Quantitative Analysis of Novel Prostate Cancer Markers in Tissue

Prostate cancer is a heterogeneous disease affecting an increasing number of men all over the world, but particularly in the countries with the Western lifestyle. The best biomarker assay currently available for the diagnosis of the disease, the measurement of prostate specific antigen (PSA) levels from blood, lacks specificity, and even when combined with invasive tests such as digital rectal exam and prostate tissue biopsies, these methods can both miss cancers, and lead to overdiagnosis and subsequent overtreatment of cancers. Moreover, they cannot provide an accurate prognosis for the disease. Due to the high prevalence of indolent prostate cancers, the majority of men affected by prostate cancer would be able to live without any medical intervention. Their latent prostate tumors would not cause any clinical symptoms during their lifetime, but few are willing to take the risk, as currently there are no methods or biomarkers to reliably differentiate the indolent cancers from the aggressive, lethal cases that really are in need of immediate medical treatment. This doctoral work concentrated on validating 12 novel candidate genes for use as biomarkers for prostate cancer by measuring their mRNA expression levels in prostate tissue and peripheral blood of men with cancer as well as unaffected individuals. The panel of genes included the most prominent markers in the current literature: PCA3 and the fusion gene TMPRSS2-ERG, in addition to BMP-6, FGF-8b, MSMB, PSCA, SPINK1, and TRPM8; and the kallikrein-related peptidase genes 2, 3, 4, and 15. Truly quantitative reverse-transcription PCR assays were developed for each of the genes for the purpose, time-resolved fluorometry was applied in the real-time detection of the amplification products, and the gene expression data were normalized by using artificial internal RNA standards. Cancer-related, statistically significant differences in gene transcript levels were found for TMPRSS2-ERG, PCA3, and in a more modest scale, for KLK15, PSCA, and SPINK1. PCA3 RNA was found in the blood of men with metastatic prostate cancer, but not in localized cases of cancer, suggesting limitations for using this method for early cancer detection in blood. TMPRSS2-ERG mRNA transcripts were found more frequently in cancerous than in benign prostate tissues, but they were present also in 51% of the histologically benign prostate tissues of men with prostate cancer, while being absent in specimens from men without any signs of prostate cancer. PCA3 was shown to be 5.8 times overexpressed in cancerous tissue, but similarly to the fusion gene mRNA, its levels were upregulated also in the histologically benign regions of the tissue if the corresponding prostate was harboring carcinoma. These results indicate a possibility to utilize these molecular assays to assist in prostate cancer risk evaluation especially in men with initially histologically negative biopsies.

Aineettomien riskien hallinta – case Itä-Suomen Biopankki

Aineeton pääoma nähdään organisaation keskeisenä kilpailutekijänä ja voimavarana. Se voi kuitenkin joissain tilanteissa olla organisaatiolle myös rasite tai jopa menestymistä heikentävä tekijä. Tutkimuksen tavoitteena oli laatia biopankin riskienhallinnalle malli, joka huomioi toimintaan vaikuttavat aineettomat riskitekijät ja toimii strategisena johtamisen ja toiminnan kehittämisen työvälineenä. Tutkimus toteutettiin tapaustutkimuksena, jossa käytettiin konstruktiivista tutkimusotetta. Biopankille luotiin konstruktio, riskienhallintamalli, jolla pyrittiin ratkaisemaan reaalimaailman ongelma ja samalla luomaan kontribuutiota tieteenalalle. Biopankki on uudentyyppinen organisaatio, joka kerää, hallinnoi ja säilyttää biologisia ihmisperäisiä näytteitä ja niihin liittyviä tietoja tulevaa tutkimusta varten. Toiminnan riskien taustasyyt ovat usein aineettomia, kuten toimintakulttuuri, asenne, osaaminen tai motivaatio. Tutkimuksessa löydettiin uusia biopankin toimintaan kytkeytyviä aineettomia riskejä koko aineettoman pääoman alueelta ja määriteltiin riskitasoihin perustuva lähestymistapa riskien hallintaan. Konstruktio aineettomien riskien hallintamalliksi sai selkeää vahvistusta tutkimuksen aineistosta, ja se voi toimia organisaation kehittämisen pohjana. Riskikartan luominen ja riskien arviointi ovat tekohetken poikkileikkauksia tilanteesta. Organisaation toiminta ja siihen kohdistuvat riskit ja mahdollisuudet muuttuvat ja kehittyvät. Riskien tunnistaminen lisää tietoa organisaatiosta ja sen toimintaympäristöstä, mikä luo puitteet myös uusien mahdollisuuksien tunnistamiselle. Sopivan riskienhallintamallin avulla voidaan löytää kilpailuetua suhteessa muihin organisaatioihin. Kilpailuetuna voi toimia myös muita parempi riskinkantokyky esimerkiksi toiminnan joustavuuden kautta.

Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

Public-private partnership investments in dry ports – Russian logistics markets and risks

The investments have always been considered as an essential backbone and so-called ‘locomotive’ for the competitive economies. However, in various countries, the state has been put under tight budget constraints for the investments in capital intensive projects. In response to this situation, the cooperation between public and private sector has grown based on public-private mechanism. The promotion of favorable arrangement for collaboration between public and private sectors for the provision of policies, services, and infrastructure in Russia can help to address the problems of dry ports development that neither municipalities nor the private sector can solve alone. Especially, the stimulation of public-private collaboration is significant under the exposure to externalities that affect the magnitude of the risks during all phases of project realization. In these circumstances, the risk in the projects also is becoming increasingly a part of joint research and risk management practice, which is viewed as a key approach, aiming to take active actions on existing global and specific factors of uncertainties. Meanwhile, a relatively little progress has been made on the inclusion of the resilience aspects into the planning process of a dry ports construction that would instruct the capacity planner, on how to mitigate the occurrence of disruptions that may lead to million dollars of losses due to the deviation of the future cash flows from the expected financial flows on the project. The current experience shows that the existing methodological base is developed fragmentary within separate steps of supply chain risk management (SCRM) processes: risk identification, risk evaluation, risk mitigation, risk monitoring and control phases. The lack of the systematic approach hinders the solution of the problem of risk management processes of dry port implementation. Therefore, management of various risks during the investments phases of dry port projects still presents a considerable challenge from the practical and theoretical points of view. In this regard, the given research became a logical continuation of fundamental research, existing in the financial models and theories (e.g., capital asset pricing model and real option theory), as well as provided a complementation for the portfolio theory. The goal of the current study is in the design of methods and models for the facilitation of dry port implementation through the mechanism of public-private partnership on the national market that implies the necessity to mitigate, first and foremost, the shortage of the investments and consequences of risks. The problem of the research was formulated on the ground of the identified contradictions. They rose as a continuation of the trade-off between the opportunities that the investors can gain from the development of terminal business in Russia (i.e. dry port implementation) and risks. As a rule, the higher the investment risk, the greater should be their expected return. However, investors have a different tolerance for the risks. That is why it would be advisable to find an optimum investment. In the given study, the optimum relates to the search for the efficient portfolio, which can provide satisfaction to the investor, depending on its degree of risk aversion. There are many theories and methods in finance, concerning investment choices. Nevertheless, the appropriateness and effectiveness of particular methods should be considered with the allowance of the specifics of the investment projects. For example, the investments in dry ports imply not only the lump sum of financial inflows, but also the long-term payback periods. As a result, capital intensity and longevity of their construction determine the necessity from investors to ensure the return on investment (profitability), along with the rapid return on investment (liquidity), without precluding the fact that the stochastic nature of the project environment is hardly described by the formula-based approach. The current theoretical base for the economic appraisals of the dry port projects more often perceives net present value (NPV) as a technique superior to other decision-making criteria. For example, the portfolio theory, which considers different risk preference of an investor and structures of utility, defines net present value as a better criterion of project appraisal than discounted payback period (DPP). Meanwhile, in business practice, the DPP is more popular. Knowing that the NPV is based on the assumptions of certainty of project life, it cannot be an accurate appraisal approach alone to determine whether or not the project should be accepted for the approval in the environment that is not without of uncertainties. In order to reflect the period or the project’s useful life that is exposed to risks due to changes in political, operational, and financial factors, the second capital budgeting criterion – discounted payback period is profoundly important, particularly for the Russian environment. Those statements represent contradictions that exist in the theory and practice of the applied science. Therefore, it would be desirable to relax the assumptions of portfolio theory and regard DPP as not fewer relevant appraisal approach for the assessment of the investment and risk measure. At the same time, the rationality of the use of both project performance criteria depends on the methods and models, with the help of which these appraisal approaches are calculated in feasibility studies. The deterministic methods cannot ensure the required precision of the results, while the stochastic models guarantee the sufficient level of the accuracy and reliability of the obtained results, providing that the risks are properly identified, evaluated, and mitigated. Otherwise, the project performance indicators may not be confirmed during the phase of project realization. For instance, the economic and political instability can result in the undoing of hard-earned gains, leading to the need for the attraction of the additional finances for the project. The sources of the alternative investments, as well as supportive mitigation strategies, can be studied during the initial phases of project development. During this period, the effectiveness of the investments undertakings can also be improved by the inclusion of the various investors, e.g. Russian Railways’ enterprises and other private companies in the dry port projects. However, the evaluation of the effectiveness of the participation of different investors in the project lack the methods and models that would permit doing the particular feasibility study, foreseeing the quantitative characteristics of risks and their mitigation strategies, which can meet the tolerance of the investors to the risks. For this reason, the research proposes a combination of Monte Carlo method, discounted cash flow technique, the theory of real options, and portfolio theory via a system dynamics simulation approach. The use of this methodology allows for comprehensive risk management process of dry port development to cover all aspects of risk identification, risk evaluation, risk mitigation, risk monitoring, and control phases. A designed system dynamics model can be recommended for the decision-makers on the dry port projects that are financed via a public-private partnership. It permits investors to make a decision appraisal based on random variables of net present value and discounted payback period, depending on different risks factors, e.g. revenue risks, land acquisition risks, traffic volume risks, construction hazards, and political risks. In this case, the statistical mean is used for the explication of the expected value of the DPP and NPV; the standard deviation is proposed as a characteristic of risks, while the elasticity coefficient is applied for rating of risks. Additionally, the risk of failure of project investments and guaranteed recoupment of capital investment can be considered with the help of the model. On the whole, the application of these modern methods of simulation creates preconditions for the controlling of the process of dry port development, i.e. making managerial changes and identifying the most stable parameters that contribute to the optimal alternative scenarios of the project realization in the uncertain environment. System dynamics model allows analyzing the interactions in the most complex mechanism of risk management process of the dry ports development and making proposals for the improvement of the effectiveness of the investments via an estimation of different risk management strategies. For the comparison and ranking of these alternatives in their order of preference to the investor, the proposed indicators of the efficiency of the investments, concerning the NPV, DPP, and coefficient of variation, can be used. Thus, rational investors, who averse to taking increased risks unless they are compensated by the commensurate increase in the expected utility of a risky prospect of dry port development, can be guided by the deduced marginal utility of investments. It is computed on the ground of the results from the system dynamics model. In conclusion, the outlined theoretical and practical implications for the management of risks, which are the key characteristics of public-private partnerships, can help analysts and planning managers in budget decision-making, substantially alleviating the effect from various risks and avoiding unnecessary cost overruns in dry port projects.

Lier la spéciation chimique du cérium à sa biodisponibilité sous différentes conditions environnementales

L’étude qui suit porte sur l’évaluation du risque écotoxicologique du cérium, l’élément le plus exploité de la famille des lanthanides. La présence grandissante de ce métal dans notre quotidien rend possible son relargage dans l’environnement. Il est donc primordial de comprendre l’impact qu’il aura sur les organismes vivant dans un système aquatique. Une approche centrée sur le modèle du ligand biotique a été utilisée pour évaluer adéquatement l’interaction entre le cérium et un ligand biotique à la surface de l’algue unicellulaire Chlamydomonas reinhardtii. Pour mener une étude sur le risque écotoxicologique d’un élément métallique il faut, avant tout, comprendre la spéciation (répartition sous ses différentes formes chimiques) de l’élément en question. Les premières sections du mémoire vont donc traiter des expériences qui ont été menées pour évaluer la spéciation du cérium dans les conditions expérimentales d’exposition à C. reinhardtii. Il sera question de faire la distinction entre la forme particulaire du métal et sa forme dissoute, de caractériser ces changements par spectroscopie ainsi que d’évaluer le pouvoir complexant de la matière organique naturelle. Les résultats montrent une importante déplétion du métal dissout en solution à pH neutre et basique et une forte interaction avec la matière organique naturelle, peu importe le pH de la solution. Ensuite, les expériences de bioaccumulation seront expliquéesen comparant l’effet du pH, de la présence d’un ion compétiteur et de la présence de matière organique naturelle sur les paramètres d’internalisation du cérium. Les résultats indiquent qu’à pH acide, le comportement du cérium est plus prévisible qu’à pH neutre. Néanmoins, en tenant compte de la complexité des milieux naturels, l’interaction du métal avec les molécules complexantes va diminuer son risque d’interaction avec un organisme vivant.

Evaluación de una herramienta educativa en conocimiento de donación y trasplante de órganos y tejidos en Colombia

El trasplante de órganos es considerado uno de los avances más significativos de la medicina moderna y es un procedimiento cada vez más exitoso en términos de supervivencia de los pacientes, siendo actualmente la mejor opción de tratamiento para los pacientes con innumerables patologías. El proceso de donación es insuficiente para cubrir las necesidades de trasplante de la población, por lo tanto, se hace necesario el desarrollo de nuevas estrategias para fortalecer la experiencia y efectividad de los programas existentes. La falta de conocimiento de los profesionales de la salud, su percepción y actitud hacia temas relacionados con el proceso de donación, pueden convertirlos en facilitadores o barreras para la identificación de potenciales donantes. Por esta razón, los recursos disponibles, las actitudes hacia la donación, la legislación y conocimiento de los procesos involucrados en la donación de tejidos y órganos son críticos. Dada la influencia de los profesionales de salud se definen los objetivos de este proyecto de tesis: determinar cuál es el conocimiento y las habilidades de los profesionales de la salud encargados de los trasplantes de órganos y de tejidos en la regional 1, evaluados mediante una herramienta educativa para contribuir a mejorar un programa eficiente de Donación de Órganos y tejidos y así mismo, fijar recomendaciones en aras de aumentar las tasas de donación, con especial énfasis en la actividad hospitalaria en el país. METODOLOGIA Se realizó un estudio basado en el análisis de la evaluación de conocimientos del proceso donación- trasplante de órganos y tejidos en el personal de salud participante en la herramienta educativa llamada “Curso taller primer respondiente del potencial donante de órganos y tejidos”. Este curso incluía un formato evaluativo que fue diligenciado de manera anónima por los participantes antes y después de recibir el contenido del curso. El estudio se desarrolló en personal de la Salud de IPS pertenecientes a la Regional I, de la Red Nacional de donación y trasplantes de órganos y tejidos. Con el fin de evidenciar si existen diferencias en el conocimiento de los participantes del curso antes y después de asistir al mismo, se utilizó la prueba de McNemar (p< 0.05). RESULTADOS Entre julio del 2011 y junio del 2012, se realizó el “Curso taller primer respondiente del potencial donante de órganos y tejidos” y se obtuvieron 303 encuestados incluidos médicos, enfermeras y auxiliares de enfermería. Al inicio del curso las respuestas acertadas con relación a legislación, selección del donante, muerte encefálica y mantenimiento del donante estuvieron alrededor del 50%. No fue posible detectar la profesión que pudiese generar riesgo en la detección del donante y los procesos asociados. Posterior al curso, el 72% de las preguntas se respondieron de manera correcta, lo que representa un incremento estadísticamente significativo. Este cambio evidenció significancia estadística al usar la prueba de McNemar y arrojar un valor de p=0.00. .DISCUSIÓN El personal de salud participante en el curso taller proveniente de unidades involucradas como generadoras de donantes muestra un déficit de conocimientos del proceso donación trasplantes lo que puede convertirlos en limitantes para dicho proceso

Determinación del perfil de exposición potencial a contaminantes químicos mediante el uso de metodologías de evaluación simplificada en trabajadores de autopartes en el barrio La Paz, Bogotá 2015

Las actividades de mantenimiento automotriz en el sector de autopartes conlleva el uso de agentes químicos bajo diversas circunstancias de exposición, tanto en las condiciones de manipulación de productos químicos como a las características propias de cada actividad de mantenimiento asociado a las tareas específicas del trabajo. Tradicionalmente la evaluación de contaminantes químicos desde la visión de la Higiene Ocupacional incluye la evaluación cuantitativa de la exposición mediante técnicas instrumentales concretas y estandarizadas, determinando el nivel de concentración en aire a la cual un trabajador se ve expuesto y que, en comparación con valores límites permisibles (VLPs), inducen el establecimiento de medidas de control y vigilancia, según el nivel de riesgo caracterizado. Sin embargo es evidente la limitación de la implementación de esta sistemática en particular en micros y pequeñas empresas que carecen de los recursos suficientes para abordar la problemática de forma objetiva. En este contexto diversas metodologías de evaluación cualitativa o subjetiva se han desarrollado por distintas organizaciones en el mundo con el fin de disminuir la brecha entre el establecimiento de medidas de control y la valoración del riesgo, ofreciendo alternativas confiables para la toma de decisiones preventivas sin la necesidad de acudir a mediciones cuantitativas. Mediante la presente investigación se pretende validar la efectividad en el uso de una herramienta de evaluación simplificada del riesgo químico propuesta por el INRS (Institut National de Recherche et de Sécurité Francés) mediante la determinación del perfil de exposición potencial a contaminantes químicos de la población laboral de 36 almacenes de autopartes ubicados en el barrio la Paz de la ciudad de Bogotá, Colombia, divididos según énfasis de actividades en Partes Externas, Partes Eléctricas e Inyección, Partes Mecánicas, Partes Múltiples, a través de un estudio de corte transversal. El estudio permitió Jerarquizar el riesgo potencial, valorar el riesgo vía inhalatoria y dérmica para finalmente construir el perfil de exposición potencial a contaminantes químicos de trabajadores. La información de las variables de análisis fue consolidada en una herramienta informática diseñada para tal fin, la cual facilito la administración de los datos y su respectivo análisis. Con base en los hallazgos fue posible establecer los productos químicos que de acuerdo a las condiciones de trabajo y circunstancias de exposición sugieren medidas específicas para la disminución del riesgo potencial de acuerdo a la calificación global de los agentes, permitiendo deducir la viabilidad de la aplicación de herramientas de valoración cualitativa para la evaluación del riesgo químico como estrategia de prevención primaria.

Capacidad predictiva del euroscore II en una cohorte de pacientes de cirugía cardiovascular en una institución de cuarto nivel de Bogotá

El EuroSCORE II es una de las escalas más empleadas como predictor de riesgo de mortalidad en los servicios de cirugía cardiovascular. Esta ha sido validada en diferentes hospitales alrededor del mundo demostrando una adecuada capacidad de discriminación. El objetivo de este estudio fue evaluar el valor predictivo de la escala de riesgo EuroSCORE II en los pacientes sometidos a Cirugía Cardiovascular en una institución de cuarto nivel de Bogotá. Metodología: Estudio de prueba diagnóstica observacional y retrospectivo de la cohorte de pacientes en una institución de cuarto nivel durante los años 2012 a 2014. Se realizó el cálculo del EuroSCORE II para cada paciente, comparando la mortalidad predicha versus la observada, de forma global y por grupo de riesgo. Resultados: Del total de la población que tuvo intervención cardiaca mayor en una institución de cuarto nivel en la cohorte estudiada se presentaron 58 casos de muerte en los treinta días posteriores a la intervención, que corresponde al 7,46%. La mortalidad esperada calculada con el EuroSCORE II fue del 9,26%, lo cual indica un buen poder de predicción para esta población. Por otro lado, la curva ROC evidencia con un valor de 0.757 del área bajo la curva, que el modelo El EuroSCORE II es un buen modelo predictivo con un adecuado valor de discriminación. Se evidenció que las variables estado crítico preoperatorio y función del ventrículo izquierdo tienen mayor peso estadístico en nuestra población objeto, con una significancia del 0,001, seguido de infarto agudo de miocardio, sexo y peso de la intervención con una significancia del 0,01. Adicionalmente, el Euroscore II tiene mejor valor predictivo cuando se realiza un solo procedimiento o revascularización, en comparación a cuando se realiza procedimientos mixtos. Se recomienda realizar un estudio multicéntrico donde se incluyan pacientes con diferentes características demográficas

Percepción del riesgo biológico en el personal asistencial en un hospital de alta complejidad de la ciudad de Bogotá.

OBJETIVOS: Identificar la percepción del riesgo biológico de los trabajadores asistenciales del Hospital Central de la Policía Nacional en la ciudad de Bogotá. METODOS: se realizó un estudio analítico de corte transversal para describir la percepción acerca del riesgo biológico en 159 trabajadores asistenciales de un hospital de alta complejidad en la ciudad de Bogotá (Colombia), la información se recolectó por medio de la utilización de la encuesta validada nota técnica 578 (Portell M, Solé M, 2001). Se realizó la caracterización de la población por variables de sexo, edad, tiempo de experiencia y servicio al cual pertenece y se promediaron las respuestas obtenidas para cada ítem encuestado, obteniendo una clasificación para cada dimensión de percepción de riesgo baja (1 a 3), media (4 a 5) o alta (6 a 7). Resultados: De los 159 trabajadores asistenciales encuestados el 80.4% eran de género femenino, el 22.2% pertenecían al servicio de urgencias, el 16,5% al servicio de medicina interna y el 9.5% al servicio de pediatría, de los encuestados el 62.9% fueron auxiliares de enfermería, el 21,4% enfermeras jefes y el 6.9% médicos. Se obtuvo una percepción de riesgo alta (media aritmética mayor de 5) para todas las variables incluidas en la encuesta, demostrando conocimiento de todo el personal acerca de la alta exposición a accidentes de tipo biológico. No se encontró asociación entre la labor desempeñada y la percepción del riesgo biológico, sin embargo, se encontró una asociación entre el tiempo de experiencia del trabajador y una disminución en la magnitud del riesgo percibido (Chi cuadrado de asociación, p=0.042). Conclusiones: Los trabajadores asistenciales identifican la magnitud del riesgo biológico al que se encuentran expuestos en sus labores del día a día, sin embargo, es necesaria una mayor participación por parte del personal directivo y de los responsables de la prevención en temas de reacción ante accidentes y en la valoración del riesgo, especialmente en personas que llevan mucho tiempo desempeñando la labor.

Els valors límit d'exposició professional i límits biològics per a agents químics en l'àmbit de treball, mesura i control. Evolució de la normativa sobre el plom i la seva incidència sobre els accidents laborals i malalties professionals en la indústria ceràmica

L'objectiu d'aquesta tesi és l'estudi dels valors límit d'exposició professional previstos en la normativa actual com a valors de referència per a l'avaluació i control dels riscos que comporta l'exposició a agents químics presents en el lloc de treball, fonamentalment per inhalació, per protegir la salut dels treballadors. No es pretén realitzar ni un estudi epidemiològic ni un estudi d'higiene, només s'utilitzen els valors d'exposició professional per analitzar el compliment de la normativa sobre la presència de plom en l'ambient de treball, i comprovar si el compliment de la normativa comporta la millora de la salut dels treballadors en funció de la millora de les concentracions de valors ambientals o biològics de l'exposició dels treballadors. La Directiva 98/24/CE deroga les Directives 80/1107/CEE sobre la protecció dels treballadors contra els riscos relacionats amb l'exposició a agents químics, físics i biològics durant el treball, i la Directiva 82/605/CEE, sobre la protecció dels treballadors contra riscos relacionats amb una exposició al plom metàl·lic i als seus compostos iònics durant el treball. S'analitza l'evolució de la normativa sobre la presència d'agents químics en l'ambient de treball, i en concret el plom, i la seva incidència en els accidents laborals i malalties professionals, i el compliment de la normativa al final d'un cicle marcat per l'entrada en vigor de la Directiva 98/24/CE. Per realitzar l'anàlisi anteriorment esmentada s'estudia la indústria ceràmica de les comarques gironines, de la construcció, de l'alimentació i decorativa, a través de les mesures de plom en l'ambient laboral i les mesures de plom en sang dels treballadors d'aquesta indústria des de 1991 a 1996.

Avaliação de riscos em estratégias de investimentos de longo prazo: aplicação prática em um fundo de pensão

O tema central deste trabalho é a avaliação de riscos em estratégias de investimentos de longo prazo, onde a necessidade de um exemplo prático direcionou à aplicação de Asset Liability Models em fundos de pensão, mais especificamente, a planos de benefício definido. Com os instrumentos de análise apresentados, acreditamos que o investidor com um horizonte de retorno de longo prazo tenha uma percepção mais acurada dos riscos de mercado a que está exposto, permitindo uma seleção de carteiras mais adequada aos objetivos de gestão. Para tanto, a inclusão de variáveis de decisão que procuram quantificar os objetivos de gestão - indo além do modelo simplificado de média-variância - exerce papel de fundamental importância.

Avaliação de projetos na presença de volatilidade: estudo de caso de empresas no setor de telecomunicações

Quando as empresas decidem se devem ou não investir em determinado projeto de investimentos a longo prazo (horizonte de 5 a 10 anos), algumas metodologias alternativas ao Fluxo de Caixa Descontado (FCD) podem se tornar úteis tanto para confirmar a viabilidade do negócio como para indicar o melhor momento para iniciar o Empreendimento. As análises que levam em conta a incerteza dos fluxos de caixa futuros e flexibilidade na data de início do projeto podem ser construídos com a abordagem estocástica, usando metodologias como a solução de equações diferenciais que descrevem o movimento browniano. Sob determinadas condições, as oportunidades de investimentos em projetos podem ser tratados como se fossem opções reais de compra, sem data de vencimento, como no modelo proposto por McDonald-Siegel (1986), para a tomada de decisões e momento ótimo para o investimento. Este trabalho analisa a viabilidade de investimentos no mercado de telecomunicações usando modelos não determinísticos, onde a variável mais relevante é a dispersão dos retornos, ou seja, que a variância representa o risco associado a determinado empreendimento.

Changes of metabolic and inflammatory markers in HIV infection: glucose, lipids, serum Hs-CRP and myeloperoxidase

Objective: HIV infection is exacerbated through additional pro-atherogenic mechanisms related to the processes of immune activation, inflammation, coagulation, and the modification of lipoproteins (e.g., particles of high density lipoprotein), contributing to increased cardiovascular risk. The aim of this study was to analyze the serum concentrations of myeloperoxidase (MPO) and other laboratory parameters in HIV-infected patients treated or not with antiretroviral drugs compared to non-infected individuals.Materials/Methods: The study included 154 volunteers: 47 non-infected individuals (control group - CON), 27 infected and untreated individuals (NTARv group) and 80 treated individuals (TARV group). We analyzed the counts of CD4+ lymphocytes and the viral load of the infected patients, along with the blood count, fasting glucose, total serum cholesterol (CHOL), HDL cholesterol, LDL cholesterol, triglycerides, MPO and high-sensitivity C-reactive protein (CRP) of all study participants.Results: There were significant increases in glucose, CHOL, LDL cholesterol, and triglycerides in the TARV group and significant reductions in the levels of HDL cholesterol for the TARV and NTARV groups. Significantly elevated levels of Hs-CRP were observed only in the TARV group, while levels of MPO were significantly higher in the TARV and NTARV groups compared to the control group. A correlation of MPO with Hs-CRP (r = 0.21, p = 0.032) was observed for HIV-infected patients, but MPO did not correlate significantly with the other analyzed parameters.Conclusions: The investigation of early biomarkers for cardiovascular risk evaluation, such as MPO, contributes to the clinical monitoring of HIV-infected individuals. The serum levels of MPO correlated with Hs-CRP and were high in HIV-infected individuals, indicating a possible predictor of cardiovascular events in these patients. (c) 2012 Elsevier B.V. All rights reserved.

Characterization of operational safety in offshore oil wells

The main concern of activities developed in oil and gas well construction is safety. But safety during the well construction process is not a trivial subject. Today risk evaluation approaches are based in static analyses of existent systems. In other words, those approaches do not allow a dynamic analysis that evaluates the risk for each alteration of the context. This paper proposes the use of Quantitative and Dynamic Risk Assessment (QDRA) to assess the degree of safety of each planned job. The QDRA can be understood as a safe job analysis approach, developed with the purpose of quantifying the safety degree in entire well construction and maintenance activities. The QDRA is intended to be used in the planning stages of well construction and maintenance, where the effects of hazard on job sequence are important unknowns. This paper also presents definitions of barrier, and barriers integrated set (BIS), and a modeling technique showing their relationships. (c) 2006 Elsevier B.V. All rights reserved.

Aspectos cognitivos do transtorno obsessivo-compulsivo

This paper describes the most important cognitive models for obsessive-compulsive disorder, i. e., the inference processes (thoughts and believes) underlying the patients'feelings and behaviors. The major models formulated in this area emphasize the following aspects: exacerbated perception of danger (risk evaluation), overimportance of intrusive thoughts, excessive sense of personal responsibility (blame for harm self and others), perfectionism, psychological fusion of thought and action, and illogical inference processes involving confusion between imagination and reality. The knowledge of cognitive aspects brings new perspectives for the psychological treatment of this disorder.