PERFECT Stroke : PERFormance, Effectiveness, and Costs of treatment episodes in Stroke

Stroke is a major cause of death and disability, incurs significant costs to healthcare systems, and inflicts severe burden to the whole society. Stroke care in Finland has been described in several population-based studies between 1967 and 1998, but not since. In the PERFECT Stroke study presented here, a system for monitoring the Performance, Effectiveness, and Costs of Treatment episodes in Stroke was developed in Finland. Existing nationwide administrative registries were linked at individual patient level with personal identification numbers to depict whole episodes of care, from acute stroke, through rehabilitation, until the patients went home, were admitted to permanent institutional care, or died. For comparisons in time and between providers, patient case-mix was adjusted for. The PERFECT Stroke database includes 104 899 first-ever stroke patients over the years 1999 to 2008, of whom 79% had ischemic stroke (IS), 14% intracerebral hemorrhage (ICH), and 7% subarachnoid hemorrhage (SAH). A 18% decrease in the age and sex adjusted incidence of stroke was observed over the study period, 1.8% improvement annually. All-cause 1-year case-fatality rate improved from 28.6% to 24.6%, or 0.5% annually. The expected median lifetime after stroke increased by 2 years for IS patients, to 7 years and 7 months, and by 1 year for ICH patients, to 4 years 5 months. No change could be seen in median SAH patient survival, >10 years. Stroke prevalence was 82 000, 1.5% of total population of Finland, in 2008. Modern stroke center care was shown to be associated with a decrease in both death and risk of institutional care of stroke patients. Number needed to treat to prevent these poor outcomes at one year from stroke was 32 (95% confidence intervals 26 to 42). Despite improvements over the study period, more than a third of Finnish stroke patients did not have access to stroke center care. The mean first-year healthcare cost of a stroke patient was ~20 000 , and among survivors ~10 000 annually thereafter. Only part of this cost was incurred by stroke, as the same patients cost ~5000 over the year prior to stroke. Total lifetime costs after first-ever stroke were ~85 000 . A total of 1.1 Billion , 7% of all healthcare expenditure, is used in the treatment of stroke patients annually. Despite a rapidly aging population, the number of new stroke patients is decreasing, and the patients are more likely to survive. This is explained in part by stroke center care, which is effective, and should be made available for all stroke patients. It is possible, in a suitable setting with high-quality administrative registries and a common identifier, to avoid the huge workload and associated costs of setting up a conventional stroke registry, and still acquire a fairly comprehensive dataset on stroke care and outcome.

System reliability analysis of granular filter for protection against piping in dams

Granular filters are provided for the safety of water retaining structure for protection against piping failure. The phenomenon of piping triggers when the base soil to be protected starts migrating in the direction of seepage flow under the influence of seepage force. To protect base soil from migration, the voids in the filter media should be small enough but it should not also be too small to block smooth passage of seeping water. Fulfilling these two contradictory design requirements at the same time is a major concern for the successful performance of granular filter media. Since Terzaghi era, conventionally, particle size distribution (PSD) of granular filters is designed based on particle size distribution characteristics of the base soil to be protected. The design approach provides a range of D15f value in which the PSD of granular filter media should fall and there exist infinite possibilities. Further, safety against the two critical design requirements cannot be ensured. Although used successfully for many decades, the existing filter design guidelines are purely empirical in nature accompanied with experience and good engineering judgment. In the present study, analytical solutions for obtaining the factor of safety with respect to base soil particle migration and soil permeability consideration as proposed by the authors are first discussed. The solution takes into consideration the basic geotechnical properties of base soil and filter media as well as existing hydraulic conditions and provides a comprehensive solution to the granular filter design with ability to assess the stability in terms of factor of safety. Considering the fact that geotechnical properties are variable in nature, probabilistic analysis is further suggested to evaluate the system reliability of the filter media that may help in risk assessment and risk management for decision making.

Comparison of marketing policies applied by the same company in different countries and analysis of the reasons for the differences

The focus of this project is going to be, as the title indicates, on the comparison of marketing policies applied by the same company in different countries and analysis of the reasons for the differences. In order to do that, I have selected the company Nestlé to analyze the marketing decisions it makes across national boundaries to market the brand of Kit Kat and keep it as a leader snack worldwide. After having analyzed the brand in all continents, I can say the execution of the strategy used by Nestlé with Kit Kat really matches the planning of the strategy which is to think globally and act locally. Nestlé uses global brand identity but, from the internal point of view, it uses local ingredients and gives autonomy to its local branches based in different countries to make pricing and distributions decisions and therefore satisfy different consumers’ needs and preferences in local environments where changes happen very rapidly. The “glocal” approach to marketing is an effective way for Nestlé Kit Kat to stay focused on the consumer in worldwide markets.

A business plan development: the case of a paint company in Douala Camroon by Bomboy & Friends

This paper presents a business plan to create a new company Bomboy & Friends regarding the Exclusive Distribution of a fully Eco Friendly Water-Soluble Anti- Corrosive Prime named Life Guard Active Rust Primer Paint abbreviated as “L.G.A.R.P Paint” in Douala Cameroon and the C.E.M.A.C Region. The lack of quality paint in Cameroon has given the opportunity for a company like Bomboy & Friends to nurture its existence and be part of a fast growing economy, providing a high quality paint competition, very economical, easy to prepare, environmentally friendly, compatible with other brands and accessible to medium and small size companies.

Comparison of ilities for protection against uncertainty in system design

The concepts of reliability, robustness, adaptability, versatility, resilience and flexibility have been used to describe how a system design can mitigate the likely impact of uncertainties without removing their sources. With the increasing number of publications on designing systems to have such ilities, there is a need to clarify the relationships between the different ideas. This short article introduces a framework to compare these different ways in which a system can be insensitive to uncertainty, clarifying their meaning in the context of complex system design. We focus on relationships between the ilities listed above and do not discuss in detail methods to design-for-ilities. © 2013 The Author(s). Published by Taylor & Francis.

Seroprotection against tetanus in patients attending an emergency department in Belgium and evaluation of a bedside immunotest.

BACKGROUND: In most emergency departments, tetanus prophylaxis currently relies on vaccination history. Bedside evaluation of tetanus immunity may improve this process. OBJECTIVES: (i) To determine the seroprevalence of tetanus immunity; (ii) to evaluate the accuracy of vaccination history in assessing tetanus immunity; (iii) to identify factors predictive of seroprotection and incorrect history. METHOD: In a prospective observational study, tetanus immunity was assessed in 784 adults using Tétanos Quick Stick (TQS). A questionnaire was completed to obtain vaccination and general histories. Immunity assessed by TQS and by vaccination history were compared with anti-tetanus antibody levels measured by the enzyme-linked immunosorbent assay (seroprotection threshold >0.15 IU/ml). RESULTS: Overall, 64.2% of patients were protected according to TQS results. Four independent predictors of seroprotection were identified: young age, birthplace in Belgium, male sex and occupational medicine consultation. TQS performance was good: kappa=0.71, sensitivity 85.3%, specificity 87.2%, positive predictive value 92.1% and negative predictive value 77.2%. Seven hundred and sixty-two participants responded to the vaccination history: 23.4% said they were protected, 22.1% that they were not and 54.5% did not know. History performance was poor: kappa=0.27, sensitivity 60.3%, specificity 73.3%, positive predictive value 81.8% and negative predictive value 45.8%. Compared with history, TQS offered a significantly better sensitivity, negative and positive predictive values, but specificity was similar. No predictor of an incorrect history was identified. CONCLUSION: Lack of protective immunity against tetanus is frequent but poorly evaluated by history taking. Several demographic characteristics are good predictors of seroprotection. TQS could be a valuable tool in selected patients to improve tetanus prophylaxis in the emergency department.

Seroprotection against tetanus in patients of an an emergency department in Belgium and evaluation of a bedside immunotest (Tetanos Quick Stick R).

info:eu-repo/semantics/nonPublished

Seroprotection against tetanus in patients of an an emergency department in Belgium and evaluation of a bedside immunotest (Tetanos Quick Stick R). A prospective observational study

info:eu-repo/semantics/published

Seroprotection against tetanus in patients présenting to an emergency department in Belgium and evaluation of a bedside immunotest (Tetanos Quick Stick R): A prospective observational study

info:eu-repo/semantics/published

The importance of operating costs about making decisions in farm machine labor contractors services : the case of Cordoba province

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The energy costs of sexual dimorphism in mole-rats are morphological not behavioural.

Different reproductive strategies of males and females may lead to the evolution of differences in their energetic costs of reproduction, overall energetic requirements and physiological performances. Sexual dimorphism is often associated with costly behaviours (e.g. large males might have a competitive advantage in fighting, which is energetically expensive). However, few studies of mammals have directly compared the energy costs of reproductive activities between sexes. We compared the daily energy expenditure (DEE) and resting metabolic rate (RMR) of males and females of two species of mole-rat, Bathyergus janetta and Georychus capensis (the former is sexually dimorphic in body size and the latter is not) during a period of intense digging when males seek females. We hypothesized that large body size might be indicative of greater digging or fighting capabilities, and hence greater mass-independent DEE values in males of the sexually dimorphic species. In contrast to this prediction, although absolute values of DEE were greater in B. janetta males, mass-independent values were not. No differences were apparent between sexes in G. capensis. By comparison, although RMR values were greater in B. janetta than G. capensis, no differences were apparent between the sexes for either species. The energy cost of dimorphism is most likely to be the cost of maintenance of a large body size, and not the cost of behaviours performed when an individual is large.

Costs, outputs and outcomes in school PFI contracts and the significance of project size

This article examines operational Private Finance Initiative (PFI) school projects and reports the experiences of UK headteachers. It considers the impact of project size on value for money (VFM). Headteachers involved in small projects are more satisfied with costs than those involved in large projects, but headteachers involved in larger projects are more satisfied with affordability. Generally, heads are more satisfied with the buildings than with the services. The authors question the government’s recent policy changes to increase the size of PFI projects.