Productivity Improvement in New York State Local Governments: State Actions to Assist Local Governments

A.E. Res. 83-1

Le misure di contrasto alla corruzione nel diritto pubblico. Dalla repressione penale alla prevenzione amministrativa

La dimensione endemica assunta dal fenomeno corruttivo, specie nei settori fisiologicamente caratterizzati dall'esercizio di alta discrezionalità nella gestione delle risorse pubbliche, ed i recenti scandali giudiziari che hanno coinvolto il settore degli appalti hanno indotto ad un ripensamento dei modelli di contrasto sino ad ora vigenti. Il sensibile incremento delle fattispecie corruttive nel mondo delle commesse pubbliche ha, infatti, evidenziato i limiti di un sistema di contrasto alla corruzione fondato interamente sulla repressione penale. Di tale analisi si fa carico il presente lavoro, che cerca di porre in evidenza lo iato tra la non rinunciabilità al presidio penale e l'esigenza, ormai improcrastinabile, di una strategia di prevenzione amministrativa che consenta di promuovere la cultura della legalità in modo da ricostruire il (compromesso) rapporto fiduciario tra cittadini ed amministrazione

Relación entre el marketing boca a boca y sus consecuencias en la no adopción del comercio electrónico en mujeres de Lima Metropolitana para la compra de productos del cuidado de la piel en el 2021

Tesi

Hand Hygiene and Glove Use Behavior in an Italian Hospital

In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P<.001), but no such association was observed for the rate of glove use compliance (R2 = 0.014; P = .078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral pattern

Variable performance of models for predicting methicillin-resistant Staphylococcus aureus carriage in European surgical wards

BACKGROUND: Predictive models to identify unknown methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission may optimise targeted MRSA screening and efficient use of resources. However, common approaches to model selection can result in overconfident estimates and poor predictive performance. We aimed to compare the performance of various models to predict previously unknown MRSA carriage on admission to surgical wards. METHODS: The study analysed data collected during a prospective cohort study which enrolled consecutive adult patients admitted to 13 surgical wards in 4 European hospitals. The participating hospitals were located in Athens (Greece), Barcelona (Spain), Cremona (Italy) and Paris (France). Universal admission MRSA screening was performed in the surgical wards. Data regarding demographic characteristics and potential risk factors for MRSA carriage were prospectively collected during the study period. Four logistic regression models were used to predict probabilities of unknown MRSA carriage using risk factor data: 'Stepwise' (variables selected by backward elimination); 'Best BMA' (model with highest posterior probability using Bayesian model averaging which accounts for uncertainty in model choice); 'BMA' (average of all models selected with BMA); and 'Simple' (model including variables selected >50% of the time by both Stepwise and BMA approaches applied to repeated random sub-samples of 50% of the data). To assess model performance, cross-validation against data not used for model fitting was conducted and net reclassification improvement (NRI) was calculated. RESULTS: Of 2,901 patients enrolled, 111 (3.8%) were newly identified MRSA carriers. Recent hospitalisation and presence of a wound/ulcer were significantly associated with MRSA carriage in all models. While all models demonstrated limited predictive ability (mean c-statistics <0.7) the Simple model consistently detected more MRSA-positive individuals despite screening fewer patients than the Stepwise model. Moreover, the Simple model improved reclassification of patients into appropriate risk strata compared with the Stepwise model (NRI 6.6%, P = .07). CONCLUSIONS: Though commonly used, models developed using stepwise variable selection can have relatively poor predictive value. When developing MRSA risk indices, simpler models, which account for uncertainty in model selection, may better stratify patients' risk of unknown MRSA carriage