Uso del indicador del retorno total del negocio como alternativa para optimizar la inversión en unidades de negocio en condiciones de incertidumbre

En este articulo se hace un análisis sobre la validez de la TBR (Total Bussines return) como medida de rentabilidad de unidades de negocio que pertenecen a un portafolio corporativo. Se establecen cuales son sus debilidades y en que casos es posible aceptarla como medida de rentabilidad asociada con la creación de valor. Se expone, la coincidencia matemática entre la TBR y el WACC (costo promedio ponderado de capital) a partir del descuento de flujos de caja proyectados y entre el CAV (creación adicional de valor) y la diferencia entre el ingreso económico obtenido y el ingreso económico esperado en un periodo determinado. También se evidencia la equivalencia entre el CAV y la variación del valor de las operaciones más la variación del flujo de caja del periodo. Posteriormente se realiza una aplicación para mostrar como puede utilizar la TBR y la teoría moderna de portafolio para que un gerente corporativo pueda controlar la relación rendimiento-riesgo existente entre las distintas unidades de negocio a cargo de su corporación.

Medication reconciliation at patient admission: a randomized controlled trial

Objective: To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician. Methods: A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission. Results: The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions. Conclusion: These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety.

Severe Statin-induced Rhabdomyolysis following Cholestatic Hepatitis induced by Amoxicillin-clavulanate

We report the case of an 86-year-old man with a past history of coronary disease admitted to our internal medicine department for severe asthenia and weakness due to rhabdomyolysis. Three days earlier, he had been discharged from a gastroenterology unit with a diagnosis of amoxicillin–clavulanate-induced acute cholestatic hepatitis. A review of his drugs revealed that he had taken atorvastatin 10 mg daily in the previous six years, without clinical or laboratory signs of myopathy. Atorvastatin was therefore stopped, with gradual improvement of the rhabdomyolysis. All concomitant drug therapy needs to be reassessed in elderly patients, especially when they become acutely ill.

Anti-Signal Recognition Particle Myopathy in a Geriatric Patient

Anti-signal recognition particle (SRP) myopathy is a rare idiopathic inflammatory myositis that usually affects middle-age women, and is characterized by rapidly progressive proximal and symmetrical muscle weakness, elevated creatine kinase levels, severe necrotizing immune-mediated myopathy, presence of anti-SRP autoantibodies and poor response to steroid therapy. We report a geriatric case of a previously independent patient, presenting with slow onset of proximal paraparesis, myalgia and severe gait impairment. The patient was treated with steroid and azathioprine, with laboratory and pain response but modest muscle strength improvement. The clinical presentation of this unusual patient was atypical, which hampered the correct diagnosis.

Polymyositis and the Spectrum of Scleroderma Disorders

Polymyositis (PM) is usually associated to other autoimmune or connective tissue diseases. The authors report the case of a 59-year-old man with pulmonary fibrosis, who presented with constitutional symptoms and gradually developed proximal muscle weakness, Raynaud phenomenon, and dysphagia. Besides creatine kinase (CK) elevation, he had positive anti-Polymyositis-Scleromyositis (PM-Scl) and anti-Sjögren's-syndrome A (SSA) antibodies. Nailfold capillaroscopy showed a scleroderma pattern and muscle biopsy revealed necrosis, regeneration of muscle fibers, and inflammatory infiltrate. Prednisolone was started, with great improvement. Taking into account the overlap features between PM and systemic sclerosis sine scleroderma, it is important to closely monitor the patient for signs of pulmonary and cardiac decompensation.

The experience of teaching statistics to non-specialist students in Saudi universities

Undoubtedly, statistics has become one of the most important subjects in the modern world, where its applications are ubiquitous. The importance of statistics is not limited to statisticians, but also impacts upon non-statisticians who have to use statistics within their own disciplines. Several studies have indicated that most of the academic departments around the world have realized the importance of statistics to non-specialist students. Therefore, the number of students enrolled in statistics courses has vastly increased, coming from a variety of disciplines. Consequently, research within the scope of statistics education has been able to develop throughout the last few years. One important issue is how statistics is best taught to, and learned by, non-specialist students. This issue is controlled by several factors that affect the learning and teaching of statistics to non-specialist students, such as the use of technology, the role of the English language (especially for those whose first language is not English), the effectiveness of statistics teachers and their approach towards teaching statistics courses, students’ motivation to learn statistics and the relevance of statistics courses to the main subjects of non-specialist students. Several studies, focused on aspects of learning and teaching statistics, have been conducted in different countries around the world, particularly in Western countries. Conversely, the situation in Arab countries, especially in Saudi Arabia, is different; here, there is very little research in this scope, and what there is does not meet the needs of those countries towards the development of learning and teaching statistics to non-specialist students. This research was instituted in order to develop the field of statistics education. The purpose of this mixed methods study was to generate new insights into this subject by investigating how statistics courses are currently taught to non-specialist students in Saudi universities. Hence, this study will contribute towards filling the knowledge gap that exists in Saudi Arabia. This study used multiple data collection approaches, including questionnaire surveys from 1053 non-specialist students who had completed at least one statistics course in different colleges of the universities in Saudi Arabia. These surveys were followed up with qualitative data collected via semi-structured interviews with 16 teachers of statistics from colleges within all six universities where statistics is taught to non-specialist students in Saudi Arabia’s Eastern Region. The data from questionnaires included several types, so different techniques were used in analysis. Descriptive statistics were used to identify the demographic characteristics of the participants. The chi-square test was used to determine associations between variables. Based on the main issues that are raised from literature review, the questions (items scales) were grouped and five key groups of questions were obtained which are: 1) Effectiveness of Teachers; 2) English Language; 3) Relevance of Course; 4) Student Engagement; 5) Using Technology. Exploratory data analysis was used to explore these issues in more detail. Furthermore, with the existence of clustering in the data (students within departments within colleges, within universities), multilevel generalized linear models for dichotomous analysis have been used to clarify the effects of clustering at those levels. Factor analysis was conducted confirming the dimension reduction of variables (items scales). The data from teachers’ interviews were analysed on an individual basis. The responses were assigned to one of the eight themes that emerged from within the data: 1) the lack of students’ motivation to learn statistics; 2) students' participation; 3) students’ assessment; 4) the effective use of technology; 5) the level of previous mathematical and statistical skills of non-specialist students; 6) the English language ability of non-specialist students; 7) the need for extra time for teaching and learning statistics; and 8) the role of administrators. All the data from students and teachers indicated that the situation of learning and teaching statistics to non-specialist students in Saudi universities needs to be improved in order to meet the needs of those students. The findings of this study suggested a weakness in the use of statistical software applications in these courses. This study showed that there is lack of application of technology such as statistical software programs in these courses, which would allow non-specialist students to consolidate their knowledge. The results also indicated that English language is considered one of the main challenges in learning and teaching statistics, particularly in institutions where English is not used as the main language. Moreover, the weakness of mathematical skills of students is considered another major challenge. Additionally, the results indicated that there was a need to tailor statistics courses to the needs of non-specialist students based on their main subjects. The findings indicate that statistics teachers need to choose appropriate methods when teaching statistics courses.

The Scottish Parliament in the 15th and 16th centuries

Earlier histories of the Scottish parliament have been somewhat constitutional in emphasis and have been exceedingly critical of what was understood to be parliament's subservience to the crown. Estimates by constitutional historians of the extreme weakness of parliament rested on an assessment of the constitutional system. The argument was that many of its features were not consistent with a reasonably strong parliament. Because the 'constitution' is apparently fragmented, with active roles played by bodies such as the lords of articles, the general council and the convention of estates, each apparently suggesting that parliament was inadequate, historians have sometimes failed to appreciate the positive role played by the estates in the conduct of national affairs. The thesis begins with a discussion of the reliability of the printed text of APS and proceeds to an examination of selected aspects of the work of parliament in a period from c 1424-c 1625. The belief of constitutional historians such as Rait that conditions In Scotland proved unfavourable to the interests and. effectiveness of parliament in the fifteenth and sixteenth centuries, is also examined. Chapter 1 concludes that APS is a less than reliable text, particularly for the reign of James I. Numerous statutes were excluded from the printed text and they are offered below for the first time. These statutes have been a useful addition to our understanding of the reign of James I. Chapter 2 analyses the motives behind the schemes for shire representation and concludes that neither constitutional theory nor political opportunism explains the support which James I and James VI gave to these measures. Both these monarchs were motivated by the realisation that their particular ambitions were dependent on winning the support of the estates whose ranks should include representatives from the shires. Chapter 3 examines the method of electing the lords of articles, the composition of this committee, and some aspects of its operation. The conclusion is that in the main the estates were the deciding force in the choice of the lords of articles. The committee's composition was more a reflection of a desire for a balance between representatives from north and south of the Forth and for the most important burghs and clergy to be selected than an attempt at electing government favourites. The articles did exercise a significant control over the items which came before parliament but this control was not absolute and applied to government as well as private legislation. Chapter 4 questions the traditional view that the general council and convention of estates were the same body. It is argued that they were two different institutions with different powers, but that they nevertheless worked within certain limits and were careful not to usurp the authority of parliament. Chapter 5 concedes that taxation was sometimes decided outside parliament; that the irregularity of taxation certainly weakened the bargaining power of the estates and that the latter did not appear to capitalise on these occasions when taxation was an issue. But the tendency was to ensure that, whether in or out of parliament, the decision to impose taxation was taken by a large number of each estate. The infrequency of taxation was a direct consequence of an unwillingness among the estates to agree to a regular taxation and their preference to ensure for the crown an alternative source of income. Moreover taxation was one issue, which more than any other, would be subject to contentious opposition by the estates, and could lead to the crown's defeat. Chapter 6 is concerned with ecclesiastical representation after the Reformation and the church's attitudes to the possibility of ministerial representation. Some ministers had doctrinal misgivings but the majority came to believe that the church's absence from parliament bad severely reduced. the influence of the church. That no agreement was forthcoming on a system of ministerial representation, particularly after 1597, is attributable to the estates' unwillingness to compromise and, not to the strength of opposition in the church. Chapter 7 examines the institutions which are sometime seen as 'rivals' of parliament and concludes that institutions such as the privy council were generally very careful in matters which needed the approval of parliament, and seemed aware of the greater authority of parliament. Chapter 8 which illustrates how parliament had the right to be consulted in all important matters of state, brings together the main points of the earlier chapters and offers further illustrations of the essential role which parliament played in the conduct of national affairs. Whether or not the system can be regarded as constitutionally sound, the estates in Scotland could observe parliament's day-to-day operation with some satisfaction. All in all, there is little convincing evidence that parliament was as weak as some historians would have us believe.

A esperança do doente em contexto de cuidados continuados

Enquadramento: Actualmente existe um elevado números de pessoas em situação de dependência, com algum tipo de incapacidade funcional ou em risco de perda de funcionalidade, que necessitam ingressar na Rede Nacional de Cuidados Continuados com o intuito de se promover uma melhoria das condições de vida e bem-estar das pessoas, através da prestação de cuidados continuados de saúde e de apoio social. Aceitando a vulnerabilidade da pessoa humana, a doença revela-se como um período de fragilidade circunstancial às condições decorrentes da sua existência. O utente/família deparam-se com a desmoralização, a ameaça, o desamparo e a perda de sentido, podendo levar o mesmo a uma profunda tristeza, desespero e sofrimento. Neste sentido e tendo em conta que a esperança influencia o bem-estar e uma vez que se encontra ligada à existência, tanto física como emocional e espiritual é fundamental percebermos até que ponto a esperança pode ajudar a pessoa a lidar com o futuro. Objetivos: Avaliar níveis de esperança nos Doentes internados em Cuidados Continuados, e identificar determinantes socio-demográficos, clínicas e psicossociais correlacionadas com essa esperança. Métodos: O estudo foi realizado,na Unidade de Cuidados Continuados da Santa Casa da Misericórdia de Seia, nas unidades de internamento de Média Duração e Reabilitação e Unidade de Longa Duração e Manutenção. O questionário foi aplicado a 46 doentes, com idades compreendidas entre os 46 e os 92 anos de idade ( x =74.39 anos). Trata-se de um estudo não experimental, quantitativo, do tipo transversal, descritivo e correlacional. O instrumento de recolha de dados integrou um Questionário de caracterização sócio-demográfica e clínica, a escala da Esperança (Herth Hope Index), uma escala para a avaliação da Qualidade de Vida – Functinal Assessement of Cancer Therapy – General e o Questionário de Sono de Oviedo. Resultados: Os dados mostram que 45,7% dos participantes apresenta esperança reduzida, 39,1% esperança elevada e 15,2% esperança moderada. Constatámos ainda que apenas o “bem-estar funcional” da escala da QDV e os “fenómenos adversos” da escala do sono se correlacionam significativamente (p=0,000; p=0,035) com a esperança explicando respetivamente 55,2% e 31,1% da variância explicada. Já o género, idade, estado civil, situação profissional, escolaridade, rendimento mensal, tipologia e número de internamentos, mostraram não estar relacionados com a esperança dos nossos doentes. Conclusão: A esperança é uma crença ou virtude inerente ao Homem, que pode assumir níveis diferenciados, que acompanha o ser humano no seu processo de viver e de morrer condicionando ajustes nos momentos de crise, afectando e/ou sendo afetada pelo bem-estar e a qualidade de vida. Palavras-chave: Cuidados Continuados, Esperança, Qualidade de Vida, Doentes, Sono.

AUDITORÍA DE LA GESTIÓN DE LOS RECURSOS DE INFORMACIÓN EN LA ESCUELA DE BIBLIOTECOLOGÍA, DOCUMENTACIÓN E INFORMACIÓN

La información vista hoy en día como un recurso estratégico para la organización, ha llevado a que se evalúe su gestión de la misma forma que se hace con los demás recursos que existen en la organización.Para esta evaluación se utiliza la Auditoría de información por ser una herramienta indispensable en aquellos procesos relacionados con la gestión de información.La presente investigación surge a raíz de la necesidad que plantea la Escuela de Bibliotecología, Documentación e Información de realizar una evaluación de los recursos de información que requiere para el cumplimiento de objetivos y toma de decisiones, a fin de determinar el nivel de la gestión de éstos por medio de la aplicación de una Auditoría de Información.El desarrollo de esta auditoría se hizo a través de varias fases, las cuales permitieron obtener como resultados:- La identificación de los recursos de información estratégicos que la Escuela requiere para desarrollarse adecuadamente, a partir del análisis de diferentes estructuras de información.- La descripción de cada uno de los recursos a fin de conocer todas sus características e importancia para la Escuela.- El conocer los diferentes flujos de información que se presentan en la Escuela.- Un análisis de la situación actual de los recursos, el balance informacional y la evaluación general de los recursos para determinar las fortalezas y debilidades presentes en su gestión.- La presentación de oportunidades de mejora que aplicadas oportunamente pueden contribuir a optimizar la gestión de los recursos.- Y finalmente presentar un propuesta para la gestión de uno de los recursos de información que presentó debilidad en su gestión.En términos generales, la aplicación de la auditoría de información en la Escuela fue muy pertinente y oportuna ya que permitió identificar y evaluar los recursos de información tal y como se espera en este tipo de proceso.

CONTROL DOCUMENTAL SOBRE GRUPOS ÉTNICOS INDÍGENAS COSTARRICENSES: 1980-2003

En Costa Rica se ha hecho poco por realizar el control documental nacional sobre grupos étnicos indígenas, esto puede ser tipificado como una debilidad, dos obras son el universo de fuentes de referencia.La necesidad de contar con el control documental sobre/de grupos étnicos indígenas costarricenses entre 1980-2003, es el propósito que persiguió esta investigación, además brindar un aporte de valor histórico, cultural y científico a aquellas personas interesadas en la temática indígena costarricense.Este control documental pretende agrupar la temática en estudio de dicho período. Es importante mencionar que en Costa Rica existen controles documentales sobre otras temáticas, no así de la temática indígena.Este control facilitará el rescate de la cultura indígena costarricense, es un aporte al control documental nacional y universal, contiene documentos de los años comprendidos entre 1980-2003, el mismo es fundamental para el acceso y disponibilidad de la información que forma parte de la actividad propia del profesional en bibliotecología, el cual se realiza dé acuerdo con las normas y criterios establecidos a nivel nacional e internacional. Además servirá y contribuirá como antecedente para futuros controles documentales sobre esta temática.

NETCODE: an XOR-based warning dissemination scheme for vehicular wireless networks

The next generation of vehicles will be equipped with automated Accident Warning Systems (AWSs) capable of warning neighbouring vehicles about hazards that might lead to accidents. The key enabling technology for these systems is the Vehicular Ad-hoc Networks (VANET) but the dynamics of such networks make the crucial timely delivery of warning messages challenging. While most previously attempted implementations have used broadcast-based data dissemination schemes, these do not cope well as data traffic load or network density increases. This problem of sending warning messages in a timely manner is addressed by employing a network coding technique in this thesis. The proposed NETwork COded DissEmination (NETCODE) is a VANET-based AWS responsible for generating and sending warnings to the vehicles on the road. NETCODE offers an XOR-based data dissemination scheme that sends multiple warning in a single transmission and therefore, reduces the total number of transmissions required to send the same number of warnings that broadcast schemes send. Hence, it reduces contention and collisions in the network improving the delivery time of the warnings. The first part of this research (Chapters 3 and 4) asserts that in order to build a warning system, it is needful to ascertain the system requirements, information to be exchanged, and protocols best suited for communication between vehicles. Therefore, a study of these factors along with a review of existing proposals identifying their strength and weakness is carried out. Then an analysis of existing broadcast-based warning is conducted which concludes that although this is the most straightforward scheme, loading can result an effective collapse, resulting in unacceptably long transmission delays. The second part of this research (Chapter 5) proposes the NETCODE design, including the main contribution of this thesis, a pair of encoding and decoding algorithms that makes the use of an XOR-based technique to reduce transmission overheads and thus allows warnings to get delivered in time. The final part of this research (Chapters 6--8) evaluates the performance of the proposed scheme as to how it reduces the number of transmissions in the network in response to growing data traffic load and network density and investigates its capacity to detect potential accidents. The evaluations use a custom-built simulator to model real-world scenarios such as city areas, junctions, roundabouts, motorways and so on. The study shows that the reduction in the number of transmissions helps reduce competition in the network significantly and this allows vehicles to deliver warning messages more rapidly to their neighbours. It also examines the relative performance of NETCODE when handling both sudden event-driven and longer-term periodic messages in diverse scenarios under stress caused by increasing numbers of vehicles and transmissions per vehicle. This work confirms the thesis' primary contention that XOR-based network coding provides a potential solution on which a more efficient AWS data dissemination scheme can be built.

Avaliação de um programa de intervenção sobre leitura e escrita numa escola de intervenção prioritária

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Educacional.

Stellungnahme zu: Diagnostik und Behandlung von Kindern und Jugendlichen mit Lese- und/oder Rechtschreibstörung. Evidenz- und konsensbasierte Leitlinie

Die Leitlinie zur Diagnostik und Behandlung von Kindern mit Lese- und/ oder Rechtschreibstörung hat sich zwei Ziele gesetzt: „klare, empirisch fundierte Handlungsanweisungen für eine eindeutige und objektive Diagnostik der Lese- und/oder Rechtschreibstörung bereitzustellen und über die Wirksamkeit von Fördermaßnahmen zu informieren“ ... Ferner wird eine Konsensbasierung angestrebt, wobei allerdings zu bemerken ist, dass Verbände und Organisationen, die sich bekanntermaßen kritisch mit dem medizinischen Ansatz von Lese-Rechtschreibstörung auseinandersetzen, nicht an der Leitlinie mitgewirkt haben … Im Folgenden [erörtert die Autorin] aus der Sicht einer langjährigen Legasthenieforscherin und Grundschulpädagogin die Frage …, ob es gelungen ist, diese Zielsetzungen zu realisieren. Da – in der Terminologie der Leitlinie - auch die Schule zum „Versorgungsbereich“ gehört, in dem die hier empfohlene Diagnostik und Förderung eingesetzt werden soll, und zur „Anwenderzielgruppe“ auch Lehrkräfte, Sonderpädagog/inn/en und Heilpädagog/inn/en gehören, ist ein pädagogischer Blick auf die Leitlinie, an deren Entstehung überwiegend medizinische Fachleute beteiligt waren, wichtig und notwendig. (DIPF/Orig.)

La démocratie et ses institutions : comment les institutions perçoivent et transforment les questions de politiques publiques

Cette thèse porte sur les fondements philosophiques des institutions démocratiques canadiennes et analyse comment leur conception réelle contribue à les atteindre. Pour passer de la théorie à la pratique, la démocratie doit être institutionnalisée. Les institutions ne sont pas que de simples contraintes sur les actions du gouvernement. Elles incarnent des normes démocratiques. Cependant, les théories démocratiques contemporaines sont souvent abstraites et désincarnées. Alors qu’elles étudient les fondements normatifs de la démocratie en général, elles réfléchissent rarement sur les mécanismes permettant d’atteindre l’idéal démocratique. À l’inverse, la science politique tente de tracer l’ensemble du paysage institutionnel entourant l’action de l’État. Mais l’approche de la science politique a une faiblesse majeure : elle n’offre aucune justification épistémologique ou morale des institutions démocratiques. Cette dichotomie entre les principes et les institutions est trompeuse. Les principes de la démocratie libérale sont incarnés par les institutions. En se concentrant sur les fondements philosophiques des institutions démocratiques et libérales, cette thèse fait revivre une longue tradition d’Aristote à John Stuart Mill et réunissant des penseurs comme Montesquieu et James Madison. Actuellement, la recherche universitaire se détourne encore des questions institutionnelles, sous prétexte qu’elles ne seraient pas assez philosophiques. Cependant, le design institutionnel est une question philosophique. Cette thèse propose des améliorations pour que les institutions démocratiques remplissent leur rôle philosophique de manière plus adéquate. Le suicide médicalement assisté est utilisé comme un exemple de l’influence des institutions sur la démocratie.

Friedreich Ataxia

Friedreich ataxia (FRDA) is an autosomal recessive disease characterized by progressive neurological and cardiac abnormalities. It has a prevalence of around 2×10⁵ in whites, accounting for more than one-third of the cases of recessively inherited ataxia in this ethnic group. FRDA may not exist in nonwhite populations.The first symptoms usually appear in childhood, but age of onset may vary from infancy to adulthood. Atrophy of sensory and cerebellar pathways causes ataxia, dysarthria, fixation instability, deep sensory loss, and loss of tendon reflexes. Corticospinal degeneration leads to muscular weakness and extensor plantar responses. A hypertrophic cardiomyopathy may contribute to disability and cause premature death. Other common problems include kyphoscoliosis, pes cavus, and, in 10% of patients, diabetes mellitus.The FRDA gene (FXN) encodes a small mitochondrial protein, frataxin, which is produced in insufficient amounts in the disease, as a consequence of the epigenetic silencing of the gene triggered by a GAA triplet repeat expansion in the first intron of the gene. Frataxin deficiency results in impaired iron-sulfur cluster biogenesis in mitochondria, in turn leading to widespread dysfunction of iron-sulfur center containing enzymes (in particular respiratory complexes I, II and III, and aconitase), impaired iron metabolism, oxidative stress, and mitochondrial dysfunction. Therapy aims to restore frataxin levels or to correct the consequences of its deficiency.