Search results for: healthcare costs

Authors: Maryam Zahmatkesh

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Middle managers form a significant occupational category in organisations. They undertake a vital role, as they sit between the operational and strategic roles. Traditionally they were acting as diplomat administrators, and were only in power to meet the demands of professionals. Following the introduction of internal market, in line with the principles of New Public Management, middle managers have been considered as change agents. More recently, in the debates of middle managers, there is emphasis on entrepreneurialism and enacting strategic role. It was assumed that granting autonomy to the local organisations and the inception of semi-autonomous hospitals (Foundation Trusts in England and Board of Trustees in Iran) would give managers more autonomy to act proactively and innovatively. This thesis explores the hospital middle managers’ perception of and responses to public management reforms (in particular, hospital autonomy) in England and Iran. In order to meet the aims of the thesis, research was undertaken within the interpretative paradigm, in line with social constructivism. Data were collected from interviews with forty-five middle managers, observational fieldwork and documentary analysis across four teaching university hospitals in England and Iran. The findings show the different ways middle managers’ autonomy is constrained in the two countries. In England, middle managers have financial and human recourses, but their autonomy is constrained by government policy and targets. In Iran, middle managers are less constrained by government policy and targets, but they do not have financial and human resources to exercise autonomy. Unbalanced autonomy causes tension and frustration for middle managers. According to neo-institutional theory, organisations are deeply embedded within social, political, economic and normative settings that exert isomorphic and internal population-level pressures to conform to existing and established modes of operation. Health systems which are seeking to devolve autonomy to middle managers must appreciate the multidimensional nature of the autonomy, as well as the wider environment that organisations are embedded, if they are about to improve the performance of managers and their organisations.

Keywords: autonomy, healthcare organisations, middle managers, new public management

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Authors: Zixuan Liu, Xin Zhang, Kexin He

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In the context of widespread prevalence of multiple diseases, medication safety has become a highly concerned issue affecting patient safety. Medication reconciliation plays a vital role in preventing potential medication risks. However, in medical practice, medication reconciliation faces various challenges, and there is a wide variety of medication reconciliation tools, making the selection of appropriate tools somewhat difficult. The article introduces and analyzes the currently available medication reconciliation tools, providing a reference for healthcare professionals to choose and apply the appropriate medication reconciliation tools.

Keywords: patient safety, medication reconciliation, tools, review

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Authors: Sung Hee Ahn, Ju Rang Han

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Background: With increasing importance in healthcare organization on patient satisfaction and nurses’ job satisfaction, many studies have been conducted. But no research has been administered how nurses’ satisfaction with healthcare organization influence patient satisfaction and loyalty. Purpose: This study aims to conceptualize nurses‘ satisfaction, patient satisfaction with and patient loyalty to hospitals using a hypothetical linear structural equation model, and to identify the significance of path coefficients and goodness of fit index of the structural equation model as well. Method: A total of 2,079 nurses and 6,776 patients recruited from 5 university hospitals in South Korea participated in this study. The data on nurses, including ward nurses and outpatient nurses, were collected from June 24th to July 12th, at the 204 departments of the 5 hospitals through an on-line survey. The data on the patients, including both inpatients and outpatients, were collected from September 30th to October 24th, 2013 at the 5 hospitals using a structured questionnaire. The variable of nurses’ satisfaction was measured using a scale evaluating internal client satisfaction, which is used in SSM Health Care System in the US. Patient satisfaction with the hospital and nurses and patient loyalty were measured by assessing the patient’s intention to revisit and to recommending the hospital to others using a visual analogue scale. The data were analyzed using SPSS version 21.0 and AMOS version 21.0. Result: The hypothetical model was fairly good in terms of goodness of fit (χ2= 64.897 (df=24, p <. 001), GFI=. 906, AGFI=.823, CFI=.921, NFI=.951, NNFI=.952. RMSEA=.114). The significance of path coefficients includes followings 1)The nurses’ satisfaction has significant influence on the patient satisfaction with nurses. 2)The patient satisfaction with nurses has significant influence on the patient satisfaction with the hospital. 3)The patient satisfaction with the hospital has significant influence on the patients’ revisit intention. 4)The patient satisfaction with the hospital has significant influence on the patients’ intention to the recommendations of the hospital. Conclusion: These results provide several practical implications to hospital administrators, who should incorporate ways of improving nurses' and patients' satisfaction with the hospital into their health care marketing strategies.

Keywords: linear structural equation model, loyalty, nurse, patient satisfaction

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Authors: Mabel Usunobun Olanipekun, Henry Ogbemudia Omoregbee

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Anomalies such as water pipeline and hydraulic or petrochemical pipeline network leakages and bursts have significant implications for economic conditions and the environment. In order to ensure pipeline systems are reliable, they must be efficiently controlled. Wireless Sensor Networks (WSNs) have become a powerful network with critical infrastructure monitoring systems for water, oil and gas pipelines. The loss of water, oil and gas is inevitable and is strongly linked to financial costs and environmental problems, and its avoidance often leads to saving of economic resources. Substantial repair costs and the loss of precious natural resources are part of the financial impact of leaking pipes. Pipeline systems experts have implemented various methodologies in recent decades to identify and locate leakages in water, oil and gas supply networks. These methodologies include, among others, the use of acoustic sensors, measurements, abrupt statistical analysis etc. The issue of leak quantification is to estimate, given some observations about that network, the size and location of one or more leaks in a water pipeline network. In detecting background leakage, however, there is a greater uncertainty in using these methodologies since their output is not so reliable. In this work, we are presenting a scalable concept and simulation where a pressure-driven model (PDM) was used to determine water pipeline leakage in a system network. These pressure data were collected with the use of acoustic sensors located at various node points after a predetermined distance apart. We were able to determine with the use of correlation difference to determine the leakage point locally introduced at a predetermined point between two consecutive nodes, causing a substantial pressure difference between in a pipeline network. After de-noising the signal from the sensors at the nodes, we successfully obtained the exact point where we introduced the local leakage using the correlation difference model we developed.

Keywords: leakage detection, acoustic signals, pipeline network, correlation, wireless sensor networks (WSNs)

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Authors: Rimon Rafiah

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This paper will present a combination of two seemingly unrelated models, which are the one for estimating economic development impacts as a result of transportation investment and the other for increasing CAV penetration in order to reduce congestion. Measuring economic development impacts resulting from transportation investments is becoming more recognized around the world. Examples include the UK’s Wider Economic Benefits (WEB) model, Economic Impact Assessments in the USA, various input-output models, and additional models around the world. The economic impact model is based on WEB and is based on the following premise: investments in transportation will reduce the cost of personal travel, enabling firms to be more competitive, creating additional throughput (the same road allows more people to travel), and reducing the cost of travel of workers to a new workplace. This reduction in travel costs was estimated in out-of-pocket terms in a given localized area and was then translated into additional employment based on regional labor supply elasticity. This additional employment was conservatively assumed to be at minimum wage levels, translated into GDP terms, and from there into direct taxation (i.e., an increase in tax taken by the government). The CAV model is based on economic principles such as CAV usage, supply, and demand. Usage of CAVs can increase capacity using a variety of means – increased automation (known as Level I thru Level IV) and also by increased penetration and usage, which has been predicted to go up to 50% by 2030 according to several forecasts, with possible full conversion by 2045-2050. Several countries have passed policies and/or legislation on sales of gasoline-powered vehicles (none) starting in 2030 and later. Supply was measured via increased capacity on given infrastructure as a function of both CAV penetration and implemented technologies. The CAV model, as implemented in the USA, has shown significant savings in travel time and also in vehicle operating costs, which can be translated into economic development impacts in terms of job creation, GDP growth and salaries as well. The models have policy implications as well and can be adapted for use in Japan as well.

Keywords: CAV, economic development, WEB, transport economics

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Authors: Bianca Koroschetz, Emma Mäenpää

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The purpose of this paper is to study consumer practices and meanings of different antifouling methods in order to identify the main barriers for sustainable consumption of antifouling products in the Baltic Sea. The Baltic Sea is considered to be an important tourism area. More than 3.5 million leisure boaters use the sea for recreational boating. Most leisure boat owners use toxic antifouling paint to keep barnacles from attaching to the hull. Attached barnacles limit maneuverability and add drag which in turn increases fuel costs. Antifouling paint used to combat barnacles causes particular problems, as the use of these products continuously adds to the distribution of biocides in the coastal ecosystem and leads to the death of marine organisms. To keep the Baltic Sea as an attractive tourism area measures need to be undertaken to stop the pollution coming from toxic antifouling paints. The antifouling market contains a wide range of environment-friendly alternative products such as a brush wash for boats, hand scrubbing devices, hull covers and boat lifts. Unfortunately, not a lot of boat owners use these environment-friendly alternatives and instead prefer the use of the traditional toxic copper paints. We ask “Why is the unsustainable consumption of toxic paints still predominant when there is a big range of environment-friendly alternatives available? What are the barriers for sustainable consumption?” Environmental psychology has concentrated on developing models of human behavior, including the main factors that influence pro-environmental behavior. The main focus of these models was directed to the individual’s attitudes, principals, and beliefs. However, social practice theory emphasizes the importance to study practices, as they have a stronger explanatory power than attitude-behavior to explain unsustainable consumer behavior. Thus, the study focuses on describing the material, meaning and competence of antifouling practice in order to understand the social and cultural embeddedness of the practice. Phenomenological interviews were conducted with boat owners using antifouling products such as paints and alternative methods. This data collection was supplemented with participant observations in marinas. Preliminary results indicate that different factors such as costs, traditions, advertising, frequency of use, marinas and application of method impact on the consumption of antifouling products. The findings have shown that marinas have a big influence on the consumption of antifouling goods. Some marinas are very active in supporting the sustainable consumption of antifouling products as for example in Stockholm area several marinas subsidize costs for using environmental friendly alternatives or even forbid toxic paints. Furthermore the study has revealed that environmental friendly methods are very effective and do not have to be more expensive than painting with toxic paints. This study contributes to a broader understanding why the unsustainable consumption of toxic paints is still predominant when a big range of environment-friendly alternatives exist. Answers to this phenomenon will be gained by studying practices instead of attitudes offering a new perspective on environmental issues.

Keywords: antifouling paint, Baltic Sea, boat tourism, sustainable consumption

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Authors: Riccardo Patriarca, Giulio Di Gravio, Francesco Costantino, Massimo Tronci

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An accurate inventory management policy acquires a crucial role in the several high-availability sectors. In these sectors, due to the high-cost of spares and backorders, an (S-1, S) replenishment policy is necessary for high-availability items. The policy enables the shipment of a substitute efficient item anytime the inventory size decreases by one. This policy can be modelled following the Multi-Echelon Technique for Recoverable Item Control (METRIC). The METRIC is a system-based technique that allows defining the optimum stock level in a multi-echelon network, adopting measures in line with the decision-maker’s perspective. The METRIC defines an availability-cost function with inventory costs and required service levels, using as inputs data about the demand trend, the supplying and maintenance characteristics of the network and the budget/availability constraints. The traditional METRIC relies on the hypothesis that a Poisson distribution well represents the demand distribution in case of items with a low failure rate. However, in this research, we will explore the effects of using a Poisson distribution to model the demand of low failure rate items characterized by an irregular demand trend. This characteristic of a demand is not included in the traditional METRIC formulation leading to the need of revising its traditional formulation. Using the CV (Coefficient of Variation) and ADI (Average inter-Demand Interval) classification, we will define the inherent flaws of Poisson-based METRIC for irregular demand items, defining an innovative ad hoc distribution which can better fit the irregular demands. This distribution will allow defining proper stock levels to reduce stocking and backorder costs due to the high irregularities in the demand trend. A case study in the aviation domain will clarify the benefits of this innovative METRIC approach.

Keywords: METRIC, inventory management, irregular demand, spare parts

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Authors: Felipa De Mello-Sampayo

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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.

Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time

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Authors: Haniehsadat Jameie, Halil Zafer Alibaba

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Providing thermal comfort in urban spaces for vulnerable groups, particularly children, remains a critical yet often overlooked priority in private and governmental initiatives. Shading devices play a vital role in urban environments, regulating thermal comfort and, when integrated with photovoltaic (PV) systems, generating clean energy while enhancing user satisfaction. Cyprus, with over 300 sunny days annually, offers a unique opportunity for solar energy integration. This research investigates the design of PV-integrated shading devices for a primary school in Famagusta, Cyprus, aiming to enhance students' outdoor thermal comfort and reduce dependency on fossil fuels through efficient use of open spaces. The study employs site observations, surveys, and statistical analysis to evaluate the impact of these devices. Findings reveal significant discomfort among students and staff due to inadequate thermally comfortable outdoor spaces and high energy costs for indoor climate control. The proposed solution requires an initial investment of $1,500,000 and offers annual power generation approximately 10 times the current consumption, resulting in $500,000 in annual energy savings and surplus energy sales, with a payback period of three years. Recommendations include installing PV-integrated shading for sports spaces, parking lots, and gathering areas, as well as rooftop PV panels to maximize renewable energy generation. Beyond improving thermal comfort and reducing energy costs, this initiative fosters community engagement in outdoor spaces, enhancing societal well-being. The study concludes with recommendations for integrating sustainable urban planning practices in Cyprus.

Keywords: photovoltaic shading devices, thermal comfort, societal well-being, sustainable urban design

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Authors: Gayani K. Nandasiri, Tilak Dias, William Hurley

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Venous disease of human lower limb could range from minor asymptomatic incompetence of venous valves to chronic venous ulceration. The sheer prevalence of varicose veins and its associated significant costs of treating late complications such as chronic ulcers contribute to a higher burden on health care resources. In most of western countries with developed health care systems, treatment costs associated with Venous disease accounts for a considerable portion of their total health care budget, and it has become a high-cost burden to National Health Service (NHS), UK. The established gold standard of treatment for the venous disease is the graduated compression, where the pressure at the ankle being highest and decreasing towards the knee and thigh. Currently, medical practitioners use two main methods to treat venous disease; i.e. compression bandaging and compression stockings. Both these systems have their own disadvantages which lead to the current programme of research. The aim of the present study is to revolutionize the compression therapy by using a novel active compression system to deliver a controllable and more accurate pressure profiles using a series of inflatable mini bladders. Two types of commercially available silicones were tested for the application. The mini bladders were designed with a special fabrication procedure to provide required pressure profiles, and a series of experiments were conducted to characterise the mini bladders. The inflation/deflation heights of these mini bladders were investigated experimentally and using a finite element model (FEM), and the experimental data were compared to the results obtained from FEM simulations, which showed 70-80% agreement. Finally, the mini bladders were tested for its pressure transmittance characteristics, and the results showed a 70-80% of inlet air pressure transmitted onto the treated surface.

Keywords: finite element analysis, graduated compression, inflatable bladders, venous disease

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Authors: Lin Meng, Xi Lu, Haibo Wang, Yong Song, Lili Cao, Wenfang Song, Yong Hu

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China has abundant heavy oil resources, and thermal recovery is the main recovery method for heavy oil reservoirs. However, high energy consumption, high carbon emission and high production costs make heavy oil thermal recovery unsustainable. It is urgent to explore a replacement for developing technology. A low Carbon and cost technology of heavy oil recovery, chemical viscosity-reduction in layer (CVRL), is developed by the petroleum exploration and development research institute of Sinopec via investigated mechanisms, synthesized products, and improved oil production technologies, as follows: (1) Proposed a cascade viscous mechanism of heavy oil. Asphaltene and resin grow from free molecules to associative structures further to bulk aggregations by π - π stacking and hydrogen bonding, which causes the high viscosity of heavy oil. (2) Aimed at breaking the π - π stacking and hydrogen bond of heavy oil, the copolymer of N-(3,4-dihydroxyphenethyl) acryl amide and 2-Acrylamido-2-methylpropane sulfonic acid was synthesized as a viscosity reducer. It achieves a viscosity reduction rate of>80% without shearing for heavy oil (viscosity < 50000 mPa‧s), of which fluidity is evidently improved in the layer. (3) Synthesized hydroxymethyl acrylamide-maleic acid-decanol ternary copolymer self-assembly plugging agent. The particle size is 0.1 μm-2 mm adjustable, and the volume is 10-500 times controllable, which can achieve the efficient transportation of viscosity reducer to enriched oil areas. CVRL has applied 400 wells until now, increasing oil production by 470000 tons, saving 81000 tons of standard coal, reducing CO2 emissions by 174000 tons, and reducing production costs by 60%. It promotes the transformation of heavy oil towards low energy consumption, low carbon emissions, and low-cost development.

Keywords: heavy oil, chemical viscosity-reduction, low carbon, viscosity reducer, plugging agent

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Authors: Robin Molinier

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Industrial symbiosis (I.S) rely on two modes of cooperation that are infrastructure sharing and resource substitution to obtain economic and environmental benefits. The former consists in the intensification of use of an asset while the latter is based on the use of waste, fatal energy (and utilities) as alternatives to standard inputs. Both modes, in fact, rely on the shift from a business-as-usual functioning towards an alternative production system structure so that in a business point of view the distinction is not clear. In order to investigate the way those cooperation modes can be distinguished, we consider the stakeholders' interplay in the business model structure regarding their resources and requirements. For infrastructure sharing (following economic engineering literature) the cost function of capacity induces economies of scale so that demand pooling reduces global expanses. Grassroot investment sizing decision and the ex-post pricing strongly depends on the design optimization phase for capacity sizing whereas ex-post operational cost sharing minimizing budgets are less dependent upon production rates. Value is then mainly design driven. For resource substitution, synergies value stems from availability and is at risk regarding both supplier and user load profiles and market prices of the standard input. Baseline input purchasing cost reduction is thus more driven by the operational phase of the symbiosis and must be analyzed within the whole sourcing policy (including diversification strategies and expensive back-up replacement). Moreover, while resource substitution involves a chain of intermediate processors to match quality requirements, the infrastructure model relies on a single operator whose competencies allow to produce non-rival goods. Transaction costs appear higher in resource substitution synergies due to the high level of customization which induces asset specificity, and non-homogeneity following transaction costs economics arguments.

Keywords: business model, capacity, sourcing, synergies

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Authors: Bliss Singhal

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Epilepsy is a prevalent neurological disorder affecting approximately 50 million individuals worldwide and 1.2 million Americans. There exist millions of pediatric patients with intractable epilepsy, a condition in which seizures fail to come under control. The occurrence of seizures can result in physical injury, disorientation, unconsciousness, and additional symptoms that could impede children's ability to participate in everyday tasks. Predicting seizures can help parents and healthcare providers take precautions, prevent risky situations, and mentally prepare children to minimize anxiety and nervousness associated with the uncertainty of a seizure. This research proposes a comprehensive framework to predict seizures in pediatric patients by evaluating machine learning algorithms on unimodal neuroimaging data consisting of electroencephalogram signals. The bandpass filtering and independent component analysis proved to be effective in reducing the noise and artifacts from the dataset. Various machine learning algorithms’ performance is evaluated on important metrics such as accuracy, precision, specificity, sensitivity, F1 score and MCC. The results show that the deep learning algorithms are more successful in predicting seizures than logistic Regression, and k nearest neighbors. The recurrent neural network (RNN) gave the highest precision and F1 Score, long short-term memory (LSTM) outperformed RNN in accuracy and convolutional neural network (CNN) resulted in the highest Specificity. This research has significant implications for healthcare providers in proactively managing seizure occurrence in pediatric patients, potentially transforming clinical practices, and improving pediatric care.

Keywords: intractable epilepsy, seizure, deep learning, prediction, electroencephalogram channels

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Authors: Thuraya Ahmed Al Shidhani, Yahya Al Farsi, Alya Al Husni, Samir Al Adawi

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Background: Knee osteoarthritis (knee OA) represents a major public health burden worldwide, particularly among older adults. However, little has been documented from Arabian Gulf countries, which have left an information gap. Objective: This study describes the socio-demographic, clinical risk factors, and use of herbal medicine among men and women seeking consultation for knee OA at two secondary healthcare facilities in Muscat, Oman. Methods: A cross-sectional study was conducted among 213 Omani adults with knee OA attending a referral polyclinic in Muscat, Oman, over 12 months from January to December. Socio-demographic data were collected from the participants who are seeking consultation for knee OA. Results: Among the 213 study participants, 171 were females and 42 males. The females were comparatively older than the males, had lower education and lower-income, and more overweight. The majority of the participants were normal weight or underweight. About one-third of participants reported OA in other joints as well. Most participants recalled that they had knee OA for less than a year. About 12% reported a history of trauma. The majority (63%) concurrently had other chronic illnesses, and 33% reported having at least one complication. About 22% were using herbal medicines. About 77% are using herbal local applications in form of powder and creams. Conclusion: This study, to our knowledge, is the first to explore socio-demographic characteristics, clinical risk factors and use of herbal medicine among sufferers of knee OA in Oman. Knee OA tended to occur among our participants at younger ages than reported elsewhere, while obesity appeared orthogonal to the severity of knee OA. Women were more affected than men. About one quarter of Omani patients are using herbal medicine. More studies are needed to understand the causal factors and development of knee OA in Oman. Targeted health education and rehabilitation programs are needed, particularly among Omani women, to improve their physical quality of life.

Keywords: knee joint, osteoarthritis, herbal medicine, Oman

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Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Poojan Kothari, Yash Madhani, Chayan Jani, Bharti Saini

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The requirements for quality drinking and industrial water are increasing and water resources are depleting. Moreover large amount of wastewater is being generated and dumped into water bodies without treatment. These have made improvement in water treatment efficiency and its reuse, an important agenda. Membrane technology for wastewater treatment is an advanced process and has become increasingly popular in past few decades. There are many traditional methods for tertiary treatment such as chemical coagulation, adsorption, etc. However recent developments in membrane technology field have led to manufacturing of better quality membranes at reduced costs. This along with the high costs of conventional treatment processes, high separation efficiency and relative simplicity of the membrane treatment process has made it an economically viable option for municipal and industrial purposes. Ultrafiltration polymeric membranes can be used for wastewater treatment and drinking water applications. The proposed work focuses on preparation of one such UF membrane - Polyvinylidene fluoride (PVDF) doped with LiBr for wastewater treatment. Majorly all polymeric membranes are hydrophobic in nature. This property leads to repulsion of water and hence solute particles occupy the pores, decreasing the lifetime of a membrane. Thus modification of membrane through addition of small amount of salt such as LiBr helped us attain certain characteristics of membrane, which can then be used for wastewater treatment. The membrane characteristics are investigated through measuring its various properties such as porosity, contact angle and wettability to find out the hydrophilic nature of the membrane and morphology (surface as well as structure). Pure water flux, solute rejection and permeability of membrane is determined by permeation experiments. A study of membrane characteristics with various concentration of LiBr helped us to compare its effectivity.

Keywords: Lithium bromide (LiBr), morphology, permeability, Polyvinylidene fluoride (PVDF), solute rejection, wastewater treatment

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Authors: Maria Kralova, Michal Palecek

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We have detected factors leading to recidivism (the Czech Republic data). The employment during imprisonment turned out to be the most significant predictor with a positive effect on reduction of a rate of recidivism. Accordingly, we mainly focus on this predictor and its economic consequences. Smart public policy can cut government costs dramatically as more than a half of prisoners in the Czech Republic are recidivists. The operating cost cut of the Czech prison service could be CZK 127,680,000 (USD 5,889,623) in 2013 if a public policy had been set smarter.

Keywords: cost-cut, effective, optimal, public policy, reducing recidivism

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Authors: Shamsa Al Sharji, Athar Al Jabri, Haitham Al Dughaishi, Mirfat Al Barwani, Raja Al Rawahi, Raiya Al Rajhi, Shurooq Al Ruqaishi, Thamreen Al Zadjali, Iman Al Humaidi

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Background: External Ventricular Drains (EVDs) are critical in managing traumatic brain injuries and hydrocephalus by controlling intracranial pressure, but they carry a high risk of infection. Infection rates vary globally, ranging from 5% to 45%, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Nursing protocols play a pivotal role in reducing these infection rates. This study investigates the impact of a structured nursing protocol on EVD-associated infections in adult neurosurgery patients at the Directorate General of Khoula Hospital, Oman, from January to September 2024. Methods: A cluster-randomized trial was conducted across neurosurgery wards and the ICU. The intervention group followed a comprehensive nursing protocol, including strict sterile insertion, standardized dressing changes, infection control training, and regular clinical audits. The control group received standard care. The primary outcome was the incidence of EVD-associated infections, with secondary outcomes including protocol compliance, infection severity, recovery times, length of stay, and 30-day mortality. Statistical analysis was conducted using Chi-square tests, paired t-tests, and logistic regression to assess the differences between groups. Results: The study involved 75 patients, with an overall infection rate of 13.3%. The intervention group showed a reduced infection rate of 8.9% compared to 20% in the control group. Compliance rates for key nursing actions were high, with 89.7% for hand hygiene and 86.2% for wound dressing. The relative risk of infection was 0.44 in the intervention group, reflecting a 55.6% reduction. Logistic regression identified obesity as a significant predictor of EVD infections. Although mortality rates were slightly higher in the intervention group, the number needed to treat (NNT) of 9 suggests that the nursing protocol may improve survival outcomes. Conclusion: This study demonstrates that structured nursing protocols can reduce EVD-related infections and improve patient outcomes in neurosurgery. While the findings are promising, further research with larger sample sizes is needed to confirm these results and optimize infection control strategies in neurosurgical care.

Keywords: EVD, CSF, nursing protocol, EVD infection

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Authors: M. D. Antoine

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Despite the widespread use of complementary and alternative medicine (CAM) for autistic children, little is known about the communication flow between the different parties involved in autism care (e.g., parents/caregivers, conventional providers, alternative practitioners). This study aimed to describe how communication occurs through the first year following an autism spectrum disorder (ASD) diagnosis to identify challenges and potential barriers to communication within the healthcare system in Ottawa, Canada. From an ecological perspective, we collected qualitative data through 12 semi-structured interviews with six parents/caregivers, three conventional providers (e.g., family doctor, neurodevelopmental pediatrician, psychologist), and three alternative practitioners (e.g., naturopath, occupational therapist, speech and language pathologist) operating in Ottawa. We interpreted the data using thematic analysis. Findings revealed communication challenges between the parents/caregivers and conventional providers while they experience better communication flow with fewer challenges in alternative care settings. However, parents/caregivers are the only links between the health professionals of both streams. From the five contexts examined: organizational, interpersonal, media, cultural, and political-legal, we found four themes (provider knowledge, care integration, flexible care, and time constraints) underlining specific barriers to communication flow between the parties involved in the care of autistic children. The increasing interest in alternative medicine is forcing changes in the healthcare system. Communications occur outside the norms making openings for better communication and information-sharing increasingly essential. Within the identified themes in the current study, the necessity for better communication between all parties involved in the care of autistic children is evident. More ASD and CAM-related training for providers would support effective parent/caregiver-provider communication. The findings of the current study contribute to a better understanding of the role of communication in the care management of autism, which has implications for effective autism care.

Keywords: alternative medicine, autism care management, autism spectrum disorder, conventional medicine, parent-provider communication

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Authors: Muzaffar Shaikh, Shoaib Shaikh, Mark Moyou, Gaby Hawat

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This paper presents the use of Analytic Hierarchy Process (AHP) in evaluating the site selection of a new plant by a corporation. Due to intense competition at a global level, multinational corporations are continuously striving to minimize production and shipping costs of their products. One key factor that plays significant role in cost minimization is where the production plant is located. In the U.S. for example, labor and land costs continue to be very high while they are much cheaper in countries such as India, China, Indonesia, etc. This is why many multinational U.S. corporations (e.g. General Electric, Caterpillar Inc., Ford, General Motors, etc.), have shifted their manufacturing plants outside. The continued expansion of the Internet and its availability along with technological advances in computer hardware and software all around the globe have facilitated U.S. corporations to expand abroad as they seek to reduce production cost. In particular, management of multinational corporations is constantly engaged in concentrating on countries at a broad level, or cities within specific countries where certain or all parts of their end products or the end products themselves can be manufactured cheaper than in the U.S. AHP is based on preference ratings of a specific decision maker who can be the Chief Operating Officer of a company or his/her designated data analytics engineer. It serves as a tool to first evaluate the plant site selection criteria and second, alternate plant sites themselves against these criteria in a systematic manner. Examples of site selection criteria are: Transportation Modes, Taxes, Energy Modes, Labor Force Availability, Labor Rates, Raw Material Availability, Political Stability, Land Costs, etc. As a necessary first step under AHP, evaluation criteria and alternate plant site countries are identified. Depending upon the fidelity of analysis, specific cities within a country can also be chosen as alternative facility locations. AHP experience in this type of analysis indicates that the initial analysis can be performed at the Country-level. Once a specific country is chosen via AHP, secondary analyses can be performed by selecting specific cities or counties within a country. AHP analysis is usually based on preferred ratings of a decision-maker (e.g., 1 to 5, 1 to 7, or 1 to 9, etc., where 1 means least preferred and a 5 means most preferred). The decision-maker assigns preferred ratings first, criterion vs. criterion and creates a Criteria Matrix. Next, he/she assigns preference ratings by alternative vs. alternative against each criterion. Once this data is collected, AHP is applied to first get the rank-ordering of criteria. Next, rank-ordering of alternatives is done against each criterion resulting in an Alternative Matrix. Finally, overall rank ordering of alternative facility locations is obtained by matrix multiplication of Alternative Matrix and Criteria Matrix. The most practical aspect of AHP is the ‘what if’ analysis that the decision-maker can conduct after the initial results to provide valuable sensitivity information of specific criteria to other criteria and alternatives.

Keywords: analytic hierarchy process, multinational corporations, plant site selection, preference ratings

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Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: Danielle Katrina Santos, Koji Shimada

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Environmentally-friendly agriculture has been promoted for over two decades as a response to the environmental challenges brought by climate change and biological loss. Located above the equator, it is possible that Japan may benefit from future climate change, yet Japan is also a rarely developed country located in the Asian Monsoon climate region, making it vulnerable to the impacts of climate change. In this regard, the Japanese government has initiated policies to adapt to the adverse effects of climate change through the promotion and popularization of environmentally-friendly farming practices. This study aims to determine profit efficiency among environmentally-friendly rice farmers in Shiga Prefecture using the Stochastic Frontier Approach. A cross-sectional survey was conducted among 66 farmers from top rice-producing cities through a structured questionnaire. Results showed that the gross farm income of environmentally-friendly rice farmers was higher by JPY 316,223.00/ha. Production costs were also found to be higher among environmentally-friendly rice farmers, especially on labor costs, which accounted for 32% of the total rice production cost. The resulting net farm income of environmentally-friendly rice farmers was only higher by JPY 18,044/ha. Results from the stochastic frontier analysis further showed that the profit efficiency of conventional farmers was only 69% as compared to environmentally-friendly rice farmers who had a profit efficiency of 76%. Furthermore, environmentally-friendly agriculture participation, other types of subsidy, educational level, and farm size were significant factors positively influencing profit efficiency. The study concluded that substitution of environmentally-friendly agriculture for conventional rice farming would result in an increased profit efficiency due to the direct payment subsidy and price premium received. The direct government policies that would strengthen the popularization of environmentally-friendly agriculture to increase the production of environmentally-friendly products and reduce pollution load to the Lake Biwa ecosystem.

Keywords: profit efficiency, environmentally-friendly agriculture, rice farmers, direct payment subsidies

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Authors: M. Brockes, S. Beck, A. Sigaroudi, C. Brockes

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Over the last few years, telemedicine and telemonitoring have become popular ways of treatment, especially in other chronic diseases. Therefore, this type of treatment methodology was also implemented in patients with interstitial lung disease (ILD). In January 2024, a new service for patients with interstitial lung disease (ILD) treated with Nintedanib was established, which contains daily telemonitoring (home spirometry, pulse oximetry, and daily level of activity), daily evaluation of parameters as well as a telemedical availability answered by doctors and telemedical specialists throughout 365 days per year. The main motivational points of this service are the early detection of first signs of exacerbations and/or other symptoms/complications, as well as easier access to healthcare professionals. The evaluation of the patient’s quality of life and the subjective feeling of safetyness was measured through patient-reported experience measurements (PREMs) and patient-reported outcome measurements (PROMs). Patients were introduced to the telemedical and telemonitoring service six months ago. Within this period, every sixty days, the questionnaires were conducted by the scientific employees. Due to the unlimited time frame of the long-term service, the evaluation has not been completed. The first analysis of patient-reported experience measurements (PREMs) and patient reported outcome measurements (PROMs) had shown an increased positive effect on the patients' quality of life as well as an increased positive effect on the subjective feeling of safety at home, plus a reduction and avoidance of secondary damages (e.g., exacerbations, deterioration of typical interstitial lung disease ILD symptoms and pharmaceutical side effects). The first results have shown a tendency that the telemedical treatment combined with telemonitoring at home and the encouragement of patients to actively participate in their healthcare has a positive effect on the patient’s overall well-being and could be implemented as a complementation of the traditional standard of care.

Keywords: avoidance of secondary damages, interstitial lung disease, telemedicine and telemonitoring, subjective feeling of safety

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Authors: M. G. Cattaneo

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The non-effectiveness of certain codified human rights is particularly apparent with reference to the lack of access to essential drugs in developing countries, which represents a breach of the human right to receive adequate health assistance. This paper underlines the conflict and the legal contradictions between human rights, namely health rights, international Intellectual Property Rights, in particular patent law, as well as international trade law. The paper discusses the crucial links between R&D costs for innovation, patents and new medical drugs, with the goal of reformulating the hierarchies of priorities and of interests at stake in the international intellectual property (IP) law system. Different from what happens today, International patent law should be a legal instrument apt at rebalancing an axiological asymmetry between the (conflicting) needs at stake The core argument in the paper is the proposal of an alternative pathway, namely a feasible proposal for a patent law reform. IP laws tend to balance the benefits deriving from innovation with the costs of the provided monopoly, but since developing countries and industrialized countries are in completely different political and economic situations, it is necessary to (re)modulate such exchange according to the different needs. Based on this critical analysis, the paper puts forward a proposal, called Trading Time for Space (TTS), whereby a longer time for patent exclusive life in western countries (Time) is offered to the patent holder company, in exchange for the latter selling the medical drug at cost price in developing countries (Space). Accordingly, pharmaceutical companies should sell drugs in developing countries at the cost price, or alternatively grant a free license for the sale in such countries, without any royalties or fees. However, such social service shall be duly compensated. Therefore, the consideration for such a service shall be an extension of the temporal duration of the patent’s exclusive in the country of origin that will compensate the reduced profits caused by the supply at the price cost in developing countries.

Keywords: global health, global justice, patent law reform, access to drugs

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Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

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Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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Authors: Jessica Raven Gates, Gemma Wilson-Menzfeld, Professor Alison Steven

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In 2019, the Primary Care system in the UK National Health Service (NHS) was subject to reform and restructuring. Primary Care Networks (PCNs) were established, which aligned with a trend towards integrated care both within the NHS and internationally. The introduction of PCNs brought groups of GP practices in a locality together, to operate as a network, build on existing services and collaborate at a larger scale. PCNs were expected to bring a range of benefits to patients and address some of the workforce pressures in the NHS, through an expanded and collaborative workforce. The early establishment of PCNs was disrupted by the emerging COVID-19 pandemic. This study, set in the context of the pandemic, aimed to explore experiences of the PCN workforce, and their perceptions of the establishment of PCNs. Specific objectives focussed on examining factors perceived as enabling or hindering the success of a PCN, the impact on day-to-day work, the approach to implementing change, and the influence of the COVID-19 pandemic upon PCN development. This study is part of a three-phase PhD project that utilized qualitative approaches and was underpinned by social constructionist philosophy. Phase 1: a systematic narrative review explored the provision of preventative healthcare services in UK primary settings and examined facilitators and barriers to delivery as experienced by the workforce. Phase 2: informed by the findings of phase 1, semi-structured interviews were conducted with fifteen participants (PCN workforce). Phase 3: follow-up interviews were conducted with original participants to examine any changes to their experiences and perceptions of PCNs. Three main themes span across phases 2 and 3 and were generated through a Framework Analysis approach: 1) working together at scale, 2) network infrastructure, and 3) PCN leadership. Findings suggest that through efforts to work together at scale and collaborate as a network, participants have broadly accepted the concept of PCNs. However, the workforce has been hampered by system design and system complexity. Operating against such barriers has led to a negative psychological impact on some PCN leaders and others in the PCN workforce. While the pandemic undeniably increased pressure on healthcare systems around the world, it also acted as a disruptor, offering a glimpse into how collaboration in primary care can work well. Through the integration of findings from all phases, a new theoretical model has been developed, which conceptualises the findings from this Ph.D. study and demonstrates how the workforce has experienced change associated with the establishment of PCNs. The model includes a contextual component of the COVID-19 pandemic and has been informed by concepts from Complex Adaptive Systems theory. This model is the original contribution to knowledge of the PhD project, alongside recommendations for practice, policy and future research. This study is significant in the realm of health services research, and while the setting for this study is the UK NHS, the findings will be of interest to an international audience as the research provides insight into how the healthcare workforce may experience imposed policy and service changes.

Keywords: health services research, qualitative research, NHS workforce, primary care

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Authors: Sania Bashir

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A promising approach to healthcare delivery, telemedicine makes use of communication technology to reach out to remote regions of the world, allowing for beneficial interactions between diabetic patients and healthcare professionals as well as the provision of affordable and easily accessible medical care. The emergence of contemporary care models, fueled by the pervasiveness of mobile devices, provides better information, offers low cost with the best possible outcomes, and is known as digital health. It involves the integration of collected data using software and apps, as well as low-cost, high-quality outcomes. The goal of this study is to assess how well telemedicine works for diabetic patients and how it impacts their HbA1c levels. A questionnaire-based survey of 300 diabetics included 150 patients in each of the groups receiving usual care and via telemedicine. A descriptive and observational study that lasted from September 2021 to May 2022 was conducted. HbA1c has been gathered for both categories every three months. A remote monitoring tool has been used to assess the efficacy of telemedicine and continuing therapy instead of the customary three monthly meetings like in-person consultations. The patients were (42.3) 18.3 years old on average. 128 men were outnumbered by 172 women (57.3% of the total). 200 patients (66.6%) have type 2 diabetes, compared to over 100 (33.3%) candidates for type 1. Despite the average baseline BMI being within normal ranges at 23.4 kg/m², the mean baseline HbA1c (9.45 1.20) indicates that glycemic treatment is not well-controlled at the time of registration. While patients who use telemedicine experienced a mean percentage change of 10.5, those who visit the clinic experienced a mean percentage change of 3.9. Changes in HbA1c are dependent on several factors, including improvements in BMI (61%) after 9 months of research and compliance with healthy lifestyle recommendations for diet and activity. More compliance was achieved by the telemedicine group. It is an undeniable reality that patient-physician communication is crucial for enhancing health outcomes and avoiding long-term issues. Telemedicine has shown its value in the management of diabetes and holds promise as a novel technique for improved clinical-patient communication in the twenty-first century.

Keywords: diabetes, digital health, mobile app, telemedicine

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Authors: Amèdédjihundé H. J. Hounnou, Frédéric Dubas, François-Xavier Fifatin, Didier Chamagne, Antoine Vianou

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This paper presents the techno-economic evaluation of run-of-river small-hydropower plants. In this regard, a multi-objective optimization procedure is proposed for the optimal sizing of the hydropower plants, and NSGAII is employed as the optimization algorithm. Annual generated energy and investment cost are considered as the objective functions, and number of generator units (n) and nominal turbine flow rate (Q_T) constitute the decision variables. Site of Yeripao in Benin is considered as the case study. We have categorized the river of this site using its environmental characteristics: gross head, and first quartile, median, third quartile and mean of flow. Effects of each decision variable on the objective functions are analysed. The results gave Pareto Front which represents the trade-offs between annual energy generation and the investment cost of hydropower plants, as well as the recommended optimal solutions. We noted that with the increase of the annual energy generation, the investment cost rises. Thus, maximizing energy generation is contradictory with minimizing the investment cost. Moreover, we have noted that the solutions of Pareto Front are grouped according to the number of generator units (n). The results also illustrate that the costs per kWh are grouped according to the n and rise with the increase of the nominal turbine flow rate. The lowest investment costs per kWh are obtained for n equal to one and are between 0.065 and 0.180 €/kWh. Following the values of n (equal to 1, 2, 3 or 4), the investment cost and investment cost per kWh increase almost linearly with increasing the nominal turbine flowrate while annual generated. Energy increases logarithmically with increasing of the nominal turbine flowrate. This study made for the Yeripao river can be applied to other rivers with their own characteristics.

Keywords: hydropower plant, investment cost, multi-objective optimization, number of generator units

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Authors: Alexander Hedlund, Anna-Karin Stengard, Olof Björkqvist

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A step towards reducing greenhouse gases and energy consumption is to collaborate with the energy system between several industries. This work is based on a case study on integration of pulp and paper mills with a district heating system in Sundsvall, Sweden. Present research shows that it is possible to make a significant reduction in the electricity demand in the mechanical pulping process. However, the profitability of the efficiency measures could be an issue, as the excess steam recovered from the refiners decreases with the electricity consumption. A consequence will be that the fuel demand for steam production will increase. If the fuel price is similar to the electricity price it would reduce the profit of such a project. If the paper mill can be integrated with a district heating system, it is possible to upgrade excess heat from a nearby kraft pulp mill to process steam via the district heating system in order to avoid the additional fuel need. The concept is investigated by using a simulation model describing both the mass and energy balance as well as the operating margin. Three scenarios were analyzed: reference, electricity reduction and energy substitution. The simulation show that the total input to the system is lowest in the Energy substitution scenario. Additionally, in the Energy substitution scenario the steam from the incineration boiler covers not only the steam shortage but also a part of the steam produced using the biofuel boiler, the cooling tower connected to the incineration boiler is no longer needed and the excess heat can cover the whole district heating load during the whole year. The study shows a substantial economic advantage if all stakeholders act together as one system. However, costs and benefits are unequally shared between the actors. This means that there is a need for new business models in order to share the system costs and benefits.

Keywords: energy system, cooperation, simulation method, excess heat, district heating

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Authors: Hamed Seddighi Khavidak

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Voluntary work has a lot of economic and social benefits for a country, but the economic value is ignored because it is voluntary. The aim of this study is reviewing Monetary Value of Voluntary Work methods and comparing opportunity cost method and replacement cost method both in theory and in practice. Beside monetary value, in this study, we discuss cost-benefit analysis of health and safety plan in the New Year that conducted by young volunteers of Red Crescent society of Iran. Method: We discussed eight methods for monetary value of voluntary work including: Alternative-Employment Wage Approach, Leisure-Adjusted OCA, Volunteer Judgment OCA, Replacement Wage Approach, Volunteer Judgment RWA, Supervisor Judgment RWA, Cost of Counterpart Goods and Services and Beneficiary Judgment. Also, for cost benefit analysis we drew on 'value audit and volunteer investment' (VIVA) technique that is used widely in voluntary organizations like international federation of Red Cross and Red Crescent societies. Findings: In this study, using replacement cost approach, voluntary work by 1034 youth volunteers was valued 938000000 Riyals and using Replacement Wage Approach it was valued 2268713232 Riyals. Moreover, Yazd Red Crescent Society spent 212800000 Riyals on food and other costs for these volunteers. Discussion and conclusion: In this study, using cost benefit analysis method that is Volunteer Investment and Value Audit (VIVA), VIVA rate showed that for every Riyal that the Red Crescent Society invested in the health and safety of New Year's travelers in its volunteer project, four Riyals returned, and using the wage replacement approach, 11 Riyals returned. Therefore, New Year's travelers health and safety project were successful and economically, it was worthwhile for the Red Crescent Society because the output was much bigger than the input costs.

Keywords: voluntary work, monetary value, youth, red crescent society

Procedia PDF Downloads 217