Characterization of recombinant class I MHC alloantigen action upon the survival of disparate heart allografts

Previous studies have led to the development of allochimeric class I MHC proteins as agents that effectively induce donor-specific transplantation tolerance in a rat system with or without additional immunosuppression. Within the α1-helical region of RT1.Au, an epitope that conferred immunologic tolerance was discovered. Studies presented herein were designed to test our central hypothesis that allochimeric proteins onfer tolerance in a mouse model. To test this hypothesis, portal vein (PV) injection of wild-type H2Kd and H2Dd proteins were produced in a bacterial expression system and found to specifically prolong the survival of BALB/c (H2d) heart allografts in C57BL/10 (H2b) recipients. Although a single PV injection of 50 μg α1–α 3 H2Kd alone was ineffective, 50 μg α1 –α3 alone slightly prolonged BALB/c heart allograft survivals. In contrast, the combination of 25 μg α1–α 3 H2Kd and 25 μg α1–α 3 H2Dd proteins prolonged BALB/c graft survivals to 20.2 ± 6.4 days (p < 0.004). The effect was donor-specific, since a combination of 25 μg α1–α3 H2Kd and 25 μg α1–α3 H2Dd proteins failed to affect survivals of third-party C3H (H2k k) heart allografts, namely 9.0 ± 0.0 days in treated versus 7.8 ± 0.5 days in untreated hosts. Thus, the combination of two H2K d and H2Dd proteins is more effective in prolonging allograft survival than a single protein produced in a bacterial expression system. A single PV injection (day 0) of 25 μg α1–α 2 H2Kd and 25 μg α1–α 2 H2Dd proteins to C57BL/10 mice prolonged the survival of BALB/c heart allografts to 22.4 ± 4.5 days. Within a WF to ACI rat heart allograft system, a single PV injection of 20 μg 70–77 u-RT1.Aa induced specific tolerance of allografts. This therapy could be combined with CsA to induce transplantation tolerance. However, combination of 70–77u-RT1.Aa with CTLA4Ig, rapamycin, or AG-490 effectively blocked the induction of transplantation tolerance. Tolerance generated by allochimeric protein could be adoptively transferred to naive recipients. Intragraft cytokine mRNA levels showed a bias towards a Th2-type phenotype. Additionally, studies of cytokine signaling and activation of transcription factors revealed a requirement that these pathways remain available for signaling in order for transplantation tolerance to occur. These studies suggest that the generation of regulatory cells are required for the induction of transplantation tolerance through the use of allochimeric proteins. ^

Attributing inpatient care to diabetes: The case of Medicare for the elderly in Texas, 1995

Specific aims. This study estimated the accuracy of alternative numerator methods for attributing health care utilization and associated costs to diabetes by comparing findings from those methods with findings from a benchmark denominator method. ^ Methods. Using Medicare's 1995 inpatient and enrollment databases for the elderly in Texas, the researcher developed alternative estimates of costs attributable to diabetes. Among alternative numerator methods were selection of all records having diabetes as a principal or secondary diagnosis, and a complex ICD-9-CM sorting routine as previously developed for study of diabetes costs in Texas. Findings from numerator methods were compared with those from a benchmark denominator method based on attributable risk and adapted from a study of national diabetes costs by the American Diabetes Association. This study applied age, gender and ethnicity specific estimates of diabetes prevalence taken from the 1987–94 National Health Interview Surveys to person-months of Medicare Part A, non-HMO enrollment for Texas in 1995. Outcome measures were number of persons identified as having diabetes using alternative definitions of the disease; and number of hospital stays, patient days, and costs using alternative methods for attributing care and costs to diabetes. Cost estimates were based on Medicare payments plus deductibles, co-pays and third party payments. ^ Findings. Numerator methods for attributing costs to diabetes produced findings quite different than those from the benchmark denominator method. When attribution was based on diabetes as principal or secondary diagnosis, the resulting estimates were significantly higher than those obtained from the denominator method. The more complex sorting routine produced estimates near the lower boundary for the confidence interval associated with estimates from the benchmark method. ^ Conclusions. Numerator methods employed by previous researchers poorly estimate the costs of diabetes. While crude mathematical adjustment can be made to the respective numerator approaches, a more useful strategy would be to refine the complex sorting routine to include more hospitalizations. This report recommends approaches to improving methods previously employed in study of diabetes costs. ^

Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Self medication behaviors of illegal immigrants living along the U.S.-Mexico border

Mexican immigrants make up the largest subgroup of Hispanics living in the United States. The largest percentage of illegal immigrants comes from México. As such they are a subpopulation with limited access to health care and social services; their health seeking behaviors including self-medication behaviors that, aside from the intake of antibiotics, have not been studied in depth. The analysis of the data presented sought to document the medication behaviors of illegal immigrants living in El Paso County along the U.S.-México border. Of the 80 participants, 31 were taking medication on a regular basis. Of these, 28 claimed that at least one of the medications had been prescribed by a physician, 13 people had bought at least one of their medications in México, nine participants claimed that they had not paid for at least one of the medications they were taking, ten participants reported that they had skipped the doses of at least one of their medications due to monetary constraints. Participants were also asked if they had purchased medication in México during the year prior to the study, 68 of the 80 (85%) participants had bought 295 pharmaceutical products across the border themselves or through a third party. The most frequently purchased medications were antibiotics (17%), followed by syrups, pomades, creams, eardrops, and cold medicine as a group (15%), followed by analgesics (13%) and other non steroidal anti-inflammatory drugs (12%) and oral hypoglycemic agents (6%). ^

COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

Clostridium difficile infection (CDI): Clinical outcomes associated with concomitant non-CDI antibiotic use

This research examined the relationship between concomitant non-CDI antibiotic use and complications arising due to Clostridium difficile infection. To observe the hypothesized association, 160 total CDI patients between the ages of 50-90 were selected, 80 exposed to concomitant antibiotics and 80 unexposed. Samples were matched based upon their age and Horn's index, a severity score for underlying illness. Patients were de-identified by a third party, and analyzed retrospectively for differences between the two groups. In addition, patients exposed to broad spectrum antibiotics at the time of CDI treatment were further studied to demonstrate whether antibiotics had any effect on CDI complications. Between the two groups, the outcomes of interest (recurrent CDI, refractory CDI, mortality, ICU stay, and length of hospitalization) were not associated with concomitant antibiotic use at the time of CDI therapy. However, within the exposed population, certain classes of antibiotics such as cephalosporin, antifungals, and tetracyclines were more common in patients compared to other types of therapy. In addition, days of therapy provided evidence that sustained use of antibiotics affected CDI (p = 0.08), although a more robust sample size and additional study would be needed. Finally, refractory CDI was found to be potentially overestimated within the exposed population due to the possibility of antibiotic-associated diarrhea.^

Pasiones del riesgo y contacto con la naturaleza

Muchos deportistas aficionados en occidente, están emprendiendo hoy en día, largas e intensas ordalías donde la capacidad personal de resistir al sufrimiento en aumento constituye el objetivo principal. La carrera, el footing, el triatlón, el trekking, etc., son tipos de ordalías en las que la gente, sin apoyarse en una habilidad específica, no compite contra otros, sino que somete a prueba su propia capacidad para soportar el dolor creciente. El individuo se evalúa constantemente a sí mismo en una sociedad donde los puntos de referencia son incontables y contradictorios, donde los valores están en crisis, y busca entonces una relación cercana con significados profundos, probando su fuerza de carácter, su coraje y sus recursos personales. Seguir adelante hasta final de las ordalías autoimpuestas da una legitimidad a la vida y provee un umbral simbólico en el cual apoyarse. El funcionamiento en sí mismo tiene una importancia secundaria; sólo cuenta para el individuo. No se trata de luchar contra un tercero, es sólo un método para reforzar la voluntad personal y vencer el sufrimiento, justo al límite de una demanda personalmente impuesta. El límite físico ha venido a sustituir el límite moral que la sociedad actual no logra proporcionar. Sobreponiéndose al sufrimiento se templa el carácter del individuo, proporcionando así una importancia renovada y valiosa a su vida

Pasiones del riesgo y contacto con la naturaleza

Muchos deportistas aficionados en occidente, están emprendiendo hoy en día, largas e intensas ordalías donde la capacidad personal de resistir al sufrimiento en aumento constituye el objetivo principal. La carrera, el footing, el triatlón, el trekking, etc., son tipos de ordalías en las que la gente, sin apoyarse en una habilidad específica, no compite contra otros, sino que somete a prueba su propia capacidad para soportar el dolor creciente. El individuo se evalúa constantemente a sí mismo en una sociedad donde los puntos de referencia son incontables y contradictorios, donde los valores están en crisis, y busca entonces una relación cercana con significados profundos, probando su fuerza de carácter, su coraje y sus recursos personales. Seguir adelante hasta final de las ordalías autoimpuestas da una legitimidad a la vida y provee un umbral simbólico en el cual apoyarse. El funcionamiento en sí mismo tiene una importancia secundaria; sólo cuenta para el individuo. No se trata de luchar contra un tercero, es sólo un método para reforzar la voluntad personal y vencer el sufrimiento, justo al límite de una demanda personalmente impuesta. El límite físico ha venido a sustituir el límite moral que la sociedad actual no logra proporcionar. Sobreponiéndose al sufrimiento se templa el carácter del individuo, proporcionando así una importancia renovada y valiosa a su vida

Pasiones del riesgo y contacto con la naturaleza

Muchos deportistas aficionados en occidente, están emprendiendo hoy en día, largas e intensas ordalías donde la capacidad personal de resistir al sufrimiento en aumento constituye el objetivo principal. La carrera, el footing, el triatlón, el trekking, etc., son tipos de ordalías en las que la gente, sin apoyarse en una habilidad específica, no compite contra otros, sino que somete a prueba su propia capacidad para soportar el dolor creciente. El individuo se evalúa constantemente a sí mismo en una sociedad donde los puntos de referencia son incontables y contradictorios, donde los valores están en crisis, y busca entonces una relación cercana con significados profundos, probando su fuerza de carácter, su coraje y sus recursos personales. Seguir adelante hasta final de las ordalías autoimpuestas da una legitimidad a la vida y provee un umbral simbólico en el cual apoyarse. El funcionamiento en sí mismo tiene una importancia secundaria; sólo cuenta para el individuo. No se trata de luchar contra un tercero, es sólo un método para reforzar la voluntad personal y vencer el sufrimiento, justo al límite de una demanda personalmente impuesta. El límite físico ha venido a sustituir el límite moral que la sociedad actual no logra proporcionar. Sobreponiéndose al sufrimiento se templa el carácter del individuo, proporcionando así una importancia renovada y valiosa a su vida

Ex ante bargaining and ex post enforcement in trade credit supply: theory and evidence from China

If payment of goods is easily default, economic transaction may deeply suffer from the risk. This risky environment formed a mechanism that governs how economic transaction is realized, subsequently how trade credit is given. This paper distinguished ex ante bargaining and ex post enforcement, then modeled that bargaining power reduces trade credit ex ante, and ex post enforcement power and cash in hand of buyer can enhances both trade amount and trade credit in a presence of default risk. We modeled this relationship in order to organize findings from previous literature and from our original micro data on detailed transaction in China to consistently understand the mechanism governing trade credit. Then empirically tested a structure from the theoretical prediction with data. Results show that ex post enforcement power of seller mainly determines size of trade credit and trade amount, cash in hand of buyer can substitute with enforcement power; Bargaining power of seller is exercised to reduces trade credit and trade amount for avoiding default risk, but it simultaneously improves enforcement power as well. We found that ex post enforcement power consists of (ex ante) bargaining power on between two parties and intervention from the third party. However, its magnitude is far smaller than the direct impact to reduce trade credit and trade amount.

Food quality awareness : cases from shrimp producers in Thailand and vegetable producers in Vietnam

The high number of import rejections of food commodities suggests that producers in exporting countries are not complying with established standards. To understand why this is the case, we explore the behavior of producers and consumers in developing countries. First, we examine the successful transformation of production practices adopted by shrimp producers in Thailand. In support of the dramatic change in practices, we observe an important role played by the public sector in providing a means to visualize chemical residues and to control processes upstream of the supply chain via a registration system and a traceability system called Movement Document. Furthermore, very active information sharing by the private sector contributes to the dissemination of useful technical and market information among producers. We also examine the knowledge and perceptions of consumers with respect to food safety in Vietnam. We find that consumers in Hanoi and Ho Chi Minh City behave differently toward the third-party certification VietGAP, probably owing to differences in the history of market mechanisms between the two cities.

A Metadirectory of Web Components for Mashup Composition

Because of the growing availability of third-party APIs, services, widgets and any other reusable web component, mashup developers now face a vast amount of candidate components for their developments. Moreover, these components quite often are scattered in many different repositories and web sites, which makes difficult their selection or discovery. In this paper, we discuss the problem of component selection in Service-Oriented Architectures (SOA) and Mashup-Driven Development, and introduce the Linked Mashups Ontology (LiMOn), a model that allows describing mashups and their components for integrating and sharing mashup information such as categorization or dependencies. The model has allowed the building of an integrated, centralized metadirectory of web components for query and selection, which has served to evaluate the model. The metadirectory allows accessing various heterogeneous repositories of mashups and web components while using external information from the Linked Data cloud, helping mashup development.

VOTESCRIPT: Telematic voting system designed to enable final count verification

In this paper we present a global description of a telematic voting system based on advanced cryptography and on the use of smart cards (VOTESCRIPT system) whose most outstanding characteristic is the ability to verify that the tally carried out by the system is correct, meaning that the results published by the system correspond with votes cast. The VOTESCRIPT system provides an individual verification mechanism allowing each Voter to confirm whether his vote has been correctly counted. The innovation with respect to other solutions lies in the fact that the verification process is private so that Voters have no way of proving what they voted in the presence of a non-authorized third party. Vote buying and selling or any other kind of extortion are prevented. The existence of the Intervention Systems allows the whole electoral process to be controlled by groups of citizens or authorized candidatures. In addition to this the system can simply make an audit not only of the final results, but also of the whole process. Global verification provides the Scrutineers with robust cryptographic evidence which enables unequivocal proof if the system has operated in a fraudulent way.

Facing the climate change challenges in the mining and mineral industry as providers of a sustainable manufacturing process

A sustainable manufacturing process must rely on an also sustainable raw materials and energy supply. This paper is intended to show the results of the studies developed on sustainable business models for the minerals industry as a fundamental previous part of a sustainable manufacturing process. As it has happened in other economic activities, the mining and minerals industry has come under tremendous pressure to improve its social, developmental, and environmental performance. Mining, refining, and the use and disposal of minerals have in some instances led to significant local environmental and social damage. Nowadays, like in other parts of the corporate world, companies are more routinely expected to perform to ever higher standards of behavior, going well beyond achieving the best rate of return for shareholders. They are also increasingly being asked to be more transparent and subject to third-party audit or review, especially in environmental aspects. In terms of environment, there are three inter-related areas where innovation and new business models can make the biggest difference: carbon, water and biodiversity. The focus in these three areas is for two reasons. First, the industrial and energetic minerals industry has significant footprints in each of these areas. Second, these three areas are where the potential environmental impacts go beyond local stakeholders and communities, and can even have global impacts, like in the case of carbon. So prioritizing efforts in these areas will ultimately be a strategic differentiator as the industry businesses continues to grow. Over the next forty years, world?s population is predicted to rise from 6.300 million to 9.500 million people. This will mean a huge demand of natural resources. Indeed, consumption rates are such that current demand for raw materials will probably soon exceed the planet?s capacity. As awareness of the actual situation grows, the public is demanding goods and services that are even more environmentally sustainable. This means that massive efforts are required to reduce the amount of materials we use, including freshwater, minerals and oil, biodiversity, and marine resources. It?s clear that business as usual is no longer possible. Today, companies face not only the economic fallout of the financial crisis; they face the substantial challenge of transitioning to a low-carbon economy that is constrained by dwindling natural resources easily accessible. Innovative business models offer pioneering companies an early start toward the future. They can signal to consumers how to make sustainable choices and provide reward for both the consumer and the shareholder. Climate change and carbon remain major risk discontinuities that we need to better understand and deal with. In the absence of a global carbon solution, the principal objective of any individual country should be to reduce its global carbon emissions by encouraging conservation. The mineral industry internal response is to continue to focus on reducing the energy intensity of our existing operations through energy efficiency and the progressive introduction of new technology. Planning of the new projects must ensure that their energy footprint is minimal from the start. These actions will increase the long term resilience of the business to uncertain energy and carbon markets. This focus, combined with a strong demand for skills in this strategic area for the future requires an appropriate change in initial and continuing training of engineers and technicians and their awareness of the issue of eco-design. It will also need the development of measurement tools for consistent comparisons between companies and the assessments integration of the carbon footprint of mining equipments and services in a comprehensive impact study on the sustainable development of the Economy.

Unidad didáctica sobre el uso del programa Virtual.Lab para simulaciones acústicas. Parte I

El presente Proyecto de Fin de Carrera supone el propósito conjunto de los alumnos Álvaro Morillas y Fernando Sáez, y del profesor Vladimir Ulin, de desarrollar una unidad didáctica sobre el programa de simulación para ingeniería Virtual.Lab. La versión sobre la que se ha trabajado para realizar este texto es la 11, publicada en agosto de 2012. Virtual.Lab, del fabricante belga LMS International, es una plataforma software de ingeniería asistida por ordenador, que agrupa en una misma aplicación varias herramientas complementarias en el diseño de un producto, desde su definición geométrica a los análisis de durabilidad, ruido u optimización. No obstante, de entre todas las posibles simulaciones que nos permite el programa, en este proyecto sólo se tratan las que están relacionadas con la acústica. Cabe resaltar que gran parte de los conceptos manejados en Virtual.Lab son compatibles con el programa CATIA V5, ya que ambos programas vienen instalados y funcionan conjuntamente. Por eso, el lector de este proyecto podrá transportar sus conocimientos al que es uno de los programas estándar en las industrias aeronáutica, naval y automovilística, entre otras. Antes de este proyecto, otros alumnos de la escuela también realizaron proyectos de fin de carrera en el campo de la simulación computarizada en acústica. Una característica común a estos trabajos es que era necesario hacer uso de distintos programas para cada una de las etapas de simulación (como por ejemplo, ANSYS para el modelado y estudio de la vibración y SYSNOISE para las simulaciones acústicas, además de otros programas auxiliares para las traducciones de formato). Con Virtual.Lab desaparece esta necesidad y el tiempo empleado se reduce. Debido a que las soluciones por ordenador están ganando cada vez más importancia en la industria actual, los responsables de este proyecto consideran la necesidad de formación de profesionales en esta rama. Para responder a la demanda empresarial de trabajadores cualificados, se espera que en los próximos años los planes de estudio contengan más cursos en esta materia. Por tanto la intención de los autores es que este material sea de utilidad para el aprendizaje y docencia de estas asignaturas en cursos sucesivos. Por todo esto, se justifica la relevancia de este PFC como manual para introducir a los alumnos interesados en iniciarse en un sistema actual, de uso extendido en otras universidades tecnológicas europeas, y con buenas perspectivas de futuro. En este proyecto se incluyen varios ejemplos ejecutables desde el programa, así como vídeos explicativos que ayudan a mostrar gráficamente los procesos de simulación. Estos archivos se pueden encontrar en el CD adjunto. Abstract This final thesis is a joint project made by the students Álvaro Morillas and Fernando Sáez, and the professor Vladimir Ulin. The nature of the joint regards the writing of a didactic unit on Virtual.Lab, the simulation software. The software version used in this text is the number 11, released in August 2012. Virtual.Lab, from the Belgian developer LMS International, is a computer-aided engineering software which is used for several related tasks in this field: product design, durability simulation, optimization, etc. However, this project is focused on the acoustical capabilities. It is worthy to highlight that most procedures explained in this text can be used in the software CATIA V5 as well. Both tools come installed together and may be used at the same time. Therefore, the reader of this project will be able to use the acquired knowledge in one of the most relevant softwares for the aerospace, marine and automotive engineering. Previously to the development of this project, this School has conducted projects on this field. These projects regarded the use of ANSYS for modeling and meshing stages as well as the use of SYSNOISE for the final acoustic analysis. Since both systems use different file formats, a third-party translation software was required. This thesis fulfill this pending necessity with Virtual.Lab; the translation software procedure is not necessary anymore and simulations can be done in a more flexible, fast way. Since companies have an increasing usage of numerical methods in the development of their products and services, the authors think that it is important to develop the appropriate method to instruct new professionals in the field. Thus, the aim of this project is to help teachers and students in their process of learning the use of this leading software in acoustical simulations. For all the reasons mentioned above, we consider that this project is relevant for the School and the educational community. Aiming to achieve this objective the author offers example files and video demonstrations with guidance in the CD that accompanies this material. This facilitates the comprehension of the practical tasks and guides the prospect users of the software.