Biogas from energy crops--optimal pre-treatments and storage, co-digestion and energy balance in boreal conditions.

The objective of this research was to evaluate the biogas production from crops in boreal conditions, focusing on the optimal pre-treatment and storage methods, co-digestion and energy balance of farm-scale crop based biogas plants. Alkaline treatments offered some potential for improving the methane yield from grass and sugar beet tops. The results show that the CH4 yield of energy crops can be maintained by appropriate ensiling conditions for even after 11 months in ambient conditions. The CH4 yield was best preserved with wet grass mixture without additives. Co-digestion of manure and crops was shown to be feasible with feedstock volatile solids (VS) containing up to 40% of crops. The highest specific methane yields of 268, 229 and 213 l CH4 kg(-1) VSadded in co-digestion of cow manure with grass, sugar beet tops and straw, respectively, were obtained during feeding with 30% of crop in the feedstock, corresponding to 85-105% of the total methane potential in the substrates as determined by batch assays. The energy output:input ratio of farm-scale grass silage based biogas plant varied significantly (3.5-8.2) with different assumptions and system boundaries being lowest when using only inorganic fertilizers and highest when half of the heat demand of the system could be covered by metabolic heat.

Co-digestion of manure and biowaste according to the EC animal by-products regulation and Finnish national regulations.

The objective of this study was to compare methane production and characteristics of digested material in anaerobic digestion concepts according to the Animal By-Products Regulation (ABP-Regulation) of the EC (hygienisation of biowaste for 1 hour at 70 degrees C, particle size < 12 mm) and Finnish national regulations (treatment temperature 55 degrees C, feeding interval 24 h, hydraulic retention time (HRT) 20 d, particle size < 40 mm) and with small variations in treatment methods for treating manure and biowaste. Moreover, the survival of three different salmonella bacteria in these processes was studied. Hygienisation of biowaste prior to digestion at 35 degrees C enhanced methane production by 14-18% compared to similar treatment without hygienisation. The differences in treatment temperature, HRT and hygienisation of biowaste prior to digestion did not significantly affect the characteristics of digested material. The concepts according to the ABP-Regulation and Finnish national regulations were effective in destroying salmonella bacteria to an undetectable level.

Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics.

The clinical effectiveness and costs of videoconferencing in orthopaedics between primary and secondary care were examined in an eight-month prospective, comparative study. The general surgery outpatient clinics of two Finnish district hospitals were compared: Peijas Hospital, with telemedicine, and Hyvinkää Hospital, without it. The three study primary-care centres referred a total of 419 adult patients to the outpatient clinics. The population-based number of referrals to Peijas Hospital was similar to that to Hyvinkää Hospital after adjusting for the proportion of older people living in the Hyvinkää Hospital municipalities. Of the 225 patients referred to Peijas Hospital, 168 (75%) were given appointments at the outpatient clinic of surgery and the rest of the referred patients received a teleconsultation. All patients referred to Hyvinkää Hospital were given appointments at the outpatient clinic. The direct costs of an outpatient visit were 45% greater per patient than for a teleconsultation, with a marginal cost decrease of EU48 for every new teleconsultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU2500 in favour of teleconsultations. The use of videoconferencing between primary and secondary care was modest in orthopaedics, although the use of this telemedicine method was shown to reduce direct costs and be cost-effective.

Patient referral by telemedicine: effectiveness and cost analysis of an Intranet system.

The clinical effectiveness and costs of telemedicine in improving the referral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medicine outpatient clinics of two Finnish district hospitals were compared--Peijas Hospital (PH) with telemedicine and Hyvinkää Hospital (HH) without it. The three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/1000) from primary-care centres was twice that to HH (3.8/1000). Thirty-seven per cent of referrals to PH included requests from general practitioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patients receiving a teleconsultation ended up in the outpatient department of PH within one year. These visits were mainly due to progression of chronic disease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic visit in internal medicine (EU211) were seven times greater per patient than for an e-mail consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU7876 in favour of the teleconsultation process. General practitioners sought an outpatient visit for 130 of their patients, and advice only for another 77. On-line advice was nonetheless given in 108 cases, and only 88 patient visits were arranged. Eleven referrals were declined. The cost difference between giving on-line medical advice for the 108 cases and a visit to the outpatient clinic for the other 88 was less costly (by EU4140) than investigating the 124 patients whose original clinic referrals to the PH were not declined. Productivity in the hospital increased over threefold by using e-mail consultations instead of traditional outpatient visits. The wide interactive use of the intranet referral system between secondary and primary care improved clinical effectiveness, lowered direct costs, increased productivity and was cost-effective.