Governance of Offshore IT Outsourcing at Shell Global Functions IT-BAM Development and Application of a Governance Framework to Improve Outsourcing Relationships

The lack of effective IT governance is widely recognized as a key inhibitor to successful global IT outsourcing relationships. In this study we present the development and application of a governance framework to improve outsourcing relationships. The approach used to developing an IT governance framework includes a meta model and a customization process to fit the framework to the target organization. The IT governance framework consists of four different elements (1) organisational structures, (2) joint processes between in- and outsourcer, (3) responsibilities that link roles to processes and (4) a diverse set of control indicators to measure the success of the relationship. The IT governance framework is put in practice in Shell GFIT BAM, a part of Shell that concluded to have a lack of management control over at least one of their outsourcing relationships. In a workshop the governance framework was used to perform a gap analysis between the current and desired governance. Several gaps were identified in the way roles and responsibilities are assigned and joint processes are set-up. Moreover, this workshop also showed the usefulness and usability of the IT governance framework in structuring, providing input and managing stakeholders in the discussions around IT governance

Validity of the Empatica E4 wristband to measure heart rate variability (HRV) parameters:A comparison to electrocardiography (ECG)

Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Testmethoden waterbouwasfaltbeton \u96 Rapportage verificatiemetingen

Naar aanleiding van twijfelachtige resultaten van de stijfheidsbepaling op asfalt en van metingen op een aluminium kalibratiebalk, beide verricht in de driepuntsbuigopstelling, is een onderzoek uitgevoerd naar de verschillen die optreden bij het gebruik van diverse varianten van de opstelling. In het onderzoek zijn een drietal opstellingen onder de loep genomen: \u95 3-puntsbuigproef met SCB-rollen als oplegging; \u95 3-puntsbuigproef met 4-puntsbuigportalen als oplegging; \u95 4-puntsbuigproef volgens standaard proefvoorschrift. Metingen zijn verricht aan verschillende materialen: \u95 Een massieve stalen balk; \u95 Een aluminium kalibratiebalk voor de driepuntsbuigproef; \u95 Een aluminium kalibratiebalk voor de vierpuntsbuigproef; \u95 Een asfalt balk. In deze rapportage wordt op bondige wijze verslag gedaan van de meetresultaten en worden de conclusies en aanbevelingen gepresenteerd.Asfaltbekledinge

BEROSIN: Evaluatie proefprojecten en mogelijke verdere toepassingen van deze vorm van kustverdediging

Dit document behandelt een alternatieve vorm van kustverdediging: het BEROSIN-systeem. In hoofdzaak wordt ingegaan op de werking en toepassingsmogelijkheden ervan. Het systeem bestaat uit een doek van polypropyleen dat aan de randen met behulp van ankers op zijn plaats gehouden wordt boven een zandige ondergrond. Het doek kan 0,5 tot 2 meter zand vangen (vertikaal), waarna het strak komt te staan en in principe gaat werken als een vorm van 'harde' verdediging, een soort van bodembescherming. De Directie Noord Nederland heeft een tweetal proefprojecten met het BEROSIN-systeem uitgevoerd, maar heeft nog geen goede totaal-visie op het systeem ontwikkeld. In deze studie zijn voor genoemde proefprojecten zowel de bevindingen van de Directie Noord-Nederland als van de fabrikant in beschouwing genomen. Tevens is de werking van het systeem vergeleken met gangbare methoden van kustverdediging en zijn de mogelijkheden van toepassing van het systeem beschreven. Geconcludeerd wordt dat het BEROSIN-systeem beschouwd kan worden als een constructie, die de zandverdeling beïnvloedt; hierbij treedt lijzijde-erosie op. Voor de kerntaak van Rijkswaterstaat (bestrijding van grootschalige structurele erosie en overall-handhaving van de kustlijn) biedt het BEROSIN-systeem geen algemeen toepasbare oplossing. Kansrijke toepassingslokaties voor het systeem langs de Nederlandse kust zijn dan ook schaars. Lokaal en voor andere doeleinden zijn er wellicht wel zinvolle toepassingen denkbaar, zoals bijvoorbeeld het beteugelen van erosierond om constructies of het steiler opzetten van een stuk onderwateroever om een breder strand te kunnen realiseren. In gebieden landwaarts van de kustlijn (Waddenzee,Westerschelde,meren en rivieren) zijn misschien meer algemene toepassingen mogelijk. Dit valt echter buiten het kader van dit onderzoek.KUSTAD