind. The combination of different technologies has the potential to provide synergistic effects in the development and operation of plants and, consequently, to reduce expenses and costs. The aim of this work is to present a methodological approach to evaluate a HPP composed of wind and solar photovoltaic technologies, considering two of the main associated risk factors, that is, the randomness of the project s generation and the price of energy in the short-term market. For the case study considered, the application of the methodology was able to measure the synergistic gain with the development of the hybrid arrangement. Cash flow analyzes were performed on a monthly and hourly basis, whose results were similar for most of the situations studied. Sensitivity analyzes were carried out on the Amount of Use of the Transmission System (MUST) contracted, which indicated the feasibility of contracting 30 percent to 40 percent less than what is currently mandatory in the Brazilian electricity sector. These analyzes were followed by the dimensioning of how much of its production the project doesn t inject into the basic network due to different values of the MUST contracted.

The potential for electrical energy storage to both provide services to the electrical grid and help to better integrate renewable energies in the electrical system is promising. This report investigates one type of storage, compressed air energy storage (CAES), where energy is stored by compressing air during hours of low electricity demand and later expanding the air to generate electricity during high demand hours. To this day it exists two large plants, but small facilities have yet to be implemented, raising the question whether it could be viable to use CAES on a smaller scale as well. By creating a model of a CAES system based on the principles of thermodynamics and applying it to a hypothetical group of residences, its ability to balance daily fluctuations in electricity demand is explored. The result show that the system is able to cover some of the demand but there is no economic profit to be gained. The results of this report suggest that a CAES system of this size is not a viable option during current price market for electricity in Sweden but during other circumstances it could be relevant. / Dagens energisystem kräver vissa tjänster för att kunna behålla stabilitet och tillgodose energibehovet. Energilagring är ett sätt att förse systemet med dessa tjänster samtidigt som det också skapar möjlighet att bättre utnyttja förnyelsebara energiresurser, som vind och sol, som annars kan vara för oförutsägbara för att kunna utnyttjas maximalt. I denna studie undersöks komprimerad luft som energilagring (CAES). Sammanfattningsvis används billig elektricitet under timmar då elförbrukningen är låg för att komprimera luft och lagra denna för att sedan expandera luften igen och på så vis generera elektricitet vid behov eller då det finns ekonomisk vinstmöjlighet. CAES systemet kan vara uppbyggt och dimensionerat på flera olika sätt vilket undersöks samt beskrivs i närmare detalj. Möjligheten att använda CAES i liten skala för att tillgodose ett dagligen varierande energibehov undersöks och det utrönas ifall detta är ekonomiskt gynnsamt eller inte. Detta undersöks genom att skapa en modell över ett CAES-system som appliceras på energibehovet för en grupp bostäder. Resultatet visar att systemet kan täcka en del av energibehovet men ekonomisk vinning är inte möjligt. Utifrån dessa resultat konstateras att CAES i liten skala inte är ett ekonomiskt försvarbart alternativ för att täcka toppar i ett varierande energibehov vid det rådande energipriset i Sverige men under andra omständigheter skulle det kunna vara möjligt.

The potential for electrical energy storage to both provide services to the electrical grid and help to better integrate renewable energies in the electrical system is promising. This report investigates one type of storage, compressed air energy storage (CAES), where energy is stored by compressing air during hours of low electricity demand and later expanding the air to generate electricity during high demand hours. To this day it exists two large plants, but small facilities have yet to be implemented, raising the question whether it could be viable to use CAES on a smaller scale as well. By creating a model of a CAES system based on the principles of thermodynamics and applying it to a hypothetical group of residences, its ability to balance daily fluctuations in electricity demand is explored. The result show that the system is able to cover some of the demand but there is no economic profit to be gained. The results of this report suggest that a CAES system of this size is not a viable option during current price market for electricity in Sweden but during other circumstances it could be relevant. / Dagens energisystem kräver vissa tjänster för att kunna behålla stabilitet och tillgodose energibehovet. Energilagring är ett sätt att förse systemet med dessa tjänster samtidigt som det också skapar möjlighet att bättre utnyttja förnyelsebara energiresurser, som vind och sol, som annars kan vara för oförutsägbara för att kunna utnyttjas maximalt. I denna studie undersöks komprimerad luft som energilagring (CAES). Sammanfattningsvis används billig elektricitet under timmar då elförbrukningen är låg för att komprimera luft och lagra denna för att sedan expandera luften igen och på så vis generera elektricitet vid behov eller då det finns ekonomisk vinstmöjlighet. CAES systemet kan vara uppbyggt och dimensionerat på flera olika sätt vilket undersöks samt beskrivs i närmare detalj. Möjligheten att använda CAES i liten skala för att tillgodose ett dagligen varierande energibehov undersöks och det utrönas ifall detta är ekonomiskt gynnsamt eller inte. Detta undersöks genom att skapa en modell över ett CAES-system som appliceras på energibehovet för en grupp bostäder. Resultatet visar att systemet kan täcka en del av energibehovet men ekonomisk vinning är inte möjligt. Utifrån dessa resultat konstateras att CAES i liten skala inte är ett ekonomiskt försvarbart alternativ för att täcka toppar i ett varierande energibehov vid det rådande energipriset i Sverige men under andra omständigheter skulle det kunna vara möjligt.

for the master's thesis The structure of the master's thesis includes an introduction, three chapters, a conclusion, the references and applications. The foundations of the complex and spatial development of the city and their features are determined in the first chapter. The main directions of the complex development of the city are systematized and examples and peculiarities of quarterly construction and foreign experience of implementing projects based on the principle of quarterly development are considered. The second chapter describes the methodological aspects of the study on the choice of the strategy for the implementation of the project. The socio-economic consequences of realizing development projects and on their results the forming of the optimal way of construction are also examined. The residential property market in the city of Yekaterinburg is also analyzed. The third chapter presents an analysis of the development project, implemented by the necessary criteria and carried out its economic evaluation. The project budget was drawn up and the efficiency of the investment project for the construction of the residential property was assessed. The main part of the thesis is presented in 90 pages, contains 7 tables, 2 figures and 2 formulas. / Структура магистерской диссертации включает в себя введение, три главы, заключение, список использованных источников и приложения. В первой главе определяются основы комплексного и пространственного развития города и их особенности. Систематизируются основные направления комплексного развития города и рассматриваются примеры и особенности квартальной застройки и зарубежный опыт реализации проектов, основанных на принципе квартальной застройки. Во второй главе проводится анализ методических аспектов исследования по выбору стратегии реализации проекта. Рассмотрены социально-экономические последствия реализации девелоперских проектов и на их результатах cформированы оптимальные пути строительства. Также анализируется рынок жилой недвижимости в городе Екатеринбурге. В третьей главе представлен анализ девелоперского проекта, реализуемого по необходимым критериям и проведена его экономическая оценка. Составлен бюджет проекта и проведена оценка эффективности инвестиционного проекта по строительству объекта жилой недвижимости. Основная часть диссертационной работы изложена на 90 страницах, содержит 7 таблиц, 2 рисунка и 2 формулы.

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

Introduction: Quality improvement (QI) encompasses a wide range of healthcare studies and activities with the common goal of improving patient outcomes, healthcare system performance, and professional development. QI is characterized by a diversity of definitions, stakeholders, clinical fields and study designs, which creates challenges for rigorous reporting and evaluation of these studies. Understanding and addressing the methodological issues that arise from conducting QI studies from multiple clinical disciplines is critical for generating good evidence for healthcare improvement to tackle health system challenges. Objectives: This thesis addressed three independent objectives: (i) Determine the quality of reporting of QI studies in neonatology. (ii) Compare different statistical methods that can be used to analyze data from a cluster randomized controlled trial with repeated measures data and examine how the estimate of intervention effects varies between these approaches. (iii) Determine the cost-effectiveness of providing timely surgery or timely rehabilitation for patients with hip fracture. Methods: Objective 1: We conducted a systematic survey of quality improvement studies in neonatology to examine the extent to which these publications adhered to SQUIRE 2.0, the guidelines for reporting studies that sought to improve the quality, safety, and value of healthcare. Using the same set of articles, we examined how various methodological attributes, such as stakeholder engagement, outcome measures, and statistical process controls, are reported in these studies. Objective 2: To compare the differences in the statistical estimates of intervention effects between linear mixed models and Generalized Estimating Equations, for the CP@Clinic Program cluster randomized RCT, which contains routinely collected monthly outcome data aggregated at the cluster level. Objective 3: We constructed a Markov cohort model to estimate the cost-effectiveness of receiving timely surgery within 24 hours of admission to the emergency department, receiving immediate admission to inpatient rehabilitation following acute care discharge, receiving both, or none. Results: Objective 1: In our assessment of reporting quality, we found that adherence to SQUIRE 2.0 guidelines was inadequate and that journals should endorse the SQUIRE 2.0 guideline for improvement publications to alleviate this issue. We found that process measures was the most frequently reported methodological attribute (89%), while stakeholder engagement with leadership (32%) or caregivers (10%) were infrequently reported or conducted. Objective 2: In comparing statistical methods for analyzing a cluster randomized controlled trial with correlated data, we found that it was critical to apply a correction to the variance estimator of generalized estimating equations to produce robust estimates of the intervention effects. Objective 3: In our economic evaluation, both timely surgery alone and the combination of timely surgery and timely rehabilitation yielded cost-effective improvements in the quality-adjusted life-years of patients with hip fracture. However, the combination of receiving timely surgery and timely rehabilitation requires a high willingness-to-pay threshold, above $128,000 per quality-adjusted life-years, to be considered cost-effective. Conclusions: Overall, understanding the state of reporting and the broad spectrum of methods and methodologic issues for evaluating quality improvement initiatives will advance its rigorous research, evaluation, reporting, and contribution towards informed decision-making for tackling pressing healthcare issues. / Thesis / Doctor of Philosophy (PhD) / Quality improvement (QI) is a field of healthcare research that can be defined in many ways, and research in this field is conducted by researchers from various medical disciplines. Consequently, challenges may arise in reporting and evaluating QI interventions. Thus, it is important to examine how QI interventions are reported in academic literature and the methods used to evaluate their effectiveness in improving health. The current thesis aims to address these issues through three independent objectives: (1) examine the details reported in QI studies in neonatology, (2) compare different statistical methods that can be used to analyze data from a community paramedicine cluster randomized controlled trial, and (3) investigate whether providing timely surgery and timely hospital-based rehabilitation is a cost-effective way to improve the quality of life of patients who have experienced hip fracture. The findings of these studies will provide insights into the challenges of reporting and evaluating QI interventions, and suggest ways to improve them.

Les nouvelles technologies médicales contribuent aux dépenses en santé qui ne cessent de croître, alors que les budgets se trouvent limités. L’évaluation économique des technologies devraient permettre d’identifier quelles sont celles qui sont les plus rentables. Malgré cela, plusieurs technologies dont le rapport coût-efficacité reste plutôt limite ou défavorable sont utilisées en médecine moderne et remboursées par notre système public de santé. Ce mémoire se concentre sur deux technologies en santé cardiovasculaire dont le rapport coût-efficacité est plutôt limite mais qui sont fréquemment utilisées au Canada; les tuteurs médicamentés ou pharmaco-actifs et les défibrillateurs cardiaques implantables (DCI). Nous avons fait une évaluation contingente de ces technologies dans le but d’examiner si ce type d’évaluation économique complémentaire pouvait procurer un point de vue nouveau sur la valeur économique et sociétaire des ces technologies. Les résultats de ces deux évaluations indiquent que les patients accordent une grande importance aux bénéfices que procurent ces deux technologies. Nos résultats soutiennent les politiques de santé actuelles de rembourser de façon libérale ces deux technologies. / Technological innovations have greatly contributed to the rising costs in healthcare, while budgets have remained limited. Economic evaluations of technologies should identify which technologies are cost-effective. However, several technologies used in modern medicine are either borderline cost-effective or even not cost-effective according to many studies. This thesis focuses on two technologies in cardiovascular medicine which are considered borderline cost-effective; drug-eluting stents and implantable cardioverter defibrillators. We conducted a contingent valuation of these technologies in hopes of determining if this alternative type of economic evaluation could give a novel point of view on the economic and societal value of these technologies. Results indicated that patients greatly valued benefits provided by these two technologies. Our result support our public healthcare system policies’ of liberal reimbursement of these two technologies.