Exploration of understanding of impactibility analysis and application through workshops to inform model design for population health management policy: a qualitative assessment.

OBJECTIVES: Assess understanding of impactibility modelling definitions, benefits, challenges and approaches. DESIGN: Qualitative assessment. SETTING: Two workshops were developed. Workshop 1 was to consider impactibility definitions and terminology through moderated open discussion, what the potential pros and cons might be, and what factors would be best to assess. In workshop 2, participants appraised five approaches to impactibility modelling identified in the literature. PARTICIPANTS: National Health Service (NHS) analysts, policy-makers, academics and members of non-governmental think tank organisations identified through existing networks and via a general announcement on social media. Interested participants could enrol after signing informed consent. OUTCOME MEASURES: Descriptive assessment of responses to gain understanding of the concept of impactibility (defining impactibility analysis), the benefits and challenges of using this type of modelling and most relevant approach to building an impactibility model for the NHS. RESULTS: 37 people attended 1 or 2 workshops in small groups (maximum 10 participants): 21 attended both workshops, 6 only workshop 1 and 10 only workshop 2. Discussions in workshop 1 illustrated that impactibility modelling is not clearly understood, with it generally being viewed as a cross-sectional way to identify patients rather than considering patients by iterative follow-up. Recurrent factors arising from workshop 2 were the shortage of benchmarks; incomplete access to/recording of primary care data and social factors (which were seen as important to understanding amenability to treatment); the need for outcome/action suggestions as well as providing the data and the risk of increasing healthcare inequality. CONCLUSIONS: Understanding of impactibility modelling was poor among our workshop attendees, but it is an emerging concept for which few studies have been published. Implementation would require formal planning and training and should be performed by groups with expertise in the procurement and handling of the most relevant health-related real-world data.

Hydrocarbon liquefaction: viability as a peak oil mitigation strategy.

Current world capacity of hydrocarbon liquefaction is around 400,000 barrels per day, providing a marginal share of the global liquid fuel supply. This study performs a broad review of technical, economic, environmental and supply chain issues related to coal-to-liquids (CTL) and gas-to-liquids (GTL). We find three issues predominate. First, significant amounts of coal and gas would be required to obtain anything more than a marginal production of liquids. Second, the economics of CTL plants are clearly prohibitive, but are better for GTL. Nevertheless, large-scale GTL plants still require very high upfront costs, and for three real-world GTL plants out of four, the final cost has been so far approximately three times that initially budgeted. Small-scale GTL holds potential for associated gas. Third, both CTL and GTL incur significant environmental impacts, ranging from increased greenhouse gas emissions (in the case of CTL) to water contamination. Environmental concerns may significantly affect growth of these projects until adequate solutions are found.