141 research outputs found
A comparison of global surgery tariffs and the actual cost of bills at Hazrate Rasoole Akram educational and medical center
No full textBackground: The health service tariff is an appropriate policymaking tool and the financial leverage of the health system control which affects quality, availability, cost, efficiency, equity and accountability of health services. Global surgeries include 91 common cases of general and specialized surgeries in hospitals; fixed tariffs are annually defined for these surgeries, and insurance companies must pay medical centers based on these tariffs. The aim of this study was to examine and compare hospital bills with global surgery tariffs at Hazrate Rasoole Akram Educational and Medical Center in 2017. Methods: This descriptive-Analytic study was conducted retrospectively and compared the global and actual costs of global surgeries performed in the third quarter of the year 2017 at Hazrate Rasoole Akram Educational and Medical Center. Required data on the actual costs of surgeries was collected through the Hospital Information System (HIS) and patients' records. Information on the global costs was obtained from the Annual Circulars of Insurance Council for the studied period about the cost of global surgeries. Linear regression (STATA13 software) was used to investigate the effect of items on tariff and invoice differences; concerning other calculations, EXCEL software was used. Results: The highest frequency of global surgeries was related to ophthalmic surgery which accounted for approximately half of total surgeries performed at Hazrate Rasoole Akram Hospital. The most significant difference between global tariff and invoice was also related to ophthalmic surgery (188709.3 Dollar a year).Overall, the actual hospital bills were much higher than the tariffs approved for global surgeries, and the total difference was 461805.5 Dollar. The results revealed that there was a significant relationship between some of the items such as the cost of operating rooms, anesthesia and other services. Conclusions: Referral hospitals which are at the level three of referral networks usually treat more complex patients; this should be taken into account when defining surgery tariffs of these centers. On the other hand, hospitals need to control the costs and reduce the end cost of these surgeries by improving clinical management and cost management. In addition, prospective and case-based payment methods can control health costs. © 2020 The Author(s)
Impact of Domestic M&A on Acquirer Shareholder`s Equity: Evidence from Oslo Stock Exchange
No full textThe clear majority of research studies that has been conducted in the field of mergers and acquisition (M&A) are performance studies of acquirer post-M&A. Researchers has tried to get an insight into whether an M&A deal has had a positive or a negative effect on the acquiring company. In addition, most of these studies have been conducted on the US and UK market and hence the author wish to contribute to the existing literature by performing a specific study on the Norwegian market.
In the following thesis, I examine the short-term/immediate impact of selected domestic mergers and acquisition (M&A) deals on acquirer`s shareholder`s equity in the Norwegian market and I also examine whether this impact is influenced by the method of payment.
The author follow in the footsteps of numerous empirical researchers in the field of M&A and use event-studies to evaluate the performance of Norwegian M&A deals. The analysis investigates the Cumulative Abnormal Return (CAR) that measures a stocks unexpected returns and thus can be understood as the stock`s market reaction to the M&A announcement. The interpretation of CAR is that the stock price will on average react positively to M&A announcements when the Cumulative Average Abnormal Return (CAAR) and Average Abnormal Return (AAR) is greater than zero and statistically significant. The analysis considers selected domestic M&A deals on the Norwegian market in the period of 1995-2015 which add up to 38 deals that fulfills specific criteria`s.
HYPOTHESIS 1: Cumulative Average Abnormal Return (CAAR) is positive in the event-window
The results for CAAR show conflicting results and only significant values for the event-window of [-10, 10] and [-1, 1]. Due to significant conflicting results, Hypothesis 1 cannot be supported and hence the author has not been able to conclude whether Norwegian domestic M&A deals has created value or not.
HYPOTHESIS 2: Average Abnormal Return (AAR) is positive around the announcement date [0, 1]
The results for AAR shows that we have high statistically significant positive AAR around the announcement date. This indicates that the market views the M&A activity positively and hence Hypothesis 2 is supported.
HYPOTHESIS 3: Cash-only deals are positively related to CAAR
HYPOTHESIS 4: Mix-deal are positively related to CAAR
The results are not in line with the theoretical discussion in this thesis and not what the author would have expected. The results show that cash-only deals underperform both stock-only and mix deals.
Unfortunately, the results are not statistically significant and thus Hypothesis 3 and Hypothesis 4 are not supported.M-I
Role of biomarkers to identify individuals with silent cardiac disease to help improve primary prevention
No full textObjectivesThe aim of this study was to evaluate power of identification of silent cardiac target organ damage (TOD) in population receiving primary prevention with the use of biomarkers.BackgroundPrimary prevention of cardiovascular events could be improved by identifying patients with silent cardiac TOD (i.e., myocardial ischemia, systolic dysfunction, diastolic dysfunction, left ventricular hypertrophy or left atrial enlargement). Biomarkers used for screening included high sensitive CRP [hs-CRP] high sensitivity cardiac troponin T [hs-cTnT] , or B-type natriuretic peptide [BNP] .MethodsThe study included 271 asymptomatic individuals already receiving primary prevention therapy, they had their biomarkers evaluated. Identification of silent cardiac TOD was done by transthoracic echocardiography, stress echocardiography, and/or myocardial perfusion imaging. Carotid – femoral pulse wave velocity.ResultsShowed that ninety six (35%) patients had evidence of cTOD. Left ventricular hypertrophy evaluated by LV mass index showed the highest prevalence (32.7%), followed by left ventricular diastolic dysfunction (28.9%), left atrial enlargement (19.1%), systolic dysfunction (10.6%), ischemia (7.1%) and the lowest was PWV (2.7%). The discrimination power as evaluated by area under the curve [AUC] for BNP to identify any form of silent cTOD was 0.79 overall and 0.83 in men , while for hs-cTnT it was 0.70 and 0.74 in women. The combined AUC for BNP and hs-cTnT together was 0.81 and 0.82 in men. Week discrimination power existed for of other biomarkers, with AUCs of 0.61 for microalbuminuria, 0.60 for hs-CRP , and 0.58 for eGFR.ConclusionsAsymptomatic patients treated for primary prevention, existing silent cTOD could be identified by BNP screening. The result of hs-cTnT was weaker than that of BNP. Combining BNP plus hs-cTnT together showed best results. Primary prevention could be improved by Prescreening with BNP±cTnT followed by phenotyping
Wireless body sensor networks for health-monitoring applications
No full textThis is an author-created, un-copyedited version of an article accepted for publication in
Physiological Measurement. The publisher is
not responsible for any errors or omissions in this version of the manuscript or any version
derived from it. The Version of Record is available online at http://dx.doi.org/10.1088/0967-3334/29/11/R01
Surface Modification of Titanium and Polyimide Sheet for Adhesive Bonding
No full textMajor industrial sectors like automotive, aerospace and others are increasingly using polymer composites in their structural parts. Polyimide sheet and adhesives, are high performance polymers. They are widely used in various engineering applications due to their excellent thermal, mechanical and chemical properties and their resistance to radiation and fire. Unfortunately, the surface of polyimide like any other polymer is inert and exhibits poor adhesion properties. It is established that for successful application of polymeric composite materials to form structural parts using adhesive bonding, they need to have special surface properties like hydrophilicity. The surface modification of polymers and metals play a predominant role in enhancing the surface energy for improved adhesion properties. The aerospace industry is giving special attention to surface modification of titanium which could enhance the adhesive bond durability. In general, surface modification of titanium is carried out by chromic acid anodization. In this thesis work, an alternative surface preparation technique of titanium is investigated which could be of the interest for future research. We propose to modify the surface of titanium by plasma ion implantation, This is clean and solvent free technique, which could possibly be of interest to the aerospace industry in terms of adhesive bond strength and durability. It is also noted that in search of the long term durability and efficient service performance in the context of the future generation of aerospace structures, there is an increasing need of metal-polymer composites. Therefore, work of particular relevance to this project has been on the improvement of high performance polymer-titanium composites through high performance adhesive bonding. Several methods may be employed for modifying the surfaces of polymers and metals, which range from wet chemical processes to dry physical processes. Dry processes, like electrical treatment by exposure to plasma have received special attention because of the uniformity of these surface modifications, its precise control and the absence of chemical hazards. It is now well known that the plasma treatment creates physical and chemical changes such as cross linking, degradation, formation of free radicals, oxygen ions functionalisation and etching. A high temperature resistant and thermally stable polyimide adhesive as supplied by Creative materials Inc. was selected. TGA, DSC and FTIR analyses of this high performance polyimide adhesive were performed. After analysis, the polyimide adhesive is used as the standard adhesive for joining and testing materials in this project. There are mainly two types of surface treatments i.e. mechanical treatment and atmospheric pressure plasma treatment, that are combined in the present research. The grit blasting and atmospheric pressure plasma treatment time is optimized to get optimum values of surface roughness and surface energy. When these surfaces with optimum values of surface roughness and surface energy are joined together using the PI adhesive, a remarkable increase in the value of the adhesive bond strength during lap-shear testing is obtained. The bond strength is increased by two and half times compared to the lap-shear test results of untreated surfaces. The characterization of untreated and treated titanium surfaces with XPS, SEM, a surface roughness profiler and a contact angle analyser is performed. The Lap-shear test results suggest that the bond strength increases with an increase in surface energy. The surface roughness profiler results show that the surface energy increases with an increase in surface roughness. FTIR results suggest that the surface energy increases with a decrease in carbon contents and an increase in oxygen contents in the top layers of the titanium surface. The characterisation of the polymer surface after exposure to plasma reveals that the polar component of the surface energy increases due to chain scission and oxidation, leading to generation of polar groups such as C-O, C=O & COO on the polymer surface. Therefore, the total surface energy also increases, leading to enhanced adhesion. AFM analysis of polyimide sheet indicates that there is an increase in surface energy with an increase in surface roughness. In the last part of this research work, the effects of the moisture and high temperature on the adhesive bond strength of the modified surfaces is investigated. At high temperature and relative humidity conditions, moisture ingression in the adhesive bond line takes place at a faster pace than at room temperature. The modified surface adhesive bonds retain their bond strength at high temperature, while heated in dry environment. In case of moisture pre–condition at elevated temperature before lap-shear testing, the bond loses the improved bond strength, possibly due to the attack of polar water molecules on the interface bonds of titanium and polyimide adhesive. The present work aims to contribute to the knowledge and understanding of several aspects of the surface treatment of metals and polymers for adhesive bonding in high temperature applications. Different problems related to the surface treatment and adhesive bonding for high temperature application has been discussed. Efforts are made to evaluate the performance of the adhesive bonds between modified titanium and polyimide at elevated moisture and temperature conditions. The present work has produced some encouraging results to perform further research on surface treatment methods for coating and high temperature adhesive material for different aerospace applications.Precision and Microsystems EngineeringMechanical, Maritime and Materials Engineerin
Numerical investigation for cracks of rib-to-deck welded connection at the crossbeam junction in OSD using XFEM: A Crack Propagation Study Based on Linear Elastic Fracture Mechanics
No full textThe orthotropic steel deck (OSD) is nowadays commonly used due to its advantages, such as its lightweight, short construction time, and high capacity to bear the loads. However, fatigue cracks occur in different welded connections in the OSD. In this study, the rib to-deck-plate connection at the crossbeam conjunction has been analysed. This connection has been considered as a very critical connection due to the high-stress concentration under local wheel loading. In addition, the crack initiating at the weld root and propagating through the deck plate thickness cannot be visually inspected until surface cracks appear when the overlay is removed for the investigation. In the Netherlands, deck plate cracks at rib-to-deck plate connections at the crossbeam constitute a significant proportion of investigated cracks. In this thesis, a numerical investigation of the aforementioned cracks is carried out.First, XFEM is applied to study fatigue crack propagation using compact tension (CT) specimens. Commercial FE software package Abaqus® is used to build 2D and 3D CT models. The corresponding fatigue crack propagation is calculated in the direct cyclic step with strain energy release rate calculated using the virtual crack closure technique (VCCT). A good match is found between analytical calculation and 2D XFEM modeling. For 3D fatigue crack propagation, the number of cycles calculated from the automated crack propagation approach, using the low cycle fatigue step provided by Abaqus®, shows high sensitivity to element sizes, specifically the used element sizes through the thickness of the CT. Second, 3D crack propagation is applied to OSD with a 20 mm deck plate. For this detail, the fatigue crack initiation under compressive stress states is caused by the local loading on the deck plate. A hypothesis of changing the loading sign from compression to tension to subject the initial crack zone to tension is proposed so that this type of crack can propagate using automated XFEM. This assumption is made because high residual stresses normally exist in the welded connections and fatigue crack can propagate even under compressive stresses induced by loading. Before carrying out crack propagation calculation using VCCT, the stationary crack states were analysed using FEM and XFEM for cracks inserted with different angles. The SIFs obtained from FEM and XFEM are the same; in addition, that the SIF obtained when the detail is loaded in tension or compression has the same absolute value. Subsequently, the propagating crack analysis is carried out as a small initial crack with a depth of 0.5 mm is inserted and Paris’ law parameters C and m of 1∙ 10-13 and 3.0 were selected respectively. The obtained results of strain evolution as a function of loading history came close to that from the experiment with a difference of 7.75% for the initial strain value and 10.95 % for the maximum one. Moreover, the predicted crack shape, angle, and rate were all validated with similar crack shapes obtained from experiments in various literature. As for the crack propagation behaviour in the thickness direction, the crack arresting took place at around 75% of the deck thickness and an angle with the vertical axis of around 30o.Finally, the deck thicknesses of 16 mm and 10 mm were considered. Their results converged in terms of the crack propagation behaviour with real test specimens from the literature. It is also found that the 16 mm and 20 mm cases had a common crack propagation behaviour in the thickness direction as the crack arrest occurred at around 75% of the deck thicknesses, while for the 10 mm deck case the crack developed more dangerously by penetrating through the deck plate leading to a through-thickness crack. The approach proposed by this thesis proved to be valid for predicting the crack behaviour for the considered OSD deck plate thicknesses. Thus, the structural integrity of the detail can be assessed. This proved that for the 16 mm and 20 mm deck plates, the structural integrity is acceptable, while the 10 mm deck safety is not confirmed.Civil Engineering | Structural Engineerin
Effect of circadian rhythm of blood pressure on arterial wall stiffness and on left ventricular diastolic dysfunction
No full textBackgroundArterial stiffness is a risk factor for cardiovascular morbidity and mortality. Variability of blood pressure has been reported to be related to worse cardiovascular outcome. The relationship between the arterial stiffness and the circadian rhythm of blood pressure (BP) has been controversial. The objective was to the examine impacts of BP variability on left ventricular diastolic function and arterial stiffness in the hypertensive patients.MethodsAmbulatory BP monitoring, pulse wave velocity, and echocardiography were performed in 268 patients (153 males, 47±11years) with HTN and pre-HTN. BP was measured at the outpatient clinic and 24-h ABPM was performed. Using carotid femoral applanation tonometry, PWA was performed for evaluation of systemic arterial stiffness expressed as augmentation index. Echocardiograms were performed and an average of 3–6 cardiac cycles was done for all measurements including the left ventricular mass index (LVMI), relative wall thickness (RWT), trans mitral flow propagation velocity (Vp), TDI, and midwall shortening fraction (MWSF). Nocturnal dipping was defined as a reduction of diastolic BP (DBP) by >10% of systolic BP (SBP) when compared with the daytime values. Isolated systolic nondipping, is reduction of <10% in the SBP, When compared with the daytime values. Isolated diastolic non-dipping is reduction of <10% in the DBP. Both systolic and diastolic non-dipping is reduction of <10% in both SBP and DBP.ResultsAmong groups, the clinic SBP and DBP, daytime mean BP of 24-h ABPM, gender and body mass index were not statistically different. Augmentation pressure (AP), augmentation index (AI) showed statistically significant difference (p=0.008 and 0.021, respectively). Multivariate analysis showed that isolated diastolic non-dipping was correlated with arterial stiffness expressed as AI only in young group
Moisture absorption analysis of high performance polyimide adhesive
No full textThe high temperature resistant polymers and metal composites are used widely in aviation, space, automotive and electronics industry. The high temperature resistant polymers and metals are joined together using high temperature adhesives. Polyimide and epoxy adhesives that can withstand high temperature (200 °C-300 °C) are commonly used for joining high temperature metals and polymers. The performance of adhesively bonded metals and polymers depends upon physical properties of these high temperature adhesives. The physical properties like modulus, Tg. coefficient of thermal expansion (CTE) etc., are affected by external factors such as force, temperature, humidity etc. The external factors play a vital role in the adhesive bond strength and the durability of bond between metal and polymer. In this investigation moisture absorption analysis of polyimide adhesive is performed using Q5000 moisture absorption analyzer. The moisture absorption data of polyimide at different temperatures and humidity level is obtained. Further, the moisture absorption data is fitted to well known Fickian-fit model to determine the diffusion coefficient (D) and saturated moisture gain Msat. Diffusion coefficient (D) and Msat of polyimide and epoxy adhesive are calculated at different temperature and different humidity level. It is observed that diffusion coefficient changes with the change in temperature and humidity level. The diffusion coefficient (D) and M sat data are used in Fick’s second law of diffusion to estimate the time needed for preconditioning of the adhesively bonded titanium samples in humidity chamber at elevated temperature and higher moisture level. After preconditioning of adhesively bonded Titanium samples in moisture chamber for estimated time, samples will be subjected to lap shear tensile test to study the effect of these elevated conditions on adhesive bond strength.Precision and Microsystems EngineeringMechanical, Maritime and Materials Engineerin
"Wiersz numer 1 beta" M. R. Wiśniewskiego i "Read more+" P. P. Płucienniczaka
No full textThe article fits in the research on Polish digital poetry. It presents two realisations of digital poetry – wiersz numer 1 beta by M.R. Wiśniewski and Read more+ by P.P. Płucienniczak, focusing on aspect of work’s structural shape and possibilities of the user, given within interactive actions programmed by the author. The issues of the article are concentrated on interactive possibilities of work created in new media environment, especially on status of author and addresser, which is connected with interactivity phenomenon. Deliberations about the interactivity are based on works of Ryszard W. Kluszczyński, whereas changes made in poetry thanks to characteristics of new media were referred from works of such researchers as Urszula Pawlicka and Mariusz Pisarski. Deliberations on digital message refer mainly to works of Ewa Szczęsna. Two examples analyzed in the article represents different approaches of explorative potential of Polish digital poetry. Wiśniewski’s wiersz numer 1 beta, made in convention of game, includes the addresser as user-player in the process of work’s creation. Płucienniczak’s Read more+ is the example of intentional resignation of possibilities given by interactive actions.Artykuł wpisuje się w badania nad polską poezją cyfrową. Przedstawia analizę dwóch realizacji poezji cyfrowej – wiersza numer 1 beta Michała Radomiła Wiśniewskiego i Read more+ Piotra Puldziana Płucienniczaka, skupiając się na aspekcie strukturalnego ukształtowania utworu oraz możliwościach odbiorcy-użytkownika, jakie w ramach zaprojektowanych działań interaktywnych otrzymuje on od autora. Problematyka artykułu koncentruje się wokół zagadnień interaktywnych możliwości utworów powstających w środowisku nowych mediów, przede wszystkim zaś wokół statusu autora i odbiorcy, z czym wiąże się zjawisko interaktywności. Ustalenia dotyczące tego pojęcia oparte zostały na pracach Ryszarda W. Kluszczyńskiego, natomiast zmiany, jakie dokonały się w poezji za sprawą właściwości nowych mediów, przywołano na podstawie publikacji takich badaczy jak Urszula Pawlicka i Mariusz Pisarski. Rozważania dotyczące przekazu cyfrowego zreferowano głównie za Ewą Szczęsną. Analizowane w artykule dwa utwory cyfrowe to przykłady różnych kierunków potencjału eksploracyjnego polskiej poezji cyfrowej. Wiersz numer 1 beta Wiśniewskiego, zrobiony w konwencji gry, włącza odbiorcę jako użytkownika-gracza w proces powstawania utworu. Read more+ Płucienniczaka to z kolei przykład świadomej rezygnacji z możliwości, jaką dają interaktywne działania
Reinterpreting Palestinian Refugee Rights Under International Law, and a Framework for Durable Solutions
No full textBackground
The paper presented here is based on a much larger brief produced by two experts in international refugee law, Susan Akram and Guy Goodwin-Gill assisted by a team of law students at Boston University. Both the larger brief and the paper presented here argue for a re-interpretation of the current international refugee law which adequately expresses the principle of heightened protection for Palestinian refugees, a principle which had guided the drafting and consequent approval of international law and UN resolutions.
The author argues that the current lack of legal protection of Palestinian refugees derives from the misinterpretation of the existing refugee regime, especially the 1951 Refugee Convention, with regard to the Palestinian case. She proposes a legal reinterpretation which - if widely adopted - could turn international refugee law into an efficient tool for the protection of Palestinian refugee rights, including international protection in the framework of a durable solution based on the Palestinian right of return. The paper also addresses central strategic questions pertaining to legal representation and law enforcement which must be resolved in this context.
This paper was prepared for the international conference The Right of Return: Palestinian Refugees and Prospects for a Durable Peace organized by TARI in Boston on 8 April 2000. BADIL Resource Center thanks the organizers for their kind permission for its dissemination.
Introduction
Palestinian refugees have a status that is unique under international refugee law. Unlike any other group or category of refugees in the world, Palestinians are singled out for exceptional treatment in the major international legal instruments which govern the rights and obligations of states towards refugees: the 1951 Geneva Convention Relating to the Status of Refugees (Refugee Convention) and its 1967 Protocol (Refugee Protocol); the Statute of the United Nations High Commissioner for Refugees (UNHCR); and, specifically with regard to the Palestinians, the Regulations governing the mandate of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Almost all states and international entities have interpreted the relevant provisions in these instruments as severely restricting the rights of Palestinian refugees qua refugees in comparison to the rights guaranteed every other refugee group in the world. As a result, Palestinian refugees have been treated as ineligible for the most basic protection rights guaranteed under international law to refugees in general, further eroding the precarious international legal guarantees that international human rights and humanitarian law currently extends to this population.
There are a number of consequences flowing from this unique application of refugee law to the Palestinian refugee situation. First, it affects the question of the type of protection afforded Palestinians under international refugee law, as opposed to the assistance they receive as refugees. Second, it affects the extent to which Palestinian refugees can assert guarantees of international human rights and humanitarian law protections, and whether there are fora available for them to assert such rights. Third, it implicates the issue of what entity or agency has the authority to represent the interests of Palestinian refugees, whether in international bodies such as the United Nations, before other international or domestic legal/political fora, or in negotiations with states such as Israel. Fourth, it raises the complex issue of whether individual human rights recognized under international law can be protected and promoted in the Palestinian refugee case when such rights collide with collective rights under international law—in this case, the right to self-determination.
It is the contention of this author that interpreting refugee law principles and instruments as requiring a special and exceptionally weak international human rights regime for Palestinian refugees is an incorrect interpretation of the law. Palestinian refugees are entitled not to reduced protection, but to a heightened protection regime. These conclusions are based on an exhaustive review of the plain language of the relevant provisions, the intentions of the drafters of the instruments, and the purpose and scope of coverage of the instruments themselves. Reinterpreting the instruments in this way dramatically changes the conclusions one draws on each of the issues listed above. This paper addresses in summary form the four issues listed, examines their application under the reinterpreted instruments, and discusses some of their implications for establishing durable solutions for Palestinian refugees
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