Privatization and regulation in Turkish telecommunications

Version of RecordThe importance of efficient workings of network industries and the markets in which they operate has long been recognized in the literature. In a parallel fashion, policy makers around the world initiated various restructuring efforts focusing on these sectors. However, the issues of privatization and much needed subsequent regulatory framework face considerable challenges in developing countries. Both political opposition and difficulties encountered in the process of privatization caused major delays in overall privatization and restructuring efforts of these countries. This paper focuses on the telecommunications sector and the Turk Telekom case, in particular, assessing the prospects for its much-debated divestiture, evaluating the company specifics and subsequent regulatory agenda. In doing that, it emphasizes the current "telecom meltdown" in international markets, and compares telecommunications privatizations of various nations. Additionally, the study reviews major regulatory methods and draws on some recommendations for policy makers in the light of the U.S experience in this sector.Aybar, C. B., Guney, S., & Suel, H. (2001, March). Privatization and regulation in Turkish telecommunications: A critical assessment (Working Paper). Manchester, NH: Southern New Hampshire University. Retrieved from http://academicarchive.snhu.ed

Wind power field reconstruction from a reduced set of representative measuring points

In this paper we deal with a problem of representative measuring points selection for long-term wind power analysis. It has direct applications such as wind farm prospective location or long-term power generation prediction in wind-based energy facilities. The problem’s objective is to select the best set of N measuring points (i.e. N representative points), in such a way that a wind power error reconstruction measure is minimized, considering a monthly average wind power field. In order to solve this problem, we use a novel meta-heuristic algorithm, the Coral Reefs Optimization with Substrate Layer, which is an evolutionary-type method able to combine different search procedures within a single population. The CRO-SL is hybridized with the Analogue Method as wind power reconstruction method, to identify the most representative points for the wind field. The proposed approach has been tested in the reconstruction of monthly average wind power fields in Europe, from reanalysis data (ERAInterim reanalysis). The method exhibits strong performance as evidenced from the experiments carried out. The solutions obtained show that the more significant measuring points are mainly located over the Atlantic ocean, which is consistent with the wind speed climatology of the Northern hemisphere midlatitudes. We have also analyzed the set of least representative points to reconstruct the wind power field (less informative points for whole reconstruction of the field), obtaining points mainly located at the North of Scandinavia (which may be associated with the circumpolar circulation), and some points in the Eastern Mediterranean, which seem to be related to the Etesian winds. Reconstructions at seasonal scales show similar results, which provides confidence on the robustness of the proposed method. The proposed methodology can be further applied to alternative energy-related problems, such as the selection of critical energy infra-structures or the selection of critical points for climate change studies, among others

Determinación del periodo de retiro de enrofloxacina en cuyes (Cavia porcellus)

The aim of this study was to determine the period of withdrawal of enrofloxacin in guinea pigs (Cavia porcellus). In total, 51 guinea pigs (25 females and 26 males) of the Peru breed from a farm located in the district of Maranganí (Cusco, Peru) were used. For this, 10% enrofloxacin was administered orally at a rate of 10 mg/kg (0.1 ml/kg BW) every 24 hours for a period of 10 days. Immediately after the last administration of the antibiotic (hour 0), three guinea pigs were randomly selected and slaughtered every 2 hours until 32 hours after drug withdrawal, taking samples of the diaphragm muscle. The analysis and quantification of antibiotic residues in the muscle was performed using the commercial Max Signal® Enrofloxacin ELISA Kit. The maximum concentration of enrofloxacin (1425 ± 53.4 µg/kg) was determined 12 h after withdrawal, falling to 80.8 ± 6 µg/kg at 28 h, value below 100 µg/kg considered as the reference maximum residue limit. Under the conditions of this study, a withdrawal period of two days is suggested for guinea pigs treated with enrofloxacin.El objetivo del estudio fue determinar el periodo de retiro de enrofloxacina en cuyes (Cavia porcellus). Se utilizaron 51 cuyes (25 hembras y 26 machos) de la raza Perú de una granja ubicada en el distrito de Maranganí (Cusco, Perú). Para ello, se administró enrofloxacina al 10%, vía oral, a razón de 10 mg/kg (0.1 ml/kg PV) cada 24 horas por un periodo de 10 días. Inmediatamente después de la última administración del antibiótico (hora 0), tres cuyes fueron seleccionados en forma aleatoria y sacrificados cada dos horas hasta las 32 horas del retiro del fármaco, tomándose muestras del músculo diafragma. El análisis y cuantificación de los residuos del antibiótico en el diafragma se realizó empleando el kit comercial Max Signal® Enrofloxacin ELISA Kit. La concentración máxima de enrofloxacina (1425 ± 53.4 µg/kg) se determinó a las 12 horas del retiro, descendiendo hasta 80.8 ± 6 µg/kg a las 28 h, valor por debajo de 100 µg/kg considerado como límite máximo de referencia. Bajo las condiciones de este estudio, se sugiere un periodo de retiro de dos días para cuyes tratados con enrofloxacina

Healthcare providers' adherence to breast cancer guidelines in Europe : a systematic literature review

Clinical guidelines' (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers' adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers' adherence. We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8-67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68-77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10-80%), for the follow-up, to 90% (IQR 87-92.5%) for ET. Internal factors that potentially impact on healthcare providers' adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers' adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration:: PROSPERO (CRD42018092884)

Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital

<p>Abstract</p> <p>Background</p> <p>Multidrug resistant <it>Acinetobacter baumannii</it>, (MRAB) is an important cause of hospital acquired infection. The purpose of this study is to determine the risk factors for MRAB in a city hospital patient population.</p> <p>Methods</p> <p>This study is a retrospective review of a city hospital epidemiology data base and includes 247 isolates of Acinetobacter baumannii (AB) from 164 patients. Multidrug resistant <it>Acinetobacter baumannii </it>was defined as resistance to more than three classes of antibiotics. Using the non-MRAB isolates as the control group, the risk factors for the acquisition of MRAB were determined.</p> <p>Results</p> <p>Of the 247 AB isolates 72% (177) were multidrug resistant. Fifty-eight percent (143/247) of isolates were highly resistant (resistant to imipenem, amikacin, and ampicillin-sulbactam). Of the 37 patients who died with Acinetobacter colonization/infection, 32 (86%) patients had the organism recovered from the respiratory tract. The factors which were found to be significantly associated (p ≤ 0.05) with multidrug resistance include the recovery of AB from multiple sites, mechanical ventilation, previous antibiotic exposure, and the presence of neurologic impairment. Multidrug resistant Acinetobacter was associated with significant mortality when compared with sensitive strains (p ≤ 0.01). When surgical patients (N = 75) were considered separately, mechanical ventilation and multiple isolates remained the factors significantly associated with the development of multidrug resistant Acinetobacter. Among surgical patients 46/75 (61%) grew a multidrug resistant strain of AB and 37/75 (40%) were resistant to all commonly used antibiotics including aminoglycosides, cephalosporins, carbepenems, extended spectrum penicillins, and quinolones. Thirty-five percent of the surgical patients had AB cultured from multiple sites and 57% of the Acinetobacter isolates were associated with a co-infecting organism, usually a Staphylococcus or Pseudomonas. As in medical patients, the isolation of Acinetobacter from multiple sites and the need for mechanical ventilation were significantly associated with the development of MRAB.</p> <p>Conclusions</p> <p>The factors significantly associated with MRAB in both the general patient population and surgical patients were mechanical ventilation and the recovery of Acinetobacter from multiple anatomic sites. Previous antibiotic use and neurologic impairment were significant factors in medical patients. Colonization or infection with MRAB is associated with increased mortality.</p

Efficacy and safety of treatment with omalizumab for chronic spontaneous urticaria: A systematic review for the EAACI Biologicals Guidelines

This systematic review evaluates the efficacy and safety of omalizumab for chronic spontaneous urticaria (CSU). PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CSU-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75&nbsp;years old treated with omalizumab for 16 to 40&nbsp;weeks were evaluated. Omalizumab 150&nbsp;mg does not result in clinically meaningful improvement (high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) −5; 95%CI −7.75 to −2.25), and the itch severity score (ISS)7 (MD −2.15; 95% CI −3.2 to −1.1) does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD −2.01; 95%CI −3.22 to −0.81) and decreases (moderate certainty) rescue medication use (MD −1.68; 95%CI −2.95 to −0.4). Omalizumab 300&nbsp;mg results in clinically meaningful improvements (moderate certainty) of the UAS7 (MD −11.05; 95%CI −12.87 to −9.24), the ISS7 (MD −4.45; 95%CI −5.39 to −3.51), and QoL (high certainty) (DLQI; MD −4.03; 95% CI −5.56 to −2.5) and decreases (moderate certainty) rescue medication use (MD −2.04; 95%CI −3.19 to −0.88) and drug-related serious AEs (RR 0.77; 95%CI 0.20 to 2.91)

Monitoring and evaluation of breast cancer screening programmes : Selecting candidate performance indicators

In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality

GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence—An overview in the context of health decision-making

Objectives: The objective of the study is to present the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) conceptual approach to the assessment of certainty of evidence from modeling studies (i.e., certainty associated with model outputs). / Study Design and Setting: Expert consultations and an international multidisciplinary workshop informed development of a conceptual approach to assessing the certainty of evidence from models within the context of systematic reviews, health technology assessments, and health care decisions. The discussions also clarified selected concepts and terminology used in the GRADE approach and by the modeling community. Feedback from experts in a broad range of modeling and health care disciplines addressed the content validity of the approach. / Results: Workshop participants agreed that the domains determining the certainty of evidence previously identified in the GRADE approach (risk of bias, indirectness, inconsistency, imprecision, reporting bias, magnitude of an effect, dose–response relation, and the direction of residual confounding) also apply when assessing the certainty of evidence from models. The assessment depends on the nature of model inputs and the model itself and on whether one is evaluating evidence from a single model or multiple models. We propose a framework for selecting the best available evidence from models: 1) developing de novo, a model specific to the situation of interest, 2) identifying an existing model, the outputs of which provide the highest certainty evidence for the situation of interest, either “off-the-shelf” or after adaptation, and 3) using outputs from multiple models. We also present a summary of preferred terminology to facilitate communication among modeling and health care disciplines. / Conclusion: This conceptual GRADE approach provides a framework for using evidence from models in health decision-making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modeling community are currently developing the detailed methods and related guidance for assessing specific domains determining the certainty of evidence from models across health care–related disciplines (e.g., therapeutic decision-making, toxicology, environmental health, and health economics)