Background: Current cesarean delivery (CD) rates in many industrialized countries are well above the recommended rates. Objective: The overall goal of this thesis was to identify sources for unnecessary CD. Specific objectives were to: 1) analyze the leading indications for CD and their associations with neonatal outcomes; 2) compare adverse birth outcomes between elective primary cesarean delivery (EPCD) and trial of labor after vaginal birth (TOLAV), and between elective repeat cesarean delivery (ERCD) and trial of labor after cesarean birth (TOLAC); and 3) assess the cost-effectiveness of ERCD and TOLAC. Methods: A retrospective cohort study was conducted. Leading indications for CD were analyzed and risks of neonatal outcomes between “soft” indications and “hard” indications were compared first, using 2006 to 2013 Better Outcomes and Registry Network Ontario data. A pair of analyses: comparing risks of adverse birth outcomes between EPCD and TOLAV and between ERCD and TOLAC, were then conducted using United States 2005 to 2010 birth registration data. Analysis were performed using logistic regression and propensity score matching models. Finally, a cost-effectiveness analysis between ERCD and TOLAC was performed. Results: The single largest contributor for overall CD was ERCD (34.3%) and for primary CD was dystocia (31.9%) in Ontario. Compared with infants of mothers with CD for “hard” indications, the risks of Apgar score <7 at 5 minutes for infants of mothers with CD for non-reassuring-fetal-status was increased, while the risks of Apgar score <7 at 5 minutes and neonatal death for infants of mothers with ERCD and dystocia were decreased. Compared with infants of mothers who underwent TOLAV, infants of mothers who underwent EPCD were more likely to require antibiotics and ventilation support, but less likely to have birth injury. On the other hand, compared with infants of mothers who underwent TOLAC, infants of mothers who underwent ERCD were less likely to require antibiotics and ventilation support. ERCD was similar to the TOLAC birth option in terms of cost effectiveness. Conclusions: Tight up criteria for “soft” indications such as labor dystocia could result in substantial reduction in CD without harming the infants.

La phase de primo-infection à VIH qui correspond aux premières semaines de l'infection est une phase cruciale qui détermine en partie l'évolution clinique de la maladie. La dynamique du virus et des lymphocytes T CD4+ (principale cible) durant cette phase est complexe. D'une part cette phase est asymptomatique dans plus de la moitié des cas et est semblable à un syndrome grippal; elle passe par conséquent très souvent inaperçue et peu de données sont disponibles. D'autre part la date d'infection est généralement inconnue ce qui complique l'étude de l'évolution au cours du temps des marqueurs viro-immunologiques. Les modèles dynamiques basés sur des systèmes d'équations différentielles permettent de prendre en compte l'interaction complexe et non-linéaire existant entre le VIH et le système immunitaire. De plus, leur aspect mécanistique peut être très utile pour la compréhension de la physiopathologie ou l'effet d'intervention. Cependant l'estimation de ces modèles est complexe et plusieurs méthodes sont disponibles à ce jour. Nous proposons dans cette thèse une méthode d'estimation pour des modèles dynamiques prenant en compte l'incertitude sur la date d'infection. Nous appliquons cette méthode à un jeu de données réelles de 761 séroconverteurs de la Collaboration CASCADE durant leur première année de suivi. Ces modèles possèdent un grand nombre de paramètres pouvant inclure des effets aléatoires et des variables explicatives. La sélection du meilleur modèle peut nécessiter l'estimation d'un grand nombre de modèles et peut s'avérer très longue. Nous proposons des tests du score pour sélectionner les effets aléatoires et les variables explicatives plus rapidement dans le cadre général des modèles non-linéaires à effets mixtes avec une illustration sur des modèles dynamiques. Enfin, nous proposons de comparer plusieurs modèles biologiques possibles de la primo-infection à VIH pour prédire la dynamique de la charge virale plasmatique et des CD4. / Primary HIV infection, which corresponds to the first weeks of infection, is a crucial phase which determines partly the clinical progression. The dynamics of HIV viral load and CD4 count during this phase is complex. First, as it is asymptotic in most of the cases, the primary HIV infection is not observed. Moreover, the date of infection is generally unknown and the evolution of markers with respect to the time of infection is difficult. Dynamical models based on systems of ordinary differential equations (ODE) allow to take into account complex non-linear between HIV and the immune system. Moreover, their mechanistic characteristic can be useful through the understanding of physiopathology or the effect of an intervention. However, the estimation of this kind of models is complex and several methods are currently available. We propose here a method of estimation for ODE models taking into account the uncertainty of the date of infection. This method is applied to real dataset of 761 seroconverters from the CASCADE Collaboration during their first year of follow-up. Dynamical models have many parameters on which we can include random effects and explanatory variables. The selection of the best model can be time-consuming if we consider the computation's time issues met during estimation. We develop score tests for exploring complex models with an application to HIV dynamics models. Finally, we compare different biological models of primary HIV infection to predict the dynamics of plasma viral load and CD4 count.

The theses speaks about satisfaction of customer as about one of the most important factor of company's prosperity. Firts chapter is devoted to theory of marketing research. Second chapter speaks about satisfaction of customers. Third chapter includes facts about AV MEDIA, a.s. and its activities. Two researches about AV MEDIA's customers satisfaction are analysed in fourth and fifth chapter. The last chapter contains critical view of both methods which were used. There are also some recommendations in order to make measurements more efficient in the future.

This study examined the effects of switching from an incentive pay system solely based on productivity to a scorecard-based incentive pay system. Performance of staff and senior accountants was analyzed across three departments for a two-year baseline and a three-year intervention period. Results showed that percent of charge hour goal remained high during the study. Once the scorecard-based incentive system was implemented, performance on the other line items increased or remained at or above goal levels. Incentive payouts were generally higher under the second incentive plan than under the first for top performers. Possible explanations for data trends, weaknesses of the measures within the scorecard, measure/line item alternatives and implications for future research are also discussed.

This study was concerned with testing two hypotheses frequently made in the interpretation of performance on the Children's Scale. The first hypothesis is that maladjustment is directly related to the amount of scatter and the second stresses that the specificity of maladjustment may be determined by the pattern of successes and failures.

Orientadores: Maria Aparecida Mesquita, Ciro Garia Montes / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:48:46Z (GMT). No. of bitstreams: 1 CustodioLima_Juliana_M.pdf: 1668374 bytes, checksum: ee0f2db5e25a3f2b8735d67b17331357 (MD5) Previous issue date: 2013 / Resumo: A hemorragia digestiva alta (HDA) é a emergência gastrointestinal mais frequente em todo o mundo. De acordo com a etiologia, a HDA se divide em varicosa e não varicosa. Existem poucos dados recentes da literatura nacional com relação à evolução dos pacientes com HDA, especialmente no que se refere à população idosa. Além disso, o uso de escalas prognósticas para avaliar o risco dos pacientes, como o escore de Rockall, embora recomendado por várias diretrizes, ainda não foi incorporado na prática clínica da maior parte dos hospitais brasileiros. Os objetivos do presente estudo foram avaliar as características clínicas, os achados endoscópicos e a evolução em 30 dias de pacientes com HDA não varicosa, e identificar os principais aspectos associados com a idade avançada...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital / Abstract: Upper gastrointestinal bleeding (UGIB) is the most frequent gastrointestinal emergency worldwide. According to the etiology, UGIB is classified into variceal and non variceal bleeding. There is a lack of recent data regarding the outcomes of non variceal UGIB in Brazil, specially in the elderly. Furthermore, although recommended by several guidelines, the use of prognostic scales for risk assessment, such as the Rockall score, has not yet been included in the daily practice of most Brazilian hospitals. The aims of this study were to evaluate the clinical features, endoscopic findings and outcomes within 30 days in patients with non variceal UGIB, and to identify the main characteristics related to advanced age...Note: The complete abstract is available with the full electronic document / Mestrado / Clinica Medica / Mestra em Clínica Médica

Autor no autoriza el acceso a texto completo de su documento hasta el 5/10/2020. / Magíster en Ingeniería de Negocios con Tecnologías de Información / Ingeniera Civil Industrial / Compañía Pesquera Camanchaca ha participado del mercado pesquero chileno desde 1965, convirtiéndose en la segunda empresa pesquera con mayor presencia en el país. Debido a los cambios en los mercados y con el fin de mejorar su competitividad, en el año 2012 la compañía lanzó el ambicioso proyecto Fish to Cash, cuyo fin era el rediseño y optimización de las cadenas de valor y sus procesos de soporte. Al alero de esta instancia, nace este proyecto de grado, cuyo objetivo principal es el rediseño y automatización del ciclo productivo y comercial de la línea de negocio de harina de pescado, perteneciente a la División Pesca, utilizando las herramientas y metodologías aprendidas en el Magíster de Ingeniería de Negocios con Tecnologías de Información, de la Universidad de Chile. El proyecto propone un rediseño transversal, con enfoque en la excelencia operacional de los procesos asociados al registro de la información de recepción de materia prima, producción, almacenamiento y gestión del producto terminado, además de las actividades relacionadas a la venta y generación de documentación. Los rediseños propuestos se basan en la definición e implementación de un sistema de asignación de puntaje al producto terminado, de acuerdo a su composición química y organoléptica. Adicionalmente, este sistema de score, se utiliza como base para reflejar el estado actual del mercado de la harina de pescado y para entregar una medición transversal de la calidad esperada y producida en todas las etapas. Al interior de la compañía, este proyecto es el primero de su tipo y ha generado un gran impacto debido a la profunda transformación de los procesos abordados, traduciéndose en beneficios económicos, como la disminución de la perdida de ganancias de un 12,47% en Septiembre 2013, a un 0,33% en Septiembre del 2014. Las herramientas desarrolladas son utilizadas en la compañía desde Octubre del 2013 de forma no automatizada, y desde Octubre del 2014 con una plataforma tecnológica. El proyecto es económicamente viable gracias al aumento en la facturación de la línea de negocio de harina de pescado, por mejoras en precios y calidad producida, esto es reflejado en el Valor Actual Neto positivo del proyecto, que con una tasa de descuento del 18%, alcanza los USD$ 5.463.336.

A partir da finalização do projeto genoma humano, fornecendo informação sobre o código genético de um indivíduo referência, pesquisadores direcionam a busca por sítios polimórficos existentes no DNA genômicos e mitocondrial capazes de influenciar direta ou indiretamente traços relevantes nas mais diversas áreas. No esporte esta busca tem sido direcionada para identificar marcadores genéticos associados aos fenótipos envolvidos com o desempenho físico (endurance vs. força e potência muscular). Atualmente, diversos polimorfismos foram associados ao desempenho físico-esportivo, em pelo menos um estudo. No entanto, como o rendimento desportivo é um fenômeno poligênico, ou seja, sob a regulação de vários genes, a associação de um polimorfismo é insuficiente para caracterizar o atleta. Hipóteses estão sendo desenvolvidas na tentativa de identificar o perfil poligênico (combinação de vários polimorfismos) em grupos de atletas. Alguns pesquisadores avaliaram o perfil poligênico preliminar de atletas europeus, analisando um conjunto de 7 a 10 polimorfismos, entretanto, esses achados precisam ser investigados em outras populações. O objetivo deste projeto foi traçar o perfil poligênico de atletas brasileiros. Para tanto, uma coorte brasileira envolvendo 342 atletas de endurance, 308 atletas de força e potência, 93 atletas de esportes coletivos, 165 atletas de lutas e 967 não atletas foi considerada neste estudo. O DNA genômico destes indivíduos foram extraídos e 34 polimorfismos foram genotipados. De uma forma geral, o grupo Endurance foi bem semelhante ao grupo Não atletas. Foi verificado que os polimorfismos AGT M235T - Alelo G, ACTN3 R577X - Alelo R, MCT1 D490E - Alelo T, PPARGC1A G482S - Alelo C, VEGFR2 Q472H - Alelo T, CNDP2 C/G - Alelo G e PPARA G/C - Alelo C podem ser considerados marcadores genéticos para atletas de atividades que envolvam a força e a potência muscular. Ainda, dos sete marcadores genéticos associados ao grupo Força/Potência, dois deles foram associados em coortes estrangeiras ao grupo Endurance, sugerindo que a população Brasileira pode apresentar associações específicas e diferenciadas. O escore total dos genótipos (TGS; modelo aditivo), utilizando os sete polimorfismos mais relevantes para a força e potência, foi eficiente em discriminar o grupo alvo, dos demais grupos. Foi observado que possuir uma quantidade >= 9 alelos associados (escore >= 64,3) aumentou significativamente a chance (76,8%) do indivíduo pertencer ao grupo Força/Potência. No entanto, existem atletas do grupo alvo, de destaque internacional (top atletas), que possuem um baixo número de alelos associados (2 a 4 alelos associados), bem como existem atletas de endurance que possuem um alto número de alelos associados (10 a 12 alelos associados). Possuir um número maior de alelos associados ao fenótipo alvo pode ser uma vantagem para o atleta, que precisa ser adequadamente estimulado por fatores ambientais. Contudo, uma associação genótipo-fenótipo não indica que o indivíduo pode antecipar uma carreira vitoriosa. O desempenho físico-esportivo reflete uma complexa interação de fatores ambientais ou sociais / After the conclusion of the human genome project, information about the genetic code of an individual (reference) was provided. Since then, scientists directed their research to identify polymorphic sites in genomic and mitochondrial DNA able to be associated with relevant phenotypes. In sports, the search has been directed to identify genetic markers associated with performance-related phenotypes (endurance vs. muscle strength and power phenotypes). Currently, many polymorphisms have been associated with physical performance in at least one study. However, as the sport performance is a polygenic phenomenon (i.e., under the regulation of several genes), the association of a single polymorphism is insufficient to characterize the athlete biology. Hypotheses are being developed in an attempt to identify the athlete polygenic profile (i.e., the combination of several sports-relevant polymorphisms). Some researchers evaluated a preliminary polygenic profile of European athletes by analyzing a range from 7 to 10 polymorphisms; however, these findings need to be investigated in other populations. The objective of this project was to explore the polygenic profile of Brazilian athletes. A Brazilian cohort involving 342 endurance athletes, 308 strength and power athletes, 93 athletes from team sports, 165 combat sports athletes and 967 non-athletes was evaluated. Genomic DNA of these individuals was extracted and 34 polymorphisms were genotyped. In general, the Endurance group was very similar to the Non-athlete group. The main associations were found when comparing the Strength/Power group with the Non-athlete group. Seven genetic markers were highlighted in the Strength/Power group. It was found that the following polymorphisms AGT M235T - Allele G, ACTN3 R577X - Allele R, MCT1 D490E - Allele T, PPARGC1A G482S - Allele C, VEGFR2 Q472H - Allele T, CNDP2 C/G - Allele G e PPARA G/C - Allele C can be considered genetic markers for Brazilian strength and power athletes. Of the seven genetic markers associated with Strength/Power, two were previously associated in other cohorts to Endurance, suggesting that the Brazilian population may have different and specific associations. The Total Genotype Score (TGS; additive model) using the seven most relevant polymorphisms was efficient to discriminate the Strength/Power group. It was observed that having a quantity >= 9 alleles associated (score >= 64.3) significantly increased the chance (76.8%) of belong to the Strength/Power group. However, there are some athletes of the Strength/Power group (international-level) showing a low number of associated alleles (2 to 4 associated alleles), as well as Endurance athletes showing a high number of associated alleles (10 to 12 associated alleles). A high number of associated alleles may be advantageous to the athlete; however they need to be properly stimulated by environmental factors. Any genotype-phenotype association does not indicate that an individual can anticipate a successful career. The athletic performance reflects a complex interaction of genetic and environmental / social factors

O experimento foi conduzido com o objetivo de avaliar o desempenho corporal e reprodutivo de 120 novilhas de corte de um rebanho comercial Braford do desmame ao fim do período reprodutivo aos 14/15 meses de idade, quando submetidas a três sistemas alimentares: pastagem de aveia preta (Avena strigosa Schreb.) e azevém (Lolium multiflorum Lam.) (AV+AZ), pastagem de aveia e azevém mais 1% do peso corporal de farelo de trigo (FT), pastagem de aveia e azevém mais 1% de peso corporal de farelo de trigo e 200ml/cabeça/dia de glicerina bruta (FTG) e da prenhez das novilhas aos 14/15 meses de idade ao fim da prenhez quando primíparas aos 24/25 meses de idade, quando submetidas a dois sistemas alimentares: pastagem de azevém (Lolium multiflorum Lam.) por 22 dias pós-parto e mais 22 dias em pastagem natural (PSS), pastagem de azevém por 22 pós-parto recebendo 1% de peso corporal de farelo de trigo e por mais 22 dias em pastagem natural (PCS). O delineamento experimental foi o inteiramente ao acaso, com medidas repetidas no tempo. Sem limitações na oferta forrageira, as suplementações não afetaram a taxa de prenhez, mas determinaram maior concepção nos primeiros 21 dias da temporada Novilhas prenhes, independentes dos tratamentos, têm melhores características fenotípicas de conformação, precocidade, musculatura e tamanho já ao desmame, têm maiores ganhos de peso e condição corporal até o início e ao fim dos tratamentos alimentares e início da temporada reprodutiva, o que permite uma seleção prévia, à idades menores, das bezerras a serem postas em sistemas para prenhez aos 14/15 meses de idade. Rebanhos com prenhez estabilizada aos dois anos de idade necessitam de seleção para maior precocidade sexual e prenhez aos 14/15 meses de idade, não somente ter pesos e condições corporais. Novilhas prenhas aos 14/15 meses de idade têm bom desenvolvimento em pastagem de tifton 85 nos meses de outono com a oferta de 2.500kg de MS/ha. Primíparas suplementadas por 44 dias no pré-serviço têm significativo maior ganho de peso, maior prenhez, com menores intervalo parto-concepção e intervalo entre partos do que as não suplementadas, porém ainda cerca de trinta dias a mais do que o recomendado em sistemas de cria de maior produtividade e eficiência. / This study aimed to evaluate the body development and reproductive performance of 120 Braford heifers from a commercial beef herd from the weaning to first breeding at 14/15 months of age, when submitted to three different feeding systems: black oat (Avena strigosa Schreb.) and Italian ryegrass (Lolium multiflorum Lam.) pastures (AV+AZ), black oat and Italian ryegrass plus supplementation with wheat bran at 1% of the body weight (FT), and black oat and Italian ryegrass plus supplementation with wheat bran at 1% of the body weight plus 200 mL head-1 day-1 of crude glycerol (FTG). We also evaluated the reproductive performance of primiparous cows first bred with 14/15 months of age at their second calving, when submitted to two feeding systems prior to the second breeding season: Italian ryegrass pasture for 22 days postpartum following another 22 days in natural pasture (PSS), and Italian ryegrass pasture for 22 days postpartum receiving 1% of the body weight of wheat bran, following another 22 days in natural pasture (PCS). Treatments were arranged in a completely randomized design with repeated measures in time. Without limitations on herbage allowance from the pasture, supplementation did not affect the pregnancy rate, but increased conception on the first 21 days of the breeding season Heifers that conceived, regardless of the treatments, had better phenotypic characteristics of body conformation, precocity, musculature and frame size at weaning. These animals also had greater average daily gain and body condition at the beginning and at the end of the feeding treatments, and at the beginning of the breeding season. Those traits could be used as indicators for an early selection of heifers to be designated to breeding programs at 14/15 months of age. Herds with stabilized conception at two years of age require selection for greater sexual precocity and conception at 14/15 months of age, and not only have adequate body weight and condition at the time of breeding. Heifers that conceived at 14/15 months of age with forage allowance of 2,500 kg DM ha-1 present good development in tifton 85 pasture during the autumn months. Primiparous supplemented for 44 days prior to breeding had greater weight gain and conception, with shorter calving-to-conception interval and shorter interval between calving than those not supplemented, but still about thirty days longer than recommended to calving systems with higher productivity and reproductive efficiency.

Fallet om Prosolvia ledde till det största skadeståndet som någonsin utfärdats i svensk domstol. Orsaken var att revisorn för bolaget inte hade rapporterat om väsentliga osäkerheter och felaktigheter i den finansiella rapporten trots att dessa förelåg. Detta ledde till att Prosolvia senare ansökte om konkurs. När ett bolag går i konkurs inom 12 månader från senaste räkenskapsåret och revisorn inte utfärdar en fortlevnadsvarning gör revisorn ett typ II-fel. Trots risken för skadestånd uppstår typ II-fel frekvent vilket visar på svårigheten och komplexiteten med fortsatt drift-bedömningen för revisorer. Tidigare studier har undersökt vad som kan tänkas påverka uppståndelsen av typ II-fel. Denna studie utökar forskningen genom att undersöka om revisorns kön, klientens bransch och ortens storlek påverkar sannolikheten av att revisorn gör ett typ II-fel samt studerar sambandet mellan finansiell stress och typ II-fel från revisorers perspektiv. Studien har skett med hjälp av ett kvantitativt tillvägagångssätt och analys. Enbart svenska onoterade bolag har använts för undersökningen. De bolag som utgör studiens dataunderlag har vidare haft sin senaste årsredovisning 2018, konkursen har varit inledd inom 12 månader från senaste räkenskapsår och en årsredovisning med revisionsberättelse har funnits tillgänglig. Resultaten indikerar på att vissa branscher påverkar sannolikheten av att revisorn gör ett typ II-fel samt att det finns väsentliga skillnader vad gäller finansiellt stressade bolag i revisorns fortsatt drift-bedömning. För räkenskapsåret 2018 hade 76 procent av bolagen som inlett konkurs inom 12 månader från senaste räkenskapsåret en revisor som gjort ett typ II-fel, vilket tyder på låg revisionskvalité överlag. Detta är något som måste förbättras i hopp om att förhindra och undvika fall, så som Prosolvia, från att upprepas. Studien bidrar till nuvarande forskning genom en holistisk vy av fortsatt drift-problematiken i en svensk kontext för helåret 2018, samt möjliggör för ytterligare forskning inom typ II-fel genom jämförelse med fler år. Studiens resultat ger vidare en ökad insikt kring typ II-fel, vilket kan assistera revisorer och revisionsbyråer i praktiken, men även myn-digheter eller likvärdiga regelsättare att förbättra fortsatt drift-rapporteringen. Det kan på så vis förbättra revisionskvalité vilket i sin tur gynnar samhället och näringslivet.