PAlliative Care in chronic Kidney diSease: the PACKS study—quality of life, decision making, costs and impact on carers in people managed without dialysis

BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.

METHODS: In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.

DISCUSSION: The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

Exotic Endurance: Tourism, Fitness and the Marathon des Sables

This paper critically examines the intersections of global tourism and fitness in the Marathon des Sables, an annual ultramarathon in the Sahara desert in which over a thousand athletes run the equivalent of five marathons in six days. It demonstrates how the globalization of health and fitness resonates with familiar Western productions of exotic cultures for the purposes of tourist consumption. Of particular interest here is how established colonial asymmetries are recast in a neoliberal context as runners test their resilience, endurance and strength against an ‘extreme’ Saharan landscape. While the paper calls attention to these asymmetries, it is more concerned with troubling reductive colonial encounters in order to reveal their instability, heterogeneity and ambivalence. Indeed, the central conceit of the Marathon des Sables – that superior Western fitness regimes and technologies will dominate the race – is inverted by the overwhelming success of Moroccan runners and disaggregated by the biopolitical regulation of elite running bodies. These unexpected intersections of global tourism and fitness demand further attention because they reconfigure our received notions of who (and what) is capable of exerting agency in postcolonial encounters.

Off-Duty Resilience: Re-orienting Tourism, Leisure and Recreation in the US Army BOSS program

Understanding how US imperial strategy is sustained by tourism and militarism requires an account of how American soldiers learn to understand themselves in relation to a variety of marginalized others. This paper explores how the US Army’s ‘Ready and Resilient’ (R2) campaign constructs soldier / other relations by mobilizing off-duty time through the ‘Better Opportunities for Single Soldiers’ (BOSS) program. BOSS’s first two platforms of ‘Well-Being’ and ‘Community Service’ feed into the R2 agenda by producing highly-skilled leaders (who govern a disengaged rank and file) and benevolent humanitarians (who provide charity for abject civilians). When these dispositions are transposed into BOSS’s third platform of ‘Recreation and Leisure’, soldiers turn away from the goals of leadership and humanitarianism to reveal the privileged narcissism underscoring the R2 agenda. This self-focus is intensified by familiar power relations in the tourism industry as soldiers pursue self-improvement by commodifying, distancing and effacing local tourist workers. Using the BOSS program as a case study, this paper critically interrogates how the US Army is assimilating off-duty practices of tourism, leisure and recreation into the wider program of resilience training.

The Impacts of Variety on the Costs and Profits of a Hotel Chain’s Properties

In the hotel industry, undistributed operating expenses represent a significant portion of the operating costs for a hotel. Exactly how most of these expenses arise is not well understood. Using data from more than 40 hotels operated by a major chain, the authors examine the links between the variety of a hotel’s products and customers and its undistributed operating expenses and revenues. Their findings show that undistributed operating expenses are related to the extent of the property’s business and product-services mix. The results suggest that although increasing a property's product-service mix results in higher undistributed operating expenses, the incremental costs are compensated for by higher revenues. However, increasing business mix while increasing undistributed operating expenses does not result in higher revenues.

Serving More Segments and Offering More Products: What Are the Costs and Where Are the Profits?

Making more money involves more than targeting new customer segments and offering new services.

Using official data sources to analyse the light goods vehicle fleet and operations in Britain

Report produced as part of the Green Logistics project (EPSRC and Department for Transport funded). Light goods vehicles play a key role in providing goods and services to businesses and other organisations in Britain. In order to better understand the relationship between costs and benefits of LGV operations it is necessary to gain a more detailed appreciation of the roles that these vehicles are fulfilling. This report aims to provide a better understanding of this sector by examining LGV fleet and operations in terms of their characteristics, utilisation and efficiency and purpose. Important potential external impacts of LGVs are also considered.

Cruise tourism in Lisbon - Cruise tourism activity and its impact on the city

Field lab: Tourism

Firing and training costs and labour market segmentation

This dissertation consists of three essays on the labour market impact of firing and training costs. The modelling framework resorts to the search and matching literature. The first chapter introduces firing costs, both liner and non-linear, in a new Keynesian model, analysing business cycle effects for different wage rigidity degrees. The second chapter adds training costs in a model of a segmented labour market, accessing the interaction between these two features and the skill composition of the labour force. Finally, the third chapter analyses empirically some of the issues raised in the second chapter.

Context costs and comparative advantages in the telecommunications sector in Portugal and China

This Work Project aims to discuss the Context Costs and Comparative Advantages of the Telecommunications sector both in Portugal and China. The work was built mostly on primary research by interviews with relevant people (business persons, University Professors and Agencies directors), and by economic data publicly available. A list of context costs and comparative advantages was drawn for each country and possible resolutions suggestions were made in the end. The context costs depend heavily on the economic situation of the countries and it should be taken into account when assessing the degree of magnitude of each cost of context. The competitive advantages of each country were drawn in comparison with one another. Some key results stand out: firstly, Portugal’s costs of context depend mainly on governmental decisions, uncertainties and instability and China’s cost of context depend primarily on cultural norms, mainly the Guanxi; second, the telecommunications sector shares most of its context costs and advantages with other sectors; third, China as an economic power could use the telecommunications sector as a way to further develop and boost its economy.

Optimal dividend strategies for a compound Poisson risk process under transaction costs and power utility

We characterize the value function of maximizing the total discounted utility of dividend payments for a compound Poisson insurance risk model when strictly positive transaction costs are included, leading to an impulse control problem. We illustrate that well known simple strategies can be optimal in the case of exponential claim amounts. Finally we develop a numerical procedure to deal with general claim amount distributions.

Governments and the Decentralization

The Purpose of This Article Is to Show How Costs and Benefits of Geographical Decentralization of R&D Can Be Identified and Compared. the Benefits for the Region That Receives R&D Activities Are Studied in Section 1. They Stem From the Short-Run Multiplier Effect, the Amelioration of Human Capital and the Possible Modernization of the Local Industrial Structure. on the Cost Side Examined in Section 2, the Observable Impacts of the Decentralization of R&D Concern the Loss of Returns to Scale and of the Production of the R&D Output. It Is Shown, in Section 3, That the Flows of Costs and Benefits Must Be Discounted by the Social Cost of Capital. the Main Conclusion of This Article Is That the Decentralization of R&D in a Large Sparsely Populated Country Entails Social Cost and Would Weaken Its Competitive Position in World Commerce. on the Other Hand, the Issue of Decentralization Is More Crucial for Small Countries (In Terms of Population and Economic Size) Than for Large Ones, Like the U.S., Where Critical Masses of Research Efforts Cna Be Simulataneously Attained in Many Fields and in Many Places.

Comparative costs and outcomes of traumatic brain injury from biking accidents with or without helmet use

Contexte: Évaluer les déterminants de maladies évitables et leurs coûts est nécessaire dans le contexte d’assurance maladie universelle. Le moment d’évaluer les impacts des traumatismes crâniocérébraux (TCC) survenus lors d’accidents de vélo est idéal vu la popularité récente du cyclisme au Québec. Objectifs: Comparer les caractéristiques démographiques et médicales, ainsi que les coûts sociétaux qu’engendrent les TCC de cyclistes portant ou non un casque. Méthodologie: Étude rétrospective de 128 cyclistes avec TCC admis à l’Hôpital Général de Montréal entre 2007 et 2011. Les variables indépendantes sont sociodémographiques, cliniques et le port du casque. Les variables dépendantes sont la durée de séjour, l’échelle GOS-E, l’échelle ISS, l’orientation au congé, les décès et les coûts à la société. Résultats: Le groupe portant un casque était plus vieux, plus éduqué, retraité et marié; au niveau médical, ils avaient des TCCs moins sévères à l’imagerie, des hospitalisations aux soins intensifs plus courtes et moins de neurochirurgies. Les coûts médians à la société pour les TCC isolés de cyclistes avec casque étaient significativement moindres. Conclusion: Dans cette étude, le port du casque semblait prévenir certaines complications des TCC et permettait de faire économiser de l’argent à l’état. Le port de casque est recommandé.

Environomics - A Financial Estimate of Environmental Pollution Control and Abatement Schemes in Eloor-Edayar Industrial Belt

The present study consists of nine chapters including the introductory chapter. Chapter II makes a brief review of environmental literature and examines various measures adopted at the global level to protect the environment. The environmental problems often transgress national sovereignity and geographical boundaries. Therefore, attempts must be made at the national and international levels to protect the environment, the resources of which are the common property of mankind. The protection of the national environment from the ancient till the present forms the content of Chapter III. These chapters together provide a background to understand the issues analysed in the subsequent chapters. Carefully worked out theoretical framework is a pre-requisite for the successful study of a complex subject. Some of the theoretical issues of ‘environomics’ are examined in Chapter IV. The theoretical issues involved in estimating the costs and benefits of environmental protection constitute the theme of Chapter V. The state of environment in Eloor-Edayar Industrial belt andthe impact analysis of pollution of the area are discussed in Chapter VI and VII respectively. Chapter VIII makes the financial estimate of environmental protection of the project And finally, Chapter IX presents the findings of the study

Behavioral changes, used and benefits of a community program for the promotion in physical activity

Objective: To determine the change of behavior in physical activity and the characteristics associated with the use and benefits of Local Physical Activity Center (CLAF) in the population of the town of Santa Fe de Bogota. Materials and methods: We conducted a longitudinal study before and after, which was assessed at admission and 3 months in the intervention program CLAF physical activity, behavior change compared to the physical activity of users. Inclusion criteria: were being active user of CLAF, aged between 15 and 65 years and voluntarily express their participation in the study. Exclusion criteria: Fill incomplete measurement instruments used. The sampling frame of CLAF users, we selected n=55 subjects. To gather information, a questionnaire, which contained the behavioral stages of change, also conducted a survey which determined semistructured features about the benefits and use of CLAF. Results: The total study participants was n = 55, mean age was 40.4 ± 15.3 years, with a minimum 15 and maximum of 64 years, 83.6% were women. 78.2% do not know the purpose of the Local Centre for Physical Activity. The outreach strategy that most came to the group was 58.2 with a verbal type. The time for links to CLAF more frequently in the group evaluated was 1 to 6 months 36.4. The motivation to regularly attend the CLAF in the majority was to improve the physical and / or a 74.5% mental. 89.1% would be willing to recommend to others the use of CLAF. A 81.8% of the population physical activity performed by more than 150 min / wk at moderate intensity; Post CLAF intervention in the subjects showed positive changes in the level of physical activity (p<0.001, Test de Wilcoxon) and behavioral state (p<0.001, Test de Wilcoxon).

Impacto de la venta de acciones en la salud financiera y el riesgo en los grupos financieros

Esta investigación tiene como objetivo general el análisis del impacto de la venta de acciones sobre la salud financiera y el riesgo en el grupo Aval. La necesidad por este estudio nace del interés por conocer los costos y beneficios que tienen las empresas a la hora de emitir acciones, siendo ésta última una práctica común en las últimas décadas. Algunas de las motivaciones relevantes para emitir acciones, son la financiación de nuevos proyectos de la empresa, el status que le pueda dar a la misma, una manera de hacer frente a la deuda, etc. Es importante conocer las implicaciones que tienen sobre la empresa la venta de acciones en términos de sus resultados, el impacto sobre los accionistas y sobre la misma sociedad. Esta investigación busca responder a la pregunta: ¿Cuál es el impacto de la venta de acciones sobre la salud financiera y el riesgo en los grupos financieros? Nos interesaremos por la revisión bibliográfica acerca de la salud financiera abordando autores que hablan de la misma desde el punto de vista de la posición de la empresa, refiriéndonos siempre a tres indicadores relevantes para el estudio y que son utilizados en la literatura para medir la salud financiera: liquidez, rentabilidad y endeudamiento. En la revisión de la literatura se ha encontrado una relación entre la salud financiera y el riesgo, por lo tanto buscaremos identificar cuál es el riesgo que afecta a las empresas cuando se emiten acciones centrándonos en tres tipos de riesgos financieros: riesgo de mercado, de interés y riesgo operacional; se ha escogido el grupo Aval para éste estudio ya que es uno de los grupos financieros más importantes en Colombia, con varios años de gestión y que actualmente realiza la práctica de emitir acciones.