Comprehensive comparative economic evaluation of woody biomass energy from silvicultural fuel treatments.

Fuel treatments are used in overstocked, fire-prone forests to alter wildfire behavior and reduce fire risk. Some of the benefits they provide are not captured in markets, and therefore represent unaccounted environmental externalities that can lead to inefficient decision making. This study uses a replicable method to integrate market and nonmarket economic values into a comprehensive economic evaluation of fuel treatment and bioenergy production using a case study of ponderosa pine and mixed-conifer forests in Colorado's wildland-urban interface. Treatment costs and people's willingness to pay for better forest health, lower likelihood of wildfire, improved air quality, and expanded renewable energy production are incorporated into techno-economic analysis of biopower production. Results show that fuel treatments are likely to be undervalued when evaluated strictly on a financial basis. Under the standard practice of disposing of treatment residues through pile-burning, net present value (NPV) of fuel treatment on 138,034 ha over 20 years is -$275 million, without consideration of nonmarket benefits. If nonmarket benefits associated with forest health, wildfire likelihood and air quality are included, NPV improves to -$116 million. Without the consideration of nonmarket benefits, when treatment resides are used for biopower production, NPV is -$178 million, with net cost savings compared to pile burning attributable to reduced biomass disposal costs and electricity revenue. Accounting for additional air quality benefits and nonmarket value associated with renewable energy, the bioenergy scenario improves NPV to -$25 million, with 27.7% of outcomes having positive NPV. The impact of additional nonmarket values and potential revenues from timber harvest are discussed, and are likely to make mean NPV positive for this scenario.

Cost and performance tradeoffs between mail and internet survey modes in a nonmarket valuation study.

Using the results of a choice modeling survey, internet, mail-only and mixed internet and mail survey modes were examined with regards to their cost-effectiveness, representativeness, and willingness to pay (WTP). The topical focus of the study was biomass energy generation preferences of the residents of Montana, Colorado and Arizona, USA. Compared to the mail and mixed mode samples, the internet-only mode produced a sample of respondents that was younger, more likely to have a college degree, and more likely to have a household income of at least $100,000 per year. However, observed differences in the characteristics of the collected sample did not result in significant differences in estimates of WTP. The internet survey mode was the most cost-effective method of collecting the target sample size of 400 responses. Sensitivity analysis showed that as the target number of responses increased the cost advantage of internet over the mail-only and mixed mode surveys increased because of the low marginal cost associated with extending additional invitations.

Syncope Best Practices: A Syncope Clinical Practice Guideline to Improve Quality.

OBJECTIVE: To determine whether implementation of a standardized clinical practice guideline (CPG) for the evaluation of syncope would decrease practice variability and resource utilization. DESIGN: A retrospective review of medical records of patients presenting to our practice for outpatient evaluation of syncope before and after implementation of the CPG. The guideline included elements of history, physical exam, electrocardiogram, and "red flags" for further testing. SETTING: Outpatient pediatric cardiology offices of a large pediatric cardiology practice. PATIENTS: All new patients between 3 and 21 years old, who presented to cardiology clinic with a chief complaint of syncope. INTERVENTIONS: The CPG for the evaluation of pediatric syncope was presented to the providers. OUTCOME MEASURES: Resource utilization was determined by the tests ordered by individual physicians before and after initiation of the CPG. Patient final diagnoses were recorded and the medical records were subsequently reviewed to determine if any patients, who presented again to the system, were ultimately diagnosed with cardiac disease. RESULTS: Of the 1496 patients with an initial visit for syncope, there was no significant difference in the diagnosis of cardiac disease before or after initiation of the CPG: (0.6% vs. 0.4%, P = .55). Electrocardiography provides the highest yield in the evaluation of pediatric syncope. Despite high compliance (86.9%), there were no overall changes in costs ($346.31 vs. $348.53, P = .85) or in resource utilization. There was, however, a decrease in the variability of ordering of echocardiograms among physicians, particularly among those at the extremes of utilization. CONCLUSIONS: Although the CPG did not decrease already low costs, it did decrease the wide variability in echo utilization. Evaluation beyond detailed history, physical exam, and electrocardiography provides no additional benefit in the evaluations of pediatric patients presenting with syncope.

Training residents/fellows in paediatric cardiology: the Emory experience.

Pediatric cardiology fellowship is a very busy time, with new responsibilities, new knowledge, new technology and fast pace. Above and beyond the science and art of pediatric cardiology, we emphasize that our cardiology fellows are in the middle of the "people business", with additional roles and responsibilities as they serve their patients and communities. This manuscript provides insight into these opportunities for our pediatric cardiac professionals.