Training Costs and Performance: Do High Training Costs Lead to Higher Revenues?

The objective, or goal, of this research paper is to try and examine the relationship between training costs and corporate performance, which is measured in revenue and profits; this paper also looks at the equity of various corporations in an effort to fully examine corporate performance. Though there are many conflicting views on the subject, this paper tries to explore a common ground where all organizations, from all over the world, can consistently have reliable and valid data to see if their respective training costs should be increased, decreased, or stay the same at any given point in time

FACCE: Factors Associated with Frequent use of the Emergency Service: A Case-Control Study.

Introducción. Los consultantes crónicos (CC) aumentan el sobrecupo y sobreuso en los servicios de emergencias (SE), y no existen reglas estándar para identificarlos. Nosotros identificamos factores de riesgo (FR) y construimos un puntaje para discriminar CC en los SE (Puntaje FACCE). Metodología. Con un diseño de Casos[≥10_atenciones/año] y Controles[hospitalarios] seleccionados aleatoriamente de una base de datos con más de 100.000 atenciones/año, se recogieron datos sociodemográficos y clínicos de pacientes atendidos en tres SE de una clínica privada de Bucaramanga-Santander. Se aplicó un modelo de regresión logística (MRL) para identificar FR asociados a CC (ORa;IC95%). Con los z-score de cada FR[MRL] se construyó el puntaje FACCE. Resultados. Fueron seleccionados 200 casos[CC] y 207 controles, los CC tenían mayor edad (42 años; OR:1.02[1.01-1.03]) y predominantemente, estaban casados o en unión libre [C/UL], tenían planes de atención domiciliaria y fueron hospitalizados (valorP:<0.05). Los FR asociados a CC fueron estado civil C/UL[2.06;1.37-3.11], comorbilidad[2.40;1.52-3.79], enfermedad general no traumática[4.10;2.18-7.71], antecedente de tabaquismo[4.17;1.14-15.1] y las enfermedades primarias: neoplasia[4.32;1.41-13.1], epilepsia[10.6;1.28-87.7], enfermedad mental[3.23;1.46-7.16] y renal crónica[8.18;1.02-65.7]. La mediana[p25-p75] del puntaje FACCE [13.4;9.6-16.8] fue mayor en Casos[16.0;13.0-17.6] Vs Controles[12.6;9.14-13.9] (∆ 3.79[IC95%, 3.26-4.29]) (AUC: 0.78; OR: 1.23;1.14-1.32; valorP:<0.001). Discusión. Identificamos FR sociodemográficos y clínicos asociados a CC, que conjuntamente [puntaje_FACCE] demostraron utilidad para discriminarlos en los SE. Nuevas investigaciones permitirán una validación externa del FACCE, así como una mejoría en las capacidades operativas y calibración para discriminar CC de los SE.Introduction. Frequent ED users (FU) are responsible for the overcrowding and overuse of the services in the emergency room. There are currently no standard rules to identify them. We identify risk factors (RF) and construct a score to discriminate this FUs (FACCE Score). Methods. With a design of Cases [≥10_ERvisits / year] and Controls [hospital] randomly selected from a database with more than 100,000 visits / year, sociodemographic and clinical data of patients treated in three SE of a private clinic in Bucaramanga. Santander were collected. A logistic regression model (LRM) was applied to identify RF associated with CC (ORa; 95%CI). With the z-scores of each FR [MRL] the FACCE score was constructed. Results. 200 cases [CC] and 207 controls were selected, the CC were older than 42 years of age (OR: 1.02[1.01-1.03]) and predominantly, married or in common-law union [C/UL], had home care plans and were hospitalized (P-value <0.05). The RF associated with CC were marital status C/UL [2.06; 1.37-3.11], comorbidity [2.40; 1.52-3.79], general non-traumatic disease [4.10; 2.18-7.71], history of smoking [4.17; 1.14-15.1] and the primary diseases: neoplasia [4.32; 1.41-13.1], epilepsy [10.6; 1.28-87.7], mental illness [3.23; 1.46-7.16] and chronic kidney [8.18; 1.02-65.7]. The median [p25-p75] of the FACCE score [13.4; 9.6-16.8] was higher in Cases [16.0; 13.0-17.6] Vs Controls [12.6; 9.14-13.9] (∆ 3.79 [95%CI, 3.26-4.29]) (AUC: 0.78; OR: 1.23; 1.14-1.32; P-value <0.001). Discussion. We identified sociodemographic and clinical RF associated with FU, which together [score_FACCE] demonstrated usefulness to discriminate them in the ED. New investigations will allow an external validation of the FACCE, as well as an improvement in the operational capacities and calibration to discriminate FU in the ED

Economic costs of biological invasions in Ecuador:the importance of the Galapagos Islands

Biological invasions, as a result of human intervention through trade and mobility, are the second biggest cause of biodiversity loss. The impacts of invasive alien species (IAS) on the environment are well known, however, economic impacts are poorly estimated, especially in mega-diverse countries where both economic and ecological consequences of these effects can be catastrophic. Ecuador, one of the smallest mega-diverse countries, lacks a comprehensive description of the economic costs of IAS within its territory. Here, using &quot;InvaCost&quot;, a public database that compiles all recorded monetary costs associated with IAS from English and Non-English sources, we investigated the economic costs of biological invasions. We found that between 1983 and 2017, the reported costs associated with biological invasions ranged between US$86.17 million (when considering only the most robust data) and US$626 million (when including all cost data) belonging to 37 species and 27 genera. Furthermore, 99% of the recorded cost entries were from the Galapagos Islands. From only robust data, the costliest identified taxonomic group was feral goats (Capra hircus; US$20 million), followed by Aedes mosquitoes (US$2.14 million) while organisms like plant species from the genus Rubus, a parasitic fly (Philornis downsi), black rats (Rattus rattus) and terrestrial gastropods (Achatina fulica) represented less than US2 million each. Costs of "mixed-taxa" (i.e. plants and animals) represented the highest (61% of total robust costs; US52.44 million). The most impacted activity sector was the national park authorities, which spent about US$84 million. Results from robust data also revealed that management expenditures were the major type of costs recorded in the Galapagos Islands; however, costs reported for medical losses related to Aedes mosquitoes causing dengue fever in mainland Ecuador would have ranked first if more detailed information had allowed us to categorize them as robust data. Over 70% of the IAS reported for Ecuador did not have reported costs. These results suggest that costs reported here are a massive underestimate of the actual economic toll of invasions in the country

Non-English languages enrich scientific knowledge : The example of economic costs of biological invasions

We contend that the exclusive focus on the English language in scientific researchmight hinder effective communication between scientists and practitioners or policymakerswhose mother tongue is non-English. This barrier in scientific knowledge and data transfer likely leads to significant knowledge gaps and may create biases when providing global patterns in many fields of science. To demonstrate this, we compiled data on the global economic costs of invasive alien species reported in 15 non-English languages. We compared it with equivalent data from English documents (i.e., the InvaCost database, the most up-to-date repository of invasion costs globally). The comparison of both databases (similar to 7500 entries in total) revealed that non-English sources: (i) capture a greater amount of data than English sources alone (2500 vs. 2396 cost entries respectively); (ii) add 249 invasive species and 15 countries to those reported by English literature, and (iii) increase the global cost estimate of invasions by 16.6% (i.e., US$ 214 billion added to 1.288 trillion estimated fromthe English database). Additionally, 2712 cost entries - not directly comparable to the English database - were directly obtained frompractitioners, revealing the value of communication between scientists and practitioners. Moreover, we demonstrated how gaps caused by overlooking non-English data resulted in significant biases in the distribution of costs across space, taxonomic groups, types of cost, and impacted sectors. Specifically, costs from Europe, at the local scale, and particularly pertaining to management, were largely under-represented in the English database. Thus, combining scientific data from English and non-English sources proves fundamental and enhances data completeness. Considering non-English sources helps alleviate biases in understanding invasion costs at a global scale. Finally, it also holds strong potential for improving management performance, coordination among experts (scientists and practitioners), and collaborative actions across countries. Note: non-English versions of the abstract and figures are provided in Appendix S5 in 12 languages. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/ by/4.0/).Peer reviewe

TOWARD GLOBAL DROUGHT EARLY WARNING CAPABILITY: Expanding International Cooperation for the Development of a Framework for Monitoring and Forecasting

The need for a global drought early warning framework. Drought has had a significant impact on civilization throughout history in terms of reductions in agricultural productivity, potable water supply, and economic activity, and in extreme cases this has led to famine. Every continent has semiarid areas, which are especially vulnerable to drought. The Intergovernmental Panel on Climate Change has noted that average annual river runoff and water availability are projected to decrease by 10%–13% over some dry and semiarid regions in mid and low latitudes, increasing the frequency, intensity, and duration of drought, along with its associated impacts. The sheer magnitude of the problem demands efforts to reduce vulnerability to drought by moving away from the reactive, crisis management approach of the past toward a more proactive, risk management approach that is centered on reducing vulnerability to drought as much as possible while providing early warning of evolving drought conditions and possible impacts. Many countries, unfortunately, do not have adequate resources to provide early warning, but require outside support to provide the necessary early warning information for risk management. Furthermore, in an interconnected world, the need for information on a global scale is crucial for understanding the prospect of declines in agricultural productivity and associated impacts on food prices, food security, and potential for civil conflict

Toward Global Drought Early Warning Capability - Expanding International Cooperation for the Development of a Framework for Monitoring and Forecasting

Drought has had a significant impact on civilization throughout history in terms of reductions in agricultural productivity, potable water supply, and economic activity, and in extreme cases this has led to famine. Every continent has semiarid areas, which are especially vulnerable to drought. The Intergovernmental Panel on Climate Change has noted that average annual river runoff and water availability are projected to decrease by 10 percent-13 percent over some dry and semiarid regions in mid and low latitudes, increasing the frequency, intensity, and duration of drought, along with its associated impacts. The sheer magnitude of the problem demands efforts to reduce vulnerability to drought by moving away from the reactive, crisis management approach of the past toward a more proactive, risk management approach that is centered on reducing vulnerability to drought as much as possible while providing early warning of evolving drought conditions and possible impacts. Many countries, unfortunately, do not have adequate resources to provide early warning, but require outside support to provide the necessary early warning information for risk management. Furthermore, in an interconnected world, the need for information on a global scale is crucial for understanding the prospect of declines in agricultural productivity and associated impacts on food prices, food security, and potential for civil conflict. This paper highlights the recent progress made toward a Global Drought Early Warning Monitoring Framework (GDEWF), an underlying partnership and framework, along with its Global Drought Early Warning System (GDEWS), which is its interoperable information system, and the organizations that have begun working together to make it a reality. The GDEWF aims to improve existing regional and national drought monitoring and forecasting capabilities by adding a global component, facilitating continental monitoring and forecasting (where lacking), and improving these tools at various scales, thereby increasing the capacity of national and regional institutions that lack drought early warning systems or complementing existing ones. A further goal is to improve coordination of information delivery for drought-related activities and relief efforts across the world. This is especially relevant for regions and nations with low capacity for drought early warning. To do this requires a global partnership that leverages the resources necessary and develops capabilities at the global level, such as global drought forecasting combined with early warning tools, global real-time monitoring, and harmonized methods to identify critical areas vulnerable to drought. Although the path to a fully functional GDEWS is challenging, multiple partners and organizations within the drought, forecasting, agricultural, and water-cycle communities are committed to working toward its success

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH