基层电大成人教育办学成本效益调查研究——以常德地区为例

本文对常德地区基层电大近三年(2010-2012)几种主要成人教育形式办学的收入支出情况进行了详细调查,并结合调查数据对基层电大成人教育办学的成本效益进行初步分析,希望能够对电大的系统建设和基层电大的发展提供有益的参考借鉴。

住宅建筑节能产品选用的成本-能效分析

住宅建筑节能作为建筑节能的重头戏,其意义和地位举足轻重。如何有效地选用同时满足节能要求和节省成本的产品已成为备受关注的问题。以典型住宅单元作为载体,分别对目前市场上常见的16种节能产品进行了成本-能效分析,并根据分析结果对这些产品的能效成本比进行了排名。这些产品的能效分析借助REM/Rate软件获得,成本价格结合全国定额水平和市场调查获得。结合开发商和业主所在地区的节能产品价格,本研究所提供的分析方法可用于优化节能产品的选用。

计划统计与成本管理创效

计划统计与成本管理是辩证统一的关系,计统是前提,成本管理与创效是目标,计统与成本管理相互间有机组合,共同推动项目管理的进程。本文在计划统计与成本管理内涵的基础上,重点阐述计统与成本管理的关系,计统与成本管理的操作程序及存在的问题及应对措施。计统与成本管理同为孪生姐妹,把握好两者间的关系并加以实施,既完善了项目管理体系的建设,又使项目的成本大幅降低,真正达到管理创效的目标。

铋剂四联疗法根除幽门螺杆菌疗效研究

目的比较不同疗程铋剂四联疗法与经典三联疗法根除幽门螺杆菌(Hp)的疗效。方法选择403例符合条件的Hp阳性的消化性溃疡或慢性胃炎患者。随机分为三组,其中A组138例、B组142例、C组123例。A组采用果胶铋200 mg+雷贝拉唑10 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,2次/天,共10 d;B组采用果胶铋200 mg+雷贝拉唑10 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,2次/天,共14 d;C组采用雷贝拉唑10 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,2次/天,共14 d。观察三组患者Hp根除率、不良反应发生率及其成本-效果比。结果 A、B、C三组患者Hp根除率分别为83.33%、83.80%、71.54%,A组与B组Hp根除率比较差异无统计学意义(P>0.05),A组与C组、B组与C组Hp根除率比较均差异有统计学意义(P<0.05)。A、B、C三组患者的不良反应发生率分别为1.45%、2.11%、0.81%,均差异无统计学意义(P>0.05)。A、B、C三组成本-效果比分别为1.50、2.09、2.04。结论三种治疗方案均未达到Hp根除率>90%的理想方案。但三种方案的比较中含铋剂10 d与14 d四联疗法Hp根除率较高,接近理想方案。含铋剂10 d四联疗法成本-效果比最好,建议临床使用。14 d三联疗法Hp根除率仅达71.54%,远低于理想标准,不建议临床使用。

IT资产综合绩效评价方法

企业生产设备的资产全寿命管理相当成熟,但IT资产与企业产值无直接关联,对IT资产的管理相对薄弱。基于安全、效能和成本理论,结合IT集中监控等技术手段,研究IT设备资产的评价方法和指标计算公式,最终实现对IT设备资产的精益化管理。

能流图在洁净手术部空调设计中的应用

由于对室内环境的要求较高,医院洁净手术部的空调系统能耗比普通区域的空调系统大。为了简化能耗分析,提出一个新的技术经济评价指标——空调能效成本指标ECE,并将其与能流图融合,作为空调能耗的辅助分析工具。利用能流图和ECE分析了建筑布局、换气次数、风机风压、空气处理过程等对手术部空调能耗的影响。建议在设计阶段采用该简便方法对空调方案的能耗和能源费用进行必要的技术经济比较分析。

The Cost-effectiveness Analysis of Percutaneous Transhepatic Metal Versus Plastic Biliary Stent Implantation for Treating Malignant Biliary Obstruction (Multiple Center Investigation)

Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.

Comparison of Benefits from Different Planting Models of Ningza No.21

Ningza No.21, a new hybrid rapeseed cultivar, was used as the test mate-rial in this study. The common planting models in large-scale production （3 trans-planting models and 2 direct-seeding models） were adopted. Based on the high-yield cultivation, the yield and economic benefits of different planting models were investi-gated. ln addition, the labor costs, agricultural production materials costs and agri-cultural machinery costs of different planting model were analyzed to explore the low-costs and high-economic benefits planting model. The results showed the yields of the 5 planting models were al relatively high with average yield of 3 282.30 kg/hm2, ranging from 2 899.50 to 3 642.00 kg/hm2. Although the average yield and output value of transplanting models were higher than that of direct-seedling models by 429.25 kg/hm2 and 2 189.18 yuan/hm2 respectively, the production costs of trans-planting models were higher than that of direct-seedling model by 2 098.81 yuan/hm2 and the economic benefits were basical y equal. Among the costs of rapeseed pro-duction, the labor costs accounted for more than 60%. ln the labor costs, the har-vesting labor costs represented about 50%. Therefore, under current production con-ditions, the direct seeding and mechanized harvesting should be adopted in the rapeseed production to reduce production costs and improve economic benefits.

浅谈正确理解税收筹划

市场经济中,在不违背法律法规的前提下,追求利润最大化,通过合理安排企业的生产、经营、投资、理财等事项降低税收支出成本,做好税收筹划,成为企业经济决策越来越重要的内容。一、税收筹划的涵义与原则税收筹划是指纳税人在实际履行纳税义务之前,对纳税负担所作出的选择。也就是说。

Constitutive modeling and springback simulation for 2524 aluminum alloy in creep age forming

The constitutive modeling and springback simulation for AA2524 sheet in creep age forming（CAF） process were presented.A series of creep aging tests were performed on AA2524 at the temperature of 180-200 °C and under the stress of 140-210 MPa for 16 h.Based on these experimental data,material constitutive equations which can well characterize creep aging behaviors of the tested alloy were developed.The effect of interior stress distributed along the sheet thickness on springback was simulated using FE software MSC.MARC by compiling the established constitutive models into the user subroutine.The simulation results showed that the amount of sheet springback was 61.12% when merely considering tensile stress existing along the sheet thickness;while sheet springback was up to 65.93% when taking both tensile and compressive stresses into account.In addition,an AA2524 rectangular sheet was subjected to CAF experiment in resistance furnace.The springback value of the formed rectangular sheet was 68.2%,which was much closer to 65.93%.This confirms that both tensile and compressive stresses across the sheet thickness should be considered in accurately predicting springback of the sheet after forming,which can be more consistent with experimental results.

Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China

AIM:To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer(EC)in high-risk areas of China. METHODS:Markov model-based analyses were conducted to compare the net present values(NPVs)and the benefit-cost ratios(BCRs)of 12 EC endoscopic screening strategies.Strategies varied according to the targeted screening age,screening frequencies,and follow-up intervals.Model parameters were collected from population-based studies in China,published literatures,and surveillance data. RESULTS:Compared with non-screening outcomes,all strategies with hypothetical 100 000 subjects saved life years.Among five dominant strategies determined by the incremental cost-effectiveness analysis,screening once at age 50 years incurred the lowest NPV(international dollar-I$55 million)and BCR(2.52).Screening six times between 40-70 years at a 5-year interval[i.e., six times(40)f-strategy]yielded the highest NPV(I$99 million)and BCR(3.06).Compared with six times(40)fstrategy,screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV,but the same BCR. CONCLUSION:EC endoscopic screening is cost-beneficial in high-risk areas of China.Policy-makers should consider the cost-benefit,population acceptance,and local economic status when choosing suitable screening strategies.

Evolution of microstructure in semi-solid slurries of rheocast aluminum alloy

Semi-solid metal processing is being developed in die casting applications to give several cost benefits. To efficiently apply this emerging technology, it is important to understand the evolution of microstructure in semi-solid slurries for the control of the theological behavior in semi-solid state. An experimental apparatus was developed which can capture the grain structure at different times at early stages to understand how the semi-solid structure evolves. In this technique, semi-solid slurry was produced by injecting fine gas bubbles into the melt through a graphite diffuser during solidification. Then, a copper quenching mold was used to draw some semi-solid slurry into a thin channel. The semi-solid slurry was then rapidly frozen in the channel giving the microstructure of the slurry at the desired time. Samples of semi-solid 356 aluminum alloy were taken at different gas injection times of 1, 5, 10, 15, 20, 30, 35, 40, and 45 s. Analysis of the microstructure suggests that the fragmentation by remelting mechanism should be responsible for the formation of globular structure in this rheocasting process.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Appendiceal mass:Is interval appendicectomy “something of the past” ?

The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.

Establishment of a chronic left ventricular aneurysm model in rabbit

Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm （LVA） in rabbits. Methods Acute myocardial infarction （AMI） was induced in 35 rabbits via concomitant ligation of the left anterior descending （LAD） coronary artery and the circumflex （Cx） branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure （LVESP） and diastolic pressure （LVEDP） were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum （IVS） and the left ventricular posterior wall （LVPW） left ventricular end diastolic volume （LVEDV） and systolic volume （LVESV）, and ejection fraction （EF） were recorded by echo-cardiography. Results Thirty one （88.6%） rabbits survived myocardial infarction and 26 of them developed aneurysm （83.9%）. The mean area of aneurysm was 33.4% ＆#177; 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle （LV） that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%＆#177;2.4%which involves the apex, anterior wall and lateral wall of the LV.

Management strategies of Barrett's esophagus

Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.

A novel model for cost performance evaluation of pulverized coal injected into blast furnace based on effective calorific value

The combustion process of pulverized coal injected into blast furnace involves a lot of physical and chemical reactions. Based on the combustion behaviors of pulverized coal, the conception of coal effective calorific value representing the actual thermal energy provided for blast furnace was proposed. A cost performance evaluation model of coal injection was built up for the optimal selection of various kinds of coal based on effective calorific value. The model contains two indicators: coal effective calorific value which has eight sub-indicators and coal injection cost which includes four sub-indicators. In addition, the calculation principle and application of cost performance evaluation model in a Chinese large-scale iron and steel company were comprehensively introduced. The evaluation results finally confirm that this novel model is of great significance to the optimal selection of blast furnace pulverized coal.

Chicken soup for teaching and learning ESD

Endoscopic submucosal dissection(ESD) is becoming a popular procedure for the diagnosis and treatment of superficial mucosal lesions,and has the advantage of en bloc resection which yields a higher complete resection and remission rate compared to endoscopic mucosal resection(EMR).However,the learning process of this advanced endoscopic procedure requires a lengthy training period and considerable experience to be proficient.A well framed training protocol which is safe,effective,easily reproducible and cost-effective is desirable to teach ESD.In addition,the training course may need to be tailored around settings such as ethnicity,culture,workload,and disease incidence.In Asian countries with a large volume of early gastric lesions which need endoscopic treatment,endoscopists would be able to learn ESD expanding their skills from EMR to ESD under the supervision of experts.Whereas,in Western countries due to the low incidence of superficial gastric tumors,trials have utilized simulator models to improve learning.In Korea,the Korean Society of Gastrointestinal Endoscopy(KSGE) is playing an important role in training many gastroenterologists who have shown an interest in performing ESD by providing an annual live demonstration and a nationwide tutoring program.The purpose of this article is to introduce our ESD tutoring experience,review the published papers related to this topic,and propose several suggestions for future directions in teaching and learning ESD.

Use of the tumor necrosis factor-blockers for Crohn's disease

The use of anti-tumor necrosis factor-α therapy for inflammatory bowel disease represents the most important advance in the care of these patients since the publication of the National Co-operative Crohn＇s disease study thirty years ago. The recommendations of numerous consensus groups worldwide are now supported by a wealth of clinical trials and several meta-analyses. In general, it is suggested that tumor necrosis factor-c~ blockers （TNFBs） are indicated （1） for persons with moderately-severe Crohn＇s disease or ulcerative colitis （UC） who have failed two or more causes of glucocorticosteroids and an acceptably long cause （8 wk to 12 wk） of an immune modulator such as azathioprine or methotrexate; （2） non-responsive perianal disease; and （3） severe UC not responding to a 3-d to 5-d course of steroids. Once TNFBs have been introduced and the patient is responsive, therapy given by the IV and SC rate must be continued. It remains open to definitive evidence if concomitant immune modulators are required with TNFB maintenance ther- apy, and when or if TNFB may be weaned and discon- tinued. The supportive evidence from a single study on the role of early versus later introduction of TNFB in the course of a patient＇s illness needs to be confirmed. The risk/benefit profile of TNFB appears to be accept- able as long as the patient is immunized and tested for tuberculosis and viral hepatitis before the initiation of TNFB, and as long as the long-term adverse effects on the development of lymphoma and other tumors do not prone to be problematic. Because the rates of ben- efits to TNFB are modest from a population perspec- tive and the cost of therapy is very high, the ultimate application of use of TNFBs will likely be established by cost/benefit studies.

What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?

AIM： To identify a cost-effective strategy of second primary colorectal cancer （CRC） screening for cancer survivors in Korea using a decision-analytic model. METHODS： A Markov model estimated the clinical and economic consequences of a simulated 50-year- old male cancer survivors＇ cohort, and we compared the results of eight screening strategies： no screening, fecal occult blood test （FOBT） annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years （COL10）, every 5 years （COL5）, and every 3 years （COL3）. We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost- effectiveness ratio （ICER）. RESULTS： In the base-case analysis, the non-dominat- ed strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life- year saved （LYS）, and did not exceed $10000/LYS in one-way sensitivity analyses. If the risk of CRC in can- cer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was tess than $7400/LYS regardless of screening compliance. CONCLUSION： Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.