Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial).

ABSTRACT: BACKGROUND: Perfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference. METHODS: In 33 centers (in US and Europe) 533 patients, eligible for CXA or SPECT, were enrolled in this multivendor trial. SPECT and CXA were performed within 4 weeks before or after CMR in all patients. Prevalence of CAD in the sample was 49% and 515 patients received MR contrast medium. Drop-out rates for CMR and SPECT were 5.6% and 3.7%, respectively (ns). The study was powered for the primary endpoint of non-inferiority of CMR vs SPECT for both, sensitivity and specificity for the detection of CAD (using a single-threshold reading), the results for the primary endpoint were reported elsewhere. In this article secondary endpoints are presented, i.e. the diagnostic performance of CMR versus SPECT in subpopulations such as multi-vessel disease (MVD), in men, in women, and in patients without prior myocardial infarction (MI). For diagnostic performance assessment the area under the receiver-operator-characteristics-curve (AUC) was calculated. Readers were blinded versus clinical data, CXA, and imaging results. RESULTS: The diagnostic performance (= area under ROC = AUC) of CMR was superior to SPECT (p = 0.0004, n = 425) and to gated-SPECT (p = 0.018, n = 253). CMR performed better than SPECT in MVD (p = 0.003 vs all SPECT, p = 0.04 vs gated-SPECT), in men (p = 0.004, n = 313) and in women (p = 0.03, n = 112) as well as in the non-infarct patients (p = 0.005, n = 186 in 1-3 vessel disease and p = 0.015, n = 140 in MVD). CONCLUSION: In this large multicenter, multivendor study the diagnostic performance of perfusion-CMR to detect CAD was superior to perfusion SPECT in the entire population and in sub-groups. Perfusion-CMR can be recommended as an alternative for SPECT imaging. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT00977093.

An online assessment and development tool for business incubators:optimising business-incubation management practice, performance and impact, Project Report

This project is focused on exchanging knowledge between ABS, UKBI and managers of business incubators in the UK. The project relates to exploitation of extant knowledge-base on assessing and improving business incubation management practice and performance and builds on two earlier studies. It addresses a pressing need for assessing and benchmarking business incubation input, process and outcome performance and highlighting best practice. The overarching aim of this project was to obtain proof-of-concept for a business incubation performance assessment and benchmarking online tool, fine-tune it and put it in use by nurturing a community of business incubation management practice, aligned by the resultant tool. The purpose was to offer an appropriate set of measures, in areas identified by relevant research on business incubation performance management and impact as critical, against which: 1.The input and process performance of business incubation management practice can be assessed and benchmarked within the auspices of a community of incubator managers concerned with best practice 2.The outcome performance and impact of business incubators can be assessed longitudinally. As such, the developed online assessment framework is geared towards the needs of researchers, policy makers and practitioners concerned with business incubation performance, added value and impact.

Performance evaluation of dual-flush WC cistern in a multifamily building in Brazil

The performance assessment as to water consumption in WC cisterns has contributed to the development of flushing system technologies, which allow smaller flushing volumes. The purpose of this work is to assess the performance of the the low water consumption requirement of WC cisterns with dual flushing system (6/3L), when compared to 6L flushing volume WC cisterns in multifamily buildings. The research methodology consisted of a case study in a multifamily residential building with submetering system, by monitoring the total water consumption and the two flushing systems using water meters installed in WC cisterns. By means of a mathematical model, a comparison of the design flowrate in the main branch was carried out considering the two types of WC cisterns. The results indicated that the water consumption in the 6L WC cistern was 20% in relation to the total domestic consumption, whereas the water consumption observed in the dual-flush WC cistern (6/3L) was 16%. The dual flushing system (6/3L) presented about 18% consumption reduction impact as compared to the 6 L system. The design flowrate values in the main branch, obtained by the mathematical model, were 0.35 L/s for systems with 6 L WC cistern and 0.34 L/s with dual-flush WC cistern (6/3 L), that is, a reduction of similar to 3%. Practical application: The knowledge of the performance in field of dual-flush WC cistern contributes to industry to improve this system and to users to aid their choice of technologies aimed at water conservation, and so assisting to the development of sustainable buildings.

Inovação tecnológica e performance empresarial

Mestrado em Controlo e Gestão de Negócios

Environmental performance policy indicators for the public sector: The case of the defence sector

Journal of Environmental Management, nº 82 p. 410–432

Fish Habitat Indicators for the Assessment of Wadeable, Warmwater Streams

Physical habitat characteristics such as stream width, depth, instream cover, and substrate composition are important environmental factors that shape Iowa’s stream fish species assemblages. The Iowa Department of Natural Resources (IDNR) stream biological assessment program collects physical habitat data to help interpret fish assemblage sampling results in order to assess stream health condition and the attainment status of designated aquatic life uses. The quantitative habitat indicators and interpretative guidelines developed in this study are designed for specific applications within the stream bioassessment program. These tools might also be useful to natural resource managers for purposes such as stream habitat improvement prioritization, goal-setting, and performance assessment.

Biogas production in regional integrated biodegradable waste treatment – Possibilities for improving energy performance and reducing GHG emissions

The greatest threat that the biodegradable waste causes on the environment is the methane produced in landfills by the decomposition of this waste. The Landfill Directive (1999/31/EC) aims to reduce the landfilling of biodegradable waste. In Finland, 31% of biodegradable municipal waste ended up into landfills in 2012. The pressure of reducing disposing into landfills is greatly increased by the forthcoming landfill ban on biodegradable waste in Finland. There is a need to discuss the need for increasing the utilization of biodegradable waste in regional renewable energy production to utilize the waste in a way that allows the best possibilities to reduce GHG emissions. The objectives of the thesis are: (1) to find important factors affecting renewable energy recovery possibilities from biodegradable waste, (2) to determine the main factors affecting the GHG balance of biogas production system and how to improve it and (3) to find ways to define energy performance of biogas production systems and what affects it. According to the thesis, the most important factors affecting the regional renewable energy possibilities from biodegradable waste are: the amount of available feedstock, properties of feedstock, selected utilization technologies, demand of energy and material products and the economic situation of utilizing the feedstocks. The biogas production by anaerobic digestion was seen as the main technology for utilizing biodegradable waste in agriculturally dense areas. The main reason for this is that manure was seen as the main feedstock, and it can be best utilized with anaerobic digestion, which can produce renewable energy while maintaining the spreading of nutrients on arable land. Biogas plants should be located close to the heat demand that would be enough to receive the produced heat also in the summer months and located close to the agricultural area where the digestate could be utilized. Another option for biogas use is to upgrade it to biomethane, which would require a location close to the natural gas grid. The most attractive masses for biogas production are municipal and industrial biodegradable waste because of gate fees the plant receives from them can provide over 80% of the income. On the other hand, directing gate fee masses for small-scale biogas plants could make dispersed biogas production more economical. In addition, the combustion of dry agricultural waste such as straw would provide a greater energy amount than utilizing them by anaerobic digestion. The complete energy performance assessment of biogas production system requires the use of more than one system boundary. These can then be used in calculating output–input ratios of biogas production, biogas plant, biogas utilization and biogas production system, which can be used to analyze different parts of the biogas production chain. At the moment, it is difficult to compare different biogas plants since there is a wide variation of definitions for energy performance of biogas production. A more consistent way of analyzing energy performance would allow comparing biogas plants with each other and other recovery systems and finding possible locations for further improvement. Both from the GHG emission balance and energy performance point of view, the energy consumption at the biogas plant was the most significant factor. Renewable energy use to fulfil the parasitic energy demand at the plant would be the most efficient way to reduce the GHG emissions at the plant. The GHG emission reductions could be increased by upgrading biogas to biomethane and displacing natural gas or petrol use in cars when compared to biogas CHP production. The emission reductions from displacing mineral fertilizers with digestate were seen less significant, and the greater N2O emissions from spreading digestate might surpass the emission reductions from displacing mineral fertilizers.

Les dimensions négligées de l'évaluation de la performance : les valeurs et la qualité de vie au travail

L’objet de cette thèse est l’élaboration d’un modèle logique de mesure du maintien des valeurs, ainsi que son opérationnalisation afin d’entreprendre l’évaluation de la performance des systèmes de santé. Le maintien des valeurs est l’une des quatre fonctions de la théorie de l’action sociale de T.Parsons permettant d’analyser les systèmes d’action. Les autres fonctions sont l’adaptation, la production et l’atteinte des buts. Cette théorie est la base du modèle EGIPSS (évaluation globale et intégrée de la performance des systèmes de santé), dans lequel cette thèse s’insère. La fonction étudiée correspond, dans l’oeuvre de T.Parsons, au sous-système culturel. Elle renvoie à l’intangible, soit à l’univers symbolique par lequel l’action prend son sens et les fonctions du système s’articulent. Le modèle logique de mesure du maintien des valeurs est structuré autour de deux concepts principaux, les valeurs individuelles et organisationnelles et la qualité de vie au travail. À travers les valeurs individuelles et organisationnelles, nous mesurons la hiérarchie et l’intensité des valeurs, ainsi que le niveau de concordance interindividuelle et le degré de congruence entre les valeurs individuelles et organisationnelles. La qualité de vie au travail est composée de plusieurs concepts permettant d’analyser et d’évaluer l’environnement de travail, le climat organisationnel, la satisfaction au travail, les réactions comportementales et l’état de santé des employés. La mesure de ces différents aspects a donné lieu à la conception de trois questionnaires et de trente indicateurs. Ma thèse présente, donc, chacun des concepts sélectionnés et leurs articulations, ainsi que les outils de mesure qui ont été construits afin d’évaluer la dimension du maintien des valeurs. Enfin, nous exposons un exemple d’opérationnalisation de ce modèle de mesure appliqué à deux hôpitaux dans la province du Mato Grosso du Sud au Brésil. Cette thèse se conclut par une réflexion sur l’utilisation de l’évaluation comme outil de gestion soutenant l’amélioration de la performance et l’imputabilité. Ce projet comportait un double enjeu. Tout d’abord, la conceptualisation de la dimension du maintien des valeurs à partir d’une littérature abondante, mais manquant d’intégration théorique, puis la création d’outils de mesure permettant de saisir autant les aspects objectifs que subjectifs des valeurs et de la qualité de vie au travail. En effet, on trouve dans la littérature de nombreuses disciplines et de multiples courants théoriques tels que la psychologie industrielle et organisationnelle, la sociologie, les sciences infirmières, les théories sur le comportement organisationnel, la théorie des organisations, qui ont conçu des modèles pour analyser et comprendre les perceptions, les attitudes et les comportements humains dans les organisations. Ainsi, l’intérêt scientifique de ce projet découle de la création d’un modèle dynamique et intégrateur offrant une synthèse des différents champs théoriques abordant la question de l’interaction entre les perceptions individuelles et collectives au travail, les conditions objectives de travail et leurs influences sur les attitudes et les comportements au travail. D’autre part, ce projet revêt un intérêt opérationnel puisqu’il vise à fournir aux décideurs du système de santé des connaissances et données concernant un aspect de la performance fortement négligé par la plupart des modèles internationaux d’évaluation de la performance.

Student self-assessment a feedback seeking strategy through competence evaluation

There is a body of literature that suggests that student self-assessment is a main goal in higher education (Boud et al., 1995; Tan, 2008); moreover new forms of work organization require a high level of skills and competences. The efforts to deal with competence gaps could be developed at many levels, such as employers, educational institutions, individuals and public agents. Employers could put into practice competence development programs to moderate these gaps. Educational institutions can restructure the curriculum to support students in attaining the competences that are essential in the labour market. Individuals themselves may deploy their resources (time and money) in general or specific competence training. Further, government agencies could fund competence promotion programs. Such challenges for education drive change in learning curricula and method, to properly include the competences required for developing global workers who can move beyond basic competence, to enhanced flexibility and adaptability. In performance assessment methods, there is a shift from the traditional exam-based assessments to more innovative task assessment, which considers performance in multiple different tasks carry out by students. ICTs make it technologically feasible to carry out a complete and complex selfassessment of competences, which provides immediate results to students or other recipients. In the case of students, the evaluation of competences is relevant as developing competences is part - if not all - of the objectives of education. Therefore, it is an important element of the quality of educational organizations (e.g., universities), and of their organizational success. Further, educational organizations may put special emphasis on some differentiating competences, which can be a means of positioning and differentiation from competitors. Competence assessment is an instrument to make students conscious of their strengths and weaknesses, leading to higher motivation to develop their own learning career

The air distribution index as an indicator for energy consumption and performance of ventilation systems

This paper deals with the energy consumption and the evaluation of the performance of air supply systems for a ventilated room involving high- and low-level supplies. The energy performance assessment is based on the airflow rate, which is related to the fan power consumption by achieving the same environmental quality performance for each case. Four different ventilation systems are considered: wall displacement ventilation, confluent jets ventilation, impinging jet ventilation and a high level mixing ventilation system. The ventilation performance of these systems will be examined by means of achieving the same Air Distribution Index (ADI) for different cases. The widely used high-level supplies require much more fan power than those for low-level supplies for achieving the same value of ADI. In addition, the supply velocity, hence the supply dynamic pressure, for a high-level supply is much larger than for low-level supplies. This further increases the power consumption for high-level supply systems. The paper considers these factors and attempts to provide some guidelines on the difference in the energy consumption associated with high and low level air supply systems. This will be useful information for designers and to the authors' knowledge there is a lack of information available in the literature on this area of room air distribution. The energy performance of the above-mentioned ventilation systems has been evaluated on the basis of the fan power consumed which is related to the airflow rate required to provide equivalent indoor environment. The Air Distribution Index (ADI) is used to evaluate the indoor environment produced in the room by the ventilation strategy being used. The results reveal that mixing ventilation requires the highest fan power and the confluent jets ventilation needs the lowest fan power in order to achieve nearly the same value of ADI.

Supply management capabilities, routine bundles and their impact on firm performance

Despite the generally positive contribution of supply management capabilities to firm performance their respective routines require more depth of assessment. Using the resource-based view we examine four routines bundles comprising ostensive and performative aspects of supply management capability – supply management integration, coordinated sourcing, collaboration management and performance assessment. Using structural equation modelling we measure supply management capability empirically as a second-order latent variable and estimate its effect on a series of financial and operational performance measures. The routines-based approach allows us to demonstrate a different, more fine-grained approach for assessing consistent bundles of homogeneous patterns of activity across firms. The results suggest supply management capability is formed of internally consistent routine bundles, which are significantly related to financial performance, mediated by operational performance. Our results confirm an indirect effect of firm performance for ‘core’ routines forming the architecture of a supply management capability. Supply management capability primarily improves the operational performance of the business, which is subsequently translated into improved financial performance. The study is significant for practice as it offers a different view about the face-valid rationale of supply management directly influencing firm financial performance. We confound this assumption, prompting caution when placing too much importance on directly assessing supply management capability using financial performance of the business.

Assessing the performance of dynamical trajectory estimates

Estimating trajectories and parameters of dynamical systems from observations is a problem frequently encountered in various branches of science; geophysicists for example refer to this problem as data assimilation. Unlike as in estimation problems with exchangeable observations, in data assimilation the observations cannot easily be divided into separate sets for estimation and validation; this creates serious problems, since simply using the same observations for estimation and validation might result in overly optimistic performance assessments. To circumvent this problem, a result is presented which allows us to estimate this optimism, thus allowing for a more realistic performance assessment in data assimilation. The presented approach becomes particularly simple for data assimilation methods employing a linear error feedback (such as synchronization schemes, nudging, incremental 3DVAR and 4DVar, and various Kalman filter approaches). Numerical examples considering a high gain observer confirm the theory.

Concord Grape Juice, cognitive function and driving performance: a 12 week, placebo controlled, randomised, crossover trial in mothers of pre-teen children

Background: Daily consumption of Concord grape juice (CGJ) over three to four months has been shown to improve memory function in adults with mild cognitive impairment, and reduce blood pressure in hypertensive adults. These benefits are likely due to the high concentration of polyphenols in CGJ. Increased stress can impair cognitive function and elevate blood pressure. Thus we examined the potential beneficial effect of CGJ in individuals experiencing somewhat stressful demanding lifestyles. Objective: To examine the effects of twelve weeks’ daily consumption of CGJ on cognitive function, driving performance, and blood pressure in healthy, middle-aged working mothers. Design: Twenty five healthy mothers of pre-teen children, aged 40-50 years, who were employed for > 30 hours/week consumed 12oz (355ml) CGJ (containing 777mg total polyphenols) or an energy, taste and appearance matched placebo daily for twelve weeks according to a randomised, crossover design with a four week washout. Verbal and spatial memory, executive function, attention, blood pressure and mood were assessed at baseline, six weeks and twelve weeks. Immediately following the cognitive battery, a subsample of seventeen females completed a driving performance assessment in the University of Leeds Driving Simulator. The twenty five minute driving task required participants to match the speed and direction of a lead vehicle. Results: Significant improvements in immediate spatial memory and driving performance were observed following CGJ relative to placebo. There was evidence of an enduring effect of CGJ such that participants who received CGJ in arm 1 maintained better performance in the placebo arm. Conclusions: Cognitive benefits associated with chronic consumption of flavonoid-rich grape juice are not exclusive to adults with mild cognitive impairment. Moreover, these cognitive benefits are apparent in complex everyday tasks such as driving. Effects may persist beyond cessation of flavonoid consumption and future studies should carefully consider the length of washout within crossover designs.

Performance of constructed wetland system for public water supply

The project is being conducted in the town of Analândia, São Paulo, Brazil. The constructed wetlands system for water supply consists of a channel with floating aquatic macrophytes, HDS system (Water Decontamination with Soil - Patent PI 850.3030), chlorinating system, filtering system and distribution. The project objectives include investigating the process variables to further optimize design and operation factors, evaluating the relation of nutrients and plants development, biomass production, shoot development, nutrient cycling and total and fecal coliforms removal, comparing the treatment efficiency among the seasons of the year; and moreover to compare the average values obtained between February and June 1998 (Salati et al., 1998) with the average obtained for the same parameters between March and June 2000. Studies have been developed in order to verify during one year the drinking quality of the water for the following parameters: turbidity, color, pH, dissolved oxygen, total of dissolved solids, COD, chloride, among others, according to the Ministry of Health's Regulation 36. This system of water supply projected to treat 15 L s-1 has been in continuous operation for 2 years, it was implemented with support of the National Environment Fund (FNMA), administered by the Center of Environmental Studies (CEA-UNESP), while the technical supervision and design were performed by the Institute of Applied Ecology. The actual research project is being supported by FAPESP.

Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model

Background and Purpose: Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery-each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons. Materials and Methods: Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis. Results: With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P = 0.006). Depth perception showed an improvement close to 35% (P = 0.041), and dexterity showed an improvement close to 25% (P = 0.011). Total operative time showed trends of improvement, although it was not significant (P = 0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P = 0.202, P = 0.677, and P = 0.456, respectively). Conclusions: These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.