Kundelønnsomhet i bank : en casestudie av Sparebanken Sogn og Fjordane

Hovedtemaet i denne masterutredningen er hvordan man kan tilnærme seg fenomenet kundelønnsomhet i bank. Vi har ved hjelp av to forskningsspørsmål forsøkt å besvare vår hovedproblemstilling: Hvordan kan vi ved hjelp av dagens registreringssystem og tilgjengelige data i Sparebanken Sogn og Fjordane utarbeide en kundelønnsomhetsmodell? Som problemstillingen indikerer, har vi tatt utgangspunkt i én casebank: Sparebanken Sogn og Fjordane. Da banken selv ikke benytter seg av modeller for beregning av kundelønnsomhet, valgte vi å gå inn og gjøre en kostnadsanalyse. Hensikten var å identifisere mest mulig kundedrevne kostnader, for senere å inkludere kostnadene i kundelønnsomhetsmodeller. I tillegg til å finne kostnadsdrivere som kunne fordeles på den enkelte kunde, var det viktig for oss at kostnadene var beslutningsrelevante og at det ga styringsmessig meningsfullhet å inkludere dem i modellene. Som et ledd i vår utredning, har det vært viktig å vurdere de faktiske observasjoner opp mot teori. Derfor bygger utredningens teorigrunnlag i stor grad på kostnadsbegreper, analyse av disse, og senere anvendelse i forskjellige kalkulasjonsmetoder. Et funn vi tidlig gjorde, var at bankens kostnadsstruktur er svært kompleks, og dermed en stor utfordring i vår sammenheng. Videre var det krevende å identifisere gode kostnadsdrivere, da en svært liten andel av kostnadene fordeles og registreres på kundenivå. Gjennom utredningen vil det komme frem at fordeling av alle kunderelaterte kostnader er nært umulig. Det lar seg likevel gjøre å lage modeller som fordeler noen av de kostnadene som utgjør den største delen av kundelønnsomhetselementet. Følgelig er det mulig å gjøre beregningen som til en viss grad besvarer spørsmålet mang en bedriftsleder sitter med: Hvor lønnsom er egentlig kunden min

MMIC HEMT Power Amplifier for 140 to 170 GHz

A three-stage monolithic microwave integrated circuit (MMIC) power amplifier that features high-electron-mobility transistors (HEMTs) as gain elements is reviewed. This amplifier is designed to operate in the frequency range of 140 to 170 GHz, which contains spectral lines of several atmospheric molecular species plus subharmonics of other such spectral lines. Hence, this amplifier could serve as a prototype of amplifiers to be incorporated into heterodyne radiometers used in atmospheric science. The original intended purpose served by this amplifier is to boost the signal generated by a previously developed 164-GHz MMIC HEMT doubler and drive a 164-to-328-GHz doubler to provide a few milliwatts of power at 328 GHz

80-GHz MMIC HEMT Voltage-Controlled Oscillator

A voltage-controlled oscillator (VCO) that operates in the frequency range from 77.5 to 83.5 GHz has been constructed in the form of a monolithic microwave integrated circuit (MMIC) that includes high-electron-mobility transistors (HEMTs). This circuit is a prototype of electronically tunable signal sources in the 75-to-110-GHz range, needed for communication, imaging, and automotive radar applications, among others. This oscillator (see Figure 1) includes two AlInAs/GaInAs/InP HEMTs. One HEMT serves mainly as an oscillator gain element. The other HEMT serves mainly as a varactor for controlling the frequency: the frequency-control element is its gate-to-source capacitance, which is varied by changing its gate supply voltage. The gain HEMT is biased for class-A operation (meaning that current is conducted throughout the oscillation cycle). Grounded coplanar waveguides are used as impedance-matching transmission lines, the input and output matching being chosen to sustain oscillation and maximize output power. Air bridges are placed at discontinuities to suppress undesired slot electromagnetic modes. A high density of vias is necessary for suppressing a parallel-plate electromagnetic mode that is undesired because it can propagate energy into the MMIC substrate. Previous attempts at constructing HEMT-based oscillators yielded circuits with relatively low levels of output power and narrow tuning ranges. For example, one HEMT VCO reported in the literature had an output power of 7 dBm (.5 mW) and a tuning range 2-GHz wide centered approximately at a nominal frequency of 77 GHz. In contrast, as shown in Figure 2, the present MMIC HEMT VCO puts out a power of 12.5 dBm (.18 mW) or more over the 6-GHz-wide frequency range from 77.5 to 83.5 GH

Low-cost high-performance W-band LNA MMICs for millimeter-wave imaging

The main limitation to the sensitivity of a radiometer or imager is its equivalent noise temperatures, T_e. Placing a low noise amplifier (LNA) at a radiometer's front end can dramatically reduce T_e. LNA performance has steadily improved over recent years, and here we report on a W-band LNA with the lowest T_e measured at room temperature. Furthermore, we present statistical RF data showing high yield and consistency for future high volume production that is needed for commercial radiometric imaging array applications such as security screening, aircraft landing, and other systems

164-GHz MMIC HEMT Frequency Doubler

A monolithic microwave integrated circuit (MMIC) that includes a high-electron-mobility transistor (HEMT) has been developed as a prototype of improved frequency doublers for generating signals at frequencies greater than 100 GHz. Signal sources that operate in this frequency range are needed for a variety of applications, notably including general radiometry and, more specifically, radiometric remote sensing of the atmosphere. Heretofore, it has been common practice to use passive (diode-based) frequency multipliers to obtain frequencies greater than 100 GHz. Unfortunately, diode-based frequency multipliers are plagued by high DC power consumption and low conversion efficiency. Moreover, multiplier diodes are not easily integrated with such other multiplier-circuit components as amplifiers and oscillators. The goals of developing the present MMIC HEMT frequency doubler were (1) to utilize the HEMT as an amplifier to increase conversion efficiency (more precisely, to reduce conversion loss), thereby increasing the output power for a given DC power consumption or, equivalently, reducing the DC power consumption for a given output power; and (2) to provide for the integration of amplifier and oscillator components on the same chip. The MMIC frequency doubler (see Figure 1) contains an AlInAs/GaInAs/InP HEMT biased at pinch-off to make it function as a class-B amplifier (meaning that it conducts in half-cycle pulses). Grounded coplanar waveguides (GCPWs) are used as impedance-matching transmission lines. Air bridges are placed at discontinuities to suppress undesired slot electromagnetic modes. Another combination of GCPWs also serves both as a low-pass filter to suppress undesired oscillations at frequencies below 60 GHz and as a DC blocker. Large decoupling capacitors and epitaxial resistors are added in the drain and gate lines to suppress bias oscillations. At the output terminal, the fundamental frequency is suppressed by a quarter-wave open stub, which presents a short circuit at the fundamental frequency and an open circuit at the second harmonic. At an input power of 7 mW, the output power and conversion loss at an output frequency of 164 GHz were found to be 5 dBm (approximately equal to 3.2 mW) and 2 dB, respectively, with a 3-dB output-power bandwidth of 14 GHz. This is the best performance reported to date for an MMIC HEMT frequency doubler above 100 GHz

Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference

BACKGROUND: Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them. OBJECTIVES: This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP). METHODS: Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. RESULTS: Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or other race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference. CONCLUSION: Participants self-identifying as Black or other race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities

Ex Vivo Expanded Multi-Specific Cytotoxic T Lymphocytes Derived from HIV+ Patients and HIV Negative Donors Using GMP Compliant Methodologies Recognize Multiple HIV Antigens and Suppress HIV Replication

Coderch de Sentmenat, José Antoni

Post-Acute Sequelae of COVID-19 (PASC) in Pediatrics: Factors That Impact Symptom Severity and Referral to Treatment.

The post-acute sequelae of COVID-19 (PASC) is a complex condition. While there are emerging studies on its effects in adults, there is scarce research regarding the long-term effects of COVID-19 infection among youth. Several researchers have likened long-haul COVID-19 to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and postural orthostatic tachycardia syndrome (POTS). In adults, the prognosis for these diagnoses is less promising than that in youth; however, there is currently very little information available on the presentation of youth with PASC. A better understanding of the specific symptom presentation for youth diagnosed with PASC is necessary. Retrospective chart reviews were conducted collecting demographic data, COVID-19 symptoms and disease progression, and vaccination status. Additional data on referrals to a PASC treatment program and appointments attended were collected. Overall, data suggested that youth present with less severe PASC symptoms than adults, and the role of vaccination is unclear. These youth are often not referred to treatment programs. More exploration is necessary to continue to build an understanding of how best to aid youth diagnosed with PASC

Partnering With Patients and Families Living With Chronic Conditions to Coproduce Diagnostic Safety Through OurDX: A Previsit Online Engagement Tool

OBJECTIVE: Patients and families are key partners in diagnosis, but methods to routinely engage them in diagnostic safety are lacking. Policy mandating patient access to electronic health information presents new opportunities. We tested a new online tool ( OurDX ) that was codesigned with patients and families, to determine the types and frequencies of potential safety issues identified by patients/families with chronic health conditions and whether their contributions were integrated into the visit note. METHODS: Patients/families at 2 US healthcare sites were invited to contribute, through an online previsit survey: (1) visit priorities, (2) recent medical history/symptoms, and (3) potential diagnostic concerns. Two physicians reviewed patient-reported diagnostic concerns to verify and categorize diagnostic safety opportunities (DSOs). We conducted a chart review to determine whether patient contributions were integrated into the note. We used descriptive statistics to report implementation outcomes, verification of DSOs, and chart review findings. RESULTS: Participants completed OurDX reports in 7075 of 18 129 (39%) eligible pediatric subspecialty visits (site 1), and 460 of 706 (65%) eligible adult primary care visits (site 2). Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. In total, probable DSOs were identified by 7.5% of pediatric and adult patients/families with underlying health conditions, respectively. The most common types of DSOs were patients/families not feeling heard; problems/delays with tests or referrals; and problems/delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories. CONCLUSIONS: OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients/families identified DSOs and most of their OurDX contributions were included in the visit note

Long-Term Hepatitis B Virus (HBV) Response to Lamivudine-Containing Highly Active Antiretroviral Therapy in HIV-HBV Co-Infected Patients in Thailand

Background: Approximately 4 million of people are co-infected with HIV and Hepatitis B virus (HBV). In resource-limited settings, the majority of HIV-infected patients initiate first-line highly active antiretroviral therapy containing lamivudine (3TC-containing-HAART) and long-term virological response of HBV to lamivudine-containing HAART in co-infected patients is not well known. Methodology/Principal Finding: HIV-HBV co-infected patients enrolled in the PHPT cohort (ClinicalTrials.gov NCT00433030) and initiating a 3TC-containing-HAART regimen were included. HBV-DNA, HIV-RNA, CD4+ T-cell counts and alanine transaminase were measured at baseline, 3 months, 12 months and then every 6 months up to 5 years. Kaplan-Meier analysis was used to estimate the cumulative rates of patients who achieved and maintained HBV-DNA suppression. Of 30 co-infected patients, 19 were positive for HBe antigen (HBeAg). At initiation of 3TC-containing-HAART, median HBV DNA and HIV RNA levels were 7.35 $log_{10}$ IU/mL and 4.47 $log_{10}$ copies/mL, respectively. At 12 months, 67% of patients achieved HBV DNA suppression: 100% of HBeAg-negative patients and 47% of HBeAg-positive. Seventy-three percent of patients had HIV RNA below 50 copies/mL. The cumulative rates of maintained HBV-DNA suppression among the 23 patients who achieved HBV-DNA suppression were 91%, 87%, and 80% at 1, 2, and 4 years respectively. Of 17 patients who maintained HBV-DNA suppression while still on 3TC, 4 (24%) lost HBsAg and 7 of 8 (88%) HBeAg-positive patients lost HBeAg at their last visit (median duration, 59 months). HBV breakthrough was observed only in HBeAg-positive patients and 6 of 7 patients presenting HBV breakthrough had the rtM204I/V mutations associated with 3TC resistance along with rtL180M and/or rtV173L. Conclusions: All HBeAg-negative patients and 63% of HBeAg-positive HIV-HBV co-infected patients achieved long-term HBV DNA suppression while on 3TC-containing-HAART. This study provides information useful for the management of co-infected patients in resource-limited countries where the vast majority of co-infected patients are currently receiving 3TC