The economic cost of hospital malnutrition in Europe; a narrative review

Background: Malnutrition among hospitalized patients increases length of stay (LOS) and carries extra hospitalization costs. Objective: To review the impact of malnutrition on hospital LOS and costs in Europe. Methods: PubMed and Google Scholar search. All articles from January 2004 until November 2014 were identified. Reference lists of relevant articles were also manually searched. Results: Ten studies on LOS and nine studies on costs were reviewed. The methods used to assess malnutrition and to calculate costs differed considerably between studies. Malnutrition led to an increased LOS ranging from 2.4 to 7.2 days. Among hospitalized patients, malnutrition led to an additional individual cost ranging between 1640 V and 5829 V. At the national level, the costs of malnutrition ranged between 32.8 million V and 1.2 billion V. Expressed as percentage of national health expenditures, the values ranged between 2.1% and 10%. Conclusions: In Europe, malnutrition leads to an increase in LOS and in hospital costs, both at the individual and the national level. Standardization of methods and results reported is needed to adequately compare results between countries. © 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Proyecto de una Torre Grúa. Normas de seguridad y salud laboral

This project is a tool for engineers and technicians in the development and knowledge of the most important construction equipment, tower crane. It consists of a memory, 10 annexes and an Excel spreadsheet to do the calculations automatically . Some of these annexes are: Annex 1. Types of cranes and elements of them. Annex 2. Mounting and dismounting. Annex 3. Useful clamping loads. Annex 4. Safety systems , etc. Every single annex separately, provides detailed explanations , both written and visual of problems and solutions in the world of tower cranes . Professionals are able to learn in an orderly way, definitions, developments, calculations, processes etc., Which will greatly easy people's job in the construction and in the writing of a project. Also a spreadsheet with the Excel program has been made to help engineers on calculations. This sheet is protected and it can be accesed only to enter the data needed to perform the calculations of the safety factor and weight of shoes . The results will tell us if there is a risk of tipping of the tower crane and the weight of shoes. This tool will greatly help engineers on their calculations. All documentation is based on laws, regulations and no legal rules status, they guarantee that we are always within the Spanish and legislative Autonomous framework. This fact makes the professional carries out a project to a successful future and a legalistic view. Also note that these rules are in constant change, which makes it necessary for the professional to always be in a constant revision of the legislation.

Duration of anticoagulation after venous thromboembolism in real world clinical practice.

INTRODUCTION: Venous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants should be administered for a minimum of three months. Since little is known about real life management of VTE, we aimed to describe current practice in the secondary prevention of VTE. MATERIALS AND METHODS: Using the database of an international, prospective registry on patients treated for VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant treatment, and clinical outcomes during follow up. Multivariate analysis using logistic regression was performed to identify predictors of treatment duration. RESULTS: Of 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient risk factors, 27.1% had cancer. After the exclusion of patients who died during the first year of observation, the rate of patients treated for >12 months was 55.1%, 41.9%, and 43.2%, respectively (p<0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic heart failure and age >65 years were independently associated with treatment for >12 months. Body weight <75 kg, anemia, cancer, and the presence of transient risk factors were associated with treatment for 12 months or less. Major bleeding occurred more frequently than recurrent VTE in patients with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent than fatal recurrent PE in all subgroups. CONCLUSIONS: We observed heterogeneous duration of anticoagulant treatment for the secondary prevention of VTE. A substantial proportion of patients, in particular those with VTE secondary to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.

Anàlisi del bloc de fonaments individuals per demarcació (fid) corresponent a la defensa de l'espai per la posició dels laterals en el futbol: comparació entre categories amateur i semi-professional

L’objectiu d’aquest estudi va ser analitzar un element del component tàctic com a factor determinant en el rendiment del futbol, és a dir, comprovar si hi ha diferències en l’execució del bloc de Fonaments Individuals per Demarcació (FID) corresponent a la defensa de l’espai per la posició dels laterals en el futbol, entre les categories amateur i semi-professional. Es van enregistrar un total de 18 partits, on 9 dels quals feien referència a l’equip de l’Arbúcies Club de Futbol i la resta a l’equip de la Unió Esportiva Llagostera. Les variables estudiades van ser les següents: cobertures al central que defensa al possessor de la pilota, evitar passades interiors que guanyin l’esquena, defensa individual dels jugadors que intenten passar per l’esquena del segon central (entrar-sortir) i eliminar l’espai de desmarcada en profunditat, mantenint la línia amb el central. Per analitzar-les es va utilitzar el programa Longomatch i el Excel on hi vam configurar un instrument d’avaluació. Els principals resultats del treball van ser que l’equip de la Unió Esportiva Llagostera va fer menys errors en l’execució dels FID, tot i que va seguir tenint errors en el compliment d’aquests fonaments.

Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis.

BACKGROUND: Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. METHODS: MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. FINDINGS: We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). INTERPRETATION: AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption.

People favour imperfect catching by assuming a stable world

The visual angle that is projected by an object (e.g. a ball) on the retina depends on the object's size and distance. Without further information, however, the visual angle is ambiguous with respect to size and distance, because equal visual angles can be obtained from a big ball at a longer distance and a smaller one at a correspondingly shorter distance. Failure to recover the true 3D structure of the object (e.g. a ball's physical size) causing the ambiguous retinal image can lead to a timing error when catching the ball. Two opposing views are currently prevailing on how people resolve this ambiguity when estimating time to contact. One explanation challenges any inference about what causes the retinal image (i.e. the necessity to recover this 3D structure), and instead favors a direct analysis of optic flow. In contrast, the second view suggests that action timing could be rather based on obtaining an estimate of the 3D structure of the scene. With the latter, systematic errors will be predicted if our inference of the 3D structure fails to reveal the underlying cause of the retinal image. Here we show that hand closure in catching virtual balls is triggered by visual angle, using an assumption of a constant ball size. As a consequence of this assumption, hand closure starts when the ball is at similar distance across trials. From that distance on, the remaining arrival time, therefore, depends on ball's speed. In order to time the catch successfully, closing time was coupled with ball's speed during the motor phase. This strategy led to an increased precision in catching but at the cost of committing systematic errors.

Apical access and closure devices for transapical transcatheter heart valve procedures.

The majority of transcatheter aortic valve implantations, structural heart procedures and the newly developed transcatheter mitral valve repair and replacement are traditionally performed either through a transfemoral or a transapical access site, depending on the presence of severe peripheral vascular disease or anatomic limitations. The transapical approach, which carries specific advantages related to its antegrade nature and the short distance between the introduction site and the cardiac target, is traditionally performed through a left anterolateral mini-thoracotomy and requires rib retractors, soft tissue retractors and reinforced apical sutures to secure, at first, the left ventricular apex for the introduction of the stent-valve delivery systems and then to seal the access site at the end of the procedure. However, despite the advent of low-profile apical sheaths and newly designed delivery systems, the apical approach represents a challenge for the surgeon, as it has the risk of apical tear, life-threatening apical bleeding, myocardial damage, coronary damage and infections. Last but not least, the use of large-calibre stent-valve delivery systems and devices through standard mini-thoracotomies compromises any attempt to perform transapical transcatheter structural heart procedures entirely percutaneously, as happens with the transfemoral access site, or via a thoracoscopic or a miniaturised video-assisted percutaneous technique. During the past few years, prototypes of apical access and closure devices for transapical heart valve procedures have been developed and tested to make this standardised successful procedure easier. Some of them represent an important step towards the development of truly percutaneous transcatheter transapical heart valve procedures in the clinical setting.

Emotion and Linguistic Diversity

In this paper we shall try to explain why speakers experience their languages so passionately. One explanation is based on the role language plays in the construction of the community and in the fact that it is a clear mark of belonging. Furthermore, we support another reason. Speakers experience their language as something received from their ancestors and that they are obliged to transmit to their descendents, an imperative which carries an extraordinary emotional charge. In fact, fear of the death of a language is experienced as an act of irreparable non-fulfilment. Why? We believe that language is one of the most evident signs of community, much more than the sum of the individuals of which it is composed. Indeed, it is a long-lasting entity projected into both the past and the future and which, moreover, accumulates within the language the whole of the culture. In the survival of the community and the language we find a response, even though it may be illusory, to the need for transcendence: our ancestors live on in our language and we, if we meet our obligations, live on in the language of our descendents

Ten years of R&D and full automation in molecular diagnosis.

A 10-year experience of our automated molecular diagnostic platform that carries out 91 different real-time PCR is described. Progresses and future perspectives in molecular diagnostic microbiology are reviewed: why automation is important; how our platform was implemented; how homemade PCRs were developed; the advantages/disadvantages of homemade PCRs, including the critical aspects of troubleshooting and the need to further reduce the turnaround time for specific samples, at least for defined clinical settings such as emergencies. The future of molecular diagnosis depends on automation, and in a novel perspective, it is time now to fully acknowledge the true contribution of molecular diagnostic and to reconsider the indication for PCR, by also using these tests as first-line assays.

Online and Offline Participation at the Local Level : A Quantitative Analysis of the Catalan Municipalities

This paper presents a first analysis on local electronic participatory experiences in Catalonia. The analysis is based on a database constructed and collected by the authors. The paper carries out an explanatory analysis of local initiatives in eparticipationand off line participation taking into account political variables (usually not considered in this kind of analysis) but also classical socio-economic variables that characterise municipalities. Hence, we add a quantitative analysis to the numerous case studies on local e-participation experiences. We have chosen Catalonia because is one of the European regions with more initiatives and one that has enjoyed considerable local governmental support to citizen participation initiatives since the 80s. The paper offers a characterisation of these experiences and a first explanatory analysis, considering: i) the institutional context in which these experiences are embedded, ii) the characteristics of the citizen participation processes and mechanisms on-line, and iii) a set of explanatory variables composed by the population size, thepolitical adscription of the mayor, the electoral abstention rate, age, income and level ofeducation in the municipality. The model that we present is explanatory for the municipalities with more than 20,000 inhabitants but it is not for the fewer than 20,000inhabitants. Actually, the number of participatory activities developed by these last municipalities is very low. Among all the variables, population size becomes the mostinfluential variable. Political variables such as political party of the mayor and the localabstention rate have a certain influence but that have to be controlled by population size.

Online and Offline Participation at the Local level: A Quantitative Analysis of the Catalan Municipalities

This article presents an analysis on local participatory experiences in Catalonia,both online and in-person. The analysis is based on a database set up by theauthors. The article carries out an explanatory analysis of local participatoryinitiatives (on- and offline) taking into account political variables (not usually con-sidered in this kind of analysis) and also classical socio-economic variables thatcharacterize municipalities. Hence, we add a quantitative analysis to the numerouscase studies on local e-participation experiences. We have chosen Catalonia becauseit is one of the European regions with more initiatives and a considerable localgovernment support for citizen participation initiatives since the 1980s. Thearticle offers a characterization of these experiences and an explanatory analysis,considering: (i) the institutional context in which these experiences are embedded,(ii) the citizen participation processes and mechanisms online and (iii) a set ofexplanatory variables composed of the population size and the province to whichthe municipality belongs, the political tendency of the mayor, the electoral absten-tion rate, age, income, level of education, broadband connection and users of theInternet in the municipality. The model that we present is explanatory for munici-palities with more than 20,000 inhabitants but it is not for fewer than 20,000inhabitants. Actually, the majority of these latter municipalities have not developedany participatory activities. Among all the variables, population size is the mostinfluential variable and affects the influence of other variables, such as the politicalparty of the mayor, the local abstention rate and the province.

Troca iônica no estado sólido de európio3+ em zeólita Y: influência do tempo de reação

Rare earth elements supported in zeolites are the most important catalysts in the fluid cracking of petroleum. The solid state ion exchange of Eu3+ in Y zeolite was investigated. First of all, the hydrated EuCl3 was well mixed in a ball mill and was then heated at 300ºC for different times. The quantitative determination of Eu3+ showed that the degree of ion exchange depends on the reaction time at constant temperature, being ~95% in 4 h. The X-ray study showed that the crystallinity of the zeolite is little affected by the exchange procedure. The study of spectroscopic properties of Eu3+, emission spectra and lifetime, give information about the migration and position of the ion in the zeolite cages.

Palvelukonsernin Iiiketoimintayksikön suorituskyvyn mittaaminen

Kiristyvät markkinat ajavat yritykset tehostamaan toimintaansa. Suorituskyvyn mittaaminen on jo olennainen osa suomalaista yrityskulttuuria. Mittaamisen päätehtävä on tuottaa yritysjohdolle relevanttia informaatiota yrityksen tilasta ja auttaa valvomaan ja kehittämään toimintaa. Tämän tutkimuksen kohteena on palvelukonsernin Iiiketoimintayksikön suorituskyvyn mittaaminen. Tutkimuksen päätavoitteina on 1. valita palvelukonsernin liiketoimintayksikölle sopiva suorituskyvyn mittausjärjestelmä, 2. valita käytännöllinen implementointimalli sekä 3. laatia suorituskykymittaristo palvelukonsernin liiketoimintayksikölle. Tämä tutkimus jakautuu kahteen vaiheeseen. Ensimmäisessä vaiheessa tutkimuksen kohteena on suorituskyvyn teoria ja neljä erilaista mittausmenetelmää, joista valitaan yksi Iiiketoimintayksikön suorituskyvyn mittausjärjestelmäksi sekä syvempää tarkastelua varten. Tutkimuksen toisessa vaiheessa tutkitaan valitun mittausjärjestelmän ominaisuuksia strategisena johtamisjärjestelmänä sekä sen implementointimalleja. Toisen vaiheen keskeisin tutkimusosuus on suorituskykymittausjärjestelmän laadinta. Työn lopputuloksena syntyy palvelukonsernin Iiiketoimintayksikön suorituskyvyn mittausjärjestelmä sekä jatkotoimenpide-ehdotus Balanced Scorecardin laajentamiseksi Iiiketoimialan ohjausjärjestelmäksi.

Characterization of Mechanically Alloyed Nanocrystalline Fe(Al): Crystallite Size and Dislocation Density

A nanostructured disordered Fe(Al) solid solution was obtained from elemental powders of Fe and Al using a high-energy ball mill. The transformations occurring in the material during milling were studied with the use of X-ray diffraction. In addition lattice microstrain, average crystallite size, dislocation density, and the lattice parameter were determined. Scanning electron microscopy (SEM) was employed to examine the morphology of the samples as a function of milling times. Thermal behaviour of the milled powders was examined by differential scanning calorimetry (DSC). The results, as well as dissimilarity between calorimetric curves of the powders after 2 and 20 h of milling, indicated the formation of a nanostructured Fe(Al) solid solution

Kattilalaitosten järjestelmällinen suunnittelu ja modulaarinen rakenne

Tämän diplomityön tavoitteena on tutkia kattilalaitosten järjestelmällistä suunnittelua, huomioiden laitoksen elinkaariprosessit ja modulaarinen tuoterakenne. Kattilalaitokset investointituotteina toteutetaan tyypillisesti projektitoimintamallilla, jolloin jokainen toimitus suunnitellaan alusta kyseisen kohteen vaatimusten perusteella. Päätöksenteon peruste on laitosasiakkaiden osalta tyypillisesti hinta, jonkavuoksi laitoksen perusratkaisut tulee olla ennalta määriteltyjä ja toimitusprosessi huolellisesti suunniteltu, jotta kustannukset ja aikataulu ovat ennustettavissa. Projektitoimituksissa projektipäälliköllä on merkittävä vastuu myös suunnittelun onnistumisesta ja käytössä olevat projektinhallintamallit ovat hyvin tuotekeskeisiä, jolloin vaatimuksia ei riittävästi huomioida ja siten toteutettu laitosratkaisu ei täytä usein sidosryhmien asettamia vaatimuksia. Monimutkaisten järjestelmien kehittämiseen ja suunnitteluun on olemassa Systems Engineering - suunnittelumalli, jonka hyödyntäminen energiatekniikan alalla on ollut vielä vähäistä. Malli tarjoaa yhdessä ISO/ICE 15288 standardin kanssa valmiit prosessit tuotteen järjestelmälliselle suunnittelulle. Modulaariset tuoterakenteet ovat olleet perusvaatimus komponenttien toimitusten osalta, mutta laitosjärjestelmien tuotteistaminen on koettu vaikeaksi runsaan räätälöintitarpeen takia. Prosessimaisella toimintamallilla voidaan tuottaa modulaarisia tuoterakenteita ja tehostaa kattilalaitosten muutosten hallintaa. Tutkimuksessa tunnistettiin tyypilliset kattilalaitoksen suunnittelun prosessit kattilalaitosten kokonaistoimituksiin erikoistuneelle KPA Unicon Oy:lle.