Univ., Diss., 2010--Marburg.

Objetivo: Comparar la valoración pronóstica de sobrevivencia de los score ASCOT y TRISS, en pacientes con trauma severo que ingresan a la Unidad de Trauma Shock del Servicio de Emergencia del Hospital Nacional Hipólito Únanue. Material y métodos: Diseño y tipo de investigación, de enfoque cuantitativo observacional analítico, transversal, retrospectiva. La recolección de datos se obtuvo de la revisión de historias clínicas de los pacientes admitidos con traumatismo severo del 01 de enero del 2008 al 31 de diciembre del 2010; el dato de sobrevivencia se recogió de la condición de vida del paciente al alta hospitalaria, vivo o fallecido. De los 253 pacientes ingresados, se trabajó con 215 casos. Los datos recolectados han sido ingresados en el programa estadístico SPPS 17.0 para su análisis. La calidad de predicción, calibración y discriminación se determinó con el área bajo la curva ROC, y el test de bondad de ajuste de Hosmer-Lemeshow. Resultados: La calibración de la valoración pronostica, realizada con el test H-L 17,36 para ASCOT y 18,45 para TRISS con una correspondencia de 91,6 para ambos scores. La discriminación del área ROC fue de 0,921 y 0,888 para TRISS y ASCOT respectivamente. Sensibilidad y Especificidad de 93,30% y 86 % para ASCOT; 95,20% y 80% para TRISS. Conclusión: ASCOT y TRISS tienen buena exactitud discriminativa para predecir sobrevivencia con un área ROC de 0,888 y 0,92, una alta Sensibilidad de 0,933 y 0,951, buena Especificidad de 0,86 y 0,80 para ASCOT y TRISS respectivamente, similar grado de correspondencia 91,6%. Pero ambos tienen una calibración H-L mayor de 15,5 con 17,36 vs 18,45. / Objective: Compare the prognostic rating of survival of ASCOT and TRISS score in patients with severe trauma admitted to the Shock Trauma Unit Emergency Service Hipolito Unanue National Hospital. Methodology: Design and type of research quantitative approach, observational analytical retrospective. Data collection was obtained from the medical record review, of patients admitted with severe trauma of 2008 January 1 to 2010 December 3. The information of survival was collected from the condition of life of the patient to the hospitable discharge, alive or deceased. Of 253 patients admitted, worked with 215. The collected data have been entered in the SPPS 17.0 statistical software for analysis. The quality of prediction about discrimination was determined with the area under the ROC curve and the Hosmer–Lemeshow (H-L) test for goodness of fit. Results: The calibration of the prognostic assessment, carried out with the HL test for ASCOT 17.36 y 18.45 for TRISS with an accuracy of 91,6 for both scores. Discrimination of ROC area was 0,921 and 0.888 for TRISS and ASCOT respectively. Sensitivity and specificity of 93.30% and 86% for ASCOT 95.20% and 80% for TRISS. Conclusion: ASCOT and TRISS have discriminative accuracy predict survival with an ROC area of 0.888 and 0.92, a high sensitivity of 0.933 and 0.951, good specificity of 0.86 and 0.80 respectively for TRISS and ASCOT similar degree of correspondence 91.6 %. But both have a HL> 15.5 Calibration with 17.36 vs 18.45. Keywords: ASCOT Score, Score TRISS, Survival.

A musical score.

Master of Science / Department of Statistics / Wei-Wen Hsu / Zero-Inflated Poisson (ZIP) models are often used to analyze the count data with excess zeros. In the ZIP model, the Poisson mean and the mixing weight are often assumed to depend on covariates through regression technique. In other words, the effect of covariates on Poisson mean or the mixing weight is specified using a proper link function coupled with a linear predictor which is simply a linear combination of unknown regression coefficients and covariates. However, in practice, this predictor may not be linear in regression parameters but curvilinear or nonlinear. Under such situation, a more general and flexible approach should be considered. One popular method in the literature is Zero-Inflated Generalized Additive Models (ZIGAM) which extends the zero-inflated models to incorporate the use of Generalized Additive Models (GAM). These models can accommodate the nonlinear predictor in the link function. For ZIGAM, it is also of interest to conduct inferences for the mixing weight, particularly evaluating whether the mixing weight equals to zero. Many methodologies have been proposed to examine this question, but all of them are developed under classical zero-inflated models rather than ZIGAM. In this report, we propose a generalized score test to evaluate whether the mixing weight is equal to zero under the framework of ZIGAM with Poisson model. Technically, the proposed score test is developed based on a novel transformation for the mixing weight coupled with proportional constraints on ZIGAM, where it assumes that the smooth components of covariates in both the Poisson mean and the mixing weight have proportional relationships. An intensive simulation study indicates that the proposed score test outperforms the other existing tests when the mixing weight and the Poisson mean truly involve a nonlinear predictor. The recreational fisheries data from the Marine Recreational Information Program (MRIP) survey conducted by National Oceanic and Atmospheric Administration (NOAA) are used to illustrate the proposed methodology.

There has been a growing interest in using propensity scores in the analysis of observational studies. The propensity score is a balancing mechanism that works to create groups of subjects which have a similar distribution on background covariates. Matching, stratification, inverse propensity treatment weighting and regression adjustment are all strategies that can be used with the propensity score to create balance between groups of subjects. The aim of this paper is to introduce propensity scores and the different techniques which make use of them. We use data obtained from the Women's Health Initiative to demonstrate each of the different methods for propensity score analysis. In the example analysis we examined the association between dog ownership and CVD. The results of our analysis were quite consistent, and demonstrate the propensity score analysis can be used effectively to balance treated and untreated groups within an observational study.

One Dollar Mandala is a string quartet in five movements. Each of the movements can function separately as a short piece and together they create a cyclical form that takes a little over half an hour in performance. The first movement, in its playful persistence pays homage to Gyorgi Kurtag's string quartet op.1. The second movement - under a working title "chorale" - alludes to rich harmonies of Bach and Scriabin that I can't stop admiring. The third movement, in rehearsals referred to as "mazurek" is a return to my roots of Polish folk dances and shows my admiration for Szymanowski's brilliant Mazurki op.50 for the piano. The fourth movement is a fragilite, a poem harking back to the sensual aspect of Scriabin's music. The final movement is a moto perpetuo exploring my fascination for the South Indian classical drumming tradition.

Introducción: Las recomendaciones del ATPIII y las SSCC europeas en prevención primaria cardiovascular aconsejan para la estimación del riesgo individual las funciones de Framingham y SCORE respectivamente. Ambas disponen de versiones calibradas para la población española. Todas, excepto Framingham(ATPIII), han sido derivadas para aplicarlas en un rango de edad limitado. Por otra parte, ninguna de estas funciones predice el riesgo cardiovascular total, ya que SCORE y SCORE calibrada sólo estima el riesgo de muerte y Framingham(ATPIII) y REGICOR el riesgo coronario. Sin embargo todas las medidas preventivas van dirigidas a la prevención de la enfermedad cardiovascular globalmente y las funciones son utilizadas como proxi del riesgo cardiovascular total. El objetivo es determinar cuál de estas funciones de estimación del riesgo cardiovascular es más útil para seleccionar al mayor número de pacientes con incidencia total de episodios cardiovasculares elevada. Método: Estudio observacional de cohortes de 1642 pacientes de 20 a 79 años no diabéticos, sin enfermedad cardiovascular establecida, en una Unidad de Hipertensión y Riesgo Vascular, seguidos un tiempo mediano de 3,8 años (rango 1- 10 años). Se registraron todos los episodios cardiovasculares mayores incidentes. Se calculó el riesgo predicho individual utilizando cada función. Se analizó el grado de concordancia para clasificar en grupos de riesgo utilizando los puntos de corte ≥5% en SCORE y SCORE calibrada, >20% para Framingham(ATPIII) y ≥10% en REGICOR. Se estimó para cada función la sensibilidad, especificidad, CPP, CPN, Odds ratio diagnóstica y exactitud. Se estimó la densidad de incidencia por el método de Mantel-Haenzel, y la incidencia acumulada en grupos de riesgo obtenidos al aplicar los algoritmos y compararlos mediante análisis de Kaplan-Meier. Se compararon las curvas de supervivencia mediante test de Breslow. Resultados: SCORE calibrada clasificó de alto riesgo a un 13,5%, SCORE a un 9,8%, Framingham(ATPIII) al 8,8% y REGICOR a un 3,5%. Durante el seguimiento 74 pacientes presentaron un primer episodio cardiovascular. La concordancia a la hora de clasificar en grupos de riesgo entre Framingham y SCORE (Kappa=0,37), y entre SCORE calibrada y REGICOR (Kappa=0,34) fue débil. Para cada función, el grupo de alto riesgo presentó un HR superior a 4 respecto al grupo de riesgo moderado/bajo. Todas las funciones presentaron una baja sensibilidad sin diferencias significativas, así como una exactitud moderada para discriminar pacientes con episodio cardiovascular. Al comparar SCORE vs Framingham(ATPIII) y SCORE calibrada vs REGICOR, la incidencia de episodios cardiovasculares en los grupos con discordancia en la clasificación de alto riesgo no presentó diferencias significativas. SCORE excluyó un 4,8% de pacientes de alto riesgo frente a un 5,8% por Framingham(ATPIII). SCORE calibrada excluyó un 0,4% de pacientes de alto riesgo frente a un 10,3% en el caso de REGICOR. Además, SCORE calibrada seleccionó un 4,2% más de pacientes respecto a SCORE con una incidencia significativamente más elevada que el grupo de riesgo moderado/bajo. En las mujeres por falta de potencia estadística no se observaron diferencias significativas. En los hombres SCORE excluyó un 7,1% de pacientes de alto riesgo frente a un 10,6% por Framingham(ATPIII), mientras que SCORE calibrada excluyó un 0,4% de pacientes de alto riesgo frente a un 16,1% por REGICOR con una probabilidad acumulada de ECV a los 5 años del 19%. Además, SCORE calibrada incluyó un 5% más de pacientes que SCORE con una probabilidad acumulada de episodios cardiovasculares a los 5 años del 17%. Conclusión: En prevención primaria, aunque el rendimiento de las cuatro funciones analizadas no presenta diferencias significativas, la concordancia entre ellas es débil, siendo SCORE calibrada la más útil para seleccionar al mayor número de pacientes con una incidencia de episodios cardiovasculares aumentada. / Background: The recommendations of ATPIII and the European scientific societies in cardiovascular primary prevention advise the estimate of the individual risk by Framingham and SCORE functions respectively. Both have versions calibrated for the Spanish population. The objective is to determine which of these functions is more useful to select to the greater number of patients with high cardiovascular incidence. Method: Longitudinal study of 1642 non-diabetic patients, without previous history of cardiovascular disease attending to a Hypertension and Vascular clinic. High-risk patients were considered those with ≥5% risk according to SCORE and calibrated SCORE, >20% on Framingham(ATPIII) and ≥10% on REGICOR. Major cardiovascular events were collected during a 3 year median follow-up (range 1-10 años) and analysed by Kaplan-Meier. Results: 13,5% of patients was considered of high-risk with calibrated SCORE function, 9,8& with SCORE, 8,8% with Framingham(ATPIII) and 3,5% with REGICOR. The concordance between SCORE and Framingahm(ATPIII) (Kappa=0,37), and between calibrated SCORE and REGICOR (Kappa=0,34) was poor. During follow-up 74 cardiovascular events occurred. The incidence of cardiovascular events in groups with disagreement in high risk classification, did not present differences, upon compared SCORE vs Framingham(ATPIII) and calibrated SCORE vs REGICOR. SCORE excluded a 4,8% of high risk patients as compared to a 5,8% by Framingham(ATPIII). Calibrated SCORE excluded a 0,4% of high risk patients as compared to a 10,3% in the case of REGICOR. Furthermore, calibrated SCORE selected 4,2% patients more than SCORE with incidence of cardiovascular events significantly highest that moderate/low risk group. In women, by lack of statistics power, it’s not observed meaningful differences. In the men SCORE excluded 7,1% of high risk patients as compared to 10,6% by Framingham(ATPIII). Calibrated SCORE excluded 0,4% of high risk patients as compared to 16,1% by REGICOR with acumulative probability of cardiovascular events at 5 years of 19%. Furthermore, calibrated SCORE included a 5% of men more than SCORE with an acumulative probability of cardiovascular events at 5 years of 17%. Conclusions: In primary prevention, calibrated SCORE is the most useful to select the greater number of patients with a cardiovascular events incidence increased.

No description available.

In recent years, the area of financial control of companies has developed substantially. Traditionally, companies were using budget and simple product calculation but today companies need complementary methods for control in a broad perspective. Among these methods, the Balanced Scorecard has developed as a tool to meet the needs for financial control and measurement systems. The aim of the Balanced Scorecard is to increase the efficiency of companies both in the long and short time-perspectives by controlling, measuring, and implementing the results of a specific strategy. Today, many companies suffer from internal problems associated with a lack of strategy in the integration of different departments. It is important for the business process to focus on obtaining favourable conditions for creation of new products and services, for increasing quality while reducing the costs by rationalization and simplification, and for reaching a faster delivery in terms of lead time. In order to become top of the line in the area of integration, Volvo IT has decided to perform an integration project incorporating a Balanced Scorecard. The main objective for this thesis is to develop a proposal for the Balanced Scorecard, and to identify the critical factors for success and the corresponding strategic measures. The Balanced Scorecard methodology can be used to monitor and balance the whole company, as well as individual divisions, both on the long- and short-term time perspectives. At Volvo IT the vision is to be regarded as the ideal IT supplier among its customers. For Volvo IT we found that the following four perspectives are suitable: the financial, customer, internal, and development perspectives. These perspectives can be applied to processes and activities at all divisions and levels of the company where it is judged to be useful. The idea is that everyone in the organization should know exactly what he or she should be working on for increasing the efficiency both at the level of the own division and for the company as a whole. To reach its vision, the strategy of Volvo IT is to develop a profound competence in the area of integration. Since introducing a Balanced Scorecard into an organization is a rather demanding project that normally takes one to two years, we have limited our work to create a proposal for Volvo IT. The design of the Balanced Scorecard also needs to be discussed in detail on the different levels at the company before the actual implementation. For the implementation phase, patience and flexibility is a prerequisite in order to obtain acceptance and understanding on all levels in the organization. Moreover, the use of a Balanced Scorecard is a dynamic process, where modifications are made regularly as internal and external conditions of the company are changing. We recommend Volvo IT to use the Balanced Scorecard, as described in this thesis, as a starting-point for the implementation phase. Based on the information obtained from our research interviews with key personnel, we have identified several critical factors for success and the corresponding strategic measures. We believe that introducing the Balanced Scorecard will be useful for the integration project at Volvo IT, strengthening the company with respect to future challenges.

No description available.