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Background Screening and brief interventions (SBIs) for heavy drinking are an effective and cost-effective approach to reducing alcohol-related harm, yet delivery rates remain low. This study uses trial data to estimate the cost-effectiveness of alternative strategies to increase SBI delivery. Methods Data from a large cluster-randomized trial were combined with the Sheffield Alcohol Policy Model, a policy appraisal tool, to estimate the cost-effectiveness of eight strategies to increase SBI delivery in primary care in England, Poland and the Netherlands: care as usual (control), training and support (TS), financial reimbursement (FR), referral of patients to an online brief intervention (eBI) and all combinations of TS, FR and eBI. cost-effectiveness was assessed from a healthcare perspective by comparing health benefits (measured in Quality-Adjusted Life Years) with total implementation costs and downstream healthcare savings for each strategy over a 30-year horizon and calculating Incremental cost-effectiveness ratios (ICERs). Results All trialled strategies were cost-effective compared to control. TS combined with FR was the most cost-effective approach in England (more effective and less costly than control) and Poland (ICER €4632 vs. next-best strategy). This combination is not cost-effective in the Netherlands, where TS alone is the most cost-effective approach (ICER €3386 vs. next-best strategy). Conclusions Structured TS, financial incentives and access to online interventions are all estimated to be cost-effective methods of improving delivery of alcohol brief interventions. TS and FR together may be the most cost-effective approach, however this is sensitive to country characteristics and alternative BI effect assumptions. Trial registration ClinicalTrials.gov trial identifier: NCT01501552 [ABSTRACT FROM AUTHOR]

Thermally upgraded Kraft (TUK) "Insuldur®" papers prepared from the same batch process but with a different percentage of stabilizing additives (1.2, 2.6 and 4.4% of nitrogen) were studied under accelerated aging at 170 °C. The increment of stabilizing additives in paper with the consequent increment of nitrogen content slows down the rate of molecular chain scission of the cellulose and reduces the paper tensile strength loss rate. However, a progressive reduction in the enhancement of the paper life span by the increment of nitrogenous additives in paper was observed. The cellulose degradation methanol and ethanol markers were found to be reliable and accurate for tracking the aging of TUK papers even with the variation of nitrogen content in paper. A promising correlation between methanol concentration and the paper tensile index with different nitrogen content was determined. This correlation could be used as a basis for developing tools to assess power transformers residual life. FTIR-ATR analyses of dicyandiamide in aged papers showed a rapid reaction and decomposition of dicyandiamide in other compounds that slows down cellulose aging. The nitrogen content of aged paper, measured with the Dumas method, showed a slight variation during the study. This implies that the nitrogen compounds continue to be attached, presumably by polar forces to the paper. Thermogravimetric analysis (TGA) of new and aged Insuldur® paper samples showed that nitrogen additives improve the thermal stability of paper at high temperatures. [ABSTRACT FROM PUBLISHER]