Clinical and economic impact of exercise electrocardiography and exercise echocardiography in clinical practice

Background Patients with known or suspected coronary disease are often investigated to facilitate risk assessment. We sought to examine the cost-effectiveness of strategies based on exercise echocardiography and exercise electrocardiography. Methods and results We studied 7656 patients undergoing exercise testing; of whom half underwent exercise echocardiography. Risk was defined with the Duke treadmill score for those undergoing exercise electrocardiography alone, and by the extent of ischaemia by exercise echocardiography. Cox proportional hazards models, risk adjusted for pretest likelihood of coronary artery disease, were used to estimate time to cardiac death or myocardial infarction. Costs (including diagnostic and revascularisation procedures, hospitalisations, and events) were calculated, inflation-corrected to year 2000 using Medicare trust fund rates and discounted at a rate of 5%. A decision model was employed to assess the marginal cost effectiveness (cost/life year saved) of exercise echo compared with exercise electrocardiography. Exercise echocardiography identified more patients as low-risk (51% vs 24%, p<0.001), and fewer as intermediate- (27% vs 51%, p<0.001) and high-risk (22% vs 4%); survival was greater in low- and intermediate- risk and less in high-risk patients. Although initial procedural costs and revascularisation costs (in intermediate- high risk patients) were greater, exercise echocardiography was associated with a greater incremental life expectancy (0.2 years) and a lower use of additional diagnostic procedures when compared with exercise electrocardiography (especially in lower risk patients). Using decision analysis, exercise echocardiography (Euro 2615/life year saved) was more cost effective than exercise electrocardiography. Conclusion Exercise echocardiography may enhance cost-effectiveness for the detection and management of at risk patients with known or suspected coronary disease. (C) 2003 Published by Elsevier Science Ltd on behalf of The European Society of Cardiology.

Análise do desenvolvimento econômico e social do Espírito Santo à luz da transição demográfica

O presente trabalho tem por objetivo analisar o desenvolvimento econômico e social capixaba à luz da transição demográfica. Para tanto, procurou-se primeiro contextualizar o debate econômico-demográfico de acordo com diferentes escolas da história do pensamento econômico. Além disso, foi analisado o histórico de desenvolvimento econômico capixaba, na segunda metade do século XX, por meio dos principais indicadores utilizados, tais como PIB e PIB per capita. Por fim, verificou-se como se deu a transição demográfica no Espírito Santo, analisando se o chamado bônus demográfico foi absorvido pelo mercado de trabalho capixaba.

Integrating environmental and economic life cycle analysis in product development: a material selection case study

Purpose Achieving sustainability by rethinking products, services and strategies is an enormous challenge currently laid upon the economic sector, in which materials selection plays a critical role. In this context, the present work describes an environmental and economic life cycle analysis of a structural product, comparing two possible material alternatives. The product chosen is a storage tank, presently manufactured in stainless steel (SST) or in a glass fibre reinforced polymer composite (CST). The overall goal of the study is to identify environmental and economic strong and weak points related to the life cycle of the two material alternatives. The consequential win-win or trade-off situations will be identified via a Life Cycle Assessment/Life Cycle Costing (LCA/LCC) integrated model. Methods The LCA/LCC integrated model used consists in applying the LCA methodology to the product system, incorporating, in parallel, its results into the LCC study, namely those of the Life Cycle Inventory (LCI) and the Life Cycle Impact Assessment (LCIA). Results In both the SST and CST systems the most significant life cycle phase is the raw materials production, in which the most significant environmental burdens correspond to the Fossil fuels and Respiratory inorganics categories. The LCA/LCC integrated analysis shows that the CST has globally a preferable environmental and economic profile, as its impacts are lower than those of the SST in all life cycle stages. Both the internal and external costs are lower, the former resulting mainly from the composite material being significantly less expensive than stainless steel. This therefore represents a full win-win situation. As a consequence, the study clearly indicates that using a thermoset composite material to manufacture storage tanks is environmentally and economically desirable. However, it was also evident that the environmental performance of the CST could be improved by altering its End-of-Life stage. Conclusions The results of the present work provide enlightening insights into the synergies between the environmental and the economic performance of a structural product made with alternative materials. Further, they provide conclusive evidence to support the integration of environmental and economic life cycle analysis in the product development processes of a manufacturing company, or in some cases even in its procurement practices.

Algumas notas sobre o problema da «corrupção», sobretudo no seio do Direito penal económico e social, quer de um ponto de vista do Direito penal, quer a partir de uma perspectiva criminológica: o caso da empresa

Resumo: 1 – Introdução; 2 – Breve nota de Criminologia e Política Criminal no que diz respeito ao papel das polícias perante a teoria da discricionariedade no contexto do problema da corrupção, igualmente económica e social; 3 - O problema da «corrupção», sobretudo no seio do Direito penal económico e social: o caso da importância da empresa; 4 – Algumas pré-conclusões sobre a dificuldade de imputar crimes, nomeadamente crimes de corrupção, às «empresas»; 5 – Conclusão. § Abstract: 1 - Introduction 2 - a brief note of Criminology and Criminal Policy in relation to the role of the police before the theory of discretion in the context of the problem of corruption, also economic and social development; 3 - the problem of the «corruption», especially within the social and economic criminal law: the case of the importance of the company; 4 - Some pre-conclusions about the difficulty of attributing crimes, including crimes of corruption, the «companies», 5 - Conclusion.

Financial and economic analysis of prevention of needlesticks in the hospital sector

This paper discusses the financial and economic analysis of prevention of needlestick accidents related to Occupational Health and Safety projects and presents the application to a case study involving a Hospital.

Earnings management and economic crises in the brazilian capital market

The 2008 economic crisis challenged accounting, either demanding recognition and measurement criteria well adjusted to this scenario or even questioning its ability to inform appropriately entities' financial situation before the crisis occurred. So, our purpose was to verify if during economic crises listed companies in the Brazilian capital market tended to adopt earnings management (EM) practices. Our sample consisted in 3,772 firm-years observations, in 13 years - 1997 to 2009. We developed regression models considering discretionary accruals as EM proxy (dependent variable), crisis as a macroeconomic factor (dummy variable of interest), ROA, market-to-book, size, leverage, foreign direct investment (FDI) and sector as control variables. Different for previous EM studies two approaches were used in data panel regression models and multiple crises were observed simultaneously. Statistics tests revealed a significant relation between economic crisis and EM practices concerning listed companies in Brazil in both approaches used.

Portugal making a difference with children and families: the GADIF model

Portugal is a culture grounded in strong traditions and family. Yet, social changes like women returning to the workforce and a decreas ed national birth rate are impacting the traditional family structure and care giving environments of children. Female employment has been increasing steadily in P ortugal over the last three decades (Galego & Pereira, 2006) and the total fert ility rate decreasing from 4.1 to 2.8 (INE, 2006). Furthermore, extended family me mbers, like grandparents, no longer reside close by to their children and grandc hildren as in the past, because of a changing labor market. Many of the younger gen eration are leaving their rural communities to flock to urban areas because o f job opportunities, leaving behind older relatives who would have otherwise par ticipated in the daily care of children. Given these social and economic changes, children are spending more time in out-of-home care with non-familial caregive rs. Yet, government regulations and guidelines in early care and educat ion (ECCE) and early intervention (EI) are only just emerging; it contin ues to be a work in progress.

A new wind farm in Santiago Island, cape verde - simulation and economic studies

Ensuring sustainable development conditions is presently world widely recognized as a critically important goal. This makes the use of electricity generation technologies based on renewable energy sources very relevant. Developing countries depend on an adequate availability of electrical energy to assure economic progress and are usually characterized by a high increase in electricity consumption. This makes sustainable development a huge challenge but it can also be taken as an opportunity, especially for countries which do not have fossil resources. This paper presents a study concerning the expansion of an already existent wind farm, located in Praia, the capital of Cape Verde Republic. The paper includes results from simulation studies that have been undertaken using PSCAD software and some economic considerations.

Technical and economic resources management in smart grids using heuristic optimization methods

Intensive use of Distributed Generation (DG) represents a change in the paradigm of power systems operation making small-scale energy generation and storage decision making relevant for the whole system. This paradigm led to the concept of smart grid for which an efficient management, both in technical and economic terms, should be assured. This paper presents a new approach to solve the economic dispatch in smart grids. The proposed methodology for resource management involves two stages. The first one considers fuzzy set theory to define the natural resources range forecast as well as the load forecast. The second stage uses heuristic optimization to determine the economic dispatch considering the generation forecast, storage management and demand response

Society and technological evolution: challenges and opportunities

Starting from the assumption that, the organizational learning process influences, in a positive way, the innovative environment and that it shows positive effects on individual, group and organizational performance, this paper deals with the analysis of companies that provide knowledge-intensive products. Referring to the initial information obtained through an adequate survey that is still being performed since May 2009, the main goal is to identify the ways to an organizational learning, measure its importance and identify the effects on the social and economic development. Our reflexion study handles two Portuguese knowledge-rich-organizations, based on the metropolitan area of Lisbon. The paper has the following methodological structure: in the first chapter we will make a theoretical contextualization about the organizational learning; in the second chapter we will handle the data recovered using the SPSS statistics software and, afterwards, presenting the main results. Finally, starting from the main conclusions achieved, we willgive clues to an ongoing reflection.

O Voluntariado enquanto promotor do empreendedorismo social: o caso da Associação Humanitária dos Bombeiros Voluntários de Mangualde

Dissertação de Mestrado apresentada ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Empreendedorismo e Internacionalização, sob orientação de Doutora Deolinda Meira e Mestre Paula Alferes

Inserção no mercado de trabalho de jovens com baixas qualificações escolares: o caso de um bairro social do concelho de Ribeira Grande

Dissertação de Mestrado, Sociologia, 31 de Março de 2014, Universidade dos Açores.