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J. bras. pneumol.  vol.41 número6

J. bras. pneumol. vol.41 número6

Here, we report the cases of three patients diagnosed with extensively drug-resistant tuberculosis and admitted to a referral hospital in the state of São Paulo, Brazil, showing the clinical and radiological evolution, as well as laboratory test results, over a one- year period. Treatment was based on the World Health Organization guidelines, with the inclusion of a new proposal for the use of a combination of antituberculosis drugs (imipenem and linezolid). In the cases studied, we show the challenge of creating an acceptable, effective treatment regimen including drugs that are more toxic, are more expensive, and are administered for longer periods. We also show that treatment costs are signiicantly higher for such patients, which could have an impact on health care systems, even after hospital discharge. We highlight the fact that in extreme cases, such as those reported here, hospitalization at a referral center seems to be the most effective strategy for providing appropriate treatment and increasing the chance of cure. In conclusion, health professionals and governments must make every effort to prevent cases of multidrug-resistant and extensively drug-resistant tuberculosis.
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Economic analysis of the vaccination strategies adopted by Brazil in 1982

Economic analysis of the vaccination strategies adopted by Brazil in 1982

Average costs of vaccination versus the number of vaccinations administered at the health units of one institutfon, the Special Public Health Service (SESP), in the study municipalities[r]

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The economic costs of progressive supranuclear palsy and multiple system atrophy in France, Germany and the United Kingdom.

The economic costs of progressive supranuclear palsy and multiple system atrophy in France, Germany and the United Kingdom.

There were some similarities across the three countries in the use of services by patients with PSP (Table 2). The majority of patients had contacts with neurologists and around one-third with other specialists during the six-month period, and most had contacts with general practitioners. Most patients had also had adaptations to their homes, had prostheses such as wheelchairs or walking frames and received unpaid care from family or friends. Almost all received medication. Around one-quarter of patients spent some time in a residential or nursing home. There were some country differences to note. Physiotherapists were seen by around two-thirds of patients in France but by under half in the UK. Neurology inpatient care was used by relatively more patients in Germany (although other inpatient care was used by similar proportions). Social worker and speech therapist contacts were more likely in the UK. Nurses were seen by around two-thirds of all patients in France and the UK and fewer in Germany. Patients in Germany were more likely than those elsewhere to have received blood tests, EEGs and MRIs. Patients in France were the least likely to have received unpaid care from family/friends
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Minimum Distance Estimation of Search Costs using Price Distribution

Minimum Distance Estimation of Search Costs using Price Distribution

Building on the semi-nonparametric idea, we propose a two-step sieve least squares estimator for the cdf of the search cost. The estimation problem involved can also be seen as an asymptotic least squares problem where the parameter of interest is an in…nite dimensional object instead of a …nite dimensional one. We show that sieve estimation is a convenient way to systematically combine data from di¤erent markets. It can be used in conjunction with any aforementioned estimation method, not necessarily with the minimum distance estimator we propose in this paper. In the …rst stage an estimation procedure is performed for each individual market. In the second stage we use the …rst-step estimators as generated variables and perform sieve least squares estimation. Our sieve estimator is easy to compute as it only involves ordinary least squares estimation. We provide the uniform rate of convergence for our estimator. The ability to derive uniform rate of convergence is important as it gives us a guidance on the cost of estimation the entire function compared to at just some …nite points, which we know to converge at a parametric rate within each market.
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Costs of agency index: the need to measure agency costs

Costs of agency index: the need to measure agency costs

Munda (2012) states that “from a formal point of view, a composite indicator is an aggregate of all dimensions, objectives, individual indicators and variables used for its construction.” Also Freudenberg (2003), argues that “composite indicators are increasingly being used to make cross-national comparisons of country performance in specified areas such as competitiveness, globalization, innovation, etc. Rather than using a disaggregated menu of individual indicators, aggregated composites supposedly allow for analysis of interrelated performance or policy areas. They are popular in benchmarking exercises where countries wish to measure their performance relative to other countries and identify general areas where national performance is below expectations. Benchmarking with the aid of composites is often used to identify general trends, determine performance targets and set policy priorities.” This is the main advantage of using a composite indicator that leads us to choose one in our study.
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RAM, Rev. Adm. Mackenzie  vol.11 número5

RAM, Rev. Adm. Mackenzie vol.11 número5

Transaction costs are the costs to protect property rights. Institutions are shaped in order to control transaction costs in society. Studies have been developed to mea- sure transaction costs both at the macro and microeconomic levels. Entry costs, i.e., the cost to start up a new business are considered a proxy for business environ- ment quality, being also interpreted as a proxy to transaction cost measurement. This paper presents new elements in order to amplify the potential of research in business environment, particularly business entry costs. It stresses the limitation related to two theoretical points: first, the near decomposability of one complex transaction, and second, the complementarity between ex-ante and ex-post transac- tion costs, both related to the methodology adopted to measure business entrance costs.
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Influence of tungsten and titanium on the structure of chromium cast iron

Influence of tungsten and titanium on the structure of chromium cast iron

Studies have proved that structure of the chromium cast iron greatly depends on the additionally introduced elements such as titanium and tungsten. Titanium is a carbide-forming element, but in contrast to other elements of this type it does not form complex carbides in the chromium cast iron, but only a TiC carbide, which is formed at high temperature in the liquid metal. Tungsten is also a carbide-forming (and pearlite-forming) element but, like titanium, is rarely used in the manufacture of chromium cast iron. High melting points of tungsten and titanium may cause difficulties in the metallurgical process of chromium cast iron manufacture. Tungsten effect on the mechanical properties is similar to that of molybdenum, although it is weaker. Tungsten increases the hardenability of cast iron. Currently, the use of tungsten can be justified because of its price slightly lower than that of molybdenum.
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Evaluation of susceptibility of the ZRE1 alloy to hot cracking in conditions of forced strain

Evaluation of susceptibility of the ZRE1 alloy to hot cracking in conditions of forced strain

This work in combination with industrial tests of casting welding show that the causes of high-temperature brittleness are the partial tears of the structure and the hot cracks of both the castings and the welded and padded joints. Such phenomena should be treated as irreversible failures caused by the process of crystallisation that is in the area of co-existence of the solid and liquid structural constituent. The assessment of the resistance to hot fractures was conducted on the basis of the transvarestriant trial. The transvarestriant trial consists in changing of strain during welding It was stated that the range of the high-temperature brittleness is very broad, which significantly limits the application of the welding techniques to join or mend the elements made of alloy ZRE-1. The brittleness is caused mainly by metallurgical factors, i.e., precipitation of inter-metal phases from the solid solution.
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The Existence Of Leading Islands Securing And The Border Areas Unitary State Of Indonesia An Analysis In Law Perspective

The Existence Of Leading Islands Securing And The Border Areas Unitary State Of Indonesia An Analysis In Law Perspective

Abstract: The research was carried with the aim to discover the existence of securing the foremost islands and state border region of the Republic of Indonesia reviewed from a legal perspective, which is directly related to the existence of security and dispute resolution methods as well as the governance of the foremost islands and border region in Kalimantan which bordering Malaysia. This study was conducted in Nunukan district and the surrounding provinces of Kalimantan, in this research method that used is normative legal analysis data with juridical and qualitative descriptive approach. The results showed that the security of foremost islands and border region of law perspective in accordance with the Law No. 34 of 2004 regarding the Indonesian National Army has not been implemented to the fullest to realize the security of foremost islands and border region as the frontline of the Republic of Indonesia. The existence of leading islands securing and the border region of the Republic of Indonesia still contain many weaknesses in terms of both governance and security.
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Statistical Assessment of the Effect of Chemical Composition on Mechanical Properties of Hypereutectic AlSi17CuNiMg Silumin

Statistical Assessment of the Effect of Chemical Composition on Mechanical Properties of Hypereutectic AlSi17CuNiMg Silumin

Taking the above into consideration, for investigations the following alloys were selected: a hypereutectic AlSi17 silumin which was “enriched” with additions of ~3%Cu, ~1,5%Ni and ~1,5%Mg (added separately or jointly). A compilation of the examined silumins is given in Table 1.

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The Impact of the Expansion of the Bolsa Familia Program on the Time Allocation of Youths And Their Parents Lia Chitolina Miguel Nathan Foguel Naercio Menezes-Filho

The Impact of the Expansion of the Bolsa Familia Program on the Time Allocation of Youths And Their Parents Lia Chitolina Miguel Nathan Foguel Naercio Menezes-Filho

As the multinomial model is non-linear, the marginal effect of the treatment in a DID model is not the marginal impact of the interaction between time and treatment, but the difference of the cross-differences, as described by Puhani (2012). The results of Table 7 (in terms of marginal effects) show that the BVJ has a significant effect on the probability studying and working at the same time, but not on the other outcome variables. The estimated marginal effects mean that the probability of a youngster studying and working increases by 4.2 percentage points with the BVJ, compared with a baseline of 30% in the control group in 2006. The estimated coefficients for the categories ‘studying only’ and ‘working only’ were negative but not statistically significant. It seems, therefore, that treated adolescents do not quit their jobs to study because of the program, but do both activities at the same time. This raises questions about the long run impacts of the program, since the quality of the night classes is notoriously low in Brazil.
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The influence of the arc plasma treatment on the structure and microhardness C120U carbon tool steel

The influence of the arc plasma treatment on the structure and microhardness C120U carbon tool steel

The material used in this study was C120U steel. Chemical composition of this steel is presented in Table 1. Specimens as cuboids about dimensions 7,5 x 30 x 30 mm were conventional hardened (temperature austenitization – 770 o C, quenching in oil) and tempered (in temperature 250 o C). Temperatures hardening and tempering were chosen on the basis EN ISO 4957:1999 norms to obtain a structure with a relatively high toughness. Remelting surface was carried out using gas tungsten arc welding method. The surface of the samples were remelted by means of
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	Field Cancerisation of the Upper Aerodigestive Tract: Screening for Second Primary Cancers of the Oesophagus in Cancer Survivors

Field Cancerisation of the Upper Aerodigestive Tract: Screening for Second Primary Cancers of the Oesophagus in Cancer Survivors

Tobacco, alcohol, and betel quid are the main causes of squamous cell cancers of the upper aerodigestive tract. These substances can cause multifocal carcinogenesis leading to multiple synchronous or metachronous cancers of the oesophagus, head and neck region, and lungs (‘ield cancerisation’). Globally there are several million people who have survived either head and neck squamous cell cancer (HNSCC) or lung cancer (LC). HNSCC and LC survivors are at increased risk of developing second primary malignancies, including second primary cancers of the oesophagus. The risk of second primary oesophageal squamous cell cancer (OSCC) ranges from 8-30% in HNSCC patients. LC and HNSCC survivors should be ofered endoscopic surveillance of the oesophagus. Lugol chromoendoscopy is the traditional and best evaluated screening method to detect early squamous cell neoplasias of the oesophagus. More recently, narrow band imaging combined with magnifying endoscopy has been established as an alternative screening method in Asia. Low-dose chest computed tomography (CT) is the best evidence- based screening technique to detect (second primary) LC and to reduce LC-related mortality. Low-dose chest CT screening is therefore recommended in OSCC, HNSCC, and LC survivors. In addition, OSCC survivors should undergo periodic pharyngolaryngoscopy for early detection of second primary HNSCC. Secondary prevention aims at quitting smoking, betel quid chewing, and alcohol consumption. As ield cancerisation involves the oesophagus, the bronchi, and the head and neck region, the patients at risk are best surveilled and managed by an interdisciplinary team.
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Distributions of grain parameters on the surface of aircraft engine turbine blades

Distributions of grain parameters on the surface of aircraft engine turbine blades

In the quality assurance system for components cast using the lost wax method, the object of evaluation is the grain size on the surface of the casting. This paper describes a new method for evaluating the primary grain parameters on the surface of aircraft engine turbine blades. Effectiveness of the method has been tested on two macrostructures distinguished by a high degree of diversity in the grain size. The grounds for evaluating the grain parameters consist of geometric measurement of the turbine blade using a laser profilometer and of approximation of the measurement results using a polynomial of a proper degree. The so obtained analytical non-planar surface serves as a reference point for an assessment of the parameters of grains observed on the real blade surface of a variable curvature. The aspects subjected to evaluation included: the grain areas, shape and elongation coefficients of grains on a non-planar surface of the blade airfoil, using measurements taken on a perpendicular projection by means of a stereoscopic microscope and image analysis methods, and by making calculations using the Mathematica ® package.
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Buying Behavior Of Organic Vegetables Product The Effects Of Perceptions Of Quality And Risk

Buying Behavior Of Organic Vegetables Product The Effects Of Perceptions Of Quality And Risk

Quality is defined as the degree of excellence or superiority that an organization’s product possesses (Khan, 2005:28). Consumers judge or perceive the quality of the products and it also called perception of quality, because perception of quality derived from the analysis of consumers on product quality (Sanyal & Datta, 2011:605). Customer perceived value of product quality is a consumer opinion as ability of the product who suitable with expectation of consumer (Terenggana et al., 2013:326). Perception of quality is formed on consumers can be affected by several things including past experience, education, purchasing and consumer community (Yaseen et al., 2011:834), and perception of quality is important in improving the quality of products in the view of consumers (Parrol et al., 2013:603). Since knowledge and consumer needs change time by time, it taken an understanding related consumer perception of quality in evaluated to be known how big influence on purchase intention (Sanyal & Datta, 2011:607). Reviewing consumer behavior in foods, in previous research is often studied through perception of quality (Carrasco et al., 2012:1414). On last studied, perceived quality is the consumer’s judgment about a product’s overall excellence or superiority (Zeithaml, 1988). Meanwhile perceived quality is the judgment a consumer of product which refers to the physical characteristics of the product, and is related more to engineering and food technology (Carrasco et al., 2012). Several things that concern on perception of quality, first are spoke on the advantages related to the assessment of consumer products and the second on the technology applied to products that are both better than similar products. That matter is a critical element for consumer decision making, consequently, consumers will compare the
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Influence Of Industry Environment Adaptation To The Improved Performance Of Islamic Financial Institutions

Influence Of Industry Environment Adaptation To The Improved Performance Of Islamic Financial Institutions

Jones (2004) says that companies must constantly change or develop a way to use existing resources and capabilities to enhance the ability to create value and to develop its effectiveness. The amendment is intended to find improved performance. Performance is meant here is not the performance in the narrow sense that only limited to financial gain. Indeed, the advantage of course have to be hunted, because without profit companies will not be able to survive, but the goal of the company from a strategic management perspective is intended to Obtain and maintain a sustainable competitive advantage and Achieve superior performance. At first it only financial criteria used to assess whether or not the superior performance of a company. Performance serves as an instrument to determine whether the company has the ability to going concern, as well as a basis for formulating operational planning company in the future and for the information of shareholders, stakeholders, customers, regarding the achievements and success of the company. There are many approaches, in defining the performance, according to Mulyadi (2007: 337). Performance is the success of personnel, team, or organizational unit in achieving the strategic objectives that have been set previously with the expected behavior. Mulyadi, also explained that the successful achievement of strategic objectives needs to be measured. That is why the strategic objectives that form the basis of performance measurement is necessary to determine its size, and determined initiative to realize the strategic objectives of an organization tersebut.Tercapainya purposes only possible because of the efforts of the actors that exist in the organization. Prawirosentono (2000), defines performance as: "The work that is accomplished by a person or group in an organization within a certain time, in accordance with the authority and responsibilities of each, in an effort to achieve the goals of the organization in question legally, do not violate the law and in accordance with moral and ethical. In the related literature, there are two approaches to measuring the company's performance advantage (Supratikno et.al, 2005).
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Premature birth: An Enigma for the Society?

Premature birth: An Enigma for the Society?

Infants born preterm are at greater risk than infants born at term for mortality and a variety of health and developmental problems. Complications include acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-term motor, cognitive, visual, hearing, behavioral, social-emotional, health, and growth problems. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. The greatest risk of mortality and morbidity is for those infants born at the earliest gestational ages. However, those infants born nearer to term represent the greatest number of infants born preterm and also experience more complications than infants born at term. Preterm birth is a complex cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, neighborhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors and genetics. Many of these factors occur in combination, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. The empirical investigation was carried out to draw correlation between preterm birth and eventuality. This paper deals with various issues related to the premature deliveries from socio-biological perspectives.
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Determinants and Consequences of   the Website Perceived Value

Determinants and Consequences of the Website Perceived Value

Customer value begins to emerge in the 1990s as an issue of growing interest to business, in particular to marketing at both academic and practitioner levels. This concept is considered to be one of the most significant factors in the success of an organisation and an important element of online shopping (Burke 1999; Pulliam 1999; Klein 1998; Hoffman and Novak 1996). It has been envisioned as a critical strategic weapon in attracting and retaining customers (Lee and Overby, 2004). In this sense, the study in hand focuses on three consequences of the perceived value of the site which are site preference, future patronage intent and e-loyalty. Besides, previous researches (Parasuraman, 1997; Holbrook, 1999) have demonstrated the multi-dimensional and highly context-dependent nature of the perceived value. In the online retailing setting, not only the product itself, but also the web site contributes value to customer. Two fundamental variables are taken in consideration to describe the site quality namely telepresence and flow state.
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Prostate Cancer: A State of The Heart

Prostate Cancer: A State of The Heart

Prof Alberto Briganti’s presentation began with the case of a 57-year-old male diagnosed with a 4 + 3 bilateral extended prostate cancer. The patient displayed some CV risk factors, including diabetes and obesity. Following staging, the patient appeared to have no systemic disease in the bone or in the abdomen and pelvis; however, a prostate magnetic resonance imaging (MRI) scan showed a suspicious area of minimal extracapsular extension at the right apex. Prostate-speciic antigen (PSA) levels were 21.6 ng/mL, indicating that he was a high-risk patient. He consequently underwent bilateral extended pelvic lymph node dissection (PLND). The inal pathological report revealed that the patient had a Gleason score of 8, 2/21 positive lymph nodes, and a positive surgical margin, with complete recovery of urinary continence at 4 weeks after surgery. Post-surgery evaluation showed that the patient had a PSA of 0.07 ng/mL, had no spontaneous erections, and did not require a protective pad at 40 days.
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Modeling of Two-Stage Solidification: Part II Computational Verification of the Model

Modeling of Two-Stage Solidification: Part II Computational Verification of the Model

The above equation is one way to introduce the impingement into growth model. Another way would be to decrease the growth rate of eutectic growth by multiplying the growth velocity (Equation 3 from Part I) by factor 1 f . The later procedure is applied in models that describe solidification of alloys, with dominant eutectic structure. When grains nucleate at the boundary of other grains, the correcting factor must be changed as in [18]. Different forms of correcting factor should be also utilized when grains can move during growth process, as it was shown in [19]. For hypoeutecitc alloys preexisting dendritic structure may also delay the growth process of eutectic grains, and correcting factor is also required, as stated in [12,15]. Various types of this factor have been used for hypoeutectic alloys [12, 15, 17, 18]. For comparison purposes we have chosen the following factors: 1 f , 1 f , 1 f .
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