Ser dueño de un negocio puede ser por momentos agobiante. ASAC es una excelente opción que no sólo acompaña, sino que permite encontrar la solución a los problemas diarios desarrollando en nuestros clientes capacidades internas de gestión y ventajas competitivas fundamentadas en el conocimiento y el uso de la tecnología optimizando el tiempo dedicado a sus actividades. ASAC asesora a personas que trabajan desde casa permitiéndoles desarrollar estrategias que les permitirán reducir costos alcanzando la rentabilidad esperada, mejorando procesos y resultados, preparando a los emprendedores para ser dueños de su tiempo y no un empleado de su propia empresa; los ayudará a reencontrarse con los sueños que los llevaron a emprender y abrir su propio negocio. / Owning a business can be overwhelming at times. ASAC is an excellent option that not only accompanies, but also allows us to find the solution to daily problems by developing in our clients internal management skills and competitive advantages based on knowledge and the use of technology, optimizing the time dedicated to their activities. ASAC advises people who work from home, allowing them to develop strategies that will allow them to reduce costs, achieving the expected profitability, improving processes and results, preparing entrepreneurs to be owners of their time and not an employee of their own company; will help them to rediscover the dreams that led them to start and open their own business. / Trabajo de investigación

The Swedish electricity market was historically based on predictable and controllable power plants. The introduction variable renewable energy (VRE) sources in the market have led to less predictability and larger short-term variations in the generation profiles. These effects are compounded as the market share of VRE sources are increasing, and in Sweden’s case as the nuclear power plants are being phased out. Different metrics of value are calculated to shed light on the economic potential of new power sources. A not yet commonly used metric is the value factor of a technology, which represents the net increase or net decrease in revenue due to if the generation coincides with a high or low spot price of electricity. The thesis seeks to calculate the value factors and analyse their place within the northern European electricity market. In order to calculate the value factors and analysing them, the acquisition of datasets for varying market variables was required. The three sources of these datasets was for this thesis the ENTSO-E Transparency Platform, Nord Pool and Svenska kraftnät. These sources combined could supply datasets for market variables dating back to 2015 for Sweden and each country with an international connection with Sweden. This limits the scope of this analysis to 2015 - 2019 for Sweden and six other countries. The value factors were calculated for each Swedish electric price region divided into five categorical technologies, wind-, solar-, hydro-, nuclear- and heat power. The results from this only gave concrete results for two technologies. Wind power are shown to generally have a value factor below one and hydro power in the two northern regions have a value factor above one. This indicates that the market is saturated for wind power while in demand for hydro power from northern Sweden. Every other pair of technology and region vary as to not indicate whether the market is in demand of it or not. Analysing the association of variables was accomplished using a correlation study. Variables that consistently have a critical correlation factor, either linear or monotonic, are identified as associated variables. Out of these pairs of associated variables, the ones with a shared trend in either correlation or normalized regression with the trend of the appropriate value factor are identified as associated with the same value factor. This resulted in several associated variables for each value factor. Neither of these associations can by this methodology be identified as having a causal relation, it only displays correlations which could be incidental.

Insulin is a necessary, life-changing medication for patients living with Type 1 or Type 2 Diabetes Mellitus. Yet, a recent study at an endocrinology clinic in New England indicated that one quarter of patients experienced cost-related suboptimal insulin use. A new study based out of a primary care clinic in the Appalachian region looked at the prevalence of cost-related suboptimal insulin use within this region. The hypothesis is cost-related insulin suboptimal use is higher in the Appalachian region than as reported in the New England area. Surveys were administered to patients who were 18 years of age or older, diagnosed with Type 1 or Type 2 Diabetes Mellitus, and who had been prescribed insulin in the last 12 months. The survey instrument used was adopted and modified from the previous New England study. The survey instrument included 28 items and was administered in person prior to the start of the COVID-19 pandemic from July 2019 to April 2020. Following the start of the COVID-19 pandemic, in person recruitment was suspended. Beginning November 2020, a revised telephonic recruitment began and continued through December 2021. Interested participants were mailed the survey and consent form along with a postage paid return envelope. After the COVID-19 outbreak, the original survey instrument was revised to include 12 additional items designed to measure the impact of COVID-19 on the participant’s diabetes management and on insulin utilization. The primary outcome was cost-related underuse of insulin within the past year. This was measured by a positive response in the questionnaire to at least 1 of 6 questions: did you… (1) use less insulin than prescribed, (2) try to stretch out your insulin, (3) take smaller doses of insulin than prescribed, (4) stop using insulin, (5) not fill an insulin prescription, or (6) not start insulin… because of cost? Descriptive analysis was conducted using SPSS software. The East Tennessee State University Institutional Review Board approved the study protocol. Ninety respondents completed the survey. The average age of respondents was 68 years. The majority were diagnosed with type 2 diabetes (83%), Caucasian race (99%), male (59%), retired or disabled (76%), and had Medicare Part D prescription benefits (63%). The average monthly out-of-pocket cost for insulin was $84.10 (range $0-$566). For the primary outcome, results indicate 44.4% of participants in the Appalachian Mountain community experience cost-related suboptimal therapy. Forty participants completed the revised survey measuring the impact of COVID-19 on their diabetes self-management. From this group, 85% of participants reported their income and job did not change during the pandemic. However, increased dosing of insulin (30%) and increased insulin cost (27.5%) was reported. Respondents also reported increased stress (57.5%), worsened diet (25%) and worsened exercise (40%) as a result of the pandemic. Overall, a higher proportion of people with diabetes in the Appalachian region reported cost-related suboptimal insulin use compared to a previous study. The COVID-19 pandemic also has reportedly contributed to increased insulin requirements in one-third of the surveyed participants.

No description available.

Prior research shows that adult children of divorce (ACD) exhibit higher levels of perceived stress than adult children of marriage (ACM), and thus, potentially lower tolerance to stress. The comparison of ACD/ACM in Sweden has not been sufficiently studied. Hence, the present study aims to examine stress management among ACD and ACM, in terms of cognitive performance under different levels of induced stress, and how it correlates to self-ratings of stress. The final sample consisted of 101 adult participants (39 ACD and 62 ACM), and the mean age was 28 years old (41 males and 60 females). The result showed no difference in stress management between ACD and ACM, and their cognitive performance was not positively correlated with self-ratings of stress. However, ACD had a faster response time (RT) in all tests, even though this difference was not significant. At this time, ACD and ACM experience equally high levels of stress, as the Covid-19 pandemic might have influenced the outcome. Future research should collect more data of ACD in Sweden of other measurements of stress. / Tidigare forskning visar att vuxna skilsmässobarn (ACD) uppvisar högre nivåer av upplevd stress än vuxna med gifta föräldrar (ACM), och skulle därför potentiellt ha lägre stresstolerans. Jämförelsen mellan ACD/ACM i Sverige har inte blivit tillräckligt studerad. Därför har denna studie som mål att undersöka stresshantering bland ACD/ACM, i form av kognitiv prestanda under olika nivåer av inducerad stress, och hur det korrelerar till självskattningar av stress. Det slutgiltiga deltagarurvalet bestod av 101 myndiga deltagare (39 ACD och 62 ACM), varav medelåldern var 28 år, (41 män och 60 kvinnor). Resultatet visar att det inte var några signifikanta skillnader i stresshantering mellan ACD och ACM, och var inte positivt korreleradtill självskattningar av stress. Men, ACD hade en snabbare responstid (RT) i samtliga tester trots att resultatet inte var signifikant. Just nu, upplever ACD och ACM lika höga nivåer av stress, då Covid-19 pandemin kan ha influerat resultatet. Framtida forskning borde samla in mer data kring ACD i Sverige från andra mätningar av stress.

Presents a practical conceptual framework designed to determine the cost of quality based on nonconformance to a set of quality standards. This framework was implemented in a manufacturing environment. It utilizes an "open" system architecture which stresses a customer orientation. In this context, customer influence determines what is important in terms of quality. Standards are established for these elements which are used to gauge the performance and efficiency of the manufacturing process. Poor performance is then quantified in terms of relevant costs. The framework is designed to go beyond conventional cost of quality and nonconformance models, as it offers a solution path which utilizes employees to improve areas of nonconformance. Cultural, informational and technical organizational requirements needed to implement the framework advocated here are outlined.

To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p<.0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

Objective/Hypothesis: This study aimed to determine the clinical and cost-effectiveness of endoscopes during cholesteatoma surgery. More specifically, this study hypothesized that endoscope use would reduce cholesteatoma recurrence rates and cost. Study Design: Case series involving the prospective enrollment of 110 consecutive cholesteatoma patients over a 2-year period. Methods: Patients underwent cholesteatoma surgery with microscopy. During dissection, the location of the cholesteatoma was assessed. At the end of dissection and before reconstruction, the same subunits were visualized with straight and angled endoscopes for residual cholesteatoma. Hearing was analyzed before surgery and at the last possible examination. Costs were analyzed using Medicare reimbursement rates from the Centers for Medicare and Medicaid Services. Results: Intraoperative endoscopic surveillance was able to detect residual cholesteatoma in 18 patients. With a 0° endoscope, residual cholesteatoma was noted in the epitympanum (two patients), sinus tympani (one patient), and the supratubal air cells (one patient). With a 45° endoscope, residual cholesteatoma was noted in the epitympanum (three patients), sinus tympani (nine patients), the supratubal air cells (two patients), and the mesotympanum (two patients). From a cost analysis, endoscopic surveillance ($6110.36 per patient) are less expensive than second look surgeries ($11,829.83 per patient), observation ($7097.20 per patient), and observation with annual magnetic resonance imaging studies ($9891.95 per patient). The patients hearing improved after surgery, consistent with previous studies. No complications were noted from the use of endoscopes. Conclusions: Intraoperative endoscopic surveillance reduced recurrence in our series of 110 patients. Endoscopes are particularly useful in evaluating the epitympanum, mesotympanum, sinus tympani, and supratubal air cells. Moreover, endoscopic surveillance is cost-effective. Level of Evidence: 4 Laryngoscope, 128:2867–2871, 2018.

A group of 22 independent southeastern U.S. logging contractors provided 44 contractor-years of detailed cost and production information. Information was collected on demographics, operational characteristics, and business strategies for the participants. Precipitation was statistically proven to not be a good predictor of production, accounting for 2% of the weekly variation. High production through periods of favorable harvesting did not occur. Loggers contracting for the same mill in the same general area had higher than average production in the winter months and lower than average production in the summer months. Summary analyses for the entire population found that the cost of producing an additional ton dropped in 1997 by $0.90, but fixed annual costs rose. Predicting costs on the basis of production for the population was misleading. A comparison of total costs for individual firms with the population average (regression equation) found that the equation underestimated costs by as much as $408,000 and overestimated costs by as much as $528,000. Contracted services expenditures increased in 1997, as expenditures for equipment, consumables, and labor decreased. Over the study period, total costs per ton increased by 3.7%, but total production increased by 3.9%. The relationship between key cost components revealed strong evidence to disprove previously held theories. A major portion of the population increased production but experienced increased costs per ton. Replacement purchases of equipment tended to be of similar capabilities and technology and did not reduce labor costs. Trends in supply and equipment costs per-unit were not found in the expected fashion. / Master of Science

Despite the advances in antiretroviral therapy (ART) a disproportionate number of people living with HIV (PLWH) remain limited in their access and use of health care and treatment, including racial/ethnic minorities, persons with mental health and substance use disorders and persons experiencing homelessness or unstable housing. Patient navigation programs have emerged as a potential effective and efficient use of resources to reach and engage these vulnerable populations as part of the HIV service delivery system. This dissertation contains three chapters that aim to identify and assess the performance and mechanisms for navigation programs working with PLWH who experience homelessness and co-occurring substance use and mental health disorders. Study 1, Developing a Reliable and Valid Composite Measure of Effectiveness for HIV Navigation Programs for PLWH who are homeless/unstably housed, describes the development of a multidimensional outcome measure to assess the performance of navigation programs for this population. The composite measure was comprised of seven indicator variables: linkage to care, retention in care and adherence to treatment, patient experience of care, physical and mental health related quality of life and housing stability. Using multivariate analyses, a 3 item measure of retention, adherence, and housing stability was found to have high goodness of fit and strong predictive association with viral suppression. Study 2, Classifying Components of HIV Navigation Programs for PLWH who are homeless/unstably housed, used a latent-class analysis to identify common patterns of activities, modalities of communication, location of work, and staff composition among highest utilizers of services. Results showed that types of activities, work setting and modality of contact were significantly associated with increased retention in care. No difference in activity, staffing patterns, work setting or modality of communication of navigation programs were found on viral suppression rates. Study 3, An Economic Evaluation of HIV Navigation Programs Working with PLWH who are Homeless/Unstably housed assessed costs and net benefits of these navigation programs overall and in subpopulations. Cost utility and net benefit analyses performed indicated that navigation programs for PLWH who are homeless/unstably housed are a potential efficient investment of resources at various willingness-to-pay thresholds. Navigation programs provide a myriad of services for PLWH who are homeless/unstably housed and must be flexible in their approach to address the multiple medical and psychosocial needs of this population. The results of this dissertation provide information for improving the design, measuring performance and costs and benefits of navigation programs as part of the HIV service delivery system for PLWH who experience homelessness. / 2020-06-30T00:00:00Z