Adaptations des recommandations pour la pratique clinique: l'exemple du Programme cantonal Diabète de Vaud [Adaptation of clinical practice guidelines--the example of cantonal Diabetes Program].

With the growing number of scientific publications, practitioners can use scientific knowledge synthesis, including Clinical Practice Guidelines (CPG). The practical use of a CPG implies considering the context, that is the local healthcare system and the patient. Thus, the CPG can never replace the expertise of the practitioner! Diabetes is a wide public health issue and the canton of Vaud established the cantonal Diabetes Program (cDP), to optimize the care of diabetic patients. The cDP has many projects including the adaptation of reliable CPG to local needs. We present the pros and cons of the CPG in the cDP and the methods to adapt it to the regional healthcare context, and also at an individual level.

Estrategia de la Universidad de Alicante en la promoción del conocimiento abierto

El propòsit d'aquesta comunicació és resumir les diferents iniciatives dutes a terme a la Universitat d'Alacant per a la promoció de l'accés obert a la recerca i la docència generades pels seus membres, així com els diferents incentius destinats a afavorir l'autoarxivament en el seu Repositori institucional, RUA. Fins al moment a la Universitat d'Alacant s'ha optat per realitzar diferents convocatòries amb incentius econòmics, dirigides tant a personal investigador com a docent, en què s'especifica l'obligatorietat d'arxivar en el Repositori els materials generats arran d'aquestes convocatòries. Resumirem els resultats obtinguts fins al moment, indicant els pros i els contres d'aquest sistema d'incentius, i assenyalarem els nous reptes que se'ns presenten a curt i mitjà termini, amb especial referència a la proposició d'un nou model de política a adoptar per l'arxiu i difusió de la producció científica i docent generada a la nostra Universitat.

Costes frente a beneficios de los suplementos nutricionales orales.

Health economics pretends to assign resources that are short in essence and that may be used for other purposes. Health costs analysis pretends to compare the pros and cons of several options among which an election can be made in order to obtain greater benefits with lower costs. The current legislation on prescription of enteral nutrition entails confusing definitions about the administration route and the requirements of home-based enteral nutrition, without a specific regulation comprising the prescription of oral supplements (OS). From the year 2000 to 2007, the consumption of homebased enteral nutrition in Andalusia increased considerably; the costs generated being multiplied by 37. Although the number of persons that daily consumed supplements was higher than the number of diets through nasogastric tube (DT) during the years evaluated, the costs derived from OS surpassed those of DT from the year 2005 due to the combination of two factors: a progressive increase in the number of persons to whom supplements were prescribed, and on the other hand the incorporation of more expensive specific formulations. The use of oral supplements seems to be cost/effective in hospitalized surgical patients (during the pre- and postsurgical period) and possibly in hospitalized malnourished elderly, especially after performing a hyponutrition screening. Although they may be effective, under other circumstances, such as ambulatory patients, studies with an adequate methodology are necessary in order to adopt clinical decisions based on evidence and cost analysis.

EU “actorness” in International Relations: The Non-Proliferation Policy of the EU in the Southern Mediterranean

El punt de partida d'aquesta investigació és una retòrica molt utilitzada que la UE és un actor global. En vista d'això, la no proliferació de la política comunitària al sud de la Mediterrània s'examina. L'estudi es realitza sobre la base de la conceptualització de la UE "actorness" ia través d'alguns criteris (context extern, l'evolució de l'aparell de política exterior de la UE, la Unió Europea l'auto-presentació i la percepció de tercers, la consistència i la disponibilitat d'instruments de política i accions concretes) que involucren tant factors ideacionals i materials, d'acord amb el "pluralisme metodològic". Aquest marc conceptual va ajudar a avaluar la no proliferació de la política comunitària en aquesta regió en particular on la UE té interessos i bones raons per actuar. Cada un dels criteris de manifest els avantatges i desavantatges de la UE "actorness" en aquest camp seleccionat i la caixa. Aquest document sosté que la no proliferació "actorness" de la UE a la regió del sud de la Mediterrània ha estat limitat a causa d'una varietat de raons.

Adaptació d'itinerari d'educació ambiental i sensorial a la vall d'Alinyà

Després d’analitzar el potencial de la muntanya d’Alinyà, s’ha observat que és un lloc idoni per desenvolupar activitats d’educació ambiental (EA). Per aquest motiu s’elabora un itinerari d’EA, part del qual és adaptat sensorialment. Havent analitzat els pros i contres de cada itine-rari ja descrit en la muntanya d’Alinyà s’ha escollit l’itinerari 3 que s’amplia fins a la zona de El Ribatell per aconseguir un dels objectius inicials: l’adaptació d’un itinerari d’EA per a persones amb mobilitat reduïda o discapacita-des. En el disseny de l’itinerari s’han inclòs tots els elements d’interès socio-ambiental més desta-cables de la zona, entre els quals es pot destacar els diferents tipus de boscos, aspectes geològics com el Roc de la Pena o els quatre grans rapi-nyaires que es poden trobar a la zona.

Connectivity differences in brain networks.

The scenario considered here is one where brain connectivity is represented as a network and an experimenter wishes to assess the evidence for an experimental effect at each of the typically thousands of connections comprising the network. To do this, a univariate model is independently fitted to each connection. It would be unwise to declare significance based on an uncorrected threshold of α=0.05, since the expected number of false positives for a network comprising N=90 nodes and N(N-1)/2=4005 connections would be 200. Control of Type I errors over all connections is therefore necessary. The network-based statistic (NBS) and spatial pairwise clustering (SPC) are two distinct methods that have been used to control family-wise errors when assessing the evidence for an experimental effect with mass univariate testing. The basic principle of the NBS and SPC is the same as supra-threshold voxel clustering. Unlike voxel clustering, where the definition of a voxel cluster is unambiguous, 'clusters' formed among supra-threshold connections can be defined in different ways. The NBS defines clusters using the graph theoretical concept of connected components. SPC on the other hand uses a more stringent pairwise clustering concept. The purpose of this article is to compare the pros and cons of the NBS and SPC, provide some guidelines on their practical use and demonstrate their utility using a case study involving neuroimaging data.

Late removal of retrievable caval filters.

The advent of retrievable caval filters was a game changer in the sense, that the previously irreversible act of implanting a medical device into the main venous blood stream of the body requiring careful evaluation of the pros and cons prior to execution suddenly became a "reversible" procedure where potential hazards in the late future of the patient lost most of their weight at the time of decision making. This review was designed to assess the rate of success with late retrieval of so called retrievable caval filters in order to get some indication about reasonable implant duration with respect to relatively "easy" implant removal with conventional means, i.e., catheters, hooks and lassos. A PubMed search (www.pubmed.gov) was performed with the search term "cava filter retrieval after 30 days clinical", and 20 reports between 1994 and 2013 dealing with late retrieval of caval filters were identified, covering approximately 7,000 devices with 600 removed filters. The maximal duration of implant reported is 2,599 days and the maximal implant duration of removed filters is also 2,599 days. The maximal duration reported with standard retrieval techniques, i.e., catheter, hook and/or lasso, is 475 days, whereas for the retrievals after this period more sophisticated techniques including lasers, etc. were required. The maximal implant duration for series with 100% retrieval accounts for 84 days, which is equivalent to 12 weeks or almost 3 months. We conclude that retrievable caval filters often become permanent despite the initial decision of temporary use. However, such "forgotten" retrievable devices can still be removed with a great chance of success up to three months after implantation. Conventional percutaneous removal techniques may be sufficient up to sixteen months after implantation whereas more sophisticated catheter techniques have been shown to be successful up to 83 months or more than seven years of implant duration. Tilting, migrating, or misplaced devices should be removed early on, and replaced if indicated with a device which is both, efficient and retrievable.

What do we actually mean by talent in business? Does it really matter?

[spa] La conceptuación de talento ha ido cobrando cada vez más importancia tanto para académicos como profesionales, con el fin de avanzar en el estudio de la gestión del talento. De hecho, la confusión sobre el significado de talento en la realidad empresarial impide llegar a un consenso sobre el concepto y la práctica de la gestión del talento. En este estudio teórico revisamos el concepto de talento en el mundo de la empresa con el fin de resumir lo que hemos aprendido y discutir las ventajas y limitaciones de las diferentes acepciones. Concluimos con la formulación de una definición de este concepto, ya que una correcta interpretación de la gestión del talento—por no hablar de una exitosa gestión del talento— depende de tener una comprensión clara de lo que se entiende por talento en un contexto organizativo. Además, con la definición de talento propuesta delimitamos el concepto de talento evitando algunos problemas detectados en las definiciones anteriores (por ejemplo, generalidades y tautologías), y poniendo de relieve las variables importantes que le afectan y lo hacen más manejable.

What do we actually mean by talent in business? Does it really matter?

[spa] La conceptuación de talento ha ido cobrando cada vez más importancia tanto para académicos como profesionales, con el fin de avanzar en el estudio de la gestión del talento. De hecho, la confusión sobre el significado de talento en la realidad empresarial impide llegar a un consenso sobre el concepto y la práctica de la gestión del talento. En este estudio teórico revisamos el concepto de talento en el mundo de la empresa con el fin de resumir lo que hemos aprendido y discutir las ventajas y limitaciones de las diferentes acepciones. Concluimos con la formulación de una definición de este concepto, ya que una correcta interpretación de la gestión del talento—por no hablar de una exitosa gestión del talento— depende de tener una comprensión clara de lo que se entiende por talento en un contexto organizativo. Además, con la definición de talento propuesta delimitamos el concepto de talento evitando algunos problemas detectados en las definiciones anteriores (por ejemplo, generalidades y tautologías), y poniendo de relieve las variables importantes que le afectan y lo hacen más manejable.

Use of Railroad Flat Cars for Low-Volume Road Bridges, August 1999

In an attempt to solve the bridge problem faced by many county engineers, this investigation focused on a low cost bridge alternative that consists of using railroad flatcars (RRFC) as the bridge superstructure. The intent of this study was to determine whether these types of bridges are structurally adequate and potentially feasible for use on low volume roads. A questionnaire was sent to the Bridge Committee members of the American Association of State Highway and Transportation Officials (AASHTO) to determine their use of RRFC bridges and to assess the pros and cons of these bridges based on others’ experiences. It was found that these types of bridges are widely used in many states with large rural populations and they are reported to be a viable bridge alternative due to their low cost, quick and easy installation, and low maintenance. A main focus of this investigation was to study an existing RRFC bridge that is located in Tama County, IA. This bridge was analyzed using computer modeling and field load testing. The dimensions of the major structural members of the flatcars in this bridge were measured and their properties calculated and used in an analytical grillage model. The analytical results were compared with those obtained in the field tests, which involved instrumenting the bridge and loading it with a fully loaded rear tandem-axle truck. Both sets of data (experimental and theoretical) show that the Tama County Bridge (TCB) experienced very low strains and deflections when loaded and the RRFCs appeared to be structurally adequate to serve as a bridge superstructure. A calculated load rating of the TCB agrees with this conclusion. Because many different types of flatcars exist, other flatcars were modeled and analyzed. It was very difficult to obtain the structural plans of RRFCs; thus, only two additional flatcars were analyzed. The results of these analyses also yielded very low strains and displacements. Taking into account the experiences of other states, the inspection of several RRFC bridges in Oklahoma, the field test and computer analysis of the TCB, and the computer analysis of two additional flatcars, RRFC bridges appear to provide a safe and feasible bridge alternative for low volume roads.

A Literature Review of Urban Bypass Studies, 1992

Urban places attract most highway travel because more people are to be per acre in urban places than elsewhere. In the beginning of highway development the objective was to provide an all-weather road for the rural people to get to town and back to their farms, but there was no consideration of getting motor vehicles through the town to the opposite side. With the development of intercity travel, it soon became apparent that travel through the urban areas would have to be given consideration along with the travel to and from the urban areas. This consideration led to the urban bypass, a provision in highway location whereby the traveler may get to the opposite side of the urban area without going through it, or at least not through the central business district. Bypasses, although highly desired by the through travelers, were not welcomed by local business interests on the basis that the community would suffer a reduction in retail trade. Some discussion of the pros and cons of bypasses and their consequences as observed from experience will shed light upon this type of local highway. The bypass report summaries in this document were based on interviews with businessmen and community leaders of cities that have actually experienced firsthand the impacts of a highway bypass. Several of the studies were conducted by newspaper reporters, city council members and residents of Iowa cities.

Product costing in SAP environment

Kustannuslaskennan ala on muuttumassa. IT teknologian hämmästyttävän nopea kehitys viime vuosina on luonut kustannuslaskennalle uusia mahdollisuuksia. Toisaalta myös kustannuslaskennalle asetetut vaatimukset ovat muuttuneet. Nykyisin kustannustietoutta tarvitaan erityisesti päätöksenteon tueksi. Kaikesta huolimatta yleisesti käytetyt laskentamenetelmät eivät ole muuttuneet. Työn tavoite on tutkia mahdollisia tapoja tuotekohtaisen kustannuslaskennan toteuttamiseksi SAP toiminnanohjausjärjestelmän avulla. Erityisesti toiminnanohjausjärjestelmien nopea kehitys on mahdollistanut aikaisempaa nopeamman ja tarkemman kustannuslaskennan. On kuitenkin muistettava, että järjestelmät ovat vaintyökaluja. On siis erittäin tärkeää valita tarkoituksenmukainen laskentamenetelmä. Työn perimmäinen tarkoitus onkin valita kyseessä olevaan tilanteeseen sopivin menetelmä.Viime vuosien akateemisessa kirjoittelussa on esitelty useita uusia kustannuslaskentamenetelmiä. Toimintolaskennan uusi versio, Time-Driven Activity-Based Costing, on eräs varteenotettava vaihtoehto tuotekohtaisen kustannuslaskennan toteuttamiseksi SAP-ympäristössä. Toinen hyvin soveltuva menetelmä on Resource Consumption Accounting (RCA), joka soveltuu erityisen hyvin SAP-ympäristöön.Molemmilla menetelmillä on hyvät ja huonot puolet, mutta tässä tapauksessa RCA soveltuu tehtävään paremmin. RCA on joustava ja tarjoaa laaja-alaista tietoa. Tästä syystä Resource Consumption Accounting oli paras vaihtoehto.Työssä rakennettu RCA malli testattiin kolmen erilaisen tuotteen historiallisella datalla. RCA:ntuomia mahdollisuuksia pohdittiin ja ongelmia selvitettiin. RCA on hyvin saman tyyppinen yrityksessä jo käytettävän laskentamenetelmän kanssa. Implementointi ei siis olisi mahdoton tehtävä. RCA kuitenkin tarjoaa mahdollisuuksia, joita nykyisellä menetelmällä ei voida saavuttaa.

Direct to consumer advertising : the case for greater consumer control

A nyone traveling to the United States from countries other than New Zealand will be surprised by the prevalence of health-related advertisements on television, including ads for drugs. Typically, these TV ads follow a pattern: an ad for a burger at only 99 cents, followed by one for a proton-pump inhibitor, then an ad on healthy home-cooked food delivered directly to your home and an ad for a home-based abdominal workout DVD, followed by an ad for a lipid-lowering drug. There are, however, nuances. After 8 pm, the visitor might encounter an ad for the "little blue pill." This sequence sometimes includes an ad featuring antihistamines for allergic rhinitis in spring and one promoting antidepressants in the winter. Such direct-to-consumer advertising (DTCA) of prescription drugs is usual business in the United States and New Zealand but is prohibited in the rest of the world. Why? Because DTCA for prescribing drugs has pros and cons (discussed elsewhere,1-3 including in JGIM4) that are balanced differently in different countries. Constitutional factors-such as the First Amendment protections on speech, including commercial speech, in the United States5 -as well as patient and population safety considerations, which all differ across countries, modulate reactions to DTCA. Additionally, lack of robust data on the impact of DTCA on prescription drug use adds to the confusion. Evidence, though limited, suggests that DTCA increases drug sales. However, whether the increase in sales corrects existing underuse or encourages over/misuse is not clear.

Tuning Performance of Multi-threaded programs

Diplomityö tarkastelee säikeistettyä ohjelmointia rinnakkaisohjelmoinnin ylemmällä hierarkiatasolla tarkastellen erityisesti hypersäikeistysteknologiaa. Työssä tarkastellaan hypersäikeistyksen hyviä ja huonoja puolia sekä sen vaikutuksia rinnakkaisalgoritmeihin. Työn tavoitteena oli ymmärtää Intel Pentium 4 prosessorin hypersäikeistyksen toteutus ja mahdollistaa sen hyödyntäminen, missä se tuo suorituskyvyllistä etua. Työssä kerättiin ja analysoitiin suorituskykytietoa ajamalla suuri joukko suorituskykytestejä eri olosuhteissa (muistin käsittely, kääntäjän asetukset, ympäristömuuttujat...). Työssä tarkasteltiin kahdentyyppisiä algoritmeja: matriisioperaatioita ja lajittelua. Näissä sovelluksissa on säännöllinen muistinkäyttökuvio, mikä on kaksiteräinen miekka. Se on etu aritmeettis-loogisissa prosessoinnissa, mutta toisaalta huonontaa muistin suorituskykyä. Syynä siihen on nykyaikaisten prosessorien erittäin hyvä raaka suorituskyky säännöllistä dataa käsiteltäessä, mutta muistiarkkitehtuuria rajoittaa välimuistien koko ja useat puskurit. Kun ongelman koko ylittää tietyn rajan, todellinen suorituskyky voi pudota murto-osaan huippusuorituskyvystä.

Innovatiivisen virtuaaliyhteisön edellytykset

Tutkielmassa tutkittiin innovatiivisen virtuaaliyhteisön toiminnan edellytyksiä. Teoreettinen viitekehys muodostui virtuaaliyhteisöjen, innovatiivisuuden ja luovuuden tarkastelusta. Tutkielman empiirisessä osuudessa käytettiin kvalitatiivista tutkimusotetta. Tutkimusaineisto perustui internetiin tutkimusta varten perustetun innovointiin keskittyneen keskustelufoorumin tuottamiin tuloksiin sekä ko. foorumin käyttäjien palautteeseen. Tutkimuksessa kävi ilmi, että innovatiivisuus vaatii motivoitumista käsiteltävään aiheeseen. Ideoijan täytyy kokea aihe mielenkiintoiseksi, jotta virtuaaliyhteisössä tapahtuva innovointi pystyy tarjoamaan parhaan etunsa eli välineen ajasta ja paikasta riippumattomaan ideointiin. Virtuaaliyhteisöllä tulee olla koordinaattori, joka pitää huolen tiedon kokoamisesta, yhteenvedoista ja ruokkii yhteisön aktiivisuutta. Yhteisössä innovoiminen edellyttää yhteisön ilmapiirin rakentamista otolliseksi avoimelle viestinnälle. Tämä syntyy rakentamalla luottamusta toimijoiden välille mm. kannustamalla sosiaaliseen viestintään. Virtuaaliyhteisössä passivoituminen on suuri uhka. Virtuaaliyhteisöä täytyy johtaa kannustaen ja pitäen kaikin keinoin huolta jäsenten aktiivisen keskustelun ylläpidosta. Passiivisuus aiheuttaa yleistä passiivisuutta, aktiivisuus nostaa aktiivisuutta. Toimijoiden anonyymius voi olla yhteisön voimavara, mutta tuo sitoutumattomuutta, jolloin mikä tahansa häiritsevä tekijä saa aikaan sen, että toimija voi jättää osallistumatta asian käsittelyyn ilman muualta kohdistuvia paineita. Anonyymiyden hyödyt ja haitat tulee punnita tarkoin.