Analysis of stapling versus endoloops in appendiceal stump closure

BACKGROUND: The effectiveness of various appendiceal stump closure methods has not been evaluated systematically. The aim of this study was to compare the morbidity of stump closure by stapling or use of endoloops. METHODS: A non-concurrent cohort study of prospectively acquired data was performed. The primary outcome variable was the rate of intra-abdominal surgical-site infection. Secondary outcome measures were complications, duration of intervention, hospital stay, rate of readmission to hospital and the difference in direct costs of the operation. RESULTS: Staples were used in 60.5 per cent and endoloops in 39.5 per cent of 6486 patients operated on for suspected appendicitis between January 1995 and December 2003. Among 4489 patients with acute appendicitis the rate of intra-abdominal surgical-site infection was 0.7 per cent in the stapler group and 1.7 per cent in the endoloop group (P = 0.004). The rate of readmission to hospital was 0.9 and 2.1 per cent respectively (P = 0.001). CONCLUSION: Application of a stapler for transection and closure of the appendiceal stump in patients with acute appendicitis lowered the risk of postoperative intra-abdominal surgical-site infection and the need for readmission to hospital.

Group B Streptococcus colonization in pregnancy: prevalence and prevention strategies of neonatal sepsis

Early onset neonatal sepsis due to Group B streptococci (GBS) is responsible for severe morbidity and mortality of newborns. While different preventive strategies to identify women at risk are being recommended, the optimal strategy depends on the incidence of GBS-sepsis and on the prevalence of anogenital GBS colonization. We therefore aimed to assess the Group B streptococci prevalence and its consequences on different prevention strategies. We analyzed 1316 pregnant women between March 2005 and September 2006 at our institution. The prevalence of GBS colonization was determined by selective cultures of anogenital smears. The presence of risk factors was analyzed. In addition, the direct costs of screening and intrapartum antibiotic prophylaxis were estimated for different preventive strategies. The prevalence of GBS colonization was 21%. Any maternal intrapartum risk factor was present in 37%. The direct costs of different prevention strategies have been estimated as follows: risk-based: 18,500 CHF/1000 live births, screening-based: 50,110 CHF/1000 live births, combined screening- and risk-based: 43,495/1000 live births. Strategies to prevent GBS-sepsis in newborn are necessary. With our colonization prevalence of 21%, and the intrapartum risk profile of women, the screening-based approach seems to be superior as compared to a risk-based approach.

The high cost of inappropriate empiric treatment of presumed Clostridium difficile-associated diarrhea

The Center for Disease Control and Prevention (CDC) estimates that more than 2 million patients annually acquire an infection while hospitalized in U.S. hospitals for other health problems, and that 88,000 die as a direct or indirect result of these infections. Infection with Clostridium difficile is the most important common cause of health care associated infectious diarrhea in industrialized countries. The purpose of this study was to explore the cost of current treatment practice of beginning empiric metronidazole treatment for hospitalized patients with diarrhea prior to identification of an infectious agent. The records of 70 hospitalized patients were retrospectively analyzed to determine the pharmacologic treatment, laboratory testing, and radiographic studies ordered and the median cost for each of these was determined. All patients in the study were tested for C. difficile and concurrently started on empiric metronidazole. The median direct cost for metronidazole was $7.25 per patient (95% CI 5.00, 12.721). The median direct cost for laboratory charges was $468.00 (95% CI 339.26, 552.58) and for radiology the median direct cost was $970.00 (95% CI 738.00, 3406.91). Indirect costs, which are far greater than direct costs, were not studied. At St. Luke's, if every hospitalized patient with diarrhea was empirically treated with metronidazole at a median cost of $7.25, the annual direct cost is estimated to be over $9,000.00 plus uncalculated indirect costs. In the U.S., the estimated annual direct cost may be as much as $21,750,000.00, plus indirect costs. ^ An unexpected and significant finding of this study was the inconsistency in testing and treatment of patients with health care associated diarrhea. A best-practice model for C. difficile testing and treatment was not found in the literature review. In addition to the cost savings gained by not routinely beginning empiric treatment with metronidazole, significant savings and improvement in patient care may result from a more consistent approach to the diagnosis and treatment of all patients with health care associated diarrhea. A decision tree model for C. difficile testing and treatment is proposed, but further research is needed to evaluate the decision arms before a validated best practice model can be proposed. ^

Evaluating the Utility of Clinical Criteria for the Identification of Lynch Syndrome among Endometrial Cancer Patients

Background: Lynch Syndrome (LS) is a familial cancer syndrome with a high prevalence of colorectal and endometrial carcinomas among affected family members. Clinical criteria, developed from information obtained from familial colorectal cancer registries, have been generated to identify individuals at elevated risk for having LS. In 2007, the Society of Gynecologic Oncology (SGO) codified criteria to assist in identifying women presenting with gynecologic cancers at elevated risk for having LS. These criteria have not been validated in a population-based setting. Materials and Methods: We retrospectively identified 412, unselected endometrial cancer cases. Clinical and pathologic information were obtained from the electronic medical record, and all tumors were tested for expression of the DNA mismatch repair proteins through immunohistochemistry. Tumors exhibiting loss of MSH2, MSH6 and PMS2 were designated as probable Lynch Syndrome (PLS). For tumors exhibiting immunohistochemical loss of MLH1, we used the PCR-based MLH1 methylation assay to delineate PLS tumors from sporadic tumors. Samples lacking methylation of the MLH1 promoter were also designated as PLS. The sensitivity and specificity for SGO criteria for detecting PLS tumors was calculated. We compared clinical and pathologic features of sporadic tumors and PLS tumors. A simplified cost-effectiveness analysis was also performed comparing the direct costs of utilizing SGO criteria vs. universal tumor testing. Results: In our cohort, 43/408 (10.5%) of endometrial carcinomas were designated as PLS. The sensitivity and specificity of SGO criteria to identify PLS cases were 32.7 and 77%, respectively. Multivariate analysis of clinical and pathologic parameters failed to identify statistically significant differences between sporadic and PLS tumors with the exception of tumors arising from the lower uterine segment. These tumors were more likely to occur in PLS tumors. Cost-effectiveness analysis showed clinical criteria and universal testing strategies cost $6,235.27/PLS case identified and $5,970.38/PLS case identified, respectively. Conclusions: SGO 5-10% criteria successfully identify PLS cases among women who are young or have significant family history of LS related tumors. However, a larger proportion of PLS cases occurring at older ages with less significant family history are not detected by this screening strategy. Compared to SGO clinical criteria, universal tumor testing is a cost effective strategy to identify women presenting with endometrial cancer who are at elevated risk for having LS.

Optimización multiobjetivo inteligente del dimensionamiento energético en sistemas ferroviarios señalizados y en plataformas software de tiempo real

La capacidad de transporte es uno de los baremos fundamentales para evaluar la progresión que puede llegar a tener un área económica y social. Es un sector de elevada importancia para la sociedad actual. Englobado en los distintos tipos de transporte, uno de los medios de transporte que se encuentra más en alza en la actualidad, es el ferroviario. Tanto para movilidad de pasajeros como para mercancías, el tren se ha convertido en un medio de transporte muy útil. Se encuentra dentro de las ciudades, entre ciudades con un radio pequeño entre ellas e incluso cada vez más, gracias a la alta velocidad, entre ciudades con gran distancia entre ellas. Esta Tesis pretende ayudar en el diseño de una de las etapas más importantes de los Proyectos de instalación de un sistema ferroviario: el sistema eléctrico de tracción. La fase de diseño de un sistema eléctrico de tracción ferroviaria se enfrenta a muchas dudas que deben ser resueltas con precisión. Del éxito de esta fase dependerá la capacidad de afrontar las demandas de energía de la explotación ferroviaria. También se debe atender a los costes de instalación y de operación, tanto costes directos como indirectos. Con la Metodología que se presenta en esta Tesis se ofrecerá al diseñador la opción de manejar un sistema experto que como soluciones le plantee un conjunto de escenarios de sistemas eléctricos correctos, comprobados por resolución de modelos de ecuaciones. Correctos desde el punto de vista de validez de distintos parámetros eléctrico, como de costes presupuestarios e impacto de costes indirectos. Por tanto, el diseñador al haber hecho uso de esta Metodología, tendría en un espacio de tiempo relativamente corto, un conjunto de soluciones factibles con las que poder elegir cuál convendría más según sus intereses finales. Esta Tesis se ha desarrollado en una vía de investigación integrada dentro del Centro de Investigaciones Ferroviarias CITEF-UPM. Entre otros proyectos y vías de investigación, en CITEF se ha venido trabajando en estudios de validación y dimensionamiento de sistemas eléctricos ferroviarios con diversos y variados clientes y sistemas ferroviarios. A lo largo de los proyectos realizados, el interés siempre ha girado mayoritariamente sobre los siguientes parámetros del sistema eléctrico: - Calcular número y posición de subestaciones de tracción. Potencia de cada subestación. - Tipo de catenaria a lo largo del recorrido. Conductores que componen la catenaria. Características. - Calcular número y posición de autotransformadores para sistemas funcionando en alterna bitensión o 2x25kV. - Posición Zonas Neutras. - Validación según normativa de: o Caídas de tensión en la línea o Tensiones máximas en el retorno de la línea o Sobrecalentamiento de conductores o Sobrecalentamiento de los transformadores de las subestaciones de tracción La idea es que las soluciones aportadas por la Metodología sugieran escenarios donde de estos parámetros estén dentro de los límites que marca la normativa. Tener la posibilidad de tener un repositorio de posibles escenarios donde los parámetros y elementos eléctricos estén calculados como correctos, aporta un avance en tiempos y en pruebas, que mejoraría ostensiblemente el proceso habitual de diseño para los sistemas eléctricos ferroviarios. Los costes directos referidos a elementos como subestaciones de tracción, autotransformadores, zonas neutras, ocupan un gran volumen dentro del presupuesto de un sistema ferroviario. En esta Tesis se ha querido profundizar también en el efecto de los costes indirectos provocados en la instalación y operación de sistemas eléctricos. Aquellos derivados del impacto medioambiental, los costes que se generan al mantener los equipos eléctricos y la instalación de la catenaria, los costes que implican la conexión entre las subestaciones de tracción con la red general o de distribución y por último, los costes de instalación propios de cada elemento compondrían los costes indirectos que, según experiencia, se han pensado relevantes para ejercer un cierto control sobre ellos. La Metodología cubrirá la posibilidad de que los diseños eléctricos propuestos tengan en cuenta variaciones de coste inasumibles o directamente, proponer en igualdad de condiciones de parámetros eléctricos, los más baratos en función de los costes comentados. Analizando los costes directos e indirectos, se ha pensado dividir su impacto entre los que se computan en la instalación y los que suceden posteriormente, durante la operación de la línea ferroviaria. Estos costes normalmente suelen ser contrapuestos, cuánto mejor es uno peor suele ser el otro y viceversa, por lo que hace falta un sistema que trate ambos objetivos por separado. Para conseguir los objetivos comentados, se ha construido la Metodología sobre tres pilares básicos: - Simulador ferroviario Hamlet: Este simulador integra módulos para construir esquemas de vías ferroviarios completos; módulo de simulación mecánica y de la tracción de material rodante; módulo de señalización ferroviaria; módulo de sistema eléctrico. Software realizado en C++ y Matlab. - Análisis y estudio de cómo focalizar los distintos posibles escenarios eléctricos, para que puedan ser examinados rápidamente. Pico de demanda máxima de potencia por el tráfico ferroviario. - Algoritmos de optimización: A partir de un estudio de los posibles algoritmos adaptables a un sistema tan complejo como el que se plantea, se decidió que los algoritmos genéticos serían los elegidos. Se han escogido 3 algoritmos genéticos, permitiendo recabar información acerca del comportamiento y resultados de cada uno de ellos. Los elegidos por motivos de tiempos de respuesta, multiobjetividad, facilidad de adaptación y buena y amplia aplicación en proyectos de ingeniería fueron: NSGA-II, AMGA-II y ɛ-MOEA. - Diseño de funciones y modelo preparado para trabajar con los costes directos e indirectos y las restricciones básicas que los escenarios eléctricos no deberían violar. Estas restricciones vigilan el comportamiento eléctrico y la estabilidad presupuestaria. Las pruebas realizadas utilizando el sistema han tratado o bien de copiar situaciones que se puedan dar en la realidad o directamente sistemas y problemas reales. Esto ha proporcionado además de la posibilidad de validar la Metodología, también se ha posibilitado la comparación entre los algoritmos genéticos, comparar sistemas eléctricos escogidos con los reales y llegar a conclusiones muy satisfactorias. La Metodología sugiere una vía de trabajo muy interesante, tanto por los resultados ya obtenidos como por las oportunidades que puede llegar a crear con la evolución de la misma. Esta Tesis se ha desarrollado con esta idea, por lo que se espera pueda servir como otro factor para trabajar con la validación y diseño de sistemas eléctricos ferroviarios. ABSTRACT Transport capacity is one of the critical points to evaluate the progress than a specific social and economical area is able to reach. This is a sector of high significance for the actual society. Included inside the most common types of transport, one of the means of transport which is elevating its use nowadays is the railway. Such as for passenger transport of weight movements, the train is being consolidated like a very useful mean of transport. Railways are installed in many geography areas. Everyone know train in cities, or connecting cities inside a surrounding area or even more often, taking into account the high-speed, there are railways infrastructure between cities separated with a long distance. This Ph.D work aims to help in the process to design one of the most essential steps in Installation Projects belonging to a railway system: Power Supply System. Design step of the railway power supply, usually confronts to several doubts and uncertainties, which must be solved with high accuracy. Capacity to supply power to the railway traffic depends on the success of this step. On the other hand is very important to manage the direct and indirect costs derived from Installation and Operation. With the Methodology is presented in this Thesis, it will be offered to the designer the possibility to handle an expert system that finally will fill a set of possible solutions. These solutions must be ready to work properly in the railway system, and they were tested using complex equation models. This Thesis has been developed through a research way, integrated inside Citef (Railway Research Centre of Technical University of Madrid). Among other projects and research ways, in Citef has been working in several validation studies and dimensioning of railway power supplies. It is been working by a large range of clients and railways systems. Along the accomplished Projects, the main goal has been rounded mostly about the next list of parameters of the electrical system: - Calculating number and location of traction substations. Power of each substation. - Type of Overhead contact line or catenary through the railway line. The wires which set up the catenary. Main Characteristics. - Calculating number and position of autotransformers for systems working in alternating current bi-voltage of called 2x25 kV. - Location of Neutral Zones. - Validating upon regulation of: o Drop voltages along the line o Maximum return voltages in the line o Overheating/overcurrent of the wires of the catenary o Avoiding overheating in the transformers of the traction substations. Main objective is that the solutions given by the Methodology, could be suggest scenarios where all of these parameters from above, would be between the limits established in the regulation. Having the choice to achieve a repository of possible good scenarios, where the parameters and electrical elements will be assigned like ready to work, that gives a great advance in terms of times and avoiding several tests. All of this would improve evidently the regular railway electrical systems process design. Direct costs referred to elements like traction substations, autotransformers, neutral zones, usually take up a great volume inside the general budget in railway systems. In this Thesis has been thought to bear in mind another kind of costs related to railway systems, also called indirect costs. These could be enveloped by those enmarked during installation and operation of electrical systems. Those derived from environmental impact; costs generated during the maintenance of the electrical elements and catenary; costs involved in the connection between traction substations and general electric grid; finally costs linked with the own installation of the whole electrical elements needed for the correct performance of the railway system. These are integrated inside the set has been collected taking into account own experience and research works. They are relevant to be controlled for our Methodology, just in case for the designers of this type of systems. The Methodology will cover the possibility that the final proposed power supply systems will be hold non-acceptable variations of costs, comparing with initial expected budgets, or directly assuming a threshold of budget for electrical elements in actual scenario, and achieving the cheapest in terms of commented costs from above. Analyzing direct and indirect costs, has been thought to divide their impact between two main categories. First one will be inside the Installation and the other category will comply with the costs often happens during Railway Operation time. These costs normally are opposed, that means when one is better the other turn into worse, in costs meaning. For this reason is necessary treating both objectives separately, in order to evaluate correctly the impact of each one into the final system. The objectives detailed before build the Methodology under three basic pillars: - Railway simulator Hamlet: This software has modules to configure many railway type of lines; mechanical and traction module to simulate the movement of rolling stock; signaling module; power supply module. This software has been developed using C++ and Matlab R13a - Previously has been mandatory to study how would be possible to work properly with a great number of feasible electrical systems. The target comprised the quick examination of these set of scenarios in terms of time. This point is talking about Maximum power demand peaks by railway operation plans. - Optimization algorithms. A railway infrastructure is a very complex system. At the beginning it was necessary to search about techniques and optimization algorithms, which could be adaptable to this complex system. Finally three genetic multiobjective algorithms were the chosen. Final decision was taken attending to reasons such as time complexity, able to multiobjective, easy to integrate in our problem and with a large application in engineering tasks. They are: NSGA-II, AMGA-II and ɛ-MOEA. - Designing objectives functions and equation model ready to work with the direct and indirect costs. The basic restrictions are not able to avoid, like budgetary or electrical, connected hardly with the recommended performance of elements, catenary and safety in a electrical railway systems. The battery of tests launched to the Methodology has been designed to be as real as possible. In fact, due to our work in Citef and with real Projects, has been integrated and configured three real railway lines, in order to evaluate correctly the final results collected by the Methodology. Another topic of our tests has been the comparison between the performances of the three algorithms chosen. Final step has been the comparison again with different possible good solutions, it means power supply system designs, provided by the Methodology, testing the validity of them. Once this work has been finished, the conclusions have been very satisfactory. Therefore this Thesis suggest a very interesting way of research and work, in terms of the results obtained and for the future opportunities can be created with the evolution of this. This Thesis has been developed with this idea in mind, so is expected this work could adhere another factor to work in the difficult task of validation and design of railway power supply systems.

Who decides? Resolving failed banks in a European framework. Bruegel Policy Contribution 2013/16, 29 November 2013

As the basis for a European regime for resolving failing and failed banks, the European Commission has proposed the Bank Resolution and Recovery Directive (BRRD) and a regulation establishing a European Single Resolution Mechanism (SRM) and a Single Bank Resolution Fund (SBRF). There is a debate about which parts of the proposed SRM-SBRF to add to the BRRD. The BRRD sets out a resolution toolkit that can be used by national resolution authorities. The SRM would involve European institutions more at the expense of national resolution authorities. This change could affect resolution outcomes. Domestic resolution authorities might be more generous than supranational authorities in providing assistance to banks. A supranational approach might be more effective in minimising costs for taxpayers. But regardless of the final design, more attention is needed to ensure that resolution authorities are politically independent from governments. When public support is provided to failed institutions it should come from a bankfunded resolution fund. This would reduce taxpayers’ direct costs, and would make banks less likely to take risks and advocate for bailouts.

On Managing Stochastic Decentralized Projects

Thesis (Ph.D.)--University of Washington, 2016-06

The roles of natural and sexual selection during adaptation to a novel environment

The net effect of sexual selection on nonsexual fitness is controversial. On one side, elaborate display traits and preferences for them can be costly, reducing the nonsexual fitness of individuals possessing them, as well as their offspring, In contrast, sexual selection may reinforce nonsexual fitness if an individual's attractiveness and quality are genetically correlated. According to recent models, such good-genes mate choice should increase both the extent and rate of adaptation. We evolved 12 replicate populations of Drosophila serrata in a powerful two-way factorial experimental design to test the separate and combined contributions of natural and sexual selection to adaptation to a novel larval food resource. Populations evolving in the presence of natural selection had significantly higher mean nonsexual fitness when measured over three generations (13-15) during the course of experimental evolution (16-23% increase). The effect of natural selection was even more substantial when measured in a standardized, monogamous mating environment at the end of the experiment (generation 16; 52% increase). In contrast, and despite strong sexual selection on display traits, there was no evidence from any of the four replicate fitness measures that sexual selection promoted adaptation. In addition, a comparison of fitness measures conducted under different mating environments demonstrated a significant direct cost of sexual selection to females, likely arising from some form of male-induced harm. Indirect benefits of sexual selection in promoting adaptation to this novel resource environment therefore appear to be absent in this species, despite prior evidence suggesting the operation of good-genes mate choice in their ancestral environment. How novel environments affect the operation of good-genes mate choice is a fundamental question for future sexual selection research.

How much is corporate cash-pooling worth? Modelling and simulation

The paper analyzes a special corporate banking product, the so called cash-pool, which gained remarkable popularity in the recent years as firms try to centralize and manage their liquidity more efficiently. The novelty of this paper is the formalization of a valuation model which can serve as a basis for a Monte Carlo simulation to assess the most important benefits of the firms arising from the pooling of their cash holdings. The literature emphasizes several benefits of cash-pooling such as interest rate savings, economy of scale and reduced cash-flow volatility. The presented model focuses on the interest rate savings complemented with a new aspect: the reduced counterparty risk toward the bank. The main conclusion of the analysis is that the value of a cash-pool is higher in case of firms with large, diverse and volatile cash-flows having less access to the capital markets especially if the partner bank is risky and offers a high interest spread. It is also shown that cash-pooling is not the privilege of large multinational firms any more as the initial direct costs can be easily regained within a year even in the case of SMEs.

Fearonomics and the Role of Nigeria's Private Sector in the Nigerian Ebola Response

Background: Outbreaks of infectious diseases such as Ebola have dramatic economic impacts on affected nations due to significant direct costs and indirect costs, as well as increased expenditure by the government to meet the health and security crisis. Despite its dense population, Nigeria was able to contain the outbreak swiftly and was declared Ebola free on 13th October 2014. Although Nigeria’s Ebola containment success was multifaceted, the private sector played a key role in Nigeria’s fight against Ebola. An epidemic of a disease like Ebola, not only consumes health resources but also detrimentally disrupts trade and travel to impact both public and private sector resulting in the ‘fearonomic’ effect of the contagion. In this thesis, I have defined ‘fearonomics’ or the ‘fearonomic effects’ of a disease as the intangible and intangible economic effects of both informed and misinformed aversion behavior exhibited by individuals, organizations, or countries during an outbreak. During an infectious disease outbreak, there is a significant potential for public-private sector collaborations that can help offset some of the government’s cost of controlling the epidemic.

Objective: The main objective of this study is to understand the ‘fearonomics’ of Ebola in Nigeria and to evaluate the role of the key private sector stakeholders in Nigeria’s Ebola response.

Methods: This retrospective qualitative study was conducted in Nigeria and utilizes grounded theory to look across different economic sectors in Nigeria to understand the impact of Ebola on Nigeria’s private sector and how it dealt with the various challenges posed by the disease and its ‘fearonomic effects'.

Results: Due to swift containment of Ebola in Nigeria, the economic impact of the disease was limited especially in comparison to the other Ebola-infected countries such as Liberia, Sierra Leone, and Guinea. However, the 2014 Ebola outbreak had more than a just direct impact on the country’s economy and despite the swift containment, no economic sector was immune to the disease’s fearonomic impact. The potential scale of the fearonomic impact of a disease like Ebola was one of the key motivators for the private sector engagement in the Ebola response.

The private sector in Nigeria played an essential role in facilitating the country’s response to Ebola. The private sector not only provided in-cash donations but significant in-kind support to both the Federal and State governments during the outbreak. Swift establishment of an Ebola Emergency Operation Centre (EEOC) was essential to the country’s response and was greatly facilitated by the private sector, showcasing the crucial role of private sector in the initial phase of an outbreak. The private sector contributed to Nigeria’s fight against Ebola not only by donating material assets but by continuing operations and partaking in knowledge sharing and advocacy. Some sector such as the private health sector, telecom sector, financial sector, oil and gas sector played a unique role in orchestrating the Nigerian Ebola response and were among the first movers during the outbreak.

This paper utilizes the lessons from Nigeria’s containment of Ebola to highlight the potential of public-private partnerships in preparedness, response, and recovery during an outbreak.

Asiakasarvon kehittäminen B2B-palveluyrityksessä

Yritysten välisen yhteistyön toimittajavalinta perustuu asiakasarvon määrittämiseen ja vertailuun. Tämä tutkimus tehtiin yritys A:lle asiakasarvon ymmärtämiseksi, kehittämiseksi ja asiakaspääoman kasvattamiseksi. Teoreettisesti keskeisiä käsiteltäviä teemoja ovat asiakasarvon luonti, toimittaminen ja kasvattaminen. Tutkimus on toteutettu pääasiassa kvalitatiivisesti teemahaastattelun kautta, jossa haastateltiin viittä yritys A:n asiakasyritystä. Tutkimus suunniteltiin yhdessä työn tilanneen yrityksen kanssa suhteessa aiempiin tutkimuksiin ja tavoitteisiin. Tutkimuksen tuloksissa havaittiin selviä vahvuuksia liittyen yritys A:n asiakasyritysten asiakasarvon teemoihin. Vahvuudet liittyivät muun muassa suoriin kustannuksiin, erillisiin lisäpalveluihin ja asiakaspalveluun. Kehitettävät teemat liittyivät pääasiassa työn suorittamiseen ja markkinointiin. Tulokset ovat käsitelty niin numeerisesti kuin tärkeimpinä teemoina. Asiakasarvoon ja –pääomaan liittyvistä teemoista esitetään lopuksi ratkaisuehdotus työn tilanneelle yritykselle, jota voidaan hyödyntää jatkossa ko. johtamisessa. Asiakasarvosta tulisi tehdä niin yrityskohtaisesti kuin tieteen kannalta lisää tutkimusta, sillä siinä on onnistuessaan merkittävä liiketoiminnallinen potentiaali.

The scientific rationale, design and implementation plan for a Biogeochemical-Argo float array

Biogeochemical-Argo is the extension of the Argo array of profiling floats to include floats that are equipped with biogeochemical sensors for pH, oxygen, nitrate, chlorophyll, suspended particles, and downwelling irradiance. Argo is a highly regarded, international program that measures the changing ocean temperature (heat content) and salinity with profiling floats distributed throughout the ocean. Newly developed sensors now allow profiling floats to also observe biogeochemical properties with sufficient accuracy for climate studies. This extension of Argo will enable an observing system that can determine the seasonal to decadal-scale variability in biological productivity, the supply of essential plant nutrients from deep-waters to the sunlit surface layer, ocean acidification, hypoxia, and ocean uptake of CO2. Biogeochemical-Argo will drive a transformative shift in our ability to observe and predict the effects of climate change on ocean metabolism, carbon uptake, and living marine resource management. Presently, vast areas of the open ocean are sampled only once per decade or less, with sampling occurring mainly in summer. Our ability to detect changes in biogeochemical processes that may occur due to the warming and acidification driven by increasing atmospheric CO2, as well as by natural climate variability, is greatly hindered by this undersampling. In close synergy with satellite systems (which are effective at detecting global patterns for a few biogeochemical parameters, but only very close to the sea surface and in the absence of clouds), a global array of biogeochemical sensors would revolutionize our understanding of ocean carbon uptake, productivity, and deoxygenation. The array would reveal the biological, chemical, and physical events that control these processes. Such a system would enable a new generation of global ocean prediction systems in support of carbon cycling, acidification, hypoxia and harmful algal blooms studies, as well as the management of living marine resources. In order to prepare for a global Biogeochemical-Argo array, several prototype profiling float arrays have been developed at the regional scale by various countries and are now operating. Examples include regional arrays in the Southern Ocean (SOCCOM ), the North Atlantic Sub-polar Gyre (remOcean ), the Mediterranean Sea (NAOS ), the Kuroshio region of the North Pacific (INBOX ), and the Indian Ocean (IOBioArgo ). For example, the SOCCOM program is deploying 200 profiling floats with biogeochemical sensors throughout the Southern Ocean, including areas covered seasonally with ice. The resulting data, which are publically available in real time, are being linked with computer models to better understand the role of the Southern Ocean in influencing CO2 uptake, biological productivity, and nutrient supply to distant regions of the world ocean. The success of these regional projects has motivated a planning meeting to discuss the requirements for and applications of a global-scale Biogeochemical-Argo program. The meeting was held 11-13 January 2016 in Villefranche-sur-Mer, France with attendees from eight nations now deploying Argo floats with biogeochemical sensors present to discuss this topic. In preparation, computer simulations and a variety of analyses were conducted to assess the resources required for the transition to a global-scale array. Based on these analyses and simulations, it was concluded that an array of about 1000 biogeochemical profiling floats would provide the needed resolution to greatly improve our understanding of biogeochemical processes and to enable significant improvement in ecosystem models. With an endurance of four years for a Biogeochemical-Argo float, this system would require the procurement and deployment of 250 new floats per year to maintain a 1000 float array. The lifetime cost for a Biogeochemical-Argo float, including capital expense, calibration, data management, and data transmission, is about $100,000. A global Biogeochemical-Argo system would thus cost about $25,000,000 annually. In the present Argo paradigm, the US provides half of the profiling floats in the array, while the EU, Austral/Asia, and Canada share most the remaining half. If this approach is adopted, the US cost for the Biogeochemical-Argo system would be ~$12,500,000 annually and ~$6,250,000 each for the EU, and Austral/Asia and Canada. This includes no direct costs for ship time and presumes that float deployments can be carried out from future research cruises of opportunity, including, for example, the international GO-SHIP program (http://www.go-ship.org). The full-scale implementation of a global Biogeochemical-Argo system with 1000 floats is feasible within a decade. The successful, ongoing pilot projects have provided the foundation and start for such a system.

Caracterización y prevalencia del compromiso ocular en pacientes con enfermedad autoinmune y autoinflamatoria en un centro de referencia reumatológica en Colombia entre los años 2000 a 2015

RESUMEN Objetivo: Estimar la prevalencia de las diferentes enfermedades oftalmológicas que aparecen en el contexto de una enfermedad autoinmune (EAI) en pacientes de un centro de referencia reumatológica en Colombia, según características clínicas y sociodemográficas durante un período de 15 años, comprendido entre los años 2000 a 2015. Métodos: Se realizó un estudio descriptivo, observacional de prevalencia. El tipo de muestreo fue aleatorio estratificado con asignación proporcional en el programa Epidat 3.4. Los datos se analizaron en el programa SPSS v22.0 y se realizó análisis univariado de las variables categóricas, para las variables cuantitativas se realizaron medidas de tendencia central. Resultados: De 1640 historias clínicas revisadas, se encontraron 634 pacientes (38,65%) con compromiso ocular. Si excluimos los pacientes con SS, que por definición presentan ojo seco, 222 pacientes (13,53%) presentaron compromiso oftalmológico. Del total de pacientes, el 83,3% fueron mujeres. La AR fue la enfermedad autoinmune con mayor compromiso oftalmológico con 138 pacientes (62,2%), y en último lugar la sarcoidosis con 1 solo paciente afectado. La QCS fue la manifestación más común en todos los grupos diagnósticos de EAI, con 146 pacientes (63,5%). De 414 pacientes con Síndrome de Sjögren (SS) y QCS 8 presentaron compromiso ocular adicional, siendo la uveítis la segunda patología ocular asociada en pacientes con SS y la primera causa en las espondiloartropatias (71,4 %). Los pacientes con catarata (4,1%) presentaron la mayor prevalencia de uso de corticoide (88.8%). De 222 pacientes, 28 (12,6%) presentaron uveítis. Del total de pacientes, 16 (7,2%) presentaron maculopatía por antimalaráricos y 6 (18,75%) de los pacientes con LES. Los ANAS se presentaron en el 100% los pacientes con trastorno vascular de la retina. Los pacientes con epiescleritis presentaron la mayor proporción de positivización de anticuerpos anti-DNA. La EAI que más presentó epiescleritis fue LES con 4 pacientes (12,5%) El 22% de paciente con anticuerpos anti-RNP presentaron escleritis y 32,1% de los pacientes con uveítis presentaron HLA-B27 positivo. Las manifestaciones oftalmológicas precedieron a las sistémicas entre un 11,1% y un 33,3% de los pacientes. Conclusión: Las enfermedades oculares se presentan con frecuencia en los pacientes colombianos con EAI (38.65%), siendo la AR la enfermedad con mayor compromiso ocular (62,2%) y la QCS la enfermedad ocular con mayor prevalencia en todas las EAI (63,5%). La uveítis se presentó en 28 pacientes (12,6%). Las manifestaciones oftalmológicas pueden preceder a las sistémicas. El examen oftalmológico debe ser incluido en los pacientes con EAI, por ser la enfermedad ocular una comorbilidad frecuente. Adicionalmente, los efectos oftalmológicos de las medicaciones sistémicas utilizadas en EAI deben ser estrechamente monitorizados, durante el curso del tratamiento.

Transaction costs: an empirical analysis of their relationship with investment and foreign direct investment

As stated by the New Institutional Economics theory, transaction costs play a relevant role in economics and, according to the extent of such costs, agents make investment decisions. Actually, transaction costs may represent a disincentive to entrepreneurship. This work aims to verify whether transaction costs are related to investment rate and foreign direct investment rate (FDI) in different business environments. The results suggest that foreign investors do not have precise information about other countries as domestic investors do; as it is observed, only the relation between transaction costs and investment rate is significant. Furthermore, there is evidence that the business environments of BRIC countries are less developed when compared to business environments of other countries in the study

Direct medical costs associated with schizophrenia relapses in health care services in the city of São Paulo

OBJECTIVE: To assess direct medical costs associated with schizophrenia relapses in mental health services. METHODS: The study was conducted in three health facilities in the city of São Paulo: a public state hospital; a Brazilian National Health System (SUS)-contracted hospital; and a community mental health center. Medical records of 90 patients with schizophrenia who received care in 2006 were reviewed. Information on inpatient expenditures was collected and used for cost estimates. RESULTS: Mean direct medical cost of schizophrenia relapses per patient was US$ 4,083.50 (R$ 8,167.58) in the public state hospital; US$ 2,302.76 (R$ 4,605.46) in the community mental health center; and US$ 1,198.50 (R$ 2,397.74) in the SUS-affiliated hospital. The main component was daily inpatient room rates (87% - 98%). Medication costs varied depending on the use of typical or atypical antipsychotic drugs. Atypical antipsychotic drugs were more often used in the community mental health center. CONCLUSIONS: Costs associated with schizophrenia relapses support investments in antipsychotic drugs and strategies to reduce disease relapse and the need for mental health inpatient services. Treating patients in a community mental health center was associated with medium costs and added the benefit of not depriving these patients from family life.