PPP: a risk approach in the water sector

Objective: This thesis provides a theoretical and managerial contribution on how PPP can address risk in the water sector in developing countries. Three thesis objectives support the results. The first identifies literature contributions, the second is related to the perception of risk management by different stakeholders, and the third concerns the risk approach in PPP water contracts in developing countries. Design: A hybrid method combining systematic, semantic network, and narrative analysis review of previous research supported the first objective. To answer the second thesis’ objective, a semi-structured interview using quantitative and qualitative analysis identified the perception of risk management in PPP water projects. To support the third objective, a case study provided interesting insights regarding the risk approach in PPP contracts Findings: From a total of 122 studies, the first objective, identified five main PPP research domains: risk management, contracts, infrastructure, governance, and financing and tariffs. Twenty-five risk factors with high impact were established as a result of the semiinterviews. The top-five critical risk factors are related to political interference, no baselines for performance measurement, unfavourable global private investment climate, non-payment of bills and water asset condition uncertainty. The case study showed how PPP contracts can fail for not having risk management concerns and we have underestimated risks as conflicts between partners. The traditional risk management approach in PPP contracts showed that there is space to improve. The key risk indicators approach was proposed. Originality: Research outputs showed that PPP laws and sector legislation should be permanently adapted to the local needs. The traditional risk management framework fails to provide a solution. The key risk indicators introduce a paradigm shift, which provides useful guidelines for future studies.Objectivo: Esta tese tem como objetivo ser uma contribuição teórica para a abordagem de como os contratos de Parcerias Públicas Privadas (PPP) abordam a gestão de risco no sector da água em países em vias de desenvolvimento. Os três objetivos da tese suportam os resultados apresentados. O primeiro identifica as contribuições da literatura, o segundo recai sobre a perceção de especialistas sobre a abordagem do risco e o terceiro capta a abordagem do risco dos contratos do tipo PPP em países em vias de desenvolvimento. Metodologia: Com o objetivo de responder ao primeiro objetivo da tese, foi aplicada uma metodologia híbrida através da combinação de uma revisão bibliográfica sistemática, semântica e análise narrativa. Os contributos do segundo objetivo da tese, suportaram-se em entrevistas semiestruturadas através do recurso à estatística descritiva e análise de conteúdo. O terceiro e último objetivo teve como base um estudo de caso. Resultados: A revisão da literatura identificou um total de 122 estudos e a existência de cinco campos relevantes nos contratos do tipo PPP: gestão de risco, contratos, infraestruturas, governança, aspetos financeiros e tarifas. O resultado do segundo estudo identificou vinte e cinco fatores de risco. Os cinco fatores que apresentaram uma maior frequência foram: interferência política, ausência de bases de medição do desempenho, um contexto de investimento desfavorável, o não pagamento das faturas e o desconhecimento do estado de preservação das infraestruturas. Os resultados do terceiro estudo mostraram que o sucesso de um contrato do tipo PPP pode ser comprometido na ausência de uma gestão de risco adequada, onde as gestões de conflitos entre parceiros sejam subestimadas em termos contratuais. A temática gestão de risco nos contratos do tipo PPP tem oportunidades de melhoria. Assim, propõe-se a introdução de indicadores chave de desempenho do risco. Originalidade: As leis com impacto nos contratos do tipo PPP devem ser continuamente atualizadas e adaptadas às distintas realidades. É proposta uma alteração de paradigma através da introdução dos indicadores chave de desempenho do risco, fornecendo possíveis linhas orientadoras para pesquisa futura

Tracing Neoclassical Influences in selected solo and chamber music for the clarinet

The musical period of Neoclassicism began in the 1920's, between the first and second world wars. It was initiated by French composers and eventually spread to other countries. One of the most important themes to emerge from the movement was to escape from the formless, rather emotional music of the Romantic era and instead, emphasize balance, order, objectivity and clarity in musical form. Many popular clarinet repertoires are enjoyed by performers and listeners because the music is enjoyable to play and easy to listen to. In particular, classically influenced clarinet music is quite interesting because it features musical elements from both the past and contemporary musical styles. For instance, some composers have integrated preexisting, more traditional styles of composition with lighter styles of modern culture such as popular music and Jazz. It is difficult to discover purely neoclassical clarinet repertoires even though many composers created their pieces during the neoclassical era. What we most commonly find are both neoclassical and non-neoclassical influences in compositions from that time period. Thus, I aim to trace the influence of neoclassicism in selected clarinet repertoires that exist today. It is my hope that increased awareness and knowledge about accessible clarinet music may encourage the general public to develop a deeper interest in a wider sphere of clarinet music, beyond what is considered popular today. The works performed and discussed in this dissertation are the following: (Recital I) Duo Concertante by Darius Milhaud; Sonata by Leonard Bernstein; Sonata for Two Clarinets by Francis Poulenc; Duos for Flute and Clarinet, Op. 34 by Robert Muczynski; Dance Preludes by Witold Lutoslawski, (Recital II) Sonatine by Arthur Honegger; Time pieces by Robert Muczynski; Suite for Clarinet, Violin and Piano by Darius Milhaud; Sonate for Clarinet, Flute and Piano by Maurice Emmanuel; Tarantelle for Flute, Clarinet and Piano, Op. 6 by Camille Saint-Saëns, (Recital III) Sonatina by Joseph Horovitz; Suite from L'histoire du Soldat for Clarinet, Violin and Piano by Igor Stravinsky; Contrasts for Clarinet, Violin and Piano by Béla Bartók The recitals that took place on December 1, 2012 and on April 25, 2013 were performed in the Ulrich Recital Hall of the Clarice Performing Arts Center in College Park, Maryland. The recital that took place on November 2, 2013 was performed at the Gildenhorn Recital Hall of the same performing arts center

A regulação do sector do saneamento em Portugal : uma perspectiva económica

Mestrado em EconomiaO sector da Água e Saneamento esta fortemente marcado pela intervenção directa do Estado. Apesar de serem indústrias distintas, ainda co-existe uma plataforma comum ao nível das políticas orientadoras. Apesar da inexistência de uma política comum ao nível comunitário, surge uma tendência liberalizadora entre todos os Estados Membros. Sendo o papel de cada país preparar da melhor forma este sector de tão vital importância para o bem-estar das populações, para uma possível abertura ao sector privado. Este trabalho versa essencialmente sobre o actual molde regulatório, em vigor no nosso país, balizando as suas virtudes e principais obstáculos. A análise das características e as tendências de organização e pricing do sector a nível Europeu são desenvolvidas com base em análise de literatura e relatórios. A segunda parte aborda o caso Português, incorporando uma análise do modelo de organização e gestão, os pontos e fracos do mesmo, e demonstrando com um caso concreto as dificuldades financeiras das entidades gestoras, causadas pelo actual modelo. Ao nível dos contributos a nível académico, pretende-se para além de desenvolver uma sistematização dos possíveis modelos regulatórios, efectuouse uma revisão bibliográfica das diversas formas de pricing para os monopólios naturais. Nos contributos da componente prática, destaca-se uma revisão do actual estado dos sistemas de água e saneamento na Europa e em particular em Portugal, evidenciando a problemática da sua sustentabilidade económicofinanceira, procurando novos caminhos para a sua resolução. A reorganização interna e re-definição do pricing em vigor, são considerados dois pontos-chave para o sucesso do actual modelo regulatório em vigor. ABSTRACT: The Water and Sewerage fields are heavily subject to state intervention. Although being two distinct industries they share a common base for orientation policies. Even in the absence of a European Union common policy, emerges a tendency towards liberalisation amongst member states. These industries being of such an importance for the well being of populations that it is capital for each country to prepare for a possible opening to the private sector. This research will explore the current Portuguese regulatory frame, analysing its virtues and downsides. The analysis of the characteristics, organisational trends and pricing of the industry is based on literature and reports. Part two is dedicated to the case of Portugal including a study of the organizational and management models. A case study is used to illustrate the financial issues caused by the present model. From an academic stand point this work aims at a systematization of the regulatory models, based on an in-depth bibliographical research of the several type of pricing within the natural monopolies. In practice this work shows the current situation of the The Water and Sewerage systems in Europe and particularly Portugal. Highlighting the problems of its economic and financial sustainability and looking for new ways to solve them. The internal reorganization and re-definition of pricing are considered two key points to the success of the current regulatory model

Regulation of endothelial nitric oxide synthase by agmatine after transient global cerebral ischemia in rat brain

Nitric oxide (NO) production by endothelial nitric oxide synthase (eNOS) plays a protective role in cerebral ischemia by maintaining vascular permeability, whereas NO derived from neuronal and inducible NOS is neurotoxic and can participate in neuronal damage occurring in ischemia. Matrix metalloproteinases (MMPs) are up-regulated by ischemic injury and degrade the basement membrane if brain vessels to promote cell death and tissue injury. We previously reported that agmatine, synthesized from L-arginine by arginine decarboxylase (ADC) which is expressed in endothelial cells, has shown a direct increased eNOS expression and decreased MMPs expression in bEnd3 cells. But, there are few reports about the regulation of eNOS by agmatine in ischemic animal model. In the present study, we examined the expression of eNOS and MMPs by agmatine treatment after transient global ischemia in vivo. Global ischemia was induced with four vessel occlusion (4-VO) and agmatine (100 mg/kg) was administered intraperitoneally at the onset of reperfusion. The animals were euthanized at 6 and 24 hours after global ischemia and prepared for other analysis. Global ischemia led severe neuronal damage in the rat hippocampus and cerebral cortex, but agmatine treatment protected neurons from ischemic injury. Moreover, the level and expression of eNOS was increased by agmatine treatment, whereas inducible NOS (iNOS) and MMP-9 protein expressions were decreased in the brain. These results suggest that agmatine protects microvessels in the brain by activation eNOS as well as reduces extracellular matrix degradation during the early phase of ischemic insult

Aseptic Spondylodiscitis Resulting from Intradiscal Radiofrequency Ablation (IDRA) in Patients with Herniated Disc Disease: A Report of Ten Cases

Objective The purpose of this study was to investigate the clinical presentation, radiological features, management, and outcomes of aseptic spondylodiscitis after Intradiscal radiofrequency ablation (IDRA). Methods Between 2014 and 2015, ten patients were diagnosed with aseptic spondylodiscitis due to significant back pain after IDRA and were assessed with medical record review, telephone interviews, and imaging. The follow-up period was 12 months. Results The patients developed significant axial pain after the procedure (VAS, 2±1.6 to 8±0.7, p<0.001). Laboratory findings, including WBC, ESR, and CRP, were nonspecific. Magnetic Ressonance Imaging (MRI) showed low intensity on T1-weighted images, heterogeneous intensity on T2-weighted images, and contrast enhancement on the subchondral area adjacent to the endplate. All patients were treated conservatively with non-steroidal anti-inflammatory drugs. Back pain improved gradually in 3 months (VAS, 5.5±1.3, p<0.01).All patients had no sequelae at final follow up. Conclusion IDRA may cause thermal injury to adjacent vertebrae. If a patient complains of significant back pain after IDRA and show osteonecrosis characteristic on MRI, aseptic spondylodiscitis should be considered. To prevent this complication, the correct location of the IDRA tip distant from the endplate should be confirmed by fluoroscopy during the procedure

A Framework for Diagnosing Dyscalculia

This paper outlines the development of mathematical items which evolves from making sense of mathematics through perception, operation, and reason. There are three main constructs in this framework, and it involves seven tests namely simple reaction time, short term memory, number sense, matching Items, dot enumeration, number comparison and arithmetic. This study is concerned with how a group of students struggle with basic numerical skills which may be caused by dyscalculia. One of the most important contributions of this study, in addition to its wider theoretical and practical applications, is that it has come out with a set of standardized instruments which is called the Malaysian Dyscalculia Instrument (MDI) for primary school students. This tool could be further used widely in the fields of psychology and education, especially special education and particularly research studies related to education

FEV1 and total Cardiovascular mortality and morbidity over an 18 years follow-up Population-Based Prospective EPIC-NORFOLK Study.

BACKGROUND: Our study aimed to determine the association between forced expiratory volume in one second (FEV1) and subsequent fatal and non-fatal events in a general population. METHODS: The Norfolk (UK) based European Prospective Investigation into Cancer (EPIC-Norfolk) recruited 25,639 participants between 1993 and 1997. FEV1 measured by portable spirometry, was categorized into sex-specific quintiles. Mortality and morbidity from all causes, cardiovascular disease (CVD) and respiratory disease were collected from 1997 up to 2015. Cox proportional hazard regression analysis was used with adjustment for socio-economic factors, physical activity and co-morbidities. RESULTS: Mean age of the population was 58.7 ± 9.3 years, mean FEV1 for men was 294± 74 cL/s and 214± 52 cL/s for women. The adjusted hazard ratios for all-cause mortality for participants in the highest fifth of the FEV1 category was 0.63 (0.52, 0.76) for men and 0.62 (0.51, 0.76) for women compared to the lowest quintile. Adjusted HRs for every 70 cL/s increase in FEV1 among men and women were 0.77 (p < 0.001) and 0.68 (p < 0.001) for total mortality, 0.85 (p<0.001) and 0.77 (p<0.001) for CVD and 0.52 (p <0.001) and 0.42 (p <0.001) for respiratory disease. CONCLUSIONS: Participants with higher FEV1 levels had a lower risk of CVD and all-cause mortality. Measuring the FEV1 with a portable handheld spirometry measurement may be used as a surrogate marker for cardiovascular risk. Every effort should be made to identify those with poorer lung function even in the absence of cardiovascular disease as they are at greater risk of total and CV mortality.This work was supported by a Sabbatical programme awarded to Ching SM by Universiti Putra Malaysia. European Prospective Investigation into Cancer–Norfolk is funded by grants from the Medical Research Council UK (G9502233, G0401527) and Cancer Research UK (C864/A8257, C864/A2883). We further acknowledge core MRC Epidemiology Unit support through Programmes MC_UU_12015/1 and MC_UU_12015/5

All clinically-relevant blood components transmit prion disease following a single blood transfusion: a sheep model of vCJD

Variant CJD (vCJD) is an incurable, infectious human disease, likely arising from the consumption of BSE-contaminated meat products. Whilst the epidemic appears to be waning, there is much concern that vCJD infection may be perpetuated in humans by the transfusion of contaminated blood products. Since 2004, several cases of transfusion-associated vCJD transmission have been reported and linked to blood collected from pre-clinically affected donors. Using an animal model in which the disease manifested resembles that of humans affected with vCJD, we examined which blood components used in human medicine are likely to pose the greatest risk of transmitting vCJD via transfusion. We collected two full units of blood from BSE-infected donor animals during the pre-clinical phase of infection. Using methods employed by transfusion services we prepared red cell concentrates, plasma and platelets units (including leucoreduced equivalents). Following transfusion, we showed that all components contain sufficient levels of infectivity to cause disease following only a single transfusion and also that leucoreduction did not prevent disease transmission. These data suggest that all blood components are vectors for prion disease transmission, and highlight the importance of multiple control measures to minimise the risk of human to human transmission of vCJD by blood transfusion