Ethnographic and epidemiologic approaches for the programming of prenatal and birth services in Mesa los Hornos, Mexico

The investigator conducted an action-oriented investigation of pregnancy and birth among the women of Mesa los Hornos, an urban squatter slum in Mexico City. Three aims guided the project: (1) To obtain information for improving prenatal and maternity service utilization; (2) To examine the utility of rapid ethnographic and epidemiologic assessment methodologies; (3) To cultivate community involvement in health development.^ Viewing service utilization as a culturally-bound decision, the study included a qualitative phase to explore women's cognition of pregnancy and birth, their perceived needs during pregnancy, and their criteria of service acceptability. A probability-based community survey delineated parameters of service utilization and pregnancy health events, and probed reasons for decisions to use medical services, lay midwives, or other sources of prenatal and labor and delivery assistance. Qualitative survey of service providers at relevant clinics, hospitals, and practices contributed information on service availability and access, and on coordination among private, social security, and public assistance health service sectors. The ethnographic approach to exploring the rationale for use or non-use of services provided a necessary complement to conventional barrier-based assessment, to inform planning of culturally appropriate interventions.^ Information collection and interpretation was conducted under the aegis of an advisory committee of community residents and service agency representatives; the residents' committee formulated recommendations for action based on findings, and forwarded the mandate to governmental social and urban development offices. Recommendations were designed to inform and develop community participation in health care decision-making.^ Rapid research methods are powerful tools for achieving community-based empowerment toward investigation and resolution of local health problems. But while ethnography works well in synergy with quantitative assessment approaches to strengthen the validity and richness of short-term field work, the author strongly urges caution in application of Rapid Ethnographic Assessments. An ethnographic sensibility is essential to the research enterprise for the development of an active and cooperative community base, the design and use of quantitative instruments, the appropriate use of qualitative techniques, and the interpretation of culturally-oriented information. However, prescribed and standardized Rapid Ethnographic Assessment techniques are counter-productive if used as research short-cuts before locale- and subject-specific cultural understanding is achieved. ^

HEALTH MAINTENANCE ORGANIZATION ENVIRONMENT: AN EMPIRICAL STUDY OF THE RELATIONSHIP OF EXTERNAL CONTEXT AND PERFORMANCE

The research project is an extension of a series of administrative science and health care research projects evaluating the influence of external context, organizational strategy, and organizational structure upon organizational success or performance. The research will rely on the assumption that there is not one single best approach to the management of organizations (the contingency theory). As organizational effectiveness is dependent on an appropriate mix of factors, organizations may be equally effective based on differing combinations of factors. The external context of the organization is expected to influence internal organizational strategy and structure and in turn the internal measures affect performance (discriminant theory). The research considers the relationship of external context and organization performance.^ The unit of study for the research will be the health maintenance organization (HMO); an organization the accepts in exchange for a fixed, advance capitation payment, contractual responsibility to assure the delivery of a stated range of health sevices to a voluntary enrolled population. With the current Federal resurgence of interest in the Health Maintenance Organization (HMO) as a major component in the health care system, attention must be directed at maximizing development of HMOs from the limited resources available. Increased skills are needed in both Federal and private evaluation of HMO feasibility in order to prevent resource investment and in projects that will fail while concurrently identifying potentially successful projects that will not be considered using current standards.^ The research considers 192 factors measuring contextual milieu (social, educational, economic, legal, demographic, health and technological factors). Through intercorrelation and principle components data reduction techniques this was reduced to 12 variables. Two measures of HMO performance were identified, they are (1) HMO status (operational or defunct), and (2) a principle components factor score considering eight measures of performance. The relationship between HMO context and performance was analysed using correlation and stepwise multiple regression methods. In each case it has been concluded that the external contextual variables are not predictive of success or failure of study Health Maintenance Organizations. This suggests that performance of an HMO may rely on internal organizational factors. These findings have policy implications as contextual measures are used as a major determinant in HMO feasibility analysis, and as a factor in the allocation of limited Federal funds. ^

Use of contraception and contraceptive services among U.S. Hispanic women: 2006--2008

This study investigates the association between race/ethnicity and acculturation variables (language preference and nativity) with use of contraception and contraceptive services among Mexican/Mexican American and “other” Hispanic women aged 15-44 when compared to non- Hispanic white women.^ Data was analyzed from the 2006-2008 National Survey of Family Growth. The sample contained 3357 women aged 15-44. Multivariate logistic regression analysis was used to examine the association between race/ethnicity and acculturation variables and contraceptive-related behaviors adjusted for other known covariates. ^ After multivariate analysis, neither nativity nor language preference were significantly associated with contraception use or contraceptive services. Mexican/Mexican American women did not differ in their contraception-related behaviors when compared to non-Hispanic whites. Other Hispanic women, however, were less likely to obtain contraceptive services than non-Hispanic whites (OR=0.67, 95% CI=0.45-1.00). Women aged 30-39 and 40-44 were less likely to obtain contraception and contraceptive services than those aged 15-19. Single women were less likely to use contraception (OR=0.72, 95% CI=0.56-0.92) and contraceptive services (OR=0.69, 95% CI=0.53-0.89) than married/co-habiting women. Women with healthcare coverage were more likely to use contraception and contraceptive services than uninsured women.^ Among Hispanic women of different origin groups, age, marital status, and healthcare coverage were stronger indicators of contraception-related behavior than race/ethnicity, language preference, and nativity. Reproductive health programs that target increased use of contraception and contraceptive services among Hispanic origin groups should specifically target women who are over 30, single, and uninsured.^

Abortion clinics and contraceptive services: opportunities and challenges

http://www.guttmacher.org/pubs/gpr/14/2/gpr140202.pdf

Profile in occupational counselling and placement and employment services: social policies axis

This paper presents the gestation of a new model of Occupational Counselling, centred in the joint action of State, Third Sector and Private Organizations. Different programmes are identified which involve the treatment of issues related to Labour, Employment and Education within the framework of objectives of social development, community participation and respect for diversity. The data of the investigation make it possible to establish connections between the tasks, professional profiles and professional training of the counsellors who participate in the different programmes.

Profile in occupational counselling and placement and employment services: social policies axis

This paper presents the gestation of a new model of Occupational Counselling, centred in the joint action of State, Third Sector and Private Organizations. Different programmes are identified which involve the treatment of issues related to Labour, Employment and Education within the framework of objectives of social development, community participation and respect for diversity. The data of the investigation make it possible to establish connections between the tasks, professional profiles and professional training of the counsellors who participate in the different programmes.

Profile in occupational counselling and placement and employment services: social policies axis

This paper presents the gestation of a new model of Occupational Counselling, centred in the joint action of State, Third Sector and Private Organizations. Different programmes are identified which involve the treatment of issues related to Labour, Employment and Education within the framework of objectives of social development, community participation and respect for diversity. The data of the investigation make it possible to establish connections between the tasks, professional profiles and professional training of the counsellors who participate in the different programmes.

Concentrations of Fe, Mn, Cu, Zn, Co, Ni, Pb, Cd, B, and SiO2 in interstitial waters from bottom sediments of the Atlantis II and Discovery Deeps, Red Sea rift zone

Chemical analyzes show that interstitial waters from ore-bearing bottom sediments of the Atlantis II and Discovery Deeps are enriched in Fe, Mn, Cu, Ni, Co, Zn, Pb, and Cd compared to sea water. Enrichment factors of these trace elements in the interstitial waters of the Atlantis II Deep relative to the sea water vary within the following ranges: for Fe from 100 to 7000, for Mn from 19047 to 32738, for Zn from 500 to 1600, for Pb from 78333 to 190000, for Cu from 107 to 654. Comparison of average weighted concentrations of Fe, Mn, Zn, Pb, Cu, Ni in the bottom sediments and the interstitial waters of the Atlantis II Deep indicates common regularities and good relationship in distribution of these elements along sediment cores. Differences in concentrations and distribution of the studied trace elements in the interstitial waters of the Atlantis II and Discovery Deeps result from different chemical compositions of hydrothermal fluids entering these deeps.

Communication Architecture for Tracking and Interoperable Services at Hospitals: A Real Deployment Experience

Any new hospital communication architecture has to support existing services, but at the same time new added features should not affect normal tasks. This article deals with issues regarding old and new systems’ interoperability, as well as the effect the human factor has in a deployed architecture. It also presents valuable information, which is a product of a real scenario. Tracking services are also tested in order to monitor and administer several medical resources.

User Experience in Human-Technology Interaction. Communication, context and evaluation methodology

En esta Tesis se presentan dos líneas de investigación relacionadas y que contribuyen a las áreas de Interacción Hombre-Tecnología (o Máquina; siglas en inglés: HTI o HMI), lingüística computacional y evaluación de la experiencia del usuario. Las dos líneas en cuestión son el diseño y la evaluación centrada en el usuario de sistemas de Interacción Hombre-Máquina avanzados. En la primera parte de la Tesis (Capítulos 2 a 4) se abordan cuestiones fundamentales del diseño de sistemas HMI avanzados. El Capítulo 2 presenta una panorámica del estado del arte de la investigación en el ámbito de los sistemas conversacionales multimodales, con la que se enmarca el trabajo de investigación presentado en el resto de la Tesis. Los Capítulos 3 y 4 se centran en dos grandes aspectos del diseño de sistemas HMI: un gestor del diálogo generalizado para tratar la Interacción Hombre-Máquina multimodal y sensible al contexto, y el uso de agentes animados personificados (ECAs) para mejorar la robustez del diálogo, respectivamente. El Capítulo 3, sobre gestión del diálogo, aborda el tratamiento de la heterogeneidad de la información proveniente de las modalidades comunicativas y de los sensores externos. En este capítulo se propone, en un nivel de abstracción alto, una arquitectura para la gestión del diálogo con influjos heterogéneos de información, apoyándose en el uso de State Chart XML. En el Capítulo 4 se presenta una contribución a la representación interna de intenciones comunicativas, y su traducción a secuencias de gestos a ejecutar por parte de un ECA, diseñados específicamente para mejorar la robustez en situaciones de diálogo críticas que pueden surgir, por ejemplo, cuando se producen errores de entendimiento en la comunicación entre el usuario humano y la máquina. Se propone, en estas páginas, una extensión del Functional Mark-up Language definido en el marco conceptual SAIBA. Esta extensión permite representar actos comunicativos que realizan intenciones del emisor (la máquina) que no se pretende sean captadas conscientemente por el receptor (el usuario humano), pero con las que se pretende influirle a éste e influir el curso del diálogo. Esto se consigue mediante un objeto llamado Base de Intenciones Comunicativas (en inglés, Communication Intention Base, o CIB). La representación en el CIB de intenciones “no claradas” además de las explícitas permite la construcción de actos comunicativos que realizan simultáneamente varias intenciones comunicativas. En el Capítulo 4 también se describe un sistema experimental para el control remoto (simulado) de un asistente domótico, con autenticación de locutor para dar acceso, y con un ECA en el interfaz de cada una de estas tareas. Se incluye una descripción de las secuencias de comportamiento verbal y no verbal de los ECAs, que fueron diseñados específicamente para determinadas situaciones con objeto de mejorar la robustez del diálogo. Los Capítulos 5 a 7 conforman la parte de la Tesis dedicada a la evaluación. El Capítulo 5 repasa antecedentes relevantes en la literatura de tecnologías de la información en general, y de sistemas de interacción hablada en particular. Los principales antecedentes en el ámbito de la evaluación de la interacción sobre los cuales se ha desarrollado el trabajo presentado en esta Tesis son el Technology Acceptance Model (TAM), la herramienta Subjective Assessment of Speech System Interfaces (SASSI), y la Recomendación P.851 de la ITU-T. En el Capítulo 6 se describen un marco y una metodología de evaluación aplicados a la experiencia del usuario con sistemas HMI multimodales. Se desarrolló con este propósito un novedoso marco de evaluación subjetiva de la calidad de la experiencia del usuario y su relación con la aceptación por parte del mismo de la tecnología HMI (el nombre dado en inglés a este marco es Subjective Quality Evaluation Framework). En este marco se articula una estructura de clases de factores subjetivos relacionados con la satisfacción y aceptación por parte del usuario de la tecnología HMI propuesta. Esta estructura, tal y como se propone en la presente tesis, tiene dos dimensiones ortogonales. Primero se identifican tres grandes clases de parámetros relacionados con la aceptación por parte del usuario: “agradabilidad ” (likeability: aquellos que tienen que ver con la experiencia de uso, sin entrar en valoraciones de utilidad), rechazo (los cuales sólo pueden tener una valencia negativa) y percepción de utilidad. En segundo lugar, este conjunto clases se reproduce para distintos “niveles, o focos, percepción del usuario”. Éstos incluyen, como mínimo, un nivel de valoración global del sistema, niveles correspondientes a las tareas a realizar y objetivos a alcanzar, y un nivel de interfaz (en los casos propuestos en esta tesis, el interfaz es un sistema de diálogo con o sin un ECA). En el Capítulo 7 se presenta una evaluación empírica del sistema descrito en el Capítulo 4. El estudio se apoya en los mencionados antecedentes en la literatura, ampliados con parámetros para el estudio específico de los agentes animados (los ECAs), la auto-evaluación de las emociones de los usuarios, así como determinados factores de rechazo (concretamente, la preocupación por la privacidad y la seguridad). También se evalúa el marco de evaluación subjetiva de la calidad propuesto en el capítulo anterior. Los análisis de factores efectuados revelan una estructura de parámetros muy cercana conceptualmente a la división de clases en utilidad-agradabilidad-rechazo propuesta en dicho marco, resultado que da cierta validez empírica al marco. Análisis basados en regresiones lineales revelan estructuras de dependencias e interrelación entre los parámetros subjetivos y objetivos considerados. El efecto central de mediación, descrito en el Technology Acceptance Model, de la utilidad percibida sobre la relación de dependencia entre la intención de uso y la facilidad de uso percibida, se confirma en el estudio presentado en la presente Tesis. Además, se ha encontrado que esta estructura de relaciones se fortalece, en el estudio concreto presentado en estas páginas, si las variables consideradas se generalizan para cubrir más ampliamente las categorías de agradabilidad y utilidad contempladas en el marco de evaluación subjetiva de calidad. Se ha observado, asimismo, que los factores de rechazo aparecen como un componente propio en los análisis de factores, y además se distinguen por su comportamiento: moderan la relación entre la intención de uso (que es el principal indicador de la aceptación del usuario) y su predictor más fuerte, la utilidad percibida. Se presentan también resultados de menor importancia referentes a los efectos de los ECAs sobre los interfaces de los sistemas de diálogo y sobre los parámetros de percepción y las valoraciones de los usuarios que juegan un papel en conformar su aceptación de la tecnología. A pesar de que se observa un rendimiento de la interacción dialogada ligeramente mejor con ECAs, las opiniones subjetivas son muy similares entre los dos grupos experimentales (uno interactuando con un sistema de diálogo con ECA, y el otro sin ECA). Entre las pequeñas diferencias encontradas entre los dos grupos destacan las siguientes: en el grupo experimental sin ECA (es decir, con interfaz sólo de voz) se observó un efecto más directo de los problemas de diálogo (por ejemplo, errores de reconocimiento) sobre la percepción de robustez, mientras que el grupo con ECA tuvo una respuesta emocional más positiva cuando se producían problemas. Los ECAs parecen generar inicialmente expectativas más elevadas en cuanto a las capacidades del sistema, y los usuarios de este grupo se declaran más seguros de sí mismos en su interacción. Por último, se observan algunos indicios de efectos sociales de los ECAs: la “amigabilidad ” percibida los ECAs estaba correlada con un incremento la preocupación por la seguridad. Asimismo, los usuarios del sistema con ECAs tendían más a culparse a sí mismos, en lugar de culpar al sistema, de los problemas de diálogo que pudieran surgir, mientras que se observó una ligera tendencia opuesta en el caso de los usuarios del sistema con interacción sólo de voz. ABSTRACT This Thesis presents two related lines of research work contributing to the general fields of Human-Technology (or Machine) Interaction (HTI, or HMI), computational linguistics, and user experience evaluation. These two lines are the design and user-focused evaluation of advanced Human-Machine (or Technology) Interaction systems. The first part of the Thesis (Chapters 2 to 4) is centred on advanced HMI system design. Chapter 2 provides a background overview of the state of research in multimodal conversational systems. This sets the stage for the research work presented in the rest of the Thesis. Chapers 3 and 4 focus on two major aspects of HMI design in detail: a generalised dialogue manager for context-aware multimodal HMI, and embodied conversational agents (ECAs, or animated agents) to improve dialogue robustness, respectively. Chapter 3, on dialogue management, deals with how to handle information heterogeneity, both from the communication modalities or from external sensors. A highly abstracted architectural contribution based on State Chart XML is proposed. Chapter 4 presents a contribution for the internal representation of communication intentions and their translation into gestural sequences for an ECA, especially designed to improve robustness in critical dialogue situations such as when miscommunication occurs. We propose an extension of the functionality of Functional Mark-up Language, as envisaged in much of the work in the SAIBA framework. Our extension allows the representation of communication acts that carry intentions that are not for the interlocutor to know of, but which are made to influence him or her as well as the flow of the dialogue itself. This is achieved through a design element we have called the Communication Intention Base. Such r pr s ntation of “non- clar ” int ntions allows th construction of communication acts that carry several communication intentions simultaneously. Also in Chapter 4, an experimental system is described which allows (simulated) remote control to a home automation assistant, with biometric (speaker) authentication to grant access, featuring embodied conversation agents for each of the tasks. The discussion includes a description of the behavioural sequences for the ECAs, which were designed for specific dialogue situations with particular attention given to the objective of improving dialogue robustness. Chapters 5 to 7 form the evaluation part of the Thesis. Chapter 5 reviews evaluation approaches in the literature for information technologies, as well as in particular for speech-based interaction systems, that are useful precedents to the contributions of the present Thesis. The main evaluation precedents on which the work in this Thesis has built are the Technology Acceptance Model (TAM), the Subjective Assessment of Speech System Interfaces (SASSI) tool, and ITU-T Recommendation P.851. Chapter 6 presents the author’s work in establishing an valuation framework and methodology applied to the users’ experience with multimodal HMI systems. A novel user-acceptance Subjective Quality Evaluation Framework was developed by the author specifically for this purpose. A class structure arises from two orthogonal sets of dimensions. First we identify three broad classes of parameters related with user acceptance: likeability factors (those that have to do with the experience of using the system), rejection factors (which can only have a negative valence) and perception of usefulness. Secondly, the class structure is further broken down into several “user perception levels”; at the very least: an overall system-assessment level, task and goal-related levels, and an interface level (e.g., a dialogue system with or without an ECA). An empirical evaluation of the system described in Chapter 4 is presented in Chapter 7. The study was based on the abovementioned precedents in the literature, expanded with categories covering the inclusion of an ECA, the users’ s lf-assessed emotions, and particular rejection factors (privacy and security concerns). The Subjective Quality Evaluation Framework proposed in the previous chapter was also scrutinised. Factor analyses revealed an item structure very much related conceptually to the usefulness-likeability-rejection class division introduced above, thus giving it some empirical weight. Regression-based analysis revealed structures of dependencies, paths of interrelations, between the subjective and objective parameters considered. The central mediation effect, in the Technology Acceptance Model, of perceived usefulness on the dependency relationship of intention-to-use with perceived ease of use was confirmed in this study. Furthermore, the pattern of relationships was stronger for variables covering more broadly the likeability and usefulness categories in the Subjective Quality Evaluation Framework. Rejection factors were found to have a distinct presence as components in factor analyses, as well as distinct behaviour: they were found to moderate the relationship between intention-to-use (the main measure of user acceptance) and its strongest predictor, perceived usefulness. Insights of secondary importance are also given regarding the effect of ECAs on the interface of spoken dialogue systems and the dimensions of user perception and judgement attitude that may have a role in determining user acceptance of the technology. Despite observing slightly better performance values in the case of the system with the ECA, subjective opinions regarding both systems were, overall, very similar. Minor differences between two experimental groups (one interacting with an ECA, the other only through speech) include a more direct effect of dialogue problems (e.g., non-understandings) on perceived dialogue robustness for the voice-only interface test group, and a more positive emotional response for the ECA test group. Our findings further suggest that the ECA generates higher initial expectations, and users seem slightly more confident in their interaction with the ECA than do those without it. Finally, mild evidence of social effects of ECAs was also found: the perceived friendliness of the ECA increased security concerns, and ECA users may tend to blame themselves rather than the system when dialogue problems are encountered, while the opposite may be true for voice-only users.

Analysing trade-offs between food production and ecosystem services in tropical forests of lowland Bolivia

The expansion of agricultural land is responsible for most tropical deforestation. Historically, smallholder farming and shifting cultivation has been reported as the main agent of deforestation. However, the increasing global demand for food in recent years has greatly boosted the development of medium and large-scale commercial agriculture which is nowadays causing the majority of tropical forest cover loss, particularly in Latin America.

Nature knows best: An amazing reaction cascade is uncovered by design and discovery

The Daphniphyllum alkaloids are a group of highly complex polycyclic alkaloids. Examination of the structures if several members of this family of natural products led to a hypothesis about their mode of biosynthesis (depicted in Scheme SI). Based on this hypothetical biosynthetic pathway, a laboratory synthesis was designed that incorporated as a key transformation the novel one-pot transformation of dialdehyde 24 to pentacyclic unsaturated amine 25. This process turned out to be an exceptionally efficient way to construct the pentacyclic nucleus of the Daphniphyllum alkaloids. However, a purely fortuitous discovery, resulting from accidental use of methylamine rather than ammonia, led to a great improvement in the synthesis and suggests an even more attractive possible biosynthesis.

Structural characterization of an engineered tandem repeat contrasts the importance of context and sequence in protein folding

To test a different approach to understanding the relationship between the sequence of part of a protein and its conformation in the overall folded structure, the amino acid sequence corresponding to an α-helix of T4 lysozyme was duplicated in tandem. The presence of such a sequence repeat provides the protein with “choices” during folding. The mutant protein folds with almost wild-type stability, is active, and crystallizes in two different space groups, one isomorphous with wild type and the other with two molecules in the asymmetric unit. The fold of the mutant is essentially the same in all cases, showing that the inserted segment has a well-defined structure. More than half of the inserted residues are themselves helical and extend the helix present in the wild-type protein. Participation of additional duplicated residues in this helix would have required major disruption of the parent structure. The results clearly show that the residues within the duplicated sequence tend to maintain a helical conformation even though the packing interactions with the remainder of the protein are different from those of the original helix. It supports the hypothesis that the structures of individual α-helices are determined predominantly by the nature of the amino acids within the helix, rather than the structural environment provided by the rest of the protein.