The cost of hunger: Social and economic impact of child undernutrition in Central America and the Dominican Republic

This document presents the results derived from the analyses of the cost of undernutrition in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the Dominican Republic. The study shows that not only are the effects reported valid for the countries of Central America and the Dominican Republic, but the resultant economic impact is also significant, representing between 1.7% and 11.4% of GDP. In this regard, productivity losses as a consequence of the higher death rate and the lower level of education account for 90% of the costs. Thus, in addition to the ethical imperative, eradicating undernutrition would yield benefits as well. Therefore, any programme that is effective in reducing the prevalence of this problem will have an impact on people's quality of life, and will also represent major savings for society. The greater the problem, the greater the challenge, but the greater the benefits as well, especially in terms of countries' production capacity.

Impact of patient training patterns on peritonitis rates in a large national cohort study

Background. Ideal training methods that could ensure best peritoneal dialysis (PD) outcome have not been defined in previous reports. The aim of the present study was to evaluate the impact of training characteristics on peritonitis rates in a large Brazilian cohort.Methods. Incident patients with valid data on training recruited in the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD II) from January 2008 to January 2011 were included. Peritonitis was diagnosed according to International Society for Peritoneal Dialysis guidelines; incidence rate of peritonitis (episodes/patient-months) and time to the first peritonitis were used as end points.Results. Two thousand two hundred and forty-three adult patients were included in the analysis: 59 +/- 16 years old, 51.8% female, 64.7% with <= 4 years of education. The median training time was 15 h (IQI 10-20 h). Patients were followed for a median of 11.2 months (range 3-36.5). The overall peritonitis rate was 0.29 per year at risk (1 episode/41 patient-months). The mean number of hours of training per day was 1.8 +/- 2.4. Less than 1 h of training/day was associated with higher incidence rate when compared with the intervals of 1-2 h/day (P = 0.03) and > 2 h/day (P = 0.02). Patients who received a cumulative training of > 15 h had significantly lower incidence of peritonitis compared with < 15 h (0.26 per year at risk versus 0.32 per year at risk, P = 0.01). The presence of a caregiver and the number of people trained were not significantly associated with peritonitis incidence rate. Training in the immediate 10 days after implantation of the catheter was associated with the highest peritonitis rate (0.32 per year), compared with training prior to catheter implantation (0.28 per year) or > 10 days after implantation (0.23 per year). More experienced centers had a lower risk for the first peritonitis (P = 0.003).Conclusions. This is the first study to analyze the association between training characteristics and outcomes in a large cohort of PD patients. Low training time (particularly < 15 h), smaller center size and the timing of training in relation to catheter implantation were associated with a higher incidence of peritonitis. These results support the recommendation of a minimum amount of training hours to reduce peritonitis incidence regardless of the number of hours trained per day.

Impact of educational interventions on adverse drug events reporting

Spontaneous adverse drug events (ADE) reporting is the main source of data for assessing the risk/benefit of drugs available in the pharmaceutical market. However, its major limitation is underreporting, which hinders and delays the signal detection by Pharmacovigilance (PhV). To identify the techniques of educational intervention (EI) for promotion of PhV by health professionals and to assess their impact. A systematic review was performed in the PUBMED, PAHO, LILACS and EMBASE databases, from November/2011 to January/2012, updated in March/2013. The strategy search included the use of health descriptors and a manual search in the references cited by selected papers. 101 articles were identified, of which 16 met the inclusion criteria. Most of these studies (10) were conducted in European hospitals and physicians were the health professionals subjected to most EI (12), these studies lasted from one month to two years. EI with multifaceted techniques raised the absolute number, the rate of reporting related to adverse drug reactions (ADR), technical defects of health technologies, and also promoted an improvement in the quality of reports, since there was increased reporting of ADR classified as serious, unexpected, related to new drugs and with high degree of causality. Multifaceted educational interventions for multidisciplinary health teams working at all healthcare levels, with sufficient duration to reach all professionals who act in the institution, including issues related to medication errors and therapeutic ineffectiveness, must be validated, with the aim of standardizing the Good Practice of PhV and improve drug safety indicators.

The Impact of Teaching Presence in Intensive Online Courses on Perceived Learning and Sense of Community: A Mixed Methods Study

This mixed methods concurrent triangulation design study was predicated upon two models that advocated a connection between teaching presence and perceived learning: the Community of Inquiry Model of Online Learning developed by Garrison, Anderson, and Archer (2000); and the Online Interaction Learning Model by Benbunan-Fich, Hiltz, and Harasim (2005). The objective was to learn how teaching presence impacted students’ perceptions of learning and sense of community in intensive online distance education courses developed and taught by instructors at a regional comprehensive university. In the quantitative phase online surveys collected relevant data from participating students (N = 397) and selected instructional faculty (N = 32) during the second week of a three-week Winter Term. Student information included: demographics such as age, gender, employment status, and distance from campus; perceptions of teaching presence; sense of community; perceived learning; course length; and course type. The students claimed having positive relationships between teaching presence, perceived learning, and sense of community. The instructors showed similar positive relationships with no significant differences when the student and instructor data were compared. The qualitative phase consisted of interviews with 12 instructors who had completed the online survey and replied to all of the open-response questions. The two phases were integrated using a matrix generation, and the analysis allowed for conclusions regarding teaching presence, perceived learning, and sense of community. The findings were equivocal with regard to satisfaction with course length and the relative importance of the teaching presence components. A model was provided depicting relationships between and among teaching presence components, perceived learning, and sense of community in intensive online courses.

Saccharification of Brazilian sisal pulp: evaluating the impact of mercerization on non-hydrolyzed pulp and hydrolysis products

Cultivation of sisal, a plant with a short growth cycle, is highly productive in Brazil. This work is part of extensive research in which sisal is valued. In these studies, sisal fibers are used in the preparation of bio-based composites and in the derivatization of the pulp, including posterior preparation of films. This study aimed to examine the use of sisal pulp in the production of bioethanol, which can potentially be a high efficiency process because of the cellulose content of this fiber. A previous paper addressed the hydrolysis of sisal pulp using sulfuric acid as a catalyst. In the present study, the influence of the mercerization process on the acid hydrolysis of sisal pulp was evaluated. Mercerization was achieved in a 20% wt NaOH solution, and the cellulosic pulp was suspended and vigorously mixed for 1, 2 and 3 h, at 50 A degrees C. The previously characterized mercerized pulps were hydrolyzed (100 A degrees C, 30% H2SO4, v/v), and the results are compared with those obtained for unmercerized pulp (described in a companion paper). The starting sample was characterized by viscometry, alpha-cellulose content, crystallinity index and scanning electron microscopy. During the reactions, aliquots were withdrawn, and the liquor was analyzed by HPLC. The residual pulps (non-hydrolyzed) were also characterized by the techniques described for the initial sample. The results revealed that pretreatment decreases the polyoses content as well as causes a decrease of up to 23% in the crystallinity and up to 21% in the average molar mass of cellulose after 3 h of mercerization. The mercerization process proved to be very important to achieve the final target. Under the same reaction conditions (30% and 100 A degrees C, 6 h), the hydrolysis of mercerized pulp generated yields of up to 50% more glucose. The results of this paper will be compared with the results of subsequent studies obtained using other acids, and enzymes, as catalysts.

The impact of the Bolsa Escola/Familia conditional cash transfer program on enrollment, dropout rates and grade promotion in Brazil

We examine the impact of Brazil's Bolsa Escola/Familia program on Brazilian children's education outcomes. Bolsa provides cash payments to poor households if their children (ages 6 to 15) are enrolled in school. Using school census data to compare changes in enrollment, dropping out and grade promotion across schools that adopted Bolsa at different times, we estimate that the program has: increased enrollment by about 5.5% (6.5%) in grades 1-4 (grades 5-8); lowered dropout rates by 0.5 (0.4) percentage points in grades 1-4 (grades 5-8); and raised grade promotion rates by 0.9 (0.3) percentage points in grades 1-4 (grades 5-8). About one third of Brazil's children participate in Bolsa, so assuming no spillover effects onto non-participants implies that Bolsa's impacts are three times higher than these estimates. However, simple calculations using enrollment impacts suggest that Bolsa's benefits in terms of increased wages may not exceed its costs. (C) 2011 Elsevier B.V. All rights reserved.

Perception of the esthetic impact of mandibular incisor extraction treatment on laypersons, dental professionals, and dental students

Objective: To evaluate the degree of perception of laypersons, dental professionals, and dental students regarding dental esthetics in cases with mandibular central incisor extraction. Materials and Methods: Using a smile photograph of a person with normal occlusion and all teeth, modifications were made to reflect the extraction of a mandibular incisor of various compositions and sizes. For this purpose a program specifically for image manipulation (Adobe Photoshop CS3, Adobe Systems Inc) was used. After manipulation the images were printed on photographic paper, attached to a questionnaire and distributed to laypersons, dental professionals, and dental students (n = 90) to evaluate the degree of perception and esthetic using a scale of attractiveness, where 0 = hardly attractive, 5 = attractive, and 10 = very attractive. The differences between examiners were checked by the Mann-Whitney test. All the statistics were performed with a confidence level of 95%. Results: The results demonstrated the skill of the dental professionals and dental students in perceiving the difference between cases of normal occlusion and cases where an incisor was lacking (P < .05). The photograph in which the lateral incisors were shown to be larger than the central incisor was the one that obtained the highest value among the cases of extraction in all groups of evaluators. Conclusions: It can be concluded that dental professionals and dental students are more skillful at identifying deviation from normality. In addition, central incisor extraction should always be discarded when there are other treatment options available. (Angle Orthod. 2012;82:732-738.)

The informal market of education in Egypt: Private tutoring and its implications /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 88

Education is generally perceived as a public good which should be provided by the state. In Egypt, free and equal access to education has been guaranteed to all citizens since President Nasser’s socialist reforms in the 1950s. However, due to high population growth rates and a lack of financial resources, the public education system has been struggling to accommodate rapidly increasing numbers of students. While enrolment rates have risen steadily, the quality of state-provided services has deteriorated. Teachers and students have to cope with high class densities, insufficient facilities, a rigid syllabus and a centralized examination system. Today, teaching is among the lowest-paying occupations in the public sector. One strategy to cope with this situation is the widespread practice of private tutoring, which usually takes place at students’ homes or in commercial tutoring centers. Based on research carried out in Cairo in 2004/05 and 2006, I use an actor-centered approach to analyze the motivations of Egyptian teachers and students for participating in private tutoring and the impact that this practice has on the relationship between teachers and students. Students of all socio-economic backgrounds resort to tutoring in order to succeed in a highly competitive and exam-oriented education system. However, the form and quality of tutoring that can be accessed depends on the financial means of the family. For teachers, tutoring provides a good opportunity not only to supplement their income, but also, in the case of renowned “star teachers”, to improve their professional status and autonomy. On the informal “market of education” that has developed in Egypt during the last decades, the educational responsibilities of the state are increasingly being taken over by private actors, i.e. the process of teaching and learning is dissociated from the direct control of the state and from school as an institution. At the same time, education is turned into a marketable commodity. Despite the government’s efforts to provide free education to all citizens, the quality of social services that can be accessed in Egypt, thus, depends mainly on the financial means of the individual or the family.

Sustained impact of electronic alerts on rate of prophylaxis against venous thromboembolism

Advanced electronic alerts (eAlerts) and computerised physician order entry (CPOE) increase adequate thromboprophylaxis orders among hospitalised medical patients. It remains unclear whether eAlerts maintain their efficacy over time, after withdrawal of continuing medical education (CME) on eAlerts and on thromboprophylaxis indications from the study staff. We analysed 5,317 hospital cases from the University Hospital Zurich during 2006-2009: 1,854 cases from a medical ward with eAlerts (interventiongroup) and 3,463 cases from a surgical ward without eAlerts (controlgroup). In the intervention group, an eAlert with hospital-specific venous thromboembolism (VTE) prevention guidelines was issued in the electronic patient chart 6 hours after admission if no pharmacological or mechanical thromboprophylaxis had been ordered. Data were analysed for three phases: pre-implementation (phase 1), eAlert implementation with CME (phase 2), and post-implementation without CME (phase3). The rates of thromboprophylaxis in the intervention group were 43.4% in phase 1 and 66.7% in phase 2 (p<0.001), and increased further to 73.6% in phase3 (p=0.011). Early thromboprophylaxis orders within 12 hours after admission were more often placed in phase 2 and 3 as compared to phase 1 (67.1% vs. 52.1%, p<0.001). In the surgical control group, the thromboprophylaxis rates in the three phases were 88.6%, 90.7%, 90.6% (p=0.16). Advanced eAlerts may provide sustained efficacy over time, with stable rates of thromboprophylaxis orders among hospitalised medical patients.

The Impact of Greek Affiliation on Students’ Educational Objectives: Longitudinal Change in Clark-Trow Educational Philosophies

Change in 4,119 students' freshman to senior ratings of four educational philosophies (vocational, academic, collegiate, and nonconformist) provided four measures of educational impact. Repeated measures analyses of variance compared changes in philosophy as a function of Greek affiliation, controlling for sex, historical era, major, parents' education, scholastic aptitude, and academic motivation. Small but significantly different degrees of change in the collegiate and nonconformist philosophies suggested that Greek affiliation increased social interests and inhibited some forms of intellectual interests. These small differences across all students masked the moderating effect of major. In the nonconformist philosophy, for example, the Greek × major interaction reflected substantial Greek–independent differences among humanities majors, and progressively smaller differences or reversals among social science, physical science, and engineering majors. Possible interpretations of this interaction are offered.

Sharing vs. caring--the relative impact of sharing decisions versus managing emotions on patient outcomes

To assess the relative impact of cognitive and emotional aspects of shared decision making (SDM) on patient outcomes.

The Impact of Gender and Pedagogy on the Development of Self-Regulated Learning Strategies in Undergraduate Engineering Classrooms

The purpose of this paper is to examine ways in which pedagogy and gender of instructor impact the development of self-regulated learning strategies as assessed by the Motivated Strategies for Learning Questionnaire (MSLQ) in male and female undergraduate engineering students. Pedagogy was operationalized as two general formats: lecture plus active learning techniques or problem-base/project-based learning. One hundred seventy-six students from four universities participated in the study. Within-group analyses found significant differences with regard to pedagogy, instructors’ gender, and student gender on the learning strategies and motivation subscales as operationalized by the MSLQ. Male and females students reported significant post-test differences with regard to the gender of instructor and the style of pedagogy. The results of this study showed a pattern where more positive responses for students of both genders were found with the same-gendered instructor. The results also suggested that male students responded more positively to project and problem-based courses with changes evidenced in motivation strategies and resource management. Female students showed decreases in resource management in these two types of courses. Further, female students reported increases in the lecture with active learning courses.

The Returns to Migration: The Influence of Education and Migration Type

We show the impact of migration type on real wages over time. We create a migration and earnings history from the National Longitudinal Survey of Youth over the period 1979-2002. We estimate the effects of primary, onward, and two types of return migration on real wages using a panel data model with individual, location, and time fixed effects. Panel data are well suited for the study of the returns to U.S. internal migration because the influence of migration on wages has been found to occur years after the event. We differentiate return migration into two types: return to a location with ties that form a geographical anchor (home) and return to a prior place of work. We find that real wage growth varies by migration type. Education attainment is a significant factor in real wage growth. Our results show that onward migration is an important channel by which the monetary rewards to a college education are manifested.

The Impact of Foreign Direct Investment on Economic Growth

Over the past four decades, the number of democracies in the world has increased exponentially. This project considers how democracy and FDI affect economic growth as well as whether the impact of FDI depends on the level of democracy in a country. Thus, I explore two major research questions: 1) Whether increased FDI speeds up economic growth, controlling for political regime type, urbanization and other developmental indicators; and 2) Whether an increase in political freedom helps or hinders economic growth, and specifically whether the impact of FDI varies depending on the political regime in the recipient country. To examine these questions, this paper used data from 150 countries over a period between 1980 and 2010 and utilized several models, testing variables such as institutions, agglomerations, urbanization, FDI and type of political regime, among others, for their impact on economic growth. I found that FDI does have a positive impact on economic growth, and that this impact is often magnified when it interacts with other relevant factors. I also found that, after controlling for other variables, FDI inflows do not have a different impact on economic growth in autocracies than they do in democracies. This may be partially explained by autocratic outliers such as China and the OPEC states, which have recently experienced rapid export-led growth. This suggests that factors such as education could have a greater impact on a country¿s economic growth than does its political system.

Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience

CONCLUSION: Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE: Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS: Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS: Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.