Fatores de risco associados à lesão renal aguda em pacientes tratados com polimixina B em um hospital terciário

Resumo Introdução: O uso de polimixinas foi praticamente abandonado nos anos 1970 devido as altas taxas de nefropatia. Entretanto, foram reintroduzidas na prática médica devido a sua ação contra bactérias gram negativas resistentes a carbapenemicos. A literatura recente sugere uma taxa de nefropatia mais baixa do que a historicamente reportada. Objetivo: Determinar a incidência de nefropatia associada ao uso de polimixina utilizando os critérios de RIFLE. Métodos: Foi realizada coorte retrospectiva de todos pacientes adultos que receberam polimixina B no Hospital Nossa Senhora da Conceição de dezembro de 2010 até março de 2011. Resultados: 61 pacientes (43%) preencheram os critérios de rifle para injúria renal e 28 (13,7%) necessitaram de diálise. Preditores independentes para nefrotoxicidade foram hipotensão (OR, 2.79; CI 1.14-5.8; p = 0.006) e uso concomitante de vancomicina (OR, 2.86; CI, 1.27-6.4; p = 0.011). Conclusão: Nessa coorte retrospectiva, nefrotoxicidade (definida pelos criterios de RIFLE) ocorreu em 43% dos pacientes tratados com polimixina B. O uso concomitante de vancomicina e hipotensão foram fatores de risco independentes para desenvolvimento de nefropatia. Mais estudos são necessarios, particularmente com polimixina B, para esclarecer se as caracteristicas dessa droga e da colistina são sobreponíveis.

Protestanttista etiikkaa, sosiaalista pääomaa ja luottamusta

Kirjallisuusarvostelu

Institutionaaliset logiikat ja niistä rakentuva monimuotoisuus: Vaikutukset PK-yrityksen budjetointiprosessiin

Tämän tutkielman tavoitteena on analysoida institutionaalisien logiikoiden vaikutuksia yrityksen budjetointiin. Analyysi huomioi myös tilanteelliset tekijät, joilla saattaa olla vaikutuksia siihen, kuinka logiikat muovaavat budjetointiprosessia. Tutkielmassa pyritään etsimään vastauksia kolmeen tutkimuskysymykseen: mitkä logiikat vaikuttavat case-yrityksen budjetointiprosessiin, kuinka nämä eri logiikat muokkaavat budjetoinnin käytäntöjä organisaatiossa, joka kokee institutionaalista monimuotoisuutta ja kuinka tilanteellinen tekijä heijastuu logiikoihin. Tutkielma toteutetaan toiminta-analyyttisena tutkimuksena. Empiirisen aineiston case-yritys on suomalainen kuluttajatuotteita valmistava sekä myyvä PK-yritys, jonka palveluksessa tutkija on toiminut koko tutkielman ajan. Yrityksestä käytetään nimeä Delectus Oy. Budjetoinnin on todettu olevan yksi tutkituimmista laskentatoimen alueista. Sen lisäksi että budjetoinnin ja useimpien laskentatoimen elementtien välille on tunnistettavissa yhteys, on budjetointia hyödynnetty moniin käyttötarkoituksiin kuten suunnitteluun, seurantaan, kontrollointiin, resurssien allokointiin, keskusteluun sekä sosiaalisiin normeihin mukautumiseen. Tämän tutkielman näkökulma budjetointiin pohjautuu sosiaaliseen perspektiiviin. Tutkielmassa budjetoinnin käyttötarkoitukset jaotellaan instrumentaalisiin ja symbolisiin tapoihin. Perinteiset institutionaaliset teoriat ovat tarkastelleet organisaatioita toisiaan lähentyvinä entiteetteinä käytäntöjen valossa. Tämä tutkielma jatkaa kuitenkin neoinstitutionaalisten teorioiden uudempaa suuntausta, jossa huomion keskiössä ovat organisatorinen heterogeenisyys ja käytännönvaihtelut. Tutkielma soveltaa institutionaalisten logiikoiden teoreettista viitekehystä yksityisen yrityksen tasolla. Keskeisinä johtopäätöksinä voidaan ensinnäkin pitää viitekehyksen soveltuvuutta mikrotasolle. Tästä osoituksena neljän eri logiikan paljastuminen case-yrityksessä. Toinen keskeinen johtopäätös vahvistaa jo kirjallisuudessa vallitsevaa käsitystä toimijoiden keskeisestä roolista logiikoiden yhdistelijänä, mikä edelleen mahdollistaa budjetoinnin hybridikäytäntönä. Hybridikäytännöllä viitataan budjetoinnin erilaisiin käyttötarkoituksiin ja se voidaan nähdä organisaation vastaukseksi institutionaaliseen monimuotoisuuteen. Kolmantena johtopäätöksenä voidaan todeta case-yrityksen budjetointiprosessin ja tilanteellisen tekijän välillä vallitsevan löyhä kytkös. Tilanne on tulkittavissa sekä ratkaisuna että riskinä

Probabilistic Assignments of Identical Indivisible Objects and Uniform Probabilistic Rules.

We consider a probabilistic approach to the problem of assigning k indivisible identical objects to a set of agents with single-peaked preferences. Using the ordinal extension of preferences, we characterize the class of uniform probabilistic rules by Pareto efficiency, strategy-proofness, and no-envy. We also show that in this characterization no-envy cannot be replaced by anonymity. When agents are strictly risk averse von-Neumann-Morgenstern utility maximizers, then we reduce the problem of assigning k identical objects to a problem of allocating the amount k of an infinitely divisible commodity.

Efficient Priority Rules

We study the assignment of indivisible objects with quotas (houses, jobs, or offices) to a set of agents (students, job applicants, or professors). Each agent receives at most one object and monetary compensations are not possible. We characterize efficient priority rules by efficiency, strategy-proofness, and reallocation-consistency. Such a rule respects an acyclical priority structure and the allocations can be determined using the deferred acceptance algorithm.

Resource-Monotonicity for House Allocation Problems

We study a simple model of assigning indivisible objects (e.g., houses, jobs, offices, etc.) to agents. Each agent receives at most one object and monetary compensations are not possible. We completely describe all rules satisfying efficiency and resource-monotonicity. The characterized rules assign the objects in a sequence of steps such that at each step there is either a dictator or two agents who “trade” objects from their hierarchically specified “endowments.”

Consistent House Allocation

In practice we often face the problem of assigning indivisible objects (e.g., schools, housing, jobs, offices) to agents (e.g., students, homeless, workers, professors) when monetary compensations are not possible. We show that a rule that satisfies consistency, strategy-proofness, and efficiency must be an efficient generalized priority rule; i.e. it must adapt to an acyclic priority structure, except -maybe- for up to three agents in each object's priority ordering.

Allocation via Deferred-Acceptance under Responsive Priorities

In many economic environments - such as college admissions, student placements at public schools, and university housing allocation - indivisible objects with capacity constraints are assigned to a set of agents when each agent receives at most one object and monetary compensations are not allowed. In these important applications the agent-proposing deferred-acceptance algorithm with responsive priorities (called responsive DA-rule) performs well and economists have successfully implemented responsive DA-rules or slight variants thereof. First, for house allocation problems we characterize the class of responsive DA-rules by a set of basic and intuitive properties, namely, unavailable type invariance, individual rationality, weak non-wastefulness, resource-monotonicity, truncation invariance, and strategy-proofness. We extend this characterization to the full class of allocation problems with capacity constraints by replacing resource- monotonicity with two-agent consistent con ict resolution. An alternative characterization of responsive DA-rules is obtained using unassigned objects invariance, individual rationality, weak non-wastefulness, weak consistency, and strategy-proofness. Various characterizations of the class of "acyclic" responsive DA-rules are obtained by using the properties efficiency, group strategy-proofness, and consistency.

Strategy-proofness makes the difference: deferred-acceptance with responsive priorities

In college admissions and student placements at public schools, the admission decision can be thought of as assigning indivisible objects with capacity constraints to a set of students such that each student receives at most one object and monetary compensations are not allowed. In these important market design problems, the agent-proposing deferred-acceptance (DA-)mechanism with responsive strict priorities performs well and economists have successfully implemented DA-mechanisms or slight variants thereof. We show that almost all real-life mechanisms used in such environments - including the large classes of priority mechanisms and linear programming mechanisms - satisfy a set of simple and intuitive properties. Once we add strategy-proofness to these properties, DA-mechanisms are the only ones surviving. In market design problems that are based on weak priorities (like school choice), generally multiple tie-breaking (MTB)procedures are used and then a mechanism is implemented with the obtained strict priorities. By adding stability with respect to the weak priorities, we establish the first normative foundation for MTB-DA-mechanisms that are used in NYC.

House allocation via deferred-acceptance

We study the simple model of assigning indivisible and heterogenous objects (e.g., houses, jobs, offi ces, etc.) to agents. Each agent receives at most one object and monetary compensations are not possible. For this model, known as the house allocation model, we characterize the class of rules satisfying unavailable object invariance, individual rationality, weak non-wastefulness, resource-monotonicity, truncation invariance, and strategy-proofness: any rule with these properties must allocate objects based on (implicitly induced) objects' priorities over agents and the agent-proposing deferred-acceptance-algorithm.

Object allocation via deferred-acceptance: strategy-proofness and comparative statics

We study the problem of assigning indivisible and heterogenous objects (e.g., houses, jobs, offices, school or university admissions etc.) to agents. Each agent receives at most one object and monetary compensations are not possible. We consider mechanisms satisfying a set of basic properties (unavailable-type-invariance, individual-rationality, weak non-wastefulness, or truncation-invariance). In the house allocation problem, where at most one copy of each object is available, deferred-acceptance (DA)-mechanisms allocate objects based on exogenously fixed objects' priorities over agents and the agent-proposing deferred-acceptance-algorithm. For house allocation we show that DA-mechanisms are characterized by our basic properties and (i) strategy-proofness and population-monotonicity or (ii) strategy-proofness and resource-monotonicity. Once we allow for multiple identical copies of objects, on the one hand the first characterization breaks down and there are unstable mechanisms satisfying our basic properties and (i) strategy-proofness and population-monotonicity. On the other hand, our basic properties and (ii) strategy-proofness and resource-monotonicity characterize (the most general) class of DA-mechanisms based on objects' fixed choice functions that are acceptant, monotonic, substitutable, and consistent. These choice functions are used by objects to reject agents in the agent-proposing deferred-acceptance-algorithm. Therefore, in the general model resource-monotonicity is the «stronger» comparative statics requirement because it characterizes (together with our basic requirements and strategy-proofness) choice-based DA-mechanisms whereas population-monotonicity (together with our basic properties and strategy-proofness) does not.