Potential impact of single-risk-factor versus total risk management for the prevention of cardiovascular events in Seychelles.

OBJECTIVE: To assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management (treating individuals with arterial blood pressure >/= 140/90 mmHg and/or total serum cholesterol >/= 6.2 mmol/l) with that of management based on total CV risk (treating individuals with a total CV risk >/= 10% or >/= 20%).METHODS: CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40-64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. Treatment for patients with high total CV risk (>/= 20%) was assumed to consist of a fixed-dose combination of several drugs (polypill). Cost analyses were limited to medication.FINDINGS: A total CV risk of >/= 10% and >/= 20% was found among 10.8% and 5.1% of individuals, respectively. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100 000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted.CONCLUSION: Total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles.

World temperate fruit production: characteristics and challenges

In the last 30 years world population has increased 70% but per capita global fruit consumption is only 20% higher. Even though tropical and temperate fruit have similar contributions to the 50 kg/person/year of US consumption of fresh fruit, in the last 30 years this has been slightly greater for temperate fruit. Within fruit consumption, the largest expansion has been for organic fruit which increased more than 50% in the 2002-2006 period. The largest expansion of area planted in the 1996-2006 has been for kiwi (29%) and blueberries (20%), while apples (-24%) and sour cherries (-13%) have had the largest reductions. Nearly 50% of the total global volume of fruit is produced by 5 countries: China, USA, Brazil, Italy and Spain. The main producer (China) accounts for 23% of the total. While the main exporters are Spain, USA and Italy, the main importers are Germany, Russia and UK. Demands for the industry have evolved towards quality, food safety and traceability. The industry faces higher productions costs (labor, energy, agrichemicals). The retailers are moving towards consolidation while the customers are changing preferences (food for health). In this context there is greater pressure on growers, processors and retailers. Emerging issues are labor supply, climate change, water availability and sustainability. Recent developments in precision agriculture, molecular biology, phenomics, crop modelling and post harvest physiology should increase yields and quality, and reduce costs for temperate fruit production around the world.

Robotic-Assisted Surgery Improves the Quality of Total Mesorectal Excision for Rectal Cancer Compared to Laparoscopy: Results of a Case-Controlled Analysis.

BACKGROUND: The use of a robotic surgical system is claimed to allow precise traction and counter-traction, especially in a narrow pelvis. Whether this translates to improvement of the quality of the resected specimen is not yet clear. The aim of the study was to compare the quality of the TME and the short-term oncological outcome between robotic and laparoscopic rectal cancer resections. METHODS: 20 consecutive robotic TME performed in a single institution for rectal cancer (Rob group) were matched 1:2 to 40 laparoscopic resections (Lap group) for gender, body mass index (BMI), and distance from anal verge on rigid proctoscopy. The quality of TME was assessed by 2 blinded and independent pathologists and reported according to international standardized guidelines. RESULTS: Both samples were well matched for gender, BMI (median 25.9 vs. 24.2 kg/m(2), p = 0.24), and level of the tumor (4.1 vs. 4.8 cm, p = 0.20). The quality of the TME was better in the Robotic group (complete TME: 95 vs. 55 %; p = 0.0003, nearly complete TME 5 vs. 37 %; p = 0.04, incomplete TME 0 vs. 8 %, p = 0.09). A trend for lower positive circumferential margin was observed in the Robotic group (10 vs. 25 %, p = 0.1). CONCLUSIONS: These results suggest that robotic-assisted surgery improves the quality of TME for rectal cancer. Whether this translates to better oncological outcome needs to be further investigated.

Assessment of total cardiovascular risk in hypertensive subjects

Valtimotautiriskin arviointi verenpainepotilailla Valtimotaudit ovat yleisin kuolinsyy koko maailmassa. Väestön elintapojen muuttuminen ja ikääntyminen uhkaavat edelleen lisätä valtimotautien esiintyvyyttä. Kokemäenjokilaakson valtimotautien ehkäisyprojektin tavoitteena oli löytää 45–70-vuotiaasta väestöstä henkilöt, joilla on kohonnut riski sairastua valtimotauteihin. Kaksivaiheisen seulontamenetelmän avulla voitiin terveydenhoitajan antama elintapaneuvonta kohdistaa riskihenkilöihin ja rajoittaa lääkärin vastaanoton tarve niihin potilaisiin, jotka todennäköisesti hyötyvät ennaltaehkäisevästä lääkityksestä. Suomalainen tyypin 2 diabeteksen sairastumisriskin arviointikaavake ja hoitajan toteama kohonnut verenpaine osoittautuivat käytännöllisiksi menetelmiksi seuloa väestöstä riskihenkilöitä. Valtimotautien ehkäisyprojektissa Harjavallassa ja Kokemäellä todettiin verenpainetauti 1 106 henkilöllä, jotka eivät sairastaneet valtimotautia tai aiemmin todettua diabetesta. Heidän tutkimustulostensa avulla voidaan arvioida kohonneen verenpaineen vaikutusta sokeriaineenvaihduntaan ja verenpaineen aiheuttamiin kohde-elinvaurioihin. Sokeriaineenvaihdunnan häiriöt ovat verenpainetautia sairastavilla yleisempiä kuin väestössä muutoin. Käyttämällä metabolisen oireyhtymän kriteerejä sokerirasituskokeen suorittamisen edellytyksenä voidaan tutkimusten määrää vähentää kolmanneksella ja silti löytää lähes kaikki diabetesta tai sen esiastetta sairastavat verenpainepotilaat. Verenpainepotilaista etenkin metabolista oireyhtymää sairastavilla naisilla on suurentunut munuaisten vajaatoiminnan riski. Jos verenpainepotilaan munuaisten toimintaa arvioidaan pelkästään plasman kreatiniini -arvon perusteella, kolme neljästä munuaisten vajaatoimintaa potevasta jää toteamatta verrattuna laskennallisen glomerulusten suodattumisnopeuden määritykseen seulontamenetelmänä. Joka kolmannella verenpainetautia sairastavalla voidaan todeta alaraajavaltimoiden kovettumista; useammin niillä, joiden ylä- ja alaverenpaineen erotus, pulssipaine on yli 65 mmHg. Verenpainetauti on itsenäinen perifeerisen valtimotaudin vaaratekijä. Tutkimuksessa käytetty menetelmä nilkka-olkavarsipainesuhteen määrittämiseksi soveltunee hyvin perusterveydenhuollon käyttöön riskihenkilöiden löytämiseksi. Valtimotautien kokonaisriskin arviointimenetelmät tai uuden riskitekijän, herkän C-reaktiivisen proteiinin määritys eivät voi korvata kohde-elinvaurioiden mittaamista verenpainepotilaan valtimotautiriskin huolellisessa arvioinnissa.

Development of Total Quality Management System in Seafood (Freezing) Industry in Kerala

Quality related problems have become dominant in the seafood processing industry in Kerala. This has resulted in the rejection of seafood sent from India to many destinations. The latest being the total block listing of seafood companies from India from being exported to Europe and partial block listing by the US. The quality systems prevailed in the seafood industry in India were outdated and no longer in use in the developed world. According to EC Directive discussed above all the seafood factories exporting to European countries have to adopt HACCP. Based on this, EIA has now made HACCP system mandatory in all the seafood processing factories in India. This transformation from a traditional product based inspection system to a process control system requires thorough changes in the various stages of production and quality management. This study is conducted by the author with to study the status of the existing infrastructure and quality control system in the seafood industry in Kerala with reference to the recent developments in the quality concepts in international markets and study the drawbacks, if any, of the existing quality management systems in force in the seafood factories in Kerala for introducing the mandatory HACCP concept. To assess the possibilities of introducing Total Quality Management system in the seafood industry in Kerala in order to effectively adopt the HACCP concept. This is also aimed at improving the quality of the products and productivity of the industry by sustaining the world markets in the long run.

Liderazgo de Rango Total: revisión teórica del modelo

En el ámbito organizacional es necesario interiorizar y aplicar conceptos que generen herramientas que hagan posible el adecuado funcionamiento de las empresas a efectos de generar mejores resultados, no sólo en términos monetarios sino también sociales y éticos. En la actualidad, el entendimiento de las situaciones, circunstancias y relaciones que se dan dentro de una empresa es un factor relevante para la implementación de estrategias y técnicas, en aras de aumentar la productividad y la eficiencia de las compañías. Es allí donde empieza a tomar importancia la presencia de un líder en la compañía que actúe como agente de cambio y sea considerado como un modelo a seguir capaz de enfrentar situaciones emergentes, tanto positivas como negativas y así generar un cambio, deseos de mejora, propuestas inspiradoras e innovadoras. Lo anterior con el fin de proponer nuevas estrategias que beneficien a todos los involucrados, para así lograr los objetivos proyectados, evitando al máximo los posibles riesgos en que se pueda incurrir. A lo largo de la revisión teórica se tratará el modelo del liderazgo de rango total como un tipo de liderazgo donde el líder es capaz de moldear los puntos de vista, las percepciones, las actitudes y las creencias de los seguidores. Lo anterior sin dejar a un lado los demás estilos de liderazgo que componen el modelo de liderazgo de rango total, el cual puede ser considerado e incluido como una variable interesante en la realización de estudios para analizar la existencia de la relación entre el estilo de liderazgo y los resultados organizacionales.

Eficiencia de los sistema de salud en los países de América Latina y del Caribe desde el indicador de esperanza de vida al nacer para los años 1990 y 2012 frente al gasto total en salud como porcentaje del producto interno bruto para el año 1995 y 2012 “una oportunidad de brenchmarking para el sistema de protección social colombiano”

Para los países emergentes en América Latina y El Caribe se hace necesario determinar la eficiencia de su sistema de salud para generar beneficios a su población desde el indicador de esperanza de vida al nacer y los recursos que se hacen uso desde Colombia en comparación con sus homólogos. Se evidencia que a pesar de Colombia poseer una economía fuerte durante el análisis de los dos momentos se mantiene en la tendencia general de los demás países y con los mismos resultados del indicador. A su vez se concluye que el momento en que se tomaron las decisiones de cambio del sistema de salud es un factor diferenciador en los resultados obtenidos como fue el caso de Costa Rica identificado con el de mejor desempeño en la relación Indicador de esperanza de vida al nacer y Porcentaje de gasto en salud como parte del Producto interno bruto.

Global war : the Second World War, 1939-1945.

La Segunda Guerra se divide en tres partes que describen la propagación de la guerra de Polonia al resto de Europa, su expansión a escala mundial y, finalmente, la guerra total que terminó con la derrota de las potencias del Eje en 1943-45. Incluye fragmentos de fuentes históricas originales, así como, material de aprendizaje activo: ejercicios, preguntas, y pruebas.

Hedging effectiveness of total returns swaps: application to the Japanese market

The development of the real estate swap market offers many opportunities for investors to adjust the exposure of their portfolios to real estate. A number of OTC transactions have been observed in markets around the world. In this paper we examine the Japanese commercial real estate market from the point of view of an investor holding a portfolio of properties seeking to reduce the portfolio exposure to the real estate market by swapping an index of real estate for LIBOR. This paper explores the practicalities of hedging portfolios comprising small numbers of individual properties against an appropriate index. We use the returns from 74 properties owned by Japanese Real Estate Investment Trusts over the period up to September 2007. The paper also discusses and applies the appropriate stochastic processes required to model real estate returns in this application and presents alternative ways of reporting hedging effectiveness. We find that the development of the derivative does provide the capacity for hedging market risk but that the effectiveness of the hedge varies considerably over time. We explore the factors that cause this variability.

The decline of the world`s energy intensity

Energy intensity of the total primary energy supply (TPES), total final energy consumption (TFC) and LOSSES in the conversion from TPES to TFC were analyzed for the World, OECD and Rest of the World (ROW) countries. LOSSES increased significantly for all groups of countries due to the increase of electricity production from coal in the period studied (1971-2008). Electricity share final consumption almost doubled, increasing from 8.8% to 17.2% in the period studied. However the energy intensity of LOSSES remained practically constant, which reflects the fact that the efficiency of electricity generation from coal (the main source of electricity) remained practically constant in that period. Despite the attractiveness of end-use devices running on electricity such as computers, which is typical of modern societies, the CO(2) emissions are bound to increase unless coal is replaced by less carbon emitting sources such as natural gas, renewables and nuclear energy. (C) 2011 Elsevier Ltd. All rights reserved.

GLUON SATURATION AND THE TOTAL PROTON-AIR CROSS SECTION

In this work we propose a simple model for the total proton-air cross section, which is an improvement of the minijet model with the inclusion of a window in the p(T)-spectrum associated to the saturation physics. Our approach introduces a natural cutoff for the perturbative calculations which modifies the energy behavior of this component. The saturated component is calculated with a dipole model. The results are compared with experimental cross sections measured in cosmic ray experiments.

Total reaction cross-sections for light weakly bound systems

We have measured the elastic scattering cross-section for (8)Li + (9)Be and (8)Li + (51)V systems at 19.6 MeV and 18.5 MeV, respectively. We have also extracted total reaction cross sections from the elastic scattering analysis for several light weakly bound systems using the optical model with Woods-Saxon and double-folding-type potentials. Different reduction methods for the total reaction cross-sections have been applied to analyze and compare simultaneously all the systems.

Relação entre produtividade total dos fatores e investimento em capital fixo para a economia brasileira

O presente trabalho utiliza a teoria do crescimento econômico a fim de analisar a relação das taxas de investimento em capital fixo e a evolução da produtividade total dos fatores no Brasil a partir de 1950 ate 2005. A partir de pesquisas bibliográficas abordam-se os estudos de Romer, Arrow, Pires, Solow se apresenta conceitos como o “learning by doing”, “spillovers” e decomposição da produtividade a fim de embasar teoricamente o estudo. As pesquisas apontam a importância da variável eficiência sobre a produtividade total dos fatores no caso brasileiro, principalmente durante os anos de incidência de inflação elevada. A metodologia aplicada no trabalho se utiliza dos dados coletados junto ao IPEAdata e Pen World Tables para formação bruta de capital fixo, produto interno bruto e dados populacionais para o cálculo da produtividade total dos fatores seguindo a metodologia proposta por Solow. Utilizam-se os dados calculados para se extrair uma relação matemática entre a produtividade total dos fatores e ao nível de estoque de capital físico. O estudo comprova a relação entre a produtividade e o investimento em capital físico, também fica demonstrada a grande importância da eficiência sobre a produtividade no caso brasileiro.

Total and individual carotenoid profiles in Solanum phureja of cultivated potatoes: I. Concentrations and relationships as determined by spectrophotometry and HPLC

Total and individual carotenoid concentrations were determined by spectro photometry and HPLC, in raw tubers of a sample of 23 accessions of Solanum phureja potatoes taken at random from the world germplasm collection following its stratification on tuber flesh color. Lutein, zeaxanthin, violaxanthin, antheraxanthin and beta-carotene were detected in all accessions and three distinct patterns of carotenoid accumulation were evidenced by cluster analysis. Accessions in group 1 showed the highest concentrations of total carotenoids (1258-1840 mu g 100 g(-1) FW) comprised largely of zeaxanthin (658-1290 mu g 100 g(-1) FW) with very low or no presence of beta-carotene (below 5.4 mu g 100 g(-1) FW). Accessions in group 2 presented moderate total carotenoid concentrations with violaxanthin, antheraxanthin, lutein and zeaxanthin as the major carotenoids. Accessions in group 3 showed low concentrations of total carotenoids (97-262 mu g 100 g(-1) FW) and very low or no zeaxanthin, with lutein and violaxanthin as the predominant carotenoids and relatively high concentrations of beta-carotene(up to 27 mu g 100 g(-1) FW). Five accessions with significant concentrations of zeaxanthin were identified with the accession 703566 showing the highest concentration (1290 p g 100 g(-1) FW). This value is to our knowledge higher than any value previously reported for potatoes, including those achieved through genetic modification. For the 23 S. phureja accessions, total carotenoid concentration was positively and significantly correlated with antheraxanthin and zeaxanthin concentrations, and negatively and significantly correlated with beta-carotene concentration. (C) 2008 Elsevier B.V. All rights reserved.

The small x behavior of the gluon strucutre function from total cross-sections

Within a QCD-based eikonal model with a dynamical infrared gluon mass scale we discuss how the small x behavior of the gluon distribution function at moderate Q(2) is directly related to the rise of total hadronic cross-sections. In this model the rise of total cross-sections is driven by gluon-gluon semihard scattering processes, where the behavior of the small x gluon distribtuion function exhibits the power law xg(x, Q(2)) = h(Q(2))x(-epsilon). Assuming that the Q(2) scale is proportional to the dynamical gluon mass one, we show that the values of h(Q(2)) obtained in this model are compatible with an earlier result based on a specific nonperturbative Pomeron model. We discuss the implications of this picture for the behavior of input valence-like gluon distributions at low resolution scales.