976 resultados para Value adding
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Magdeburg, Univ., Fak. für Mathematik, kumulative Habil.-Schr., 2011
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Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.
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Background:The QRS-T angle correlates with prognosis in patients with heart failure and coronary artery disease, reflected by an increase in mortality proportional to an increase in the difference between the axes of the QRS complex and T wave in the frontal plane. The value of this correlation in patients with Chagas heart disease is currently unknown.Objective:Determine the correlation of the QRS-T angle and the risk of induction of ventricular tachycardia / ventricular fibrillation (VT / VF) during electrophysiological study (EPS) in patients with Chagas disease.Methods:Case-control study at a tertiary center. Patients without induction of VT / VF on EPS were used as controls. The QRS-T angle was categorized as normal (0-105º), borderline (105-135º) or abnormal (135-180º). Differences between groups for continuous variables were analyzed with the t test or Mann-Whitney test, and for categorical variables with Fisher's exact test. P values < 0.05 were considered significant.Results:Of 116 patients undergoing EPS, 37.9% were excluded due to incomplete information / inactive records or due to the impossibility to correctly calculate the QRS-T angle (presence of left bundle branch block and atrial fibrillation). Of 72 patients included in the study, 31 induced VT / VF on EPS. Of these, the QRS-T angle was normal in 41.9%, borderline in 12.9% and abnormal in 45.2%. Among patients without induction of VT / VF on EPS, the QRS-T angle was normal in 63.4%, borderline in 14.6% and abnormal in 17.1% (p = 0.04). When compared with patients with normal QRS-T angle, those with abnormal angle had a fourfold higher risk of inducing ventricular tachycardia / ventricular fibrillation on EPS [odds ratio (OR) 4; confidence interval (CI) 1.298-12.325; p = 0.028]. After adjustment for other variables such as age, ejection fraction (EF) and QRS size, there was a trend for the abnormal QRS-T angle to identify patients with increased risk of inducing VT / VF during EPS (OR 3.95; CI 0.99-15.82; p = 0.052). The EF also emerged as a predictor of induction of VT / VF: for each point increase in EF, there was a 4% reduction in the rate of sustained ventricular arrhythmia on EPS.Conclusions:Changes in the QRS-T angle and decreases in EF were associated with an increased risk of induction of VT / VF on EPS.
Incremental Value Of 3D Transesophageal Echocardiography for The Assessment of Mitral Valve Prolapse
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Abstract Background: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results: 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
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WATER-CULTURE EXPERIMENTS. Two water-culture experiments were carried out to study the absorption and the translocation of radiozinc in young coffee plants as influenced by two factors, namely, concentration of heavy metals (iron, man ganese, copper and molybdenum) and method of application. Inert zinc was supplied at an uniform rate of 0. 05 p. p. m.; the levels of iron supply were 0, 1.0, and 10.0 p. p.m.; manganese was supplied in three doses 0, 0.5, and 5.0 p. p.m.; copper- 0, 0. 02, and 0. 2 p. p. m.; molybdenum- 0, 0. 01, and 0. 1 p. p. m. When applied to the nutrient solution the activity os the radiozinc (as zinc chloride) was 0. 15 microcuries per plant. In the study of the leaf absorption, Zn65 was supplied at the level of 0. 10 microcuries per plant; in this case the radioative material was brushed either on the lower or on the upper surface or both two pairs of mature leaves. The absorption period was 8 weeks. The radioactivity assay showed the following results: 1 - Among the heavy metals herein investigated the iron concentration did not affect the uptake of the radiozinc; by raising the level of Mn, Cu and Mo ten times, the absorption dropped to 50 per cent and even more when compared with the control plants; when, however, these micronutrients were omitted from the nutrient solution, an increase in the uptake of zinc was registered in the minus Cu treatment only. The effects of high levels of Mn, Cu and Mo probably indicate an interionic competition for a same site on a common binding substance in the cell surface. 2 - The absorption of the radiozinc directly applied to the leaf surface reached levels as high as 8 times that registered when the root uptake took place. Among the three methods of application which have been tried, brushing the lower surface of the leaves proved to be the most effective; this result is easily understood since the stomatal openings of the coffee leaves an preferentially located in the lower surface - in this treatment, about 40 per cent of the activity was absorved and around 12 per cent were translocated either to the old or to the newer organs. Chemical analyses for heavy metals, were carried out only in the plants received Zn65Cl2 in the nutrient solution; the results were as follows; 1 - Control plants had, per 1,000 gm, of dry weight the following amounts in mg.: Zn- 48 in the roots and 29 in the tops; Fe- 165 in the roots and 9 in the tops; Mn- 58 in the roots and 15 in the tops, Cu- 15 in the roots and 1. 2 in the tops; Mo- 2. 8 in the roots and 0. 45 in the tops. 2 - The effect of different levels of micronutrients in the composition of the plants can be summarized as follows: Fe and Zn- when omitted from the nutrient solution, the iron and zinc contents in the roots decreased, no variation being noted in the tops; the higher dosis caused an accumulation in the roots but no apparent effect in the tops; Mn- by omitting this micronutrient a decrease in its content in the roots was noted, where as the concentration in the tops was the same; Mo- no variation in roots and tops contents when molybdenum was omitted; higher dosis of manganese and molybdenum increased the amounts formed both in the roots and in the tops. 3 - The influence of the different concentrations of micronutrients heavy metals on the zinc content of the coffee plants can be described by saying that: Fe and Mo- no marked variation; Mn- no effect when omitted, reduced amount when the high dosis was supplied; Mn- when the plants did not receive manganese the zinc content in roots and tops was the same as in the control plants; a decrease in the zinc content of the total plant occurred when the high dosis was employed; Cu -the situation is similar to that described for manganese. Hence, results showed by the chemical analyses roughly correspond to those of the radioactivity assay; the use of the tracer technique, however, gave best informations along this line. SOIL-POTS EXPERIMENTS. The two types of soils which when selected support the most extensive coffee plantations in the State of São Paulo, Brazil: "arenito de Bauru", a light sandy soil and "terra roxa legitima", a red soil derived from basalt. Besides NPK containing salts, the coffee plants were given two doses of inert zinc (65 and 130 mg ZnCl2 per pot) and radiozinc at a total activity of 10(6) counts/minute. The results of the countings can be summarized as follows: 1 - When plants were grown in "arenito de Bauru" the activity absorbed as per cent of the total activity supplied was not affected by the dosis of inert zinc. The highest value found was around 0. 1 per cent. 2 - For the "terra roxa" plants, the situation is almost the same; there was, however, a slight increase in the absorption of the radiozinc when 130 mgm of ZnClg2 was given: a little above 0. 2 per cent of the activity supplied was absorbed. The results clearly show that the young coffee plants practically did not absorb none of the zinc supplied; two reasons at least could be pointed out to explain such a fact: 1 - Zinc fixation by an exchange with magnesium or by filling holes in the octahedral layer of aluminosilicates, probably kaolinite; 2 - No need for fertilizer zinc in the particular stage of life cycle under which the experiment was set up. The data from chemical analysis are roughly parallel to the above mentioned. When one attempts to compare - by taking data herein reported zinc uptake from nutrient solution, leaf brushing or from fertilizers in the soil, a practical conclusion can be drawn: the control of zinc deficiency in coffee plants should not be done by adding the zinc salts to the soil; in other words: the soil applications used so extensively in other countries seem not to be suitable for our conditions; hence zinc sprays should be used wherever necessary.
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Magdeburg, Univ., Fak. für Mathematik, Diss., 2015
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Otto-von-Guericke-Universität Magdeburg, Fakultät für Wirtschaftswissenschaft, Univ., Dissertation, 2015
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n.s. no.46(2002)
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I) the A. presents a method developed for the preparation of thick blood films, specially old desiccated smears. The observations are based on the experience of more than 53000 blood samples collected in the laboratory of the Serviço de Malaria do Nordeste as well as in the research department of the Serviço de Malaria da Baixada Fluminenese. II) As in introductory matter, he emphasizes the value of the obstacles presented by overdrying of the thick blood films occurring systematically in great malaria control organizations in which the laboratory receives materials from more or less remote localities, particularly in the Brazilian northeast, in regions invaded by Anopheles gambiae. III) An analysis of the causes of failure of the methods of Chorine and Knowles recorded in the literature for such purposes is given, as well as its adaptability for the simultaneous preparation of large numbers of samples. IV) The method is based the protective action of a previous fixation by a dilute solution of formalin, which, without preventing further dehemoglobinization, prevents morphological alterations in the parasites by the action of Knowles solution which is retained in this metod without modification. V) For washing out the acids of the dehemoglobinizating solution as well as for diluting the Giemsa stain, the A. proposes a very simple technique, extremely convenient for such purpose, which consists in adding acetic acid to the distilled water in the proportion of 1 drop for each 10cc of water, and then increasing the hydrogeni-on concentration to pH 7.2 with a 2% sol. of sodium carbonate. As indicator a 0.02% solution purple-bromcresol prepared in accordante to Medalia, is used. In this reaction there is the formation of the acetic acid ↔ sodium acetate, buffer system very suitable for giving a convenient pH and for preventing the precipitation of the dye, which can be used for two or three batches of 700 or 800 slides each, without changing the staining solution. VI) The method can be summarized as follow: For a small number of samples, Coplins or any other staining jar can be used. Large number of slides must be placed in groups of 10 or 15 units each, the slides being separated by a piece of cardboard, according to Barber & Komp. A) Fix in dilute formalin (2%), during 5 minutes. b) Without washing, put in Knowles solution (see the formula in the text), no more than 20 minutes. c)Two successive washings in distilled water, buffered as explained above (which can be used several times). d) Dry and stain with Giemsa solution, prepared by using 1 drop of the stain for each c. c. of buffered distilled water. Time: 1 hour. E) Was in distilled water and dry.
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Does shareholder value orientation lead to shareholder value creation? This article proposes methods to quantify both, shareholder value orientation and shareholder value creation. Through the application of these models it is possible to quantify both dimensions and examine statistically in how far shareholder value orientation explains shareholder value creation. The scoring model developed in this paper allows quantifying the orientation of managers towards the objective to maximize wealth of shareholders. The method evaluates information that comes from the companies and scores the value orientation in a scale from 0 to 10 points. Analytically the variable value orientation is operationalized expressing it as the general attitude of managers toward the objective of value creation, investment policy and behavior, flexibility and further eight value drivers. The value creation model works with market data such as stock prices and dividend payments. Both methods where applied to a sample of 38 blue chip companies: 32 firms belonged to the share index IBEX 35 on July 1st, 1999, one company represents the “new economy” listed in the Spanish New Market as per July 1st, 2001, and 5 European multinational groups formed part of the EuroStoxx 50 index also on July 1st, 2001. The research period comprised the financial years 1998, 1999, and 2000. A regression analysis showed that between 15.9% and 23.4% of shareholder value creation can be explained by shareholder value orientation.
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In this paper, a theoretical framework for analyzing the selection of governance structures for implementing collaboration agreements between firms and Technological Centers is presented and empirically discussed. This framework includes Transaction Costs and Property Rights’ theoretical assumptions, though complemented with several proposals coming from the Transactional Value Theory. This last theory is used for adding some dynamism in the governance structure selection. As empirical evidence of this theoretical explanation, we analyse four real experiences of collaboration between firms and one Technological Center. These experiences are aimed to represent the typology of relationships which Technological Centers usually face. Among others, a key interesting result is obtained: R&D collaboration activities do not need to always be organized through hierarchical solutions. In those cases where future expected benefits and/or reputation issues could play an important role, the traditional more static theories could not fully explain the selected governance structure for managing the R&D relationship. As a consequence, these results justify further research about the adequacy of the theoretical framework presented in this paper in other contexts, for example, R&D collaborations between firms and/or between Universities or Public Research Centers and firms.
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We propose a simple mechanism that implements the Ordinal Shapley Value (Pérez-Castrillo and Wettstein [2005]) for economies with three or less agents.
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We propose a new solution concept to address the problem of sharing a surplus among the agents generating it. The problem is formulated in the preferences-endowments space. The solution is defined recursively, incorporating notions of consistency and fairness and relying on properties satisfied by the Shapley value for Transferable Utility (TU) games. We show a solution exists, and call it the Ordinal Shapley value (OSV). We characterize the OSV using the notion of coalitional dividends, and furthermore show it is monotone and anonymous. Finally, similarly to the weighted Shapely value for TU games, we construct a weighted OSV as well.