The importance of detecting and managing comorbidities in people with dementia?

Dementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which gradually interferes with social and occupational performance. It is a common worldwide condition with a significant impact on society. There are currently 36 million people worldwide with Alzheimer's disease (AD) and other dementias [1]. This is expected to more than double by 2030 (65 million) and reach ∼115 million in 2050, unless a major breakthrough is made. The worldwide societal costs were estimated at USD 604 billion in 2010 and rising [2]. To date research on the specific physical healthcare needs of people with dementia has been neglected. Yet, physical comorbidities are reported as common in people with dementia [3] and have been shown to lead to increased disability and reduced quality of life for the affected person and their carer [4]. Dementia is most frequently associated with older people who often present with other medical conditions, known as co-morbidities. Such co-morbidities include diabetes, chronic obstructive pulmonary disorder, musculoskeletal disorders and chronic cardiac failure and are common, 61% of people with …

A multi-organisational approach for disaster preparedness and response:the use of optimisation and GIS for facility location, stock pre-positioning, resource allocation and relief distribution

From 1992 to 2012 4.4 billion people were affected by disasters with almost 2 trillion USD in damages and 1.3 million people killed worldwide. The increasing threat of disasters stresses the need to provide solutions for the challenges faced by disaster managers, such as the logistical deployment of resources required to provide relief to victims. The location of emergency facilities, stock prepositioning, evacuation, inventory management, resource allocation, and relief distribution have been identified to directly impact the relief provided to victims during the disaster. Managing appropriately these factors is critical to reduce suffering. Disaster management commonly attracts several organisations working alongside each other and sharing resources to cope with the emergency. Coordinating these agencies is a complex task but there is little research considering multiple organisations, and none actually optimising the number of actors required to avoid shortages and convergence. The aim of the this research is to develop a system for disaster management based on a combination of optimisation techniques and geographical information systems (GIS) to aid multi-organisational decision-making. An integrated decision system was created comprising a cartographic model implemented in GIS to discard floodable facilities, combined with two models focused on optimising the decisions regarding location of emergency facilities, stock prepositioning, the allocation of resources and relief distribution, along with the number of actors required to perform these activities. Three in-depth case studies in Mexico were studied gathering information from different organisations. The cartographic model proved to reduce the risk to select unsuitable facilities. The preparedness and response models showed the capacity to optimise the decisions and the number of organisations required for logistical activities, pointing towards an excess of actors involved in all cases. The system as a whole demonstrated its capacity to provide integrated support for disaster preparedness and response, along with the existence of room for improvement for Mexican organisations in flood management.

Megtakarítások és külső finanszírozás az amerikai gazdaságban. A hitelpiaci válság háttere (1997-2007) (Savings and external financing in the American economy. The background to the credit-market crisis (1997–2007))

A tanulmány nem az aktuális hitelpiaci válság enyhítésének kérdésével foglalkozik, hanem az amerikai gazdaság elmúlt négy évtizedének általános és az utolsó tíz évének konkrét beruházási-megtakarítási és növekedési tendenciáit igyekszik feltárni. Azt vizsgálja, hogy milyen mélyebb, belföldi eredetű szerkezeti okai vannak a nemzetközivé dagadt jelzáloghitel-válságnak. A cikk a nyitott gazdaság külső finanszírozással összefüggő mérlegazonosságainak alapján arra a következtetésre jut, hogy az ingatlanpiaci visszaesés és a kibocsátás zsugorodása az Egyesült Államok gazdaságában már több mint másfél évtizede kialakult kedvezőtlen, de még tovább romló belföldi megtakarítási folyamatok következménye. A jelzálogpiac krízise és a lakásépítés drámai visszaesése a túlfogyasztásra és túlhitelezésre ösztönző pénzügyi környezet eredménye. A lakáspiaci és a hitelezési ciklusok pénzügyi innovációkkal történő megnyújtása inkább növelte, mint csökkentette a kibocsátásingadozás érzékenységét. A legfőbb hitelezők Kína, Japán, Németország inkább dolláralapú amerikai vállalati felvásárlásokkal ellensúlyozták a dollárgyengülésből elszenvedett veszteségeiket. 1997-2007 között az Amerikából külföldön befektetett dolláraktívák - javarészt a valuta leértékelődése nyomán - jelentős hozamemelkedést élveztek, és számottevően tompították a belföldön képződött jövedelmek csökkenését. A dollárleértékelődés az eszköz- (és nemcsak az áruexport) oldalon is előnyöket hozott számos nagyvállalatnak. / === / Rather than dealing with the immediate policy steps to dampen the crisis, this paper attempts to reveal the worsening savings/consumption pattern of the US economy over the last ten years. Based on the closed logic of open-economy GDP-accounting, it argues that the current crisis is deeply rooted in shrinking public and private savings trends discernible as early as 1997. The current mortgage-market crisis and deep fall in new residential housing are products of a distorted financial environment that encourages over-borrowing and over-consumption. Expansion of the credit cycle through successive financial innovations has increased, not decreased output volatility. But the main foreign lenders to the US—Japan, China and Germany—have managed to offset their losses on US securities by buying into US companies. Large US firms have also benefited from rapid dollar depreciation as USD-denominated yields on their foreign assets experienced strong run-ups. The weak dollar has also helped American firms with large assets on foreign markets. So there were strong benefits for the US, not just on the goods-export side, but on the asset side, an aspect rarely emphasized.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

Információtechnológiai projektek sikere és kudarca. Nemzetközi tapasztalatok és hazai kutatási eredmények

Az információtechnológiai projektek 44%-a kihívásokkal küzd és további 24%-a egyértelműen megbukott, miközben a globális IT-költés 2013-ban 3.700 milliárd USD körül alakult. Érthető, hogy a nemzetközi és a tudományos közvélemény egyaránt érdeklődéssel követi az IT-projektek sikeréhez vagy kudarcához köthető tényezők feltárására irányuló kísérleteket. A téma tárgyalását e cikkben a projektsiker alapos és többdimenziós fogalmi körüljárásával kezdik a szerzők, amely biztos alapot jelent a nemzetközi empirikus tapasztalatok bemutatásához. Kutatásuk során hazai szakértőket kérdeztek az IT-projektek bukásához vezető okokról és a sikerhez szükséges projektmenedzseri jellemzőkről. A legfontosabbnak ítélt bukási okok sorrendben a következők voltak: nem megfelelő kommunikáció az érintettek között, költségek/határidők alultervezése, és végül az elégtelen felsővezetői támogatás. Ezzel párhuzamosan a sikeres IT-projektvezetőknek a következő főbb kompetenciákkal kell rendelkezniük: változáskezelési képesség, kommunikációs képesség és vezetési képesség. Látható, hogy a kritikus tényezők elsősorban nem a technológiához kötődnek, hanem a projektmenedzsment folyamatához és emberi tényezőihez, a vezetői figyelemnek főként a tervezésre – és újratervezésre –, illetve az érintettek kezelésére érdemes irányulnia.

Economy of the island of eco-tourism: the role of shark-diving and shark harvesting

Beyond its importance in maintaining ecosystems, sharks provide services that play important socioeconomic roles. The rise in their exploitation as a tourism resource in recent years has highlighted economic potential of non-destructive uses of sharks and the extent of economic losses associated to declines in their population. In this work, we present estimates for use value of sharks in Fernando de Noronha Island - the only ecotouristic site offering shark diving experience in the Atlantic coast of South America. Through the Travel Cost Method we estimate the total touristic use value aggregated to Noronha Island by the travel cost was up to USD 312 million annually, of which USD 91.1 million are transferred to the local economy. Interviewing people from five different economic sectors, we show shark-diving contribute with USD 2.5 million per year to Noronha’s economy, representing 19% of the island’s GDP. Shark-diving provides USD 128.5 thousand of income to employed islanders, USD 72.6 thousand to government in taxes and USD 5.3 thousand to fishers due to the increase in fish consumption demanded by shark divers. We discover, though, that fishers who actually are still involved in shark fishing earn more by catching sharks than selling other fish for consumption by shark divers. We conclude, however, that the non-consumptive use of sharks is most likely to benefit large number of people by generating and money flow if compared to the shark fishing, providing economic arguments to promote the conservation of these species.

THE EPIDEMIOLOGY AND HEALTH ECONOMICS OF ANKLE INJURIES

The thesis focuses on a central theme of the epidemiology and health economics of ankle sprains to inform health policy and the provision of health services. It describes the burden, prognosis, resource utilization, and costs attributed to these injuries. The first manuscript systematically reviewed 34 studies on the direct and indirect costs of treating ankle and foot injuries. The overall costs per patient ranged from $2,075- $3,799 (2014 USD) for ankle sprains; $290-$20,132 for ankle fractures; and $6,345-$45,731 for foot fractures, reflecting differences in injury severity, treatment methods, and study characteristics. The second manuscript provided an epidemiological and economic profile of non-fracture ankle and foot injuries in Ontario using linked databases from the Institute for Clinical Evaluative Sciences. The incidence rate of ankle sprains was 16.9/1,000 person-years. Annually, ankle and foot injuries cost $21,685,876 (2015 CAD). The mean expenses per case were $99.98 (95% CI, $99.70-100.26) for any injury. Costs ranged from $133.78-$210.75 for ankle sprains and $1,497.12-$1,755.69 for dislocations. The third manuscript explored the impact of body mass index on recovery from medically attended grade 1 and 2 ankle sprains using the Foot and Ankle Outcome Score. Data came from a randomized controlled trial of a physiotherapy intervention in Kingston, Ontario. At six months, the odds ratio of recovery for participants with obesity was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment compared to non-overweight participants. The fourth manuscript used trial data to examine the health-related quality of life among ankle sprain patients using the Health Utilities Index version 3 (HUI-3). The greatest improvements in scores were seen at one month post-injury (HUI-3: 0.88, 95% CI: 0.86-0.90). Individuals with grade 2 sprains had significantly lower ambulation scores than those with grade 1 sprains (0.70 vs. 0.84; p<0.05). The final manuscript used trial data to describe the financial burden (direct and indirect costs) of ankle sprains. The overall mean costs were $1,508 (SD: $1,452) at one month and increased to $2,206 (SD: $3,419) at six months. Individuals with more severe injuries at baseline had significantly higher (p<0.001) costs compared to individuals with less severe injuries, after controlling for confounders.

An updated comprehensive techno-economic analysis of algae biodiesel

Algae biodiesel is a promising but expensive alternative fuel to petro-diesel. To overcome cost barriers, detailed cost analyses are needed. A decade-old cost analysis by the U.S. National Renewable Energy Laboratory indicated that the costs of algae biodiesel were in the range of $0.53–0.85/L (2012 USD values). However, the cost of land and transesterification were just roughly estimated. In this study, an updated comprehensive techno-economic analysis was conducted with optimized processes and improved cost estimations. Latest process improvement, quotes from vendors, government databases, and other relevant data sources were used to calculate the updated algal biodiesel costs, and the final costs of biodiesel are in the range of $0.42–0.97/L. Additional improvements on cost-effective biodiesel production around the globe to cultivate algae was also recommended. Overall, the calculated costs seem promising, suggesting that a single step biodiesel production process is close to commercial reality.

Techno-Economic Assessment of LNG and Diesel Production and Global Trading Based on Hybrid PV-Wind Power Plants and PtG, GtL and PtL Technologies

With growing demand for liquefied natural gas (LNG) and liquid transportation fuels, and concerns about climate change and causes of greenhouse gas emissions, this master’s thesis introduces a new value chain design for LNG and transportation fuels and respective fundamental business cases based on hybrid PV-Wind power plants. The value chains are composed of renewable electricity (RE) converted by power-to-gas (PtG), gas-to-liquids (GtL) or power-to-liquids (PtL) facilities into SNG (which is finally liquefied into LNG) or synthetic liquid fuels, mainly diesel, respectively. The RE-LNG or RE-diesel are drop-in fuels to the current energy system and can be traded everywhere in the world. The calculations for the hybrid PV-Wind power plants, electrolysis, methanation (H2tSNG), hydrogen-to-liquids (H2tL), GtL and LNG value chain are performed based on both annual full load hours (FLh) and hourly analysis. Results show that the proposed RE-LNG produced in Patagonia, as the study case, is competitive with conventional LNG in Japan for crude oil prices within a minimum price range of about 87 - 145 USD/barrel (20 – 26 USD/MBtu of LNG production cost) and the proposed RE-diesel is competitive with conventional diesel in the European Union (EU) for crude oil prices within a minimum price range of about 79 - 135 USD/barrel (0.44 – 0.75 €/l of diesel production cost), depending on the chosen specific value chain and assumptions for cost of capital, available oxygen sales and CO2 emission costs. RE-LNG or RE-diesel could become competitive with conventional fuels from an economic perspective, while removing environmental concerns. The RE-PtX value chain needs to be located at the best complementing solar and wind sites in the world combined with a de-risking strategy. This could be an opportunity for many countries to satisfy their fuel demand locally. It is also a specific business case for countries with excellent solar and wind resources to export carbon-neutral hydrocarbons, when the decrease in production cost is considerably more than the shipping cost. This is a unique opportunity to export carbon-neutral hydrocarbons around the world where the environmental limitations on conventional hydrocarbons are getting tighter.

Evaluating the efficiency of community-based HIV testing and counseling strategies in sub-Saharan Africa

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

Increased water charges improve efficiency and equity in an irrigation system

Conventional wisdom in many agricultural systems across the world is that farmers cannot, will not, or should not pay the full costs associated with surface water delivery. Across Organisation for Economic Co-operation and Development (OECD) countries, only a handful can claim complete recovery of operation, maintenance, and capital costs; across Central and South Asia, fees are lower still, with farmers in Nepal, India, and Kazakhstan paying fractions of a U.S. penny for a cubic meter of water. In Pakistan, fees amount to roughly USD 1-2 per acre per season. However, farmers in Pakistan spend orders of magnitude more for diesel fuel to pump groundwater each season, suggesting a latent willingness to spend for water that, under the right conditions, could potentially be directed toward water-use fees for surface water supply. Although overall performance could be expected to improve with greater cost recovery, asymmetric access to water in canal irrigation systems leaves the question open as to whether those benefits would be equitably shared among all farmers in the system. We develop an agent-based model (ABM) of a small irrigation command to examine efficiency and equity outcomes across a range of different cost structures for the maintenance of the system, levels of market development, and assessed water charges. We find that, robust to a range of different cost and structural conditions, increased water charges lead to gains in both efficiency and concomitant improvements in equity as investments in canal infrastructure and system maintenance improve the conveyance of water resources further down watercourses. This suggests that, under conditions in which (1) farmers are currently spending money to pump groundwater to compensate for a failing surface water system, and (2) there is the possibility that through initial investment to provide perceptibly better water supply, genuine win-win solutions can be attained through higher water-use fees to beneficiary farmers.

The Meanings of New Money: Social Constructions of Value in the Rise of Digital Currencies

Thesis (Ph.D.)--University of Washington, 2016-07

Modelación de la prima de riesgo que asumen los agentes en transacciones a plazo a través de los factores que influyen y explican el comportamiento de la tasa de cambio de la moneda colombiana con respecto a la de Estados Unidos

En este trabajo se pretende establecer que factores fundamentales influyen en el movimiento de la tasa de cambio COP/USD en un periodo intra-diario de forma horaria, para así poder establecer un modelo que ayude a estimar la prima de riesgo de la tasa de cambio colombiana -- Basados en Pantoja (2012)1, se pretende la aplicación de un modelo VAR (vectores autorregresivos) para estimar la prima de riesgo de la tasa de cambio, donde se encontró que este modelo no es el modelo más adecuado para explicar la serie de datos utilizada, por lo que se propone un modelo GARCH para modelar la serie -- Se encontró que hay factores fundamentales que explican la prima, como lo son el WTI, el S&P500 y la tasa de cambio EUR/USD

Puntos críticos del manejo poscosecha de cacao en Waslala, Nicaragua

En el período de enero a junio del 2009 se indagó el benefi ciado de cacao en 49 fincas de productores socios de la cooperativa CACAO-NICA en el municipio de Waslala, Nicaragua. El propósito del estudio fue generar información de los costos, tiempos y puntos críticos del benefi ciado en las fincas, y realizar un análisis FODA sobre la factibilidad de implementar el modelo de acopio de cacao en baba en dos centros comunitarios. Se aplicaron encuestas a productores y entrevistas semi-estructuradas al equipo técnico de CACAONICA y otros informantes claves vinculados con la comercialización local del cacao. Se elaboró una matriz clasifi cándose la información en relación a las variables tiempo, área de siembra, rendimientos y participación de la familia en la labores poscosecha del cacao. Todas las fi ncas visitadas poseen certifi cación orgánica. Treinta de los productores poseen áreas pequeñas de cacao (aproximadamente de una ha) y 19 cultivan entre 1.5 a siete ha. El beneficiado de cacao en la finca se compone de tres etapas y seis actividades: etapa 1 (cosecha y extracción-selección de semillas), etapa 2 (fermentación y secado) y etapa 3 (empacado y transporte). El proceso de benefi ciado se constituye de 21.7 días calendarios, sin embargo, el tiempo real requerido en días hombre resultó ser 9.14, con un costo de USD 40.33 para benefi ciar 45.45 kg de cacao (un qq). La etapa 1 resultó ser la más costosa del proceso de beneficiado (USD 30.13 por cada 45.45 kg). Los puntos críticos que afectan la calidad del benefi ciado del grano son: fermentación (41%) y secado (31%). El punto de equilibrio del benefi ciado en fi nca es 361.8 kg ha-1 ciclo-1. Rendimientos por debajo de este umbral signifi can que el cacaotal no retribuye los costos invertidos por el agricultor. La participación de la familia en el benefi ciado del cacao es relevante, especial atención requiere la participación de la mujer. La gran mayoría de los productores (69%) perciben como buena estrategia implementar el acopio de cacao en baba en beneficios centralizados, y ratifi caron su participación siempre y cuando el pago sea contra entrega del grano (USD 48.87 por cada 45.45 kg). El éxito del nuevo sistema de acopio dependerá de la gestión de capital para el condicionamiento de la instalación, la compra del grano a los productores, la definición de rutas lógicas de acopio en las comunidades, el equipamiento básico y la capacitación oportuna al personal técnico responsable de los centros de acopio.