Incidence and consequence of major bleeding in primary percutaneous intervention for ST-elevation myocardial infarction in the era of radial access: an analysis of the international randomized Acute myocardial infarction Treated with primary angioplasty and intravenous enoxaparin Or unfractionated heparin to Lower ischemic and bleeding events at short- and Long-term follow-up trial.

AIMS: The aims of the study are to compare the outcome with and without major bleeding and to identify the independent correlates of major bleeding complications and mortality in patients described in the ATOLL study. METHODS: The ATOLL study included 910 patients randomly assigned to either 0.5 mg/kg intravenous enoxaparin or unfractionated heparin before primary percutaneous coronary intervention. Incidence of major bleeding and ischemic end points was assessed at 1 month, and mortality, at 1 and 6 months. Patients with and without major bleeding complication were compared. A multivariate model of bleeding complications at 1 month and mortality at 6 months was realized. Intention-to-treat and per-protocol analyses were performed. RESULTS: The most frequent bleeding site appears to be the gastrointestinal tract. Age >75 years, cardiac arrest, and the use of insulin or >1 heparin emerged as independent correlates of major bleeding at 1 month. Patients presenting with major bleeding had significantly higher rates of adverse ischemic complications. Mortality at 6 months was higher in bleeders. Major bleeding was found to be one of the independent correlates of 6-month mortality. The addition or mixing of several anticoagulant drugs was an independent factor of major bleeding despite the predominant use of radial access. CONCLUSIONS: This study shows that major bleeding is independently associated with poor outcome, increasing ischemic events, and mortality in primary percutaneous coronary intervention performed mostly with radial access.

Use of the Flixene vascular access graft as an early cannulation solution.

OBJECTIVE: The primary end points of this study were safety and efficacy of early cannulation of the Flixene graft (Maquet-Atrium Medical, Hudson, NH). Secondary end points were complications and patency. METHODS: This is a prospective single-center nonrandomized study. Study data included patient characteristics; history of vascular access; operative technique; interval between implantation and initial cannulation; complications; and patency at 1 month, 3 months, and every 6 months. Patency rates were estimated by the Kaplan-Meier method. RESULTS: Between January 2011 and September 2013, a total of 46 Flixene grafts were implanted in 44 patients (27 men) with a mean age of 63 years. The implantation site was the upper arm in 67% of cases, the forearm in 11%, and the thigh in 22%. Seven grafts were never cannulated during the study period. Of the remaining 39 grafts, 32 (82%) were successfully cannulated within the first week after implantation, including 16 (41%) on the first day. The median interval from implantation to initial cannulation was 2 days (interquartile range, 1-3 days). The median follow-up was 223.5 days (interquartile range, 97-600 days). Five hematomas occurred, but only one required surgical revision. Primary assisted and secondary patency rates were 65% and 86%, respectively, at 6 months and 56% and 86%, respectively, at 1 year. CONCLUSIONS: This study suggests that cannulation of the Flixene graft within 1 week after implantation is safe and effective. Early cannulation avoids or shortens the need for a temporary catheter. One-year patency rates appeared to be comparable to those achieved with conventional grafts, but long-term follow-up and randomized controlled studies will be needed to confirm this finding.

Pareto- ja Kaldor-Hicks- tehokkuuden mahdollisuudet ja rajoitukset julkisen hankkeen vaikutusten arvioinnissa : esimerkkinä suunniteltu autoverotusuudistus

Abstract: The posssibilities and limitations of Pareto and Kaldor-Hicks efficiency for the evalaution of public project - reform of car taxation as an example

Gold or green: the debate on Open Access policies

The movement for open access to science seeks to achieve unrestricted and free access to academic publications on the Internet. To this end, two mechanisms have been established: the gold road, in which scientific journals are openly accessible, and the green road, in which publications are self-archived in repositories. The publication of the Finch Report in 2012, advocating exclusively the adoption of the gold road, generated a debate as to whether either of the two options should be prioritized. The recommendations of the Finch Report stirred controversy among academicians specialized in open access issues, who felt that the role played by repositories was not adequately considered and because the green road places the burden of publishing costs basically on authors. The Finch Report"s conclusions are compatible with the characteristics of science communication in the UK and they could surely also be applied to the (few) countries with a powerful publishing industry and substantial research funding. In Spain, both the current national legislation and the existing rules at universities largely advocate the green road. This is directly related to the structure of scientific communication in Spain, where many journals have little commercial significance, the system of charging a fee to authors has not been adopted, and there is a good repository infrastructure. As for open access policies, the performance of the scientific communication system in each country should be carefully analyzed to determine the most suitable open access strategy. [Int Microbiol 2013; 16(3):199-203]

Determinants of Broadband Access: Is Platform Competition always the Key Variable to Success?

Previous studies have identified the rivalry among technological platforms as one of the main driving forces of broadband services penetration. This paper draws on data from the Spanish market between 2005 and 2011 to estimate the main determinants of broadband prices. Controlling for broadband tariffs features and network variables, we examine the impact of the different modes of competition on prices. We find that inter-platform competition has no significant effects over prices, while intra-platform competition is a key driver of the prices charged in the broadband market. Our analysis suggests that the impact of different types of competition on prices is critically affected by the levels of development of the broadband market achieved by the considered country

Implementing Role Based Access Control into the Enterprise Environment to Support Business and IT Functions

The thesis studies role based access control and its suitability in the enterprise environment. The aim is to research how extensively role based access control can be implemented in the case organization and how it support organization’s business and IT functions. This study points out the enterprise’s needs for access control, factors of access control in the enterprise environment and requirements for implementation and the benefits and challenges it brings along. To find the scope how extensively role based access control can be implemented into the case organization, firstly is examined the actual state of access control. Secondly is defined a rudimentary desired state (how things should be) and thirdly completed it by using the results of the implementation of role based access control application. The study results the role model for case organization unit, and the building blocks and the framework for the organization wide implementation. Ultimate value for organization is delivered by facilitating the normal operations of the organization whilst protecting its information assets.

Building an Access Network for Triple-Play Services

This final project was made for the Broadband department of TeliaSonera. This project gives an overview on how internet service provider might build an access network so that they can offer triple-play services. It also gives information on what equipment is needed and what is required from the access, aggregation and edge networks. The project starts by describing the triple-play service. Then it moves on to optical fiber cables, the network technology and network architecture. At the end of the project there is an example of the process and construction of the access network. It will give an overview of the total process and problems that a network planner might face during the planning phase of the project. It will give some indication on how one area is built from the start to finish. The conclusion of the project presents some points that must be taken into consideration when building an access network. The building of an access network has to be divided to a time span of eight to ten years, where one year is one phase in the project. One phase is divided into three parts; Selecting the areas and targets, Planning the areas and targets, and Documentation. The example area gives indication on the planning of an area. It is almost impossible to connect all targets at the same time. This means that the service provider has to complete the construction in two or three parts. The area is considered to be complete when more than 80% of the real estates have fiber.

Social insurances system's shortcomings : the example of the low-income young retirees' access to healthcare [Imperfections du système d'assurances sociales : l'exemple de l'accès aux soins des jeunes retraité(e)s à revenu modeste]

This article presents the results of a study involving 2445 recently retired persons from the Canton of Vaud in Switzerland who choose to forego health care. These persons of modest means barely qualify for government assistance programs and do not benefit from the social safety net that is provided to the truly destitute. 17.9% of the respondents to the questionnaire said that they forego health care for financial reasons. Interviews reveal the complex reasons that lie behind such a choice, as well as the compensation strategies that are sometimes used to get medical treatment. These strategies show that the people are able to act when the circumstances require them to do so. Despite that, their situation remains insecure. Cet article analyse les résultats d'une étude sur le renoncement aux soins menée auprès de 2445 Vaudois∙e∙s récemment retraité∙e∙s. Ces personnes de situation modeste sont proches des limites d'accès aux aides étatiques et ne bénéficient pas du même filet de protection sociale que d'autres plus démunies. 17.9% des répondant∙e∙s au questionnaire déclarent renoncer à des soins pour raisons financières. Des entretiens mettent en évidence la complexité du renoncement, ainsi que les stratégies compensatoires que les personnes adoptent pour accéder à certains soins. Ces dernières démontrent une capacité d'agir en situation qui reste toutefois précaire.

The Spatial Distribution of Human Capital: Can It Really Be Explained by Regional Differences in Market Access?

This paper tests the robustness of estimates of market access impact on regional variability in human capital, as previously derived in the NEG literature. Our hypothesis is that these estimates of the coefficient of market access, in fact, capture the effects of regional differences in the industrial mix and the spatial dependence in the distribution of human capital. Results for the Spanish provinces indicate that the estimated impact of market access vanishes and becomes non-significant once these two elements are included in the empirical analysis.

Handover aspects in Unlicensed Mobile Access Technology

Fixed Mobile Convergence is the recent buzz in the field of telecommunication technology. Unlicensed Mobile Access (UMA) technology is a realistic implementation of Fixed Mobile Convergence. UMA involves communication between different types of networks. Handover is a very important issue in UMA. The study is an analysis of theoretical handover mechanism and practical test results. It includes a new proposal for handover performance test in UMA. It also provides an overview of basic handover operation on different scenarios in UMA. The practical test involves an experiment on handover performance test using network analyzers. The new proposal provides a different approach for an experimental setting on handover performance test without using network analyzers. The approach is not be implemented because of some technical problem in a network equipment in UMA. The analysis of the test results reveals that time of handover between UMA and Global System for Mobile Communication (GSM) network is similar to time of handover between inter base station controller (BSC) handover in GSM networks. The new approach is simple and provides measurement at the end point communicating entities. The study gives a general understanding of handover operation, an analysis of handover performance in UMA and specifically provides a new approach useful for further study of handover in different real world environments and scenarios.

Urban transport governance reform in Barcelona

The unusual mixed public-private structure of the urban bus market in the metropolitan area of Barcelona provides an interesting context in which to analyze the management challenges and opportunities of the partial privatization of public services. Initiatives used by the public regulator to promote competition for contracts, such as short term concessions to private contractors and the removal of entry barriers, have considerable potential for improving efficiency and quality. The growth in the share of routes managed by private firms in recent years shows that privatization is a credible threat that may well stimulate improved performance among public managers. The type of reform implemented in Barcelona is of interest to all metropolitan areas large enough to operate under constant returns to scale regimes, and suitable for potential concessions of routes in segregated areas inside the metropolitan area, so as not to miss out on the benefits of economies of density.

Does privatization spur regulation? Evidence from the regulatory reform of European airports

This paper conducts an empirical analysis of the relationship between privatization and regulation drawing on data from a wide sample of European airports. We find that privatization promotes a shift from basic regulation to a situation of more detailed or non-regulation, depending on the specific characteristics of the privatization process and on the type of airport being privatized. Moreover, we report a significant association between high traffic volumes and more detailed regulation. By contrast, airports where slot allocation is noncoordinated are significantly associated with non-regulation.

Référentiel de pratiques professionnelles: soins et surveillance des accès veineux centraux de l'adulte pour la nutrition parentérale [Formative assessment in clinical nutrition: Care management of parenteral nutrition central venous access]

Les voies veineuses centrales (VVC) sont essentielles pour l'administration de la nutrition parentérale. Le risque de complications est dépendant de la qualité des soins apportés à la VVC qui influence de ce fait la qualité de vie des patients et le coût des soins. Beaucoup de complications des VVC, infectieuses ou non, peuvent être prévenues par l'existence de protocoles de soins appropriés et standardisés. L'information sur les soins des VVC et les éventuelles complications est essentielle pour le dépistage et le traitement précoce de ces complications ; elle doit faire l'objet de protocoles partagés entre les patients et les soignants. Cet article décrit une évaluation des pratiques professionnelles sous la forme d'un audit clinique destiné à améliorer la qualité de soins des patients en nutrition parentérale porteurs de VVC. Central venous access devices (CVAD) are essential for the administration of parenteral nutrition. The quality of the care of CVAD influences the risk of complications and so the quality of life of the patients and the costs of care. Numerous infectious or non-infectious complications of CVAD can be prevented by appropriate, standardized protocols of care. Information about the care of CVAD and complications is essential for the early recognition and treatment of complications and should be shared between patients and caregivers. This article describes an audit for CAVD care that can be used to improve quality of care in a professional practice evaluation program.