943 resultados para Madison Guaranty Savings
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A acelerao do ritmo de mudana verificado nas sociedades atuais, tem sido impulsionado pela globalizao, fenmeno decorrente da evoluo das tecnologias da informao, das telecomunicaes, das comunicaes e transportes e do desaparecimento de fronteiras. Viver na aldeia global ou escala global como o previu Marshall McLuhan (1964) no livro Understanding Media, hoje uma realidade inquestionvel. As consequncias desta transformao foram mltiplas quer do ponto de vista dos benefcios, quer do ponto de vista dos problemas gerados. No plano da segurana, face ao multiculturalismo envolvido e ao aumento crescente do crime transfronteirio, tornou-se essencial a partilha de informao a nvel internacional tendo em vista o seu combate no s olhando a situao dos cidados como a defesa dos princpios democrticos. Reala-se que os progressos tecnolgicos e as facilidades que criam aos seus utilizadores, neste caso os criminosos, fazem com que as aes por estes praticadas sejam cada vez mais meticulosas, imprevisveis, sofisticadas e complexas o que impe uma resposta correspondente e adequada. Por essa razo, as polticas de segurana existentes mostraram-se insuficientes e esgotadas requerendo novas respostas capazes de produzir os efeitos desejveis para uma efetiva preveno da criminalidade. Pelas dimenses que tem vindo a tomar, a criminalidade tornou-se uma preocupao que ultrapassou o domnio da segurana interna de cada pas para ser encarada a nvel internacional ou mesmo mundial. Para o efeito urge concertar processos e procedimentos securitrios agregando vontades que convirjam e defendam a unificao dos sistemas dos pases a nvel mundial. A verificar-se tal intento, da resultariam significativas melhorias da segurana a todos os nveis (nacional, internacional e mundial). Alm disso tambm resultariam ganhos em termos de tempo, reduo de custos, impacto na qualidade dos servios prestados, na gesto das pessoas e na eficincia das organizaes. Reala-se que a democracia ao promover a dignidade do homem densificando os seus direitos, liberdades e garantias, criou indiretamente condies para que fosse gerada instabilidade e o desenvolvimento de comportamentos criminosos. Importa, portanto, face situao existente e previsvel complexidade do crime no futuro, estudar profundamente a nova realidade neste domnio, para tomar as medidas preventivas tendentes a reporem a estabilidade e a promoverem a paz social. Foi neste contexto que a presente investigao, desenvolvida no mbito acadmico, mas tambm suportado na realidade profissional, pretendeu refletir sobre o estado da segurana global e dar o seu contributo nesta matria.
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RESUMO: Este trabalho teve como objetivo a determinao de esquemas de tratamento alternativos para o carcinoma da prstata com radioterapia externa (EBRT) e braquiterapia de baixa taxa de dose (LDRBT) com implantes permanentes de Iodo-125, biologicamente equivalentes aos convencionalmente usados na prtica clnica, com recurso a modelos tericos e a mtodos de Monte Carlo (MC). Os conceitos de dose biolgica efetiva (BED) e de dose uniforme equivalente (EUD) foram utilizados, com o modelo linear-quadrtico (LQ), para a determinao de regimes de tratamento equivalentes. Numa primeira abordagem, utilizou-se a BED para determinar: 1) esquemas hipofracionados de EBRT mantendo as complicaes retais tardias de regimes convencionais com doses totais de 75,6 Gy, 77,4 Gy, 79,2 Gy e 81,0 Gy; e 2) a relao entre as doses totais de EBRT e LDRBT de modo a manter a BED do regime convencional de 45 Gy de EBRT e 110 Gy de LDRBT. Numa segunda abordagem, recorreu-se ao cdigo de MC MCNPX para a simulao de distribuies de dose de EBRT e LDRBT em dois fantomas de voxel segmentados a partir das imagens de tomografia computorizada de pacientes com carcinoma da prstata. Os resultados das simulaes de EBRT e LDRBT foram somados e determinada uma EUD total de forma a obterem-se: 1) esquemas equivalentes ao tratamento convencional de 25 fraes de 1,8 Gy de EBRT em combinao com 110 Gy de LDRBT; e 2) esquemas equivalentes a EUD na prstata de 67 Gy, 72 Gy, 80 Gy, 90 Gy, 100 Gy e 110 Gy. Em todos os resultados nota-se um ganho teraputico terico na utilizao de esquemas hipofracionados de EBRT. Para uma BED no reto equivalente ao esquema convencional, tem-se um aumento de 2% na BED da prstata com menos 5 fraes. Este incremento d-se de forma cada vez mais visvel medida que se reduz o nmero de fraes, sendo da ordem dos 10-11% com menos 20 fraes e dos 35-45% com menos 40 fraes. Considerando os resultados das simulaes de EBRT, obteve-se uma EUD mdia de 107 Gy para a prstata e de 42 Gy para o reto, com o esquema convencional de 110 Gy de LDRBT, seguidos de 25 fraes de 1,8 Gy de EBRT. Em termos de probabilidade de controlo tumoral (igual EUD), equivalente a este tratamento a administrao de EBRT em 66 fraes de 1,8 Gy, 56 de 2 Gy, 40 de 2,5 Gy, 31 de 3 Gy, 20 de 4 Gy ou 13 de 5 Gy. Relativamente administrao de 66 fraes de 1,8 Gy, a EUD generalizada no reto reduz em 6% com o recurso a fraes de 2,5 Gy e em 10% com fraes de 4 Gy. Determinou-se uma BED total de 162 Gy para a administrao de 25 fraes de 1,8 Gy de EBRT em combinao com 110 Gy de LDRBT. Variando-se a dose total de LDRBT (TDLDRBT) em funo da dose total de EBRT (TDEBRT), de modo a garantir uma BED de 162 Gy, obteve-se a seguinte relao:.......... Os resultados das simulaes mostram que a EUD no reto diminui com o aumento da dose total de LDRBT para dose por frao de EBRT (dEBRT) inferiores a 2, Gy e aumenta para dEBRT a partir dos 3 Gy. Para quantidades de TDLDRBT mais baixas (<50 Gy), o reto beneficia de fraes maiores de EBRT. medida que se aumenta a TDLDRBT, a EUD generalizada no reto torna-se menos dependente da dEBRT. Este trabalho mostra que possvel a utilizao de diferentes regimes de tratamento para o carcinoma da prstata com radioterapia que possibilitem um ganho teraputico, quer seja administrando uma maior dose biolgica com efeitos tardios constantes, quer mantendo a dose no tumor e diminuindo a toxicidade retal. A utilizao com precauo de esquemas hipofracionados de EBRT, para alm do benefcio teraputico, pode trazer vantagens ao nvel da convenincia para o paciente e economia de custos. Os resultados das simulaes deste estudo e converso para doses de efeito biolgico para o tratamento do carcinoma da prstata apresentam linhas de orientao terica de interesse para novos ensaios clnicos. --------------------------------------------------ABSTRACT: The purpose of this work was to determine alternative radiotherapy regimens for the treatment of prostate cancer using external beam radiotherapy (EBRT) and low dose-rate brachytherapy (LDRBT) with Iodine-125 permanent implants which are biologically equivalent to conventional clinical treatments, by the use of theoretical models and Monte Carlo techniques. The concepts of biological effective dose (BED) and equivalent uniform dose (EUD), together with the linear-quadratic model (LQ), were used for determining equivalent treatment regimens. In a first approach, the BED concept was used to determine: 1) hypofractionated schemes of EBRT maintaining late rectal complications as with the conventional regimens with total doses of 75.6 Gy, 77.4 Gy, 79.2 Gy and 81.0 Gy; and 2) the relationship between total doses of EBRT and LDRBT in order to keep the BED of the conventional treatment of 45 Gy of EBRT and 110 Gy of LDRBT. In a second approach, the MC code MCNPX was used for simulating dose distributions of EBRT and LDRBT in two voxel phantoms segmented from the computed tomography of patients with prostate cancer. The results of the simulations of EBRT and LDRBT were added up and given an overall EUD in order to obtain: 1) equivalent to conventional treatment regimens of 25 fraction of 1.8 Gy of EBRT in combination with 110Gy of LDRBT; and 2) equivalent schemes of EUD of 67 Gy, 72 Gy, 80 Gy, 90 Gy, 100 Gy, and 110Gy to the prostate. In all the results it is noted a therapeutic gain using hypofractionated EBRT schemes. For a rectal BED equivalent to the conventional regimen, an increment of 2% in the prostate BED was achieved with less 5 fractions. This increase is visibly higher as the number of fractions decrease, amounting 10-11% with less 20 fractions and 35-45% with less 20 fractions. Considering the results of the EBRT simulations an average EUD of 107 Gy was achieved for the prostate and of 42 Gy for the rectum with the conventional scheme of 110 Gy of LDRBT followed by 25 fractions of 1.8 Gy of EBRT. In terms of tumor control probability (same EUD) it is equivalent to this treatment, for example, delivering the EBRT in 66 fractions of 1.8 Gy, 56 fractions of 2 Gy, 40 fractions of 2.5 Gy, 31 fractions of 3 Gy, 20 fractions of 4 Gy or 13 fractions of 5 Gy. Regarding the use of 66 fractions of 1.8 Gy, the rectum EUD is reduced to 6% with 2.5 Gy per fraction and to 10% with 4 Gy. A total BED of 162 Gy was achieved for the delivery of 25 fractions of 1.8 Gy of EBRT in combination with 110 Gy of LDRBT. By varying the total dose of LDRBT (TDLDRBT) with the total dose of EBRT (TDEBRT) so as to ensure a BED of 162 Gy, the following relationship was obtained: ....... The simulation results show that the rectum EUD decreases with the increase of the TDLDRBT, for EBRT dose per fracion (dEBRT) less than 2.5 Gy and increases for dEBRT above 3 Gy. For lower amounts of TDLDRBT (< 50Gy), the rectum benefits of larger EBRT fractions. As the TDLDRBT increases, the rectum gEUD becomes less dependent on the dEBRT. The use of different regimens which enable a therapeutic gain, whether deivering a higher dose with the same late biological effects or maintaining the dose to the tumor and reducing rectal toxicity is possible. The use with precaution of hypofractionated regimens, in addition to the therapeutic benefit, can bring advantages in terms of convenience for the patient and cost savings. The simulation results of this study together with the biological dose conversion for the treatment of prostate cancer serve as guidelines of interest for new clinical trials.
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Double Degree
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This work project analyses the possibility for a company to trade their goods and services for bitcoins, by joining the Bitcoin network. It analyses the technological and business requirements to join the Bitcoin Network by looking at Bitcoins potential to act as a mean of exchange for trade, unit of account and store of value. The analysis points to the motives, benefits and risks for investors to use the Bitcoin as a traditional currency and recommends on strategies for addressing those risks and maximizing benefits. Other than companies this report, to a lesser extent, will also analyse the Bitcoin from an investors point of view, this is, should an investor buy bitcoins for trade and make savings on a regular and everyday basis? A major finding in this work project is that companies could start using the Bitcoin system as a legit form of payment since the benefits of using this technology outweigh the costs and risks, given the right approach. This form of payment will contribute for the upgrade of a companys business image, attract a new pool of consumers and businesses that already trade in bitcoins and pressure existing financial institutions and electronic payment vendors to upgrade their service levels.
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BACKGROUND: Lipid-lowering therapy is costly but effective at reducing coronary heart disease (CHD) risk. OBJECTIVE: To assess the cost-effectiveness and public health impact of Adult Treatment Panel III (ATP III) guidelines and compare with a range of risk- and age-based alternative strategies. DESIGN: The CHD Policy Model, a Markov-type cost-effectiveness model. DATA SOURCES: National surveys (1999 to 2004), vital statistics (2000), the Framingham Heart Study (1948 to 2000), other published data, and a direct survey of statin costs (2008). TARGET POPULATION: U.S. population age 35 to 85 years. Time Horizon: 2010 to 2040. PERSPECTIVE: Health care system. INTERVENTION: Lowering of low-density lipoprotein cholesterol with HMG-CoA reductase inhibitors (statins). OUTCOME MEASURE: Incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Full adherence to ATP III primary prevention guidelines would require starting (9.7 million) or intensifying (1.4 million) statin therapy for 11.1 million adults and would prevent 20,000 myocardial infarctions and 10,000 CHD deaths per year at an annual net cost of $3.6 billion ($42,000/QALY) if low-intensity statins cost $2.11 per pill. The ATP III guidelines would be preferred over alternative strategies if society is willing to pay $50,000/QALY and statins cost $1.54 to $2.21 per pill. At higher statin costs, ATP III is not cost-effective; at lower costs, more liberal statin-prescribing strategies would be preferred; and at costs less than $0.10 per pill, treating all persons with low-density lipoprotein cholesterol levels greater than 3.4 mmol/L (>130 mg/dL) would yield net cost savings. RESULTS OF SENSITIVITY ANALYSIS: Results are sensitive to the assumptions that LDL cholesterol becomes less important as a risk factor with increasing age and that little disutility results from taking a pill every day. LIMITATION: Randomized trial evidence for statin effectiveness is not available for all subgroups. CONCLUSION: The ATP III guidelines are relatively cost-effective and would have a large public health impact if implemented fully in the United States. Alternate strategies may be preferred, however, depending on the cost of statins and how much society is willing to pay for better health outcomes. FUNDING: Flight Attendants' Medical Research Institute and the Swanson Family Fund. The Framingham Heart Study and Framingham Offspring Study are conducted and supported by the National Heart, Lung, and Blood Institute.
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The trabecular bone score (TBS, Med-Imaps, Pessac, France) is an index of bone microarchitecture texture extracted from anteroposterior dual-energy X-ray absorptiometry images of the spine. Previous studies have documented the ability of TBS of the spine to differentiate between women with and without fractures among age- and areal bone mineral density (aBMD)-matched controls, as well as to predict future fractures. In this cross-sectional analysis of data collected from 3 geographically dispersed facilities in the United States, we investigated age-related changes in the microarchitecture of lumbar vertebrae as assessed by TBS in a cohort of non-Hispanic US white American women. All subjects were 30 yr of age and older and had an L1-L4aBMDZ-score within 2 SD of the population mean. Individuals were excluded if they had fractures, were on any osteoporosis treatment, or had any illness that would be expected to impact bone metabolism. All data were extracted from Prodigy dual-energy X-ray absorptiometry devices (GE-Lunar, Madison, WI). Cross-calibrations between the 3 participating centers were performed for TBS and aBMD. aBMD and TBS were evaluated for spine L1-L4 but also for all other possible vertebral combinations. To validate the cohort, a comparison between the aBMD normative data of our cohort and US non-Hispanic white Lunar data provided by the manufacturer was performed. A database of 619 non-Hispanic US white women, ages 30-90yr, was created. aBMD normative data obtained from this cohort were not statistically different from the non-Hispanic US white Lunar normative data provided by the manufacturer (p=0.30). This outcome thereby indirectly validates our cohort. TBS values at L1-L4 were weakly inversely correlated with body mass index (r=-0.17) and weight (r=-0.16) and not correlated with height. TBS values for all lumbar vertebral combinations decreased significantly with age. There was a linear decrease of 16.0% (-2.47 T-score) in TBS at L1-L4 between 45 and 90yr of age (vs. -2.34 for aBMD). Microarchitectural loss rate increased after age 65 by 50% (-0.004 to -0.006). Similar results were obtained for other combinations of lumbar vertebra. TBS, an index of bone microarchitectural texture, decreases with advancing age in non-Hispanic US white women. Little change in TBS is observed between ages 30 and 45. Thereafter, a progressive decrease is observed with advancing age. The changes we observed in these American women are similar to that previously reported for a French population of white women (r(2) > 0.99). This reference database will facilitate the use of TBS to assess bone microarchitectural deterioration in clinical practice.
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The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.
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Use of bridge deck overlays is important in maximizing bridge service life. Overlays can replace the deteriorated part of the deck, thus extending the bridge life. Even though overlay construction avoids the construction of a whole new bridge deck, construction still takes significant time in re-opening the bridge to traffic. Current processes and practices are time-consuming and multiple opportunities may exist to reduce overall construction time by modifying construction requirements and/or materials utilized. Reducing the construction time could have an effect on reducing the socioeconomic costs associated with bridge deck rehabilitation and the inconvenience caused to travelers. This work included three major tasks with literature review, field investigation, and laboratory testing. Overlay concrete mix used for present construction takes long curing hours and therefore an investigation was carried out to find fast-curing concrete mixes that could reduce construction time. Several fast-cuing concrete mixes were found and suggested for further evaluation. An on-going overlay construction project was observed and documented. Through these observations, several opportunities were suggested where small modifications in the process could lead to significant time savings. With current standards of the removal depth of substrate concrete in Iowa, it takes long hours for the removal process. Four different laboratory tests were performed with different loading conditions to determine the necessary substrate concrete removal depth for a proper bond between the substrate concrete and the new overlay concrete. Several parameters, such as failure load, bond stress, and stiffness, were compared for four different concrete removal depths. Through the results and observations of this investigation several conclusions were made which could reduce bridge deck overlay construction time.
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Biopolttoaineet ovat trke energianlhde suomalaisessa energiantuotannossa. Biopoltto- aineille on kuitenkin ominaista laadun vaihtelevuus. Yksi trkeimmist laatutekijist on kosteus, joka vaikuttaa mys polttoaineen energiasisltn. Laatutekijt puolestaan vai- kuttavat polttoaineksittelyyn, polttoprosessiin ja koko laitoksen hytysuhteeseen. Tmn tyn tarkoituksena oli tutkia voisiko biopolttoaineiden online-laadunmittaus tuoda lisarvoa energiantuotantolaitokselle. Esimerkkin kytettiin yht online-laadunmittaus- sovellusta, InrayFuel-rntgenmittausjrjestelm. Sill voidaan seurata biopolttoaineiden kosteutta ja polttoaineen sisltmi vierasaineita. Tyss on laadittu kustannusanalyysi, jolla pyritn selvittmn, onko nykyisen kertaluontoisen mittausmenetelmn korvaami- nen jatkuvatoimisella kannattavaa. Esimerkkilaitoksena on Etel-Savon Energian Pur- sialan voimalaitos, jossa rntgenmittausjrjestelmn on testattu. Saatujen tulosten mukaan investoiminen esimerkkimittausjrjestelmn maksaisi itsens takaisin alle vuodessa. Kun laitoksella pystytn seuraamaan polttoaineen laatua jatkuva- toimisesti, laadunhallinta paranee ja sit kautta voidaan saavuttaa kustannussstj. Polt- toaineesta johtuvat hiritilanteet vhenevt, polttoaine on mahdollista optimoida edulli- semmaksi polton kannalta ja poltto-olosuhteita voidaan st paremmin, jolloin pstt vhenevt ja hytysuhde kasvaa. Tyss kytetty laskenta analysoi kuitenkin hyvin ylei- sell tasolla, sill kytss ei ollut laitoksen omaa taselaskentajrjestelm. Laskenta siis sislt paljon oletuksia. Tmn ja rohkaisevien tulosten vuoksi tutkimusta jatkuvatoimi- sen laadunmittauksen hydyist kannattaa tehd enemmn.
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The thesis presents a comparison of the national energy policies of the Federal Republic of Germany and Canada from 1973 until the late 1980s. The purpose of this paper is to analyze whether economic and/or environmental concerns were responsible for changes in the West-German and Canadian national energy policies. Furthermore, the feasibility of implementing a soft energy path in West-Germany and Canada is examined. For better comprehension of the policy-making process and implemented changes in the national energy policies of the two states, the West-German and Canadian parliamentary systems and the political cultures were compared. For the analysis, several events with international impact were taken as guidelines. Furthermore, based on statistical data, the West-German and Canadian energy production and consumption were analyzed. With reference to these results the degree of the de facto changes in the national energy policies were analyzed. In addition, the thesis discusses the possibilities which a soft energy path offers to both national governments to renounce themselves from the dependencies on a few energy resources. The thesis reveals that changes in the West-German and Canadian national energy policies, in their energy production and consumption are correlated to various world events. In particular, governmental reponses security of energy supply by the two international oil crises of 1973 and 1979/1980 demonstrate that changes in the West-German and Canadian national energy policies were implemented in reaction to economic concerns than environmental ones. With the policies "away from oil" and "off oil", the West-German and Canadian government implemented the i i substitution of oil through various diverse energy supply resources. However, energy savings concepts and policies were initiated through the first oil crisis in 1973. The world recessions in 1975 and 1982 had no 'profound impacts on the agenda of West-German and Canadian energy policies. As a consequence of the stagnation or the negative growth of the world economic market, changes in their energy production and consumption can be perceived. However, the West-German and Canadian energy production and consumption intensified with the augmentation of the world economy. During the period of study, environmental concerns were taken into account in the energy policy agendas of the Federal Republic of Germany and Canada but they were not of primary concern. wi thin the decade of. the 1980s notably more environmental considerations were taken into account in the energy policies of the two states. The two nuclear reactor accidents in 1979 and 1986 sharpened to various degrees West-German and Canadian public discourse of present energy supply mix and attitude towards energy production and consumption. The statistical data reflects yet no changes in the energy policies in regard to the position of nuclear power. However, in the next several years possible changes can be observed through statistical data, because the planning, the construction and possible phase out of nuclear power requires several years. Finally, the thesis reveals that the implementation of a soft energy path requires profound changes in the consumer behaviour. As several studies indicate, a soft energy path is technological and economically feasible for the Federal Republic of Germany and Canada, its implementation remains to be a political decision.
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Message to the Senate and House of Representatives of the United States / James Madison -- Report : the Committee on Foreign relations, to whom was referred the message of the President of the United States of the 1st of June, 1812 -- An Act, declaring war between the United Kingdom of Great Britain and Ireland and the dependencies thereof, and the United States of America and their territories -- Address of the Senate to the people of the Commonwealth of Massachusetts.
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13th Congress, 3d session. House. Doc. no. 13.
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April 16, 1814. Printed by order of the Senate of the United States.
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13th Congress, 3d session. House. Doc. 6.
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13th Congress, 3d session. House. Doc. no. 8.
