Effect of standardized training on the reliability of the Cochrane risk of bias assessment tool: a study protocol

BACKGROUND The Cochrane risk of bias (RoB) tool has been widely embraced by the systematic review community, but several studies have reported that its reliability is low. We aim to investigate whether training of raters, including objective and standardized instructions on how to assess risk of bias, can improve the reliability of this tool. We describe the methods that will be used in this investigation and present an intensive standardized training package for risk of bias assessment that could be used by contributors to the Cochrane Collaboration and other reviewers. METHODS/DESIGN This is a pilot study. We will first perform a systematic literature review to identify randomized clinical trials (RCTs) that will be used for risk of bias assessment. Using the identified RCTs, we will then do a randomized experiment, where raters will be allocated to two different training schemes: minimal training and intensive standardized training. We will calculate the chance-corrected weighted Kappa with 95% confidence intervals to quantify within- and between-group Kappa agreement for each of the domains of the risk of bias tool. To calculate between-group Kappa agreement, we will use risk of bias assessments from pairs of raters after resolution of disagreements. Between-group Kappa agreement will quantify the agreement between the risk of bias assessment of raters in the training groups and the risk of bias assessment of experienced raters. To compare agreement of raters under different training conditions, we will calculate differences between Kappa values with 95% confidence intervals. DISCUSSION This study will investigate whether the reliability of the risk of bias tool can be improved by training raters using standardized instructions for risk of bias assessment. One group of inexperienced raters will receive intensive training on risk of bias assessment and the other will receive minimal training. By including a control group with minimal training, we will attempt to mimic what many review authors commonly have to do, that is-conduct risk of bias assessment in RCTs without much formal training or standardized instructions. If our results indicate that an intense standardized training does improve the reliability of the RoB tool, our study is likely to help improve the quality of risk of bias assessments, which is a central component of evidence synthesis.

Protocol for a randomized, placebo-controlled, double-blind clinical trial investigating sacral neuromodulation for neurogenic lower urinary tract dysfunction

BACKGROUND Sacral neuromodulation has become a well-established and widely accepted treatment for refractory non-neurogenic lower urinary tract dysfunction, but its value in patients with a neurological cause is unclear. Although there is evidence indicating that sacral neuromodulation may be effective and safe for treating neurogenic lower urinary tract dysfunction, the number of investigated patients is low and there is a lack of randomized controlled trials. METHODS AND DESIGN This study is a prospective, randomized, placebo-controlled, double-blind multicenter trial including 4 sacral neuromodulation referral centers in Switzerland. Patients with refractory neurogenic lower urinary tract dysfunction are enrolled. After minimally invasive bilateral tined lead placement into the sacral foramina S3 and/or S4, patients undergo prolonged sacral neuromodulation testing for 3-6 weeks. In case of successful (defined as improvement of at least 50% in key bladder diary variables (i.e. number of voids and/or number of leakages, post void residual) compared to baseline values) prolonged sacral neuromodulation testing, the neuromodulator is implanted in the upper buttock. After a 2 months post-implantation phase when the neuromodulator is turned ON to optimize the effectiveness of neuromodulation using sub-sensory threshold stimulation, the patients are randomized in a 1:1 allocation in sacral neuromodulation ON or OFF. At the end of the 2 months double-blind sacral neuromodulation phase, the patients have a neuro-urological re-evaluation, unblinding takes place, and the neuromodulator is turned ON in all patients. The primary outcome measure is success of sacral neuromodulation, secondary outcome measures are adverse events, urodynamic parameters, questionnaires, and costs of sacral neuromodulation. DISCUSSION It is of utmost importance to know whether the minimally invasive and completely reversible sacral neuromodulation would be a valuable treatment option for patients with refractory neurogenic lower urinary tract dysfunction. If this type of treatment is effective in the neurological population, it would revolutionize the management of neurogenic lower urinary tract dysfunction. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov; Identifier: NCT02165774.

New perioperative fluid and pharmacologic management protocol results in reduced blood loss, faster return of bowel function, and overall recovery.

Cystectomy and urinary diversion have high morbidity, and strategies to reduce complications are of utmost importance. Epidural analgesia and optimized fluid management are considered key factors contributing to successful enhanced recovery after surgery. In colorectal surgery, there is strong evidence that an intraoperative fluid management aiming for a postoperative zero fluid balance results in lower morbidity including a faster return of bowel function. Recently, a randomized clinical trial focusing on radical cystectomy demonstrated that a restrictive intraoperative hydration combined with a concomitant administration of norepinephrine reduced intraoperative blood loss, the need for blood transfusion and morbidity. The purpose of this review is to highlight specific anesthesiological aspects which have been shown to improve outcome after RC with urinary diversion.

Chow–Liu trees are sufficient predictive models for reproducing key features of functional networks of periictal EEG time-series

Seizure freedom in patients suffering from pharmacoresistant epilepsies is still not achieved in 20–30% of all cases. Hence, current therapies need to be improved, based on a more complete understanding of ictogenesis. In this respect, the analysis of functional networks derived from intracranial electroencephalographic (iEEG) data has recently become a standard tool. Functional networks however are purely descriptive models and thus are conceptually unable to predict fundamental features of iEEG time-series, e.g., in the context of therapeutical brain stimulation. In this paper we present some first steps towards overcoming the limitations of functional network analysis, by showing that its results are implied by a simple predictive model of time-sliced iEEG time-series. More specifically, we learn distinct graphical models (so called Chow–Liu (CL) trees) as models for the spatial dependencies between iEEG signals. Bayesian inference is then applied to the CL trees, allowing for an analytic derivation/prediction of functional networks, based on thresholding of the absolute value Pearson correlation coefficient (CC) matrix. Using various measures, the thus obtained networks are then compared to those which were derived in the classical way from the empirical CC-matrix. In the high threshold limit we find (a) an excellent agreement between the two networks and (b) key features of periictal networks as they have previously been reported in the literature. Apart from functional networks, both matrices are also compared element-wise, showing that the CL approach leads to a sparse representation, by setting small correlations to values close to zero while preserving the larger ones. Overall, this paper shows the validity of CL-trees as simple, spatially predictive models for periictal iEEG data. Moreover, we suggest straightforward generalizations of the CL-approach for modeling also the temporal features of iEEG signals.

Probability sampling protocol of classification maps from spaceborne/airborne image

To deliver sample estimates provided with the necessary probability foundation to permit generalization from the sample data subset to the whole target population being sampled, probability sampling strategies are required to satisfy three necessary not sufficient conditions: (i) All inclusion probabilities be greater than zero in the target population to be sampled. If some sampling units have an inclusion probability of zero, then a map accuracy assessment does not represent the entire target region depicted in the map to be assessed. (ii) The inclusion probabilities must be: (a) knowable for nonsampled units and (b) known for those units selected in the sample: since the inclusion probability determines the weight attached to each sampling unit in the accuracy estimation formulas, if the inclusion probabilities are unknown, so are the estimation weights. This original work presents a novel (to the best of these authors' knowledge, the first) probability sampling protocol for quality assessment and comparison of thematic maps generated from spaceborne/airborne Very High Resolution (VHR) images, where: (I) an original Categorical Variable Pair Similarity Index (CVPSI, proposed in two different formulations) is estimated as a fuzzy degree of match between a reference and a test semantic vocabulary, which may not coincide, and (II) both symbolic pixel-based thematic quality indicators (TQIs) and sub-symbolic object-based spatial quality indicators (SQIs) are estimated with a degree of uncertainty in measurement in compliance with the well-known Quality Assurance Framework for Earth Observation (QA4EO) guidelines. Like a decision-tree, any protocol (guidelines for best practice) comprises a set of rules, equivalent to structural knowledge, and an order of presentation of the rule set, known as procedural knowledge. The combination of these two levels of knowledge makes an original protocol worth more than the sum of its parts. The several degrees of novelty of the proposed probability sampling protocol are highlighted in this paper, at the levels of understanding of both structural and procedural knowledge, in comparison with related multi-disciplinary works selected from the existing literature. In the experimental session the proposed protocol is tested for accuracy validation of preliminary classification maps automatically generated by the Satellite Image Automatic MapperT (SIAMT) software product from two WorldView-2 images and one QuickBird-2 image provided by DigitalGlobe for testing purposes. In these experiments, collected TQIs and SQIs are statistically valid, statistically significant, consistent across maps and in agreement with theoretical expectations, visual (qualitative) evidence and quantitative quality indexes of operativeness (OQIs) claimed for SIAMT by related papers. As a subsidiary conclusion, the statistically consistent and statistically significant accuracy validation of the SIAMT pre-classification maps proposed in this contribution, together with OQIs claimed for SIAMT by related works, make the operational (automatic, accurate, near real-time, robust, scalable) SIAMT software product eligible for opening up new inter-disciplinary research and market opportunities in accordance with the visionary goal of the Global Earth Observation System of Systems (GEOSS) initiative and the QA4EO international guidelines.

Evaluación de los co-beneficios sobre el desarrollo sostenible y la reducción de la pobreza de proyectos de mitigación del cambio climático en Brasil

El cambio climático y los diferentes aspectos del concepto de “desarrollo” están intrínsecamente interconectados. Por un lado, el desarrollo económico de nuestras sociedades ha contribuido a un aumento insostenible de las emisiones de gases de efecto invernadero, las cuales están desestabilizando el sistema climático global, generando al mismo tiempo una distribución desigual de la capacidad de las personas para hacer frente a estos cambios. Por otro lado, en la actualidad existe un amplio consenso sobre que el cambio climático impacta directamente y de manera negativa sobre el denominando desarrollo sostenible. De igual manera, cada vez existe un mayor consenso de que el cambio climático va a desafiar sustancialmente nuestra capacidad de erradicar la pobreza a medio y largo plazo. Ante esta realidad, no cabe duda de que las estrategias de adaptación son esenciales para mantener el desarrollo. Es por esto que hasta el momento, los mayores esfuerzos realizados por unir las agendas globales de la lucha contra la pobreza y del cambio climático se han dado en el entorno de la adaptación al cambio climático. Sin embargo, cada vez son más los actores que defienden, desde distintos escenarios, que existen sinergias entre la mitigación de emisiones y la mejora de las condiciones de vida de las poblaciones más vulnerables, favoreciendo así un “desarrollo sostenible” sin disminuir los recursos financieros destinados a la adaptación. Para hacer efectivo este potencial, es imprescindible identificar diseños de estrategias de mitigación que incrementen los resultados de desarrollo, contribuyendo al desarrollo sostenible al mismo tiempo que a reducir la pobreza. En este contexto se sitúa el objetivo principal de esta investigación, consistente en analizar los co-beneficios locales, para el desarrollo sostenible y la reducción la pobreza, de proyectos de mitigación del cambio climático que se implementan en Brasil. Por co-beneficios se entienden, en el lenguaje de las discusiones internacionales de cambio climático, aquellos beneficios que van más allá de la reducción de emisiones de Gases de Efecto Invernadero (GEI) intrínsecas por definición a los proyectos de mitigación. Los proyectos de mitigación más relevantes hasta el momento bajo el paraguas de la Convención Marco de las Naciones Unidas para el Cambio Climático (CMNUCC), son los denominados Mecanismos de Desarrollo Limpio (MDL) del Protocolo de Kioto. Sin embargo, existen alternativas de proyectos de mitigación (tales como los denominados “estándares adicionales” a los MDL de los Mercados Voluntarios de Carbono y las Tecnologías Sociales), que también serán tenidos en cuenta en el marco de este estudio. La elección del tema se justifica por la relevancia del mismo en un momento histórico en el que se está decidiendo el futuro del régimen climático a partir del año 2020. Aunque en el momento de redactar este documento, todavía no se ha acordado la forma que tendrán los futuros instrumentos de mitigación, sí que se sabe que los co-beneficios de estos instrumentos serán tan importantes, o incluso más, que las reducciones de GEI que generan. Esto se debe, principalmente, a las presiones realizadas en las negociaciones climáticas por parte de los países menos desarrollados, para los cuales el mayor incentivo de formar parte de dichas negociaciones se basa principalmente en estos potenciales co-beneficios. Los resultados de la tesis se estructuran alrededor de tres preguntas de investigación: ¿cómo están contribuyendo los MDL implementados en Brasil a generar co-beneficios que fomenten el desarrollo sostenible y reduzcan la pobreza?; ¿existen proyectos de mitigación en Brasil que por tener compromisos más exigentes en cuanto a su contribución al desarrollo sostenible y/o la reducción de la pobreza que los MDL estén siendo más eficientes que estos en relación a los co-beneficios que generan?; y ¿qué características de los proyectos de mitigación pueden resultar críticas para potenciar sus co-beneficios en las comunidades en las que se implementan? Para dar respuesta a estas preguntas, se ha desarrollado durante cuatro años una labor de investigación estructurada en varias fases y en la que se combinan diversas metodologías, que abarcan desde el desarrollo de un modelo de análisis de cobeneficios, hasta la aplicación del mismo tanto a nivel documental sobre 194 documentos de diseño de proyecto (denominado análisis ex-ante), como a través de 20 casos de estudio (denominado análisis ex-post). Con la realización de esta investigación, se ha confirmado que los requisitos existentes hasta el momento para registrar un proyecto como MDL bajo la CMNUCC no favorecen sustancialmente la generación de co-beneficios locales para las comunidades en las que se implementan. Adicionalmente, se han identificado prácticas y factores, que vinculadas a las actividades intrínsecas de los proyectos de mitigación, son efectivas para incrementar sus co-beneficios. Estas prácticas y factores podrán ser tenidas en cuenta tanto para mejorar los requisitos de los actuales proyectos MDL, como para apoyar la definición de los nuevos instrumentos climáticos. ABSTRACT Climate change and development are inextricably linked. On the one hand, the economic development of our societies has contributed to the unsustainable increase of Green House Gases emissions, which are destabilizing the global climate system while fostering an unequal distribution of people´s ability to cope with these changes. On the other hand, there is now a consensus that climate change directly impacts the so-called sustainable development. Likely, there is a growing agreement that climate change will substantially threaten our capacity to eradicate poverty in the medium and long term. Given this reality, there is no doubt that adaptation strategies are essentials to keep development. This is why, to date, much of the focus on poverty in the context of climate change has been on adaptation However, without diverting resources from adaptation, there may exist the potential to synergize efforts to mitigate emissions, contribute to sustainable development and reduce poverty. To fulfil this potential, it is key identifying how mitigation strategies can also support sustainable development and reduce poverty. In this context, the main purpose of this investigation is to explore the co-benefits, for sustainable development and for poverty reduction, of climate change mitigation projects being implemented in Brazil. In recent years the term co-benefits, has been used by policy makers and academics to refer the potentially large and diverse range of collateral benefits that can be associated with climate change mitigation policies in addition to the direct avoided climate impact benefits. The most relevant mitigation projects developed during the last years under the United Nations Framework Convention on Climate Change (UNFCCC) are the so-called Clean Development Mechanisms (CDM) of the Kyoto Protocol. Thus, this research will analyse this official mechanism. However, there are alternatives to the mitigation projects (such as the "add-on standards" of the Voluntary Carbon Markets, and the Social Technologies) that will also be assessed as part of the research. The selection of this research theme is justified because its relevance in a historic moment in which proposals for a future climate regime after 2020 are being negotiated. Although at the moment of writing this document, there is not a common understanding on the shape of the new mitigation instruments, there is a great agreement about the importance of the co-benefits of such instruments, which may be even more important for the Least Developed Countries that their expected greenhouse gases emissions reductions. The results of the thesis are structured around three research questions: how are the CDM projects being implemented in Brazil generating local co-benefits that foster sustainable development and poverty reduction?; are other mitigation projects in Brazil that due to their more stringent sustainable development and/o poverty reduction criteria, any more successful at delivering co-benefits than regular CDM projects?; and what are the distinguishing characteristics of mitigation projects that are successful at delivering co-benefits? To answer these research questions, during four years it has been developed a research work structured in several phases and combining various methodologies. Those methodologies cover from the development of a co-benefits assessment model, to the application of such model both to a desktop analysis of 194 project design documents, and to 20 case studies using field data based on site visits to the project sites. With the completion of this research, it has been confirmed that current requirements to register a CDM project under the UNFCCC not substantially favour co-benefits at the local level. In addition, some practices and factors enablers of co-benefits have been identified. These characteristics may be taken into consideration to improve the current CDM and to support the definition of the new international market mechanisms for climate mitigation.

Validation of an instrument for injury data collection in strength training

Purpose: To provide for the basis for collecting strength training data using a rigorously validated injury report form. Methods: A group of specialist designed a questionnaire of 45 item grouped into 4 dimensions. Six stages were used to assess face, content, and criterion validity of the weight training injury report form. A 13 members panel assessed the form for face validity, and an expert panel assessed it for content and criterion validity. Panel members were consulted until consensus was reached. A yardstick developed by an expert panel using Intraclass correlation technique was used to assess the reability of the form. Test-retest reliability was assessed with the intraclass correlation coefficient (ICC).The strength training injury report form was developed, and the face, content, and criterion validity successfully assessed. A six step protocol to create a yardstick was also developed to assist in the validation process. Both inter-rater and intra rater reliability results indicated a 98% agreement. Inter-rater reliability agreement of 98% for three injuries. Results: The Cronbach?s alpha of the questionnaire was 0.944 (pmenor que0.01) and the ICC of the entire questionnaire was 0.894 (pmenor que0.01). Conclusion: The questionnaire gathers together enough psychometric properties to be considered a valid and reliable tool for register injury data in strength training, and providing researchers with a basis for future studies in this area. Key Words: data collection; validation; injury prevention; strength training

Information reconciliation methods in secret key distribution

We consider in this thesis the problem of information reconciliation in the context of secret key distillation between two legitimate parties. In some scenarios of interest this problem can be advantageously solved with low density parity check (LDPC) codes optimized for the binary symmetric channel. In particular, we demonstrate that our method leads to a significant efficiency improvement, with respect to earlier interactive reconciliation methods. We propose a protocol based on LDPC codes that can be adapted to changes in the communication channel extending the original source. The efficiency of our protocol is only limited by the quality of the code and, while transmitting more information than needed to reconcile Alice’s and Bob’s sequences, it does not reveal any more information on the original source than an ad-hoc code would have revealed.---ABSTRACT---En esta tesis estudiamos el problema de la reconciliación de información en el contexto de la destilación de secreto entre dos partes. En algunos escenarios de interés, códigos de baja densidad de ecuaciones de paridad (LDPC) adaptados al canal binario simétrico ofrecen una buena solución al problema estudiado. Demostramos que nuestro método mejora significativamente la eficiencia de la reconciliación. Proponemos un protocolo basado en códigos LDPC que puede ser adaptado a cambios en el canal de comunicaciones mediante una extensión de la fuente original. La eficiencia de nuestro protocolo está limitada exclusivamente por el código utilizado y no revela información adicional sobre la fuente original que la que un código con la tasa de información adaptada habría revelado.

Diseño y configuración de una red de comunicaciones en un Centro de Contactos - Contact Center

Este proyecto muestra una solución de red para una empresa que presta servicios de Contact Center desde distintas sedes distribuidas geográficamente, utilizando la tecnología de telefonía sobre IP. El objetivo de este proyecto es el de convertirse en una guía de diseño para el despliegue de soluciones de red utilizando los actuales equipos de comunicaciones desarrollados por el fabricante Cisco Systems, Inc., los equipos de seguridad desarrollados por el fabricante Fortinet y los sistemas de telefonía desarrollados por Avaya Inc. y Oracle Corporation, debido a su gran penetración en el mercado y a las aportaciones que cada uno ha realizado en el sector de Contact Center. Para poder proveer interconexión entre las sedes de un Contact Center se procede a la contratación de un acceso a la red MPLS perteneciente a un operador de telecomunicaciones, quien provee conectividad entre las sedes utilizando la tecnología VPN MPLS con dos accesos diversificados entre sí desde cada una de las sedes del Contact Center. El resultado de esta contratación es el aprovechamiento de las ventajas que un operador de telecomunicaciones puede ofrecer a sus clientes, en relación a calidad de servicio, disponibilidad y expansión geográfica. De la misma manera, se definen una serie de criterios o niveles de servicio que aseguran a un Contact Center una comunicación de calidad entre sus sedes, entendiéndose por comunicación de calidad aquella que sea capaz de transmitirse con unos valores mínimos de pérdida de paquetes así como retraso en la transmisión, y una velocidad acorde a la demanda de los servicios de voz y datos. Como parte de la solución, se diseña una conexión redundante a Internet que proporciona acceso a todas las sedes del Contact Center. La solución de conectividad local en cada una de las sedes de un Contact Center se ha diseñado de manera general acorde al volumen de puestos de usuarios y escalabilidad que pueda tener cada una de las sedes. De esta manera se muestran varias opciones asociadas al equipamiento actual que ofrece el fabricante Cisco Systems, Inc.. Como parte de la solución se han definido los criterios de calidad para la elección de los Centros de Datos (Data Center). Un Contact Center tiene conexiones hacia o desde las empresas cliente a las que da servicio y provee de acceso a la red a sus tele-trabajadores. Este requerimiento junto con el acceso y servicios publicados en Internet necesita una infraestructura de seguridad. Este hecho da lugar al diseño de una solución que unifica todas las conexiones bajo una única infraestructura, dividiendo de manera lógica o virtual cada uno de los servicios. De la misma manera, se ha definido la utilización de protocolos como 802.1X para evitar accesos no autorizados a la red del Contact Center. La solución de voz elegida es heterogénea y capaz de soportar los protocolos de señalización más conocidos (SIP y H.323). De esta manera se busca tener la máxima flexibilidad para establecer enlaces de voz sobre IP (Trunk IP) con proveedores y clientes. Esto se logra gracias a la utilización de SBCs y a una infraestructura interna de voz basada en el fabricante Avaya Inc. Los sistemas de VoIP en un Contact Center son los elementos clave para poder realizar la prestación del servicio; por esta razón se elige una solución redundada bajo un entorno virtual. Esta solución permite desplegar el sistema de VoIP desde cualquiera de los Data Center del Contact Center. La solución llevada a cabo en este proyecto está principalmente basada en mi experiencia laboral adquirida durante los últimos siete años en el departamento de comunicaciones de una empresa de Contact Center. He tenido en cuenta los principales requerimientos que exigen hoy en día la mayor parte de empresas que desean contratar un servicio de Contact Center. Este proyecto está dividido en cuatro capítulos. El primer capítulo es una introducción donde se explican los principales escenarios de negocio y áreas técnicas necesarias para la prestación de servicios de Contact Center. El segundo capítulo describe de manera resumida, las principales tecnologías y protocolos que serán utilizados para llevar a cabo el diseño de la solución técnica de creación de una red de comunicaciones para una empresa de Contact Center. En el tercer capítulo se expone la solución técnica necesaria para permitir que una empresa de Contact Center preste sus servicios desde distintas ubicaciones distribuidas geográficamente, utilizando dos Data Centers donde se centralizan las aplicaciones de voz y datos. Finalmente, en el cuarto capítulo se presentan las conclusiones obtenidas tras la elaboración de la presente memoria, así como una propuesta de trabajos futuros, que permitirían junto con el proyecto actual, realizar una solución técnica completa incluyendo otras áreas tecnológicas necesarias en una empresa de Contact Center. Todas las ilustraciones y tablas de este proyecto son de elaboración propia a partir de mi experiencia profesional y de la información obtenida en diversos formatos de la bibliografía consultada, excepto en los casos en los que la fuente es mencionada. ABSTRACT This project shows a network solution for a company that provides Contact Center services from different locations geographically distributed, using the Telephone over Internet Protocol (ToIP) technology. The goal of this project is to become a design guide for performing network solutions using current communications equipment developed by the manufacturer Cisco Systems, Inc., firewalls developed by the manufacturer Fortinet and telephone systems developed by Avaya Inc. and Oracle Corporation, due to their great market reputation and their contributions that each one has made in the field of Contact Center. In order to provide interconnection between its different sites, the Contact Center needs to hire the services of a telecommunications’ operator, who will use the VPN MPLS technology, with two diversified access from each Contact Center’s site. The result of this hiring is the advantage of the benefits that a telecommunications operator can offer to its customers, regarding quality of service, availability and geographical expansion. Likewise, Service Level Agreement (SLA) has to be defined to ensure the Contact Center quality communication between their sites. A quality communication is understood as a communication that is capable of being transmitted with minimum values of packet loss and transmission delays, and a speed according to the demand for its voice and data services. As part of the solution, a redundant Internet connection has to be designed to provide access to every Contact Center’s site. The local connectivity solution in each of the Contact Center’s sites has to be designed according to its volume of users and scalability that each one may have. Thereby, the manufacturer Cisco Systems, Inc. offers several options associated with the current equipment. As part of the solution, quality criteria are being defined for the choice of the Data Centers. A Contact Center has connections to/from the client companies that provide network access to teleworkers. This requires along the access and services published on the Internet, needs a security infrastructure. Therefore is been created a solution design that unifies all connections under a single infrastructure, dividing each services in a virtual way. Likewise, is been defined the use of protocols, such as 802.1X, to prevent unauthorized access to the Contact Center’s network. The voice solution chosen is heterogeneous and capable of supporting best-known signaling protocols (SIP and H.323) in order to have maximum flexibility to establish links of Voice over IP (IP Trunk) with suppliers and clients. This can be achieved through the use of SBC and an internal voice infrastructure based on Avaya Inc. The VoIP systems in a Contact Center are the key elements to be able to provide the service; for this reason a redundant solution under virtual environment is been chosen. This solution allows any of the Data Centers to deploy the VoIP system. The solution carried out in this project is mainly based on my own experience acquired during the past seven years in the communications department of a Contact Center company. I have taken into account the main requirements that most companies request nowadays when they hire a Contact Center service. This project is divided into four chapters. The first chapter is an introduction that explains the main business scenarios and technical areas required to provide Contact Center services. The second chapter describes briefly the key technologies and protocols that will be used to carry out the design of the technical solution for the creation of a communications network in a Contact Center company. The third chapter shows a technical solution required that allows a Contact Center company to provide services from across geographically distributed locations, using two Data Centers where data and voice applications are centralized. Lastly, the fourth chapter includes the conclusions gained after making this project, as well as a future projects proposal, which would allow along the current project, to perform a whole technical solution including other necessary technologic areas in a Contact Center company All illustrations and tables of this project have been made by myself from my professional experience and the information obtained in various formats of the bibliography, except in the cases where the source is indicated.

Ordered water molecules as key allosteric mediators in a cooperative dimeric hemoglobin

One of the most remarkable structural aspects of Scapharca dimeric hemoglobin is the disruption of a very well-ordered water cluster at the subunit interface upon ligand binding. We have explored the role of these crystallographically observed water molecules by site-directed mutagenesis and osmotic stress techniques. The isosteric mutation of Thr-72 → Val in the interface increases oxygen affinity more than 40-fold with a surprising enhancement of cooperativity. The only significant structural effect of this mutation is to destabilize two ordered water molecules in the deoxy interface. Wild-type Scapharca hemoglobin is strongly sensitive to osmotic conditions. Upon addition of glycerol, striking changes in Raman spectrum of the deoxy form are observed that indicate a transition toward the liganded form. Increased osmotic pressure, which lowers the oxygen affinity in human hemoglobin, raises the oxygen affinity of Scapharca hemoglobin regardless of whether the solute is glycerol, glucose, or sucrose. Analysis of these results provides an estimate of six water molecules lost upon oxygen binding to the dimer, in good agreement with eight predicted from crystal structures. These experiments suggest that the observed cluster of interfacial water molecules plays a crucial role in communication between subunits.

How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

Background: Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods: This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion: Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.

First steps toward harmonized human biomonitoring in Europe : demonstration project to perform human biomonitoring on a European scale

'Reproduced with permission from Environmental Health Perspectives'

Low key but not low impact: the results of the EU's 'transition' summit. EPC Post-Summit Analysis, 27 October 2014

The European Council Summit of 23-24 October 2014 may have been relatively low key, but many important decisions were made which could encourage historical changes. In this post-summit analysis, Janis A. Emmanouilidis examines the agreement reached on a new climate and energy policy framework for 2020-2030 which despite falling short of the European Commission’s original proposals, it nevertheless delivers a positive message to international community ahead of the global climate negotiations next year. He also highlights the significance of the request from euro-zone leaders for a new report on ‘better economic governance’ by December. More broadly, he uses this moment of transition in the EU’s leadership to analyse the current state and future direction of the Union, and underlines the need to provide a coherent and holistic response to the damage caused by the crisis and the challenges facing the Union, on the basis of an ambitious but pragmatic ‘package deal’ – a new pact between EU governments, and between the Union and its citizens – to heal the divisions of recent years and restore public faith in the benefits of EU membership.

The prospects for the EU-Ukraine free trade agreement. OSW Commentary No. 94, 2012-10-15

The European Union and Ukraine initialled the Deep and Comprehensive Free Trade Area Agreement (DCFTA) on 19 July 2012. The scope of the agreement which the EU and Ukraine reached following their negotiations is much more extensive than that of a typical free trade agreement. It envisages not only the lifting of tariff and extra-tariff barriers but also, more importantly, Kyiv adopting EU legal solutions and standards in this area. Whether the agreement will be signed and implemented is still an open question and depends on the existing political conditions. On the one hand, the repression imposed by the government in Kyiv on its political opponents (including the detention of the former prime minister, Yulia Tymoshenko) has provoked criticism from the EU, which refuses to sign the agreement if the government in Kyiv continues to violate democratic principles. The manner in which Ukraine’s parliamentary elections are conducted this October will be the key test. On the other hand, Russia is increasingly active in its efforts to involve Ukraine in the integration projects it has initiated (the Customs Union and the Eurasian Economic Community). It should be noted that Moscow has effective instruments to exert its will, such as the dependence of the Ukrainian economy on supplies of Russian oil and gas and on exports to the Russian market. Besides, Moscow also has political instruments at its disposal. It is impossible to participate in integration projects both with the EU and with Russia. Therefore, Kyiv will have to make a strategic decision and choose the direction of its economic integration. Unless Ukraine takes concrete action to implement its agreements with the EU, primarily including the free trade agreement, its economic dependence on Russia will grow, and it will be more likely to join the Russian integration projects.

THE KYOTO PROTOCOL AND THE WTO: INSTITUTIONAL EVOLUTION AND ADAPTATION. CEPS Policy Brief No. 28/December

Overview. Questions about the interface between the multilateral climate regime embodied in the Kyoto Protocol and the multilateral trade regime embodied in the World Trade Organisation (WTO) have become especially timely since the fall of 2001. At that time, ministerial-level meetings in Marrakech and Doha agreed to advance the agendas, respectively, for the implementation of the Kyoto Protocol and for negotiations on further agreements at the WTO. There have been concerns that each of these multilateral arrangements could constrain the effectiveness of the other, and these concerns will become more salient with the entry into force of the Kyoto Protocol. There are questions about whether and how the rights and obligations of the members of the WTO and the parties to the Protocol may conflict. Of particular concern is whether provisions in the Protocol, as well as government policies and business activities undertaken in keeping with those provisions, may conflict with the WTO non-discrimination principles of national treatment and most-favoured nation treatment. The WTO agreements that are potentially relevant to climate change issues include many of the individual Uruguay Round agreements and subsequent agreements as well. The principal elements of the Kyoto Protocol that are particularly relevant are its provisions concerning emissions trading, the Clean Development Mechanism, Joint Implementation, enforcement, and parties’ policies and measures. In combination, therefore, there are numerous potential points of intersection between the elements of the Kyoto Protocol and the WTO agreements. Previous studies have clarified many issues, as they have focused on particular aspects of the regimes’ relationships. Yet, some analyses suggest that the two regimes are largely compatible and even mutually reinforcing, while others suggest that there are significant conflicts between them. Those and other studies are referenced in the ‘suggestions for further reading’ section at the end of the paper.1 The present paper seeks to expand on those studies by providing additional breadth and depth to understanding of the issues. The analysis gives special attention to key issues on the agenda – i.e. issues that are particularly problematic because of the likelihood of occurrence of specific conflicts and the significance of their economic and/or political consequences. The paper adopts a modified ‘triage’ approach, which classifies points of intersection as (a) highly problematic and clearly in need of further attention, (b) perhaps problematic but less urgent, and (c) apparently not problematic, at least at this point in time. The principal conclusions are that: · The missions and objectives of the two regimes are largely compatible, and their operations are potentially mutually reinforcing in several respects. · Some provisions of the multilateral agreements that may superficially seem at odds are not likely to become particularly problematic in practice. · ‘Domestic policies and measures’ that governments may undertake in the context of the Protocol could pose difficult issues in the context of WTO dispute cases. · Recent WTO agreements and dispute cases acknowledge the legitimacy of the ‘precautionary principle’ and are thus consistent with the environmental protection objectives of the Protocol. · The relative newness of the climate regime creates opportunities for institutional adaptation, as compared with the constraints of tradition in the trade-investment regime. · The prospect of largely independent evolutionary paths for the two regimes poses a series of issues about future international regime design and management, which may require new institutional arrangements. In sum, the present paper thus finds that although there are some areas of interaction that are problematic, the two regimes may nevertheless co-exist in relative harmony in other respects –more like ‘neighbours’ than either ‘friends’ or ‘foes’, as Krist (2001) has suggested.