Implementation of a trauma registry in a brazilian public hospital: the first 1,000 patients

OBJECTIVE: Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.

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.

Arrêt du conseil d'Etat qui ordonne que le recouvrement de la finance de la vente des offices de greffiers secrétaires et gardes des archives des universités sera fait à la requête de Me E. Bertier

[Acte. 1704-02-16. Versailles]

Arrêt du Conseil d'Etat qui subroge François Fontaine au lieu et place de François Cheron pour faire le recouvrement de la finance qui doit provenir de la vente des offices de conseillers secrétaires de Sa Majesté, créés par édit du mois de décembre 1708

[Acte. 1712-03-15. Versailles]

Édit... portant suppression des offices de conseillers du Roy notaires et secrétaires dans les cours de Parlement, Chambres des Comptes et Cours des Aydes, Grand Conseil, Requestes de l'Hostel et du Palais, Conseils supérieurs et provinciaux, Cours des monnoies et Bureaux des Finances ; ordonne que les greffiers en chef des cours seront tous tenus de se pourvoir de l'un des offices de secrétaires, créez dans les chancelleries près les Cours par édit... de juin 1715 ; que la vente des offices de receveurs et payeurs des gages des officiers desdites chancelleries créez par édits... de novembre 1707 et décembre 1708 sera continuée ; et restablit les gardes des sceaux des chancelleries près les Cours dans leurs offices, en payant un supplément de finance... [Enregistré au Parlement le 13 juin 1716.]

[Acte royal. 1716-05-00. Paris]

Arrêt du conseil d'état qui ordonne que ceux des officiers des chancelleries près les cours et conseils supérieurs du royaume, qui payeront leur supplément de finance dans les termes y indiqués, seront déchargés des 2 sols pour livre

[Acte. 1755-11-25. Versailles]

Arrêt du conseil d'état qui ordonne que les quittances de finance pour l'acquisition des 1800000 livres de rentes héréditaires au denier vingt, créées sur l'imposition des deux sols pour livres en sus du dixième, seront expédiées au choix des acquéreurs en leur nom ou au porteur

[Acte. 1756-08-31. Versailles]

Instruction pour le recouvrement de la finance des jurez des arts et métiers, créez par édit du 12 mars 1691

[Acte. 1691]

« Recueil de matières de finance pour l'instruction du Roy, par M. D. C[HANDÉ]. Tome Ier. — 1722 ».

Contient : Abrégé chronologique des monnoies ; Dissertation sur la livre de compte ; Ferme du tabac ; Francs-fiefs ; Amortissemens ; Huitième et sixième denier ecclésiastique ; Insinuations laïques ; Controlle des actes des notaires ; Petits scels ; Cartes à jouer

Recueil de pièces, manuscrites et imprimées, concernant les relations commerciales et maritimes entre la France et l'Angleterre, avec quelques pièces relatives à des matières de finance. (1559-1605).

Contient : « Parties deues par le Roy à la royne d'Escosse, douairière de France » [cf. ms. français 15972, f. 35] ; « Estat de la despense fournie... par Monsieur de Beaumont, en divers voyages qu'il a faict faire exprès en Escosse..., vers Mr le baron Du Tour [Maupas], pour lui faire tenir les pacquetz de Sa Majesté... », duplicata, 1603 ; « Mémoire des sommes de deniers que la royne d'Angleterre a prestées ou desboursées pour le Roy très-chrestien », 1587-1596 ; « Mémoires touchant les traictez faicts entre les Anglois et François, pour empescher les pirateries et establir la liberté et seureté du commerce et de la navigation entre ces nations » [différents des pièces contenues dans le ms. français 15975, f. 71 et suiv.], et pièces relatives à divers actes de piraterie, états de marchandises, etc., 1559-1605 ; On remarque dans ce dossier : « Mémoire » orig. de Henri IV, « contenant la volonté du Roy sur les articles du règlement de la mer, proposez et traictez en Angleterre par le sieur de Boissize... », 1599 (f. 25), — une lettre orig. de « François Lefort » à Mr de Boissise, 1599 (f. 27), — et une lettre orig. de Henri IV au même, 1601 (f. 86) ; Pièces diverses, relatives au commerce des draps entre la France et l'Angleterre, 1600-1605