Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi – a systematic review and economic evaluation

Background: Sepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity. Objectives: To determine the clinical effectiveness and cost-effectiveness of three tests [LightCycler SeptiFast Test MGRADE® (Roche Diagnostics, Risch-Rotkreuz, Switzerland); SepsiTest™ (Molzym Molecular Diagnostics, Bremen, Germany); and the IRIDICA BAC BSI assay (Abbott Diagnostics, Lake Forest, IL, USA)] for the rapid identification of bloodstream bacteria and fungi in patients with suspected sepsis compared with standard practice (blood culture with or without matrix-absorbed laser desorption/ionisation time-offlight mass spectrometry). Data sources: Thirteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from January 2006 to May 2015 and supplemented by hand-searching relevant articles. Review methods: A systematic review and meta-analysis of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. A decision tree was used to estimate the costs and quality-adjusted life-years (QALYs) associated with each test; all other parameters were estimated from published sources. The model was populated with evidence from the systematic review or individual studies, if this was considered more appropriate (base case 1). In a secondary analysis, estimates (based on experience and opinion) from seven clinicians regarding the benefits of earlier test results were sought (base case 2). A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Scenario analyses were used to assess uncertainty. Results: For the review of diagnostic test accuracy, 62 studies of varying methodological quality were included. A meta-analysis of 54 studies comparing SeptiFast with blood culture found that SeptiFast had an estimated summary specificity of 0.86 [95% credible interval (CrI) 0.84 to 0.89] and sensitivity of 0.65 (95% CrI 0.60 to 0.71). Four studies comparing SepsiTest with blood culture found that SepsiTest had an estimated summary specificity of 0.86 (95% CrI 0.78 to 0.92) and sensitivity of 0.48 (95% CrI 0.21 to 0.74), and four studies comparing IRIDICA with blood culture found that IRIDICA had an estimated summary specificity of 0.84 (95% CrI 0.71 to 0.92) and sensitivity of 0.81 (95% CrI 0.69 to 0.90). Owing to the deficiencies in study quality for all interventions, diagnostic accuracy data should be treated with caution. No randomised clinical trial evidence was identified that indicated that any of the tests significantly improved key patient outcomes, such as mortality or duration in an intensive care unit or hospital. Base case 1 estimated that none of the three tests provided a benefit to patients compared with standard practice and thus all tests were dominated. In contrast, in base case 2 it was estimated that all cost per QALY-gained values were below £20,000; the IRIDICA BAC BSI assay had the highest estimated incremental net benefit, but results from base case 2 should be treated with caution as these are not evidence based. Limitations: Robust data to accurately assess the clinical effectiveness and cost-effectiveness of the interventions are currently unavailable. Conclusions: The clinical effectiveness and cost-effectiveness of the interventions cannot be reliably determined with the current evidence base. Appropriate studies, which allow information from the tests to be implemented in clinical practice, are required.

Uses of Agent-Based Modeling for Health Communication: the TELL ME Case Study

Government communication is an important management tool during a public health crisis, but understanding its impact is difficult. Strategies may be adjusted in reaction to developments on the ground and it is challenging to evaluate the impact of communication separately from other crisis management activities. Agent-based modeling is a well-established research tool in social science to respond to similar challenges. However, there have been few such models in public health. We use the example of the TELL ME agent-based model to consider ways in which a non-predictive policy model can assist policy makers. This model concerns individuals' protective behaviors in response to an epidemic, and the communication that influences such behavior. Drawing on findings from stakeholder workshops and the results of the model itself, we suggest such a model can be useful: (i) as a teaching tool, (ii) to test theory, and (iii) to inform data collection. We also plot a path for development of similar models that could assist with communication planning for epidemics.

Perceived Work-related Factors and Turnover Intention : A Case Study of a South Korean Construction Company

Purpose – Employee turnover entails considerable costs and is a major problem for the construction industry. By creating an extensive framework, this study aims to examine whether perceived work-related factors affect turnover intention in South Korean construction companies. Research design – The paper is based on the results of a questionnaire of 136 employees that was conducted and provided by a Korean construction company. Research hypotheses were tested via correlation analyses. The most influencing work-related factors, as well as differences among job levels, were determined by multiple regression analyses. Findings – Communication, immediate leaders, organizational commitment, and organizational pride substantially affect turnover intentions. All of these factors can be considered as relational factors. The most influencing factors differ among job levels. Discussion/practical implications – Immediate leaders should be aware of their role in retaining employees and enhance communication, organizational commitment and pride. This study shows how the importance of certain variables differs for groups of employees. Theoretical implications/limitations– This study is based on a sample of employees from a Korean construction company. Therefore, the generalizability of the findings has to be tested. Future research should test the proposed framework with other factors or resources. Originality/value – This study shed light on the turnover subject in the South Korean construction industry. It shows that different factors can influence turnover intention among job levels. A framework was created, which is based on 16 work-related factors including organizational factors, HRM practices and job attitudes.

Perceived Work-related Factors and Turnover Intention : - A Case Study of a South Korean Construction Company

Purpose – Employee turnover entails considerable costs and is a major problem for the construction industry. By creating an extensive framework, this study aims to examine whether perceived work-related factors affect turnover intention in South Korean construction companies. Research design – The paper is based on the results of a questionnaire of 136 employees that was conducted and provided by a Korean construction company. Research hypotheses were tested via correlation analyses. The most influencing work-related factors, as well as differences among job levels, were determined by multiple regression analyses. Findings – Communication, immediate leaders, organizational commitment, and organizational pride substantially affect turnover intentions. All of these factors can be considered as relational factors. The most influencing factors differ among job levels. Discussion/practical implications – Immediate leaders should be aware of their role in retaining employees and enhance communication, organizational commitment and pride. This study shows how the importance of certain variables differs for groups of employees. Theoretical implications/limitations– This study is based on a sample of employees from a Korean construction company. Therefore, the generalizability of the findings has to be tested. Future research should test the proposed framework with other factors or resources. Originality/value – This study shed light on the turnover subject in the South Korean construction industry. It shows that different factors can influence turnover intention among job levels. A framework was created, which is based on 16 work-related factors including organizational factors, HRM practices and job attitudes.

European life project: a global strategy for the responsible use of a coastal lagoon: a case study from Portugal

Rin de Aveiro is a coastal lagoon located at the Central Region of Portugal subjected to the influence of the tides, resulting in a set of characteristic biotopes favouring anthropic and natural processes. Once managed and controlled correctly, each of these biotopes will allow simultaneously the biodiversity and integration in the making of the wetland landscape. In 1998, one of the final conclusions of the "MARIA" Demonstration Programme for the Integrated Management of Ria de Aveiro was that the poor current state of the environment area resulted from a set of interrelated factors. The Programme selected four (4) pilot-projects towards the integrated management of the lagoon biotopes as possible scenarios for an intervention. This selection was based in criteria related to environmental priorities and the maintenance of traditional economic activities in the region. The idea of choosing projects that would involve the whole geographic space of the Ria, without forgetting the other important themes interrelated with the Management Structure, emerged as a relevant aspect for their definition. Thus, and as a first test of this Management Structure functionality, the following task forces were put forward: Recovery and valorisation of the piers; Recovery of the former salt pans; Management of the agricultural fields of Baixo-Vouga; Implementation of measures for the classification of the Protected Landscape Area of the River Caster Mouth. This payer will report the main results of these pilot-projects attained during their first year period, especially the intervention strategies defined by the Partnership created for this aim.

Convex Optimization Algorithms and Statistical Bounds for Learning Structured Models

Thesis (Ph.D.)--University of Washington, 2016-08

Optimization of wastepaper sludge ash (WSA) in robust cementitious systems

Abstract : Wastepaper sludge ash (WSA) is generated by a cogeneration station by burning wastepaper sludge. It mainly consists of amorphous aluminosilicate phase, anhydrite, gehlenite, calcite, lime, C2S, C3A, quartz, anorthite, traces of mayenite. Because of its free lime content (~10%), WSA suspension has a high pH (13). Previous researchers have found that the WSA composition has poor robustness and the variations lead to some unsoundness for Portland cement (PC) blended WSA concrete. This thesis focused on the use of WSA in different types of concrete mixes to avoid the deleterious effect of the expansion due to the WSA hydration. As a result, WSA were used in making alkali-activated materials (AAMs) as a precursor source and as a potential activator in consideration of its amorphous content and the high alkaline nature. Moreover, the autogenous shrinkage behavior of PC concrete at low w/b ratio was used in order to compensate the expansion effect due to WSA. The concrete properties as well as the volume change were investigated for the modified WSA blended concrete. The reaction mechanism and microstructure of newly formed binder were evaluated by X-ray diffraction (XRD), calorimetry, thermogravimetric analysis (TGA), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). When WSA was used as precursor, the results showed incompatible reaction between WSA and alkaline solution. The mixtures were not workable and provided very low compressive strength no matter what kinds of chemical activators were used. This was due to the metallic aluminum in WSA, which releases abundant hydrogen gas when WSA reacts with strong alkaline solution. Besides, the results of this thesis showed that WSA can activate the glassy phase contained in slag, glass powder (GP) and class F fly ash (FFA) with an optimum blended ratio of 50:50. The WSA/slag (mass ratio of 50:50) mortar (w/b of 0.47) attained 46 MPa at 28 days without heat curing assistance. A significant fast setting was noticed for the WSA-activated binder due to the C3A phase, free lime and metallic aluminum contained in the WSA. Adding 5% of gypsum can delay the fast setting, but this greatly increased the potential risk of intern sulfate attack. The XRD, TGA and calorimetry analyses demonstrated the formation of ettringite, C-S-H, portlandite, hydrogarnet and calcium carboaluminate in the hydrated binder. The mechanical performance of different binder was closely related to the microstructure of corresponding binder which was proved by the SEM observation. The hydrated WSA/slag and WSA/FFA binder formed a C-A-S-H type of gel with lower Ca/Si ratio (0.47~1.6). A hybrid gel (i.e. C-N-A-S-H) was observed for the WSA/GP binder with a very low Ca/Si ratio (0.26) and Na/Si ratio (0.03). The SEM/EDX analyses displayed the formation of expansive gel (ettringite and thaumasite) in the gypsum added WSA/slag concrete. The gradual emission of hydrogen gas due to the reaction of WSA with alkaline environment significantly increased the porosity and degraded the microstructure of hydrated matrix after the setting. In the last phase of this research WSA-PC blended binder was tailored to form a high autogenous shrinkage concrete in order to compensate the initial expansion. Different binders were proportioned with PC, WSA, silica fume or slag. The microstructure and mechanical properties of concrete can be improved by decreasing w/b ratios and by incorporating silica fume or slag. The 28-day compressive strength of WSA-blended concrete was above 22 MPa and reached 45 MPa when silica fume was added. The PC concrete incorporating silica fume or slag tended to develop higher autogenous shrinkage at low w/b ratios, and thus the ternary binder with the addition of WSA inhibited the long term shrinkage due to the initial expansion property to WSA. In the restrained shrinkage test, the concrete ring incorporating the ternary binder (PC/WSA/slag) revealed negligible potential to cracking up to 96 days as a result of the offset effect by WSA expansion. The WSA blended regular concrete could be produced for potential applications with reduced expansion, good mechanical property and lower permeability.

Discrete-event Simulation and Optimization to Improve the Performance of a Healthcare System

Thesis (Ph.D.)--University of Washington, 2016-08

Application of meta-analytical probabilistic approach for reliability benefits reflective optimal transmission costing – the case of India

In the deregulated Power markets it is necessary to have a appropriate Transmission Pricing methodology that also takes into account “Congestion and Reliability”, in order to ensure an economically viable, equitable, and congestion free power transfer capability, with high reliability and security. This thesis presents results of research conducted on the development of a Decision Making Framework (DMF) of concepts and data analytic and modelling methods for the Reliability benefits Reflective Optimal “cost evaluation for the calculation of Transmission Cost” for composite power systems, using probabilistic methods. The methodology within the DMF devised and reported in this thesis, utilises a full AC Newton-Raphson load flow and a Monte-Carlo approach to determine, Reliability Indices which are then used for the proposed Meta-Analytical Probabilistic Approach (MAPA) for the evaluation and calculation of the Reliability benefit Reflective Optimal Transmission Cost (ROTC), of a transmission system. This DMF includes methods for transmission line embedded cost allocation among transmission transactions, accounting for line capacity-use as well as congestion costing that can be used for pricing using application of Power Transfer Distribution Factor (PTDF) as well as Bialek’s method to determine a methodology which consists of a series of methods and procedures as explained in detail in the thesis for the proposed MAPA for ROTC. The MAPA utilises the Bus Data, Generator Data, Line Data, Reliability Data and Customer Damage Function (CDF) Data for the evaluation of Congestion, Transmission and Reliability costing studies using proposed application of PTDF and other established/proven methods which are then compared, analysed and selected according to the area/state requirements and then integrated to develop ROTC. Case studies involving standard 7-Bus, IEEE 30-Bus and 146-Bus Indian utility test systems are conducted and reported throughout in the relevant sections of the dissertation. There are close correlation between results obtained through proposed application of PTDF method with the Bialek’s and different MW-Mile methods. The novel contributions of this research work are: firstly the application of PTDF method developed for determination of Transmission and Congestion costing, which are further compared with other proved methods. The viability of developed method is explained in the methodology, discussion and conclusion chapters. Secondly the development of comprehensive DMF which helps the decision makers to analyse and decide the selection of a costing approaches according to their requirements. As in the DMF all the costing approaches have been integrated to achieve ROTC. Thirdly the composite methodology for calculating ROTC has been formed into suits of algorithms and MATLAB programs for each part of the DMF, which are further described in the methodology section. Finally the dissertation concludes with suggestions for Future work.

Effects of IFRS adoption on the financial statements of Nigerian listed entities: the case of oil and gas companies

On 28 July 2010, the Nigerian Federal Executive Council approved January 1, 2012 as the effective date for the convergence of Nigerian Statement of Accounting Standards (SAS) or Nigerian GAAP (NG-GAAP) with International Financial Reporting Standards (IFRS). By this pronouncement, all publicly listed companies and significant public interest entities in Nigeria were statutorily required to issue IFRS based financial statements for the year ended December, 2012. This study investigates the impact of the adoption of IFRS on the financial statements of Nigerian listed Oil and Gas entities using six years of data which covers three years before and three years after IFRS adoption in Nigeria and other African countries. First, the study evaluates the impact of IFRS adoption on the Exploration and Evaluation (E&E) expenditures of listed Oil and Gas companies. Second, it examines the impact of IFRS adoption on the provision for decommissioning of Oil and Gas installations and environmental rehabilitation expenditures. Third, the study analyses the impact of the adoption of IFRS on the average daily Crude Oil production cost per Barrel. Fourth, it examines the extent to which the adoption and implementation of IFRS affects the Key Performance Indicators (KPIs) of listed Oil and Gas companies. The study further explores the impact of IFRS adoption on the contractual relationships between Nigerian Government and Oil and Gas companies in terms of Joint Ventures (JVs) and Production Sharing Contracts (PSCs) as it relates to taxes, royalties, bonuses and Profit Oil Split. A Paired Samples t-test, Wilcoxon Signed Rank test and Gray’s (Gray, 1980) Index of Conservatism analyses were conducted simultaneously where the accounting numbers, financial ratios and industry specific performance measures of GAAP and IFRS were computed and analysed and the significance of the differences of the mean, median and Conservatism Index values were compared before and after IFRS adoption. Questionnaires were then administered to the key stakeholders in the adoption and implementation of IFRS and the responses collated and analysed. The results of the analyses reveal that most of the accounting numbers, financial ratios and industry specific performance measures examined changed significantly as a result of the transition from GAAP to IFRS. The E&E expenditures and the mean cost of Crude Oil production per barrel of Oil and Gas companies increased significantly. The GAAP values of inventories, GPM, ROA, Equity and TA were also significantly different from the IFRS values. However, the differences in the provision for decommissioning expenditures were not statistically significant. Gray’s (Gray, 1980) Conservatism Index shows that Oil and Gas companies were more conservative under GAAP when compared to the IFRS regime. The Questionnaire analyses reveal that IFRS based financial statements are of higher quality, easier to prepare and present to management and easier to compare among competitors across the Oil and Gas sector but slightly more difficult to audit compared to GAAP based financial statements. To my knowledge, this is the first empirical research to investigate the impact of IFRS adoption on the financial statements of listed Oil and Gas companies. The study will therefore make an enormous contribution to academic literature and body of knowledge and void the existing knowledge gap regarding the impact and implications of IFRS adoption on the financial statements of Oil and Gas companies.

Ulnar artery aneurysm: case report and review of the literature

Aim. We report a case of ulnar and palmar arch artery aneurysm in a 77 years old man without history of any occupational or recreational trauma, vasculitis, infections or congenital anatomic abnormalities. We also performed a computed search of literature in PUBMED using the keywords “ulnar artery aneurysm” and “palmar arch aneurysm”. Case report. A 77 years old male patient was admitted to hospital with a pulsing mass at distal right ulnar artery and deep palmar arch; at ultrasound and CT examination a saccular aneurysm of 35 millimeters at right ulnar artery and a 15 millimeters dilatation at deep palmar arch were detected. He was asymptomatic for distal embolization and pain. In local anesthesia ulnar artery and deep palmar arch dilatations were resected. Reconstruction of vessels was performed through an end-to-end microvascular repair. Histological examination confirmed the absence of vasculitis and collagenopaties. In postoperative period there were no clinical signs of peripheral ischemia, Allen’s test and ultrasound examination were normal. At follow-up of six months, the patient was still asymptomatic with a normal Allen test, no signs of distal digital ischemia and patency of treated vessel with normal flow at duplex ultrasound. Conclusion. True spontaneous aneurysms of ulnar artery and palmar arch are rare and can be successfully treated with resection and microvascular reconstruction.

Price transmission dynamics between ADRs and their underlying foreign security: The case of Banco de Colombia S.A.- Bancolombia.

This paper analyzes the dynamics ofthe American Depositary Receipt (ADR) of a Colombian bank (Bancolombia) in relation to its pricing factors (underlying (preferred) shares price, exchange rate and the US market index). The aim is to test if there is a long-term relation among these variables that would imply predictability. One cointegrating relation is found allowing the use of a vector error correction model to examine the transmission of shocks to the underlying prices, the exchange rate, and the US market index. The main finding of this paper is that in the short run, the underlying share price seems to adjust after changes in the ADR price, pointing to the fact that the NYSE (trading market for the ADR) leads the Colombian market. However, in the long run, both, the underlying share price and the ADR price, adjust to changes in one another.

Coupled CFD Shape Optimization for aerodynamic profiles

The present document deals with the optimization of shape of aerodynamic profiles -- The objective is to reduce the drag coefficient on a given profile without penalising the lift coefficient -- A set of control points defining the geometry are passed and parameterized as a B-Spline curve -- These points are modified automatically by means of CFD analysis -- A given shape is defined by an user and a valid volumetric CFD domain is constructed from this planar data and a set of user-defined parameters -- The construction process involves the usage of 2D and 3D meshing algorithms that were coupled into own- code -- The volume of air surrounding the airfoil and mesh quality are also parametrically defined -- Some standard NACA profiles were used by obtaining first its control points in order to test the algorithm -- Navier-Stokes equations were solved for turbulent, steady-state ow of compressible uids using the k-epsilon model and SIMPLE algorithm -- In order to obtain data for the optimization process an utility to extract drag and lift data from the CFD simulation was added -- After a simulation is run drag and lift data are passed to the optimization process -- A gradient-based method using the steepest descent was implemented in order to define the magnitude and direction of the displacement of each control point -- The control points and other parameters defined as the design variables are iteratively modified in order to achieve an optimum -- Preliminary results on conceptual examples show a decrease in drag and a change in geometry that obeys to aerodynamic behavior principles

Efficient algorithms to solve scheduling problems with a variety of optimization criteria

La programmation par contraintes est une technique puissante pour résoudre, entre autres, des problèmes d’ordonnancement de grande envergure. L’ordonnancement vise à allouer dans le temps des tâches à des ressources. Lors de son exécution, une tâche consomme une ressource à un taux constant. Généralement, on cherche à optimiser une fonction objectif telle la durée totale d’un ordonnancement. Résoudre un problème d’ordonnancement signifie trouver quand chaque tâche doit débuter et quelle ressource doit l’exécuter. La plupart des problèmes d’ordonnancement sont NP-Difficiles. Conséquemment, il n’existe aucun algorithme connu capable de les résoudre en temps polynomial. Cependant, il existe des spécialisations aux problèmes d’ordonnancement qui ne sont pas NP-Complet. Ces problèmes peuvent être résolus en temps polynomial en utilisant des algorithmes qui leur sont propres. Notre objectif est d’explorer ces algorithmes d’ordonnancement dans plusieurs contextes variés. Les techniques de filtrage ont beaucoup évolué dans les dernières années en ordonnancement basé sur les contraintes. La proéminence des algorithmes de filtrage repose sur leur habilité à réduire l’arbre de recherche en excluant les valeurs des domaines qui ne participent pas à des solutions au problème. Nous proposons des améliorations et présentons des algorithmes de filtrage plus efficaces pour résoudre des problèmes classiques d’ordonnancement. De plus, nous présentons des adaptations de techniques de filtrage pour le cas où les tâches peuvent être retardées. Nous considérons aussi différentes propriétés de problèmes industriels et résolvons plus efficacement des problèmes où le critère d’optimisation n’est pas nécessairement le moment où la dernière tâche se termine. Par exemple, nous présentons des algorithmes à temps polynomial pour le cas où la quantité de ressources fluctue dans le temps, ou quand le coût d’exécuter une tâche au temps t dépend de t.

THE ROLE OF DYNAMIC CAPABILITIES IN THE INTERNATIONALIZATION OF MEDIUM SIZED FINNISH MANUFACTURING FIRMS - A case for Sormat Oy

A rapidly changing business environment has necessitated most small and medium sized enterprises with international ambitions to reconsider their sources of competitive advantage. To survive in the face of a changing business environment, firms should utilize their dynamic organizational capabilities as well as their internationalization capabilities. Firms develop a competitive advantage if they can exploit their unique organizational competences in a new or foreign market and also if they can acquire new capabilities as a result of engaging in foreign markets. The acquired capabilities from foreign locations enhance the existing capability portfolio of a firm with a desire to internationalize. The study combined the research streams of SME organizational dynamic capability and internationalization capability to build a complete picture on the existing knowledge. An intensive case study was used for empirically testing the theoretical framework of the study and compared with the literature on various organizational capability factors and internationalization capabilities. Sormay Oy was selected because it is a successful medium sized company operating in Finland in the manufacturing industry which has a high international profile. In addition, it has sufficient rate of growth in sales that warrants it to engage internationally in matters such as, acquisitions, joint ventures and partnerships. The key findings of the study suggests that, medium sized manufacturing firms have a set of core competences arising from their organizational capabilities which were identified to be employee know how and relationship with stakeholders which aid the firm in its quest for attaining competitive advantage, ensuring production flexibility and gaining benefits present in a network. In addition, internationalization capabilities were identified under both the RAT test and CAT test whereby the primary findings suggests that, firms that outperform their competitors produce products that meet specific customer and country requirements, foresee the pitfalls of imitation brought about by the foreign local companies and members of a particular network through joint ventures, acquisitions or partnerships as well as those firms that are capable to acquire new capabilities in the foreign markets and successfully use these acquired capabilities to enhance or renew their capability portfolio for their competitive advantage. Additional significant findings under internationalization capabilities were discovered whereby, Sormay Oy was able to develop a new market space for its products despite the difficult institutional environment present in Russia.