Os estados no SUAS: uma análise da capacidade institucional dos governos estaduais na assistência social

This paper deals of the effects generated by institutional designs in the behavior of political actors. The literature that discusses the implications of federal arrangements in the production of public policies to dock at two opposing arguments: (1) the federal configuration would cause dispersion and variation in service provision between subnational governments; and (2) the central government would own mechanisms to induce the provision of national policies in more homogeneous levels, similar to unitary states. The research is part of this discussion because it analyzes the effects of the institutional design of the Sistema Único de Assistência Social (SUAS) in the decisions of states in Brazil. Therefore, we analyzed the institutional capacity built by the 26 state governments after the implementation of SUAS, conceiving this system as defined mechanism of government functions and federative cooperation.It is argued that the existence of a heterogeneous institutional capacity of state governments in social assistance is a result of the autonomy contained in the institutional design of SUAS to this level of government. This freedom of action relativize the idea that the implementation of national public policy systems would generate positive (or homogeneous) effects in all subnational governments, at the same time as it preclude to generalize the premise of fragility of the states in the brazilian federal plan.

The French Canadian founder population : lessons and insights for genetic epidemiological research

La population canadienne-française a une histoire démographique unique faisant d’elle une population d’intérêt pour l’épidémiologie et la génétique. Cette thèse vise à mettre en valeur les caractéristiques de la population québécoise qui peuvent être utilisées afin d’améliorer la conception et l’analyse d’études d’épidémiologie génétique. Dans un premier temps, nous profitons de la présence d’information généalogique détaillée concernant les Canadiens français pour estimer leur degré d’apparentement et le comparer au degré d’apparentement génétique. L’apparentement génétique calculé à partir du partage génétique identique par ascendance est corrélé à l’apparentement généalogique, ce qui démontre l'utilité de la détection des segments identiques par ascendance pour capturer l’apparentement complexe, impliquant entre autres de la consanguinité. Les conclusions de cette première étude pourront guider l'interprétation des résultats dans d’autres populations ne disposant pas d’information généalogique. Dans un deuxième temps, afin de tirer profit pleinement du potentiel des généalogies canadienne-françaises profondes, bien conservées et quasi complètes, nous présentons le package R GENLIB, développé pour étudier de grands ensembles de données généalogiques. Nous étudions également le partage identique par ascendance à l’aide de simulations et nous mettons en évidence le fait que la structure des populations régionales peut faciliter l'identification de fondateurs importants, qui auraient pu introduire des mutations pathologiques, ce qui ouvre la porte à la prévention et au dépistage de maladies héréditaires liées à certains fondateurs. Finalement, puisque nous savons que les Canadiens français ont accumulé des segments homozygotes, à cause de la présence de consanguinité lointaine, nous estimons la consanguinité chez les individus canadiens-français et nous étudions son impact sur plusieurs traits de santé. Nous montrons comment la dépression endogamique influence des traits complexes tels que la grandeur et des traits hématologiques. Nos résultats ne sont que quelques exemples de ce que nous pouvons apprendre de la population canadienne-française. Ils nous aideront à mieux comprendre les caractéristiques des autres populations de même qu’ils pourront aider la recherche en épidémiologie génétique au sein de la population canadienne-française.

Election Forecasting under Opaque Conditions

Election forecasting models assume retrospective economic voting and clear mechanisms of accountability. Previous research indeed indicates that incumbent political parties are being held accountable for the state of the economy. In this article we develop a ‘hard case’ for the assumptions of election forecasting models. Belgium is a multiparty system with perennial coalition governments. Furthermore, Belgium has two completely segregated party systems (Dutch and French language). Since the prime minister during the period 1974-2011 has always been a Dutch language politician, French language voters could not even vote for the prime minister, so this cognitive shortcut to establish political accountability is not available. Results of an analysis for the French speaking parties (1981-2010) show that even in these conditions of opaque accountability, retrospective economic voting occurs as election results respond to indicators with regard to GDP and unemployment levels. Party membership figures can be used to model the popularity function in election forecasting.

Irish dental practitioners perceived barriers to the care of patients with special healthcare needs and the effect of postgraduate training

Inequalities in oral healthcare service provision to people with special health needs have been reported in the Republic of Ireland. These include higher unmet dental treatment needs and longer waiting period to access routine dental treatment than the general population. Aim: The aims of this study were to determine the groups of patients with special needs which pose a challenge to manage in the dental surgery and to examine perceived barriers to the care of these patients. We aimed to determine whether postgraduate training in the management of these patients increases the practitioners’ frequency of treatment and their desire for further training in this area. Methods: A questionnaire was used to survey 326 randomly selected dentists from the Dental Council’s register of dentists. Questionnaire and information sheets explaining the purpose of the survey, confidentiality and anonymity of the responses were posted to the dentists. Results: The results showed that children with intellectual disability posed the biggest challenge for dentists to manage in the dental surgery. Behaviour management issues and the degree of disability were perceived by many dentists as factors that would have high effects on their willingness to treat patients with special needs. Dentists who have postgraduate training in the management of patients with special needs were significantly more willing to treat these patients and to seek additional training in the future. Conclusion: There are links between the training and the willingness of practitioners to undertake dental treatment or patients with special healthcare needs.

The French Canadian founder population : lessons and insights for genetic epidemiological research

La population canadienne-française a une histoire démographique unique faisant d’elle une population d’intérêt pour l’épidémiologie et la génétique. Cette thèse vise à mettre en valeur les caractéristiques de la population québécoise qui peuvent être utilisées afin d’améliorer la conception et l’analyse d’études d’épidémiologie génétique. Dans un premier temps, nous profitons de la présence d’information généalogique détaillée concernant les Canadiens français pour estimer leur degré d’apparentement et le comparer au degré d’apparentement génétique. L’apparentement génétique calculé à partir du partage génétique identique par ascendance est corrélé à l’apparentement généalogique, ce qui démontre l'utilité de la détection des segments identiques par ascendance pour capturer l’apparentement complexe, impliquant entre autres de la consanguinité. Les conclusions de cette première étude pourront guider l'interprétation des résultats dans d’autres populations ne disposant pas d’information généalogique. Dans un deuxième temps, afin de tirer profit pleinement du potentiel des généalogies canadienne-françaises profondes, bien conservées et quasi complètes, nous présentons le package R GENLIB, développé pour étudier de grands ensembles de données généalogiques. Nous étudions également le partage identique par ascendance à l’aide de simulations et nous mettons en évidence le fait que la structure des populations régionales peut faciliter l'identification de fondateurs importants, qui auraient pu introduire des mutations pathologiques, ce qui ouvre la porte à la prévention et au dépistage de maladies héréditaires liées à certains fondateurs. Finalement, puisque nous savons que les Canadiens français ont accumulé des segments homozygotes, à cause de la présence de consanguinité lointaine, nous estimons la consanguinité chez les individus canadiens-français et nous étudions son impact sur plusieurs traits de santé. Nous montrons comment la dépression endogamique influence des traits complexes tels que la grandeur et des traits hématologiques. Nos résultats ne sont que quelques exemples de ce que nous pouvons apprendre de la population canadienne-française. Ils nous aideront à mieux comprendre les caractéristiques des autres populations de même qu’ils pourront aider la recherche en épidémiologie génétique au sein de la population canadienne-française.

Cultural cooperation, institution building, and metropolitan governance in decentralizing Indonesia

The institutional turn in metropolitan governance has been influenced to a considerable degree by a rational choice approach, which views metropolitan governance as essentially created by local actors to reduce the transaction costs of inter-jurisdictional public-service provision. Another influential theoretical route follows a historical approach, which emphasizes the role of the state structure in producing formal institutions to enable governance at the regional level. Both approaches tend to be formalistic, simplistic and deterministic in nature, thus neglecting the dynamic interactions between the actors and their more informal, intangible, yet more basic, legitimate institutions, such as culture. This article examines the dynamic role of culture in metropolitan governance building in the context of decentralizing Indonesia. The analysis focuses on ‘best-practice’ experiences of metropolitan cooperation in greater Yogyakarta, where three neighbouring local governments known as Kartamantul have collaboratively performed cross-border infrastructure development to deal with the consequences of extended urbanization. We draw on sociological institutionalism to argue that building this metropolitan cooperation has its roots in the capacity of the actors to use and mobilize culture as a resource for collaborative action.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Chief Medical Officer's Report - Evidential Base and Clinical Practice Aspects of Congenital Cardiac Services (August 2013) (PDF 77KB)

Report on Evidential Base and Clinical Practice Aspects of Congenital Cardiac Services The principle drivers that should determine the optimal arrangements for the provision of congenital cardiac services, including  paediatric and adult cardiac surgery, for the population of Northern Ireland is how best those services can be configured to ensure the safest possible care that is of the highest quality possible in order to optimise outcomes and experience for patients and carers. Of necessity, this requires consideration of all requisite supporting services and arrangements to ensure access across the continuum of care. Such a configuration should support safe, high quality service provision on an on-going basis i.e. ensure sustainability as far as can be determined. In addressing this issue, consideration to the changing profile of population need and the evolving nature specialist services is required.  

Justified assessments of service provider reputation

Abstract Reputation, influenced by ratings from past clients, is crucial for providers competing for custom. For new providers with less track record, a few negative ratings can harm their chances of growing. In the JASPR project, we aim to look at how to ensure automated reputation assessments are justified and informative. Even an honest balanced review of a service provision may still be an unreliable predictor of future performance if the circumstances differ. For example, a service may have previously relied on different sub-providers to now, or been affected by season-specific weather events. A common way to ameliorate the ratings that may not reflect future performance is by weighting by recency. We argue that better results are obtained by querying provenance records on how services are provided for the circumstances of provision, to determine the significance of past interactions. Informed by case studies in global logistics, taxi hire, and courtesy car leasing, we are going on to explore the generation of explanations for reputation assessments, which can be valuable both for clients and for providers wishing to improve their match to the market, and applying machine learning to predict aspects of service provision which may influence decisions on the appropriateness of a provider. In this talk, I will give an overview of the research conducted and planned on JASPR. Speaker Biography Dr Simon Miles Simon Miles is a Reader in Computer Science at King's College London, UK, and head of the Agents and Intelligent Systems group. He conducts research in the areas of normative systems, data provenance, and medical informatics at King's, and has published widely and manages a number of research projects in these areas. He was previously a researcher at the University of Southampton after graduating from his PhD at Warwick. He has twice been an organising committee member for the Autonomous Agents and Multi-Agent Systems conference series, and was a member of the W3C working group which published standards on interoperable provenance data in 2013.

Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.

BACKGROUND: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. METHODS: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. RESULTS: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. CONCLUSION: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

Using Social Worlds Theory to Explore Influences on Community Nurses’ Experiences of Providing Out of Hours Paediatric Palliative Care

Abstract Background: Paediatric oncology palliative care in the community is rare and nationally there is a lack of standardisation of out of hours nursing service provision. Objectives: This paper seeks to explore influences on the experiences of paediatric nurses providing out of hours palliative care within the family home to children with cancer. The study used social worlds theory to aid identification and demonstration of the findings. Methods: Twelve community-based palliative cases were purposively selected from children with cancer treated at one regional centre. Tape-recorded interviews were undertaken with 54 health professionals (general practitioners, community nurses and allied health professionals) involved in providing their palliative care and five facilitated case discussions completed. Data analysis followed a grounded theory approach; chronological comparative data analysis identifying generated themes. Social worlds theory was used as a framework to examine the data. Results: Nurses’ experiences are shaped by their social world and those of the nursing team,child and family and the inter-professional team providing the care. The lack of a formalised service, sub-optimal inter-professional working and impact of social worlds influence the experience of the nurse. Conclusions: Social worlds theory provided a new perspective in understanding these experiences based within a paediatric palliative care setting, knowledge that can be used to inform service provision.

Role of climate on barn owls road-kill likelihood and the effect on population viability in future climate change

Roads represent a new source of mortality due to animal-vehicle risk of collision threatening log-term populations’ viability. Risk of road-kill depends on species sensitivity to roads and their specific life-history traits. The risk of road mortality for each species depends on the characteristics of roads and bioecological characteristics of the species. In this study we intend to know the importance of climatic parameters (temperature and precipitation) together with traffic and life history traits and understand the role of drought in barn owl population viability, also affected by road mortality in three scenarios: high mobility, high population density and the combination of previous scenarios (mixed) (Manuscript). For the first objective we correlated the several parameters (climate, traffic and life history traits). We used the most correlated variables to build a predictive mixed model (GLMM) the influence of the same. Using a population model we evaluated barn owl population viability in all three scenarios. Model revealed precipitation, traffic and dispersal have negative relationship with road-kills, although the relationship was not significant. Scenarios showed different results, high mobility scenario showed greater population depletion, more fluctuations over time and greater risk of extinction. High population density scenario showed a more stable population with lower risk of extinction and mixed scenario showed similar results as first scenario. Climate seems to play an indirect role on barn owl road-kills, it may influence prey availability which influences barn owl reproductive success and activity. Also, high mobility scenario showed a greater negative impact on viability of populations which may affect their ability and resilience to other stochastic events. Future research should take in account climate and how it may influence species life cycles and activity periods for a more complete approach of road-kills. Also it is important to make the best mitigation decisions which might include improving prey quality habitat.

A critical analysis of the prospects for the effective development of a regional approach to competition law in the ASEAN region

This thesis is an examination of the ASEAN’s prospects in establishing regional competition policy in the Southeast Asia region, a topic of contemporary relevance in light of the ASEAN’s recent foray into the economic integration field on 31 December 2015. It questions whether the current approach undertaken by the ASEAN could contribute to an effective regional competition policy under the regional market integration. In answering this question, the thesis first critically surveys the current terrain of regional competition laws and policies in order to determine the possible existence of an optimal template. It argues that although the EU model is oft used as a source of inspiration, each regional organisation conceives different configurations of the model in order to best adjust to the local regional contexts. The thesis makes an inquiry into the narratives of the ASEAN’s competition policy, as well as the ASEAN’s specific considerations in the development of competition policy, before comparing the findings to the actual approaches taken by the ASEAN in its pursuit of regional competition policy. This thesis reveals that the actual approach taken by the ASEAN demonstrates an important discrepancy from the economic integration goal. The ASEAN applies a soft harmonisation approach regarding substantive competition law while refraining from establishing a centralised institution or a representative institution. The sole organ with regards to competition policy at the regional level is an expert organ. The thesis also conducts an investigation into the reception of the ASEAN’s regional policy by the member states in order to ascertain the possibility of the achievement of the ASEAN’s aspiration of regional competition policy. The study reveals that despite some shared similarities in the broad principles of competition law amongst the member states, the various competition law regimes are not harmonised thus creating challenging obstacle to the ASEAN’s ambition. The thesis then concludes that the ASEAN’s approach to regional competition law is unlikely to be effective.

Using a CGE Model to Identify the Policy Trade-Off between Unemployment and Inflation: The Efficient Phillips Curve

This paper provides a new reading of a classical economic relation: the short-run Phillips curve. Our point is that, when dealing with inflation and unemployment, policy-making can be understood as a multicriteria decisionmaking problem. Hence, we use so-called multiobjective programming in connection with a computable general equilibrium (CGE) model to determine the combinations of policy instruments that provide efficient combinations of inflation and unemployment. This approach results in an alternative version of the Phillips curve labelled as efficient Phillips curve. Our aim is to present an application of CGE models to a new area of research that can be especially useful when addressing policy exercises with real data. We apply our methodological proposal within a particular regional economy, Andalusia, in the south of Spain. This tool can give some keys for policy advice and policy implementation in the fight against unemployment and inflation.

Radiogenic isotopes in the Mediterranean Sea: water mass exchange and precessional variability during the Messinian

During the late Miocene, exchange between the Mediterranean Sea and Atlantic Ocean changed dramatically, culminating in the Messinian Salinity Crisis (MSC). Understanding Mediterranean-Atlantic exchange at that time could answer the enigmatic question of how so much salt built up within the Mediterranean, while furthering the development of a framework for future studies attempting to understand how changes may have impacted global thermohaline circulation. Due to their association with specific water masses at different scales, radiogenic Sr, Pb, and Nd isotope records were generated from various archives contained within marine deposits to endeavour to understand better late Miocene Mediterranean-Atlantic exchange. The archives used include foraminiferal calcite (Sr), fish teeth and bone (Nd), dispersed authigenic ferromanganese oxyhydroxides (Nd, Pb), and a ferromanganese crust (Pb). The primary focus is on sediments preserved at one end of the Betic corridor, a gateway that once connected the Mediterranean to the Atlantic through southern Spain, although other locations are investigated. The Betic gateway terminated within several marginal sub-basins before entering the Western Mediterranean; one of these is the Sorbas Basin, a well-studied location whose sediments have been astronomically tuned at high temporal resolution, providing the necessary age control for sub-precessional resolution records. Since the climatic history of the Mediterranean is strongly controlled by precessional changes in regional climate, the aim was to produce records at high (sub-precessional) temporal resolution, to be able to observe clearly any precessional cyclicity driven by regional climate which could be superimposed over longer trends. This goal was achieved for all records except the ferromanganese crust record. The 87Sr/86Sr isotope record (Ch. 3) shows precessional frequency excursions away from the global seawater curve. As precessional frequency oscillations are unexpected for this setting, a numerical box model was used to determine the mechanisms causing the excursions. To enable parameterisation of model variables, regional Sr characteristics, data from general circulation model HadCM3L, and new benthic foraminiferal assemblage data are employed. The model results imply that the Sorbas Basin likely had a positive hydrologic budget in the late Miocene, very different to that of today. Moreover, the model indicates that the mechanism controlling the Sr isotope ratio of Sorbas Basin seawater was not restriction, but a lack of density-driven exchange with the Mediterranean. Beyond improving our understanding of how marginal Mediterranean sub-basins may evolve different isotope signatures, these results have implications for astronomical tuning and stratigraphy in the region, findings which are crucial considering the geological and climatic history of the late Miocene Mediterranean is based entirely on marginal deposits. An improved estimate for the Nd isotope signature of late Miocene Mediterranean Outflow (MO) was determined by comparing Nd isotope signatures preserved in the deeper Alborán Sea at ODP Site 978 with literature data as well as the signature preserved in the Sorbas Basin (Ch. 4; -9.34 to -9.92 ± 0.37 εNd(t)). It was also inferred that it is unlikely that Nd isotopes can be used reliably to track changes in circulation within the shallow settings characteristic of the Mediterranean-Atlantic connections; this is significant in light of a recent publication documenting corridor closure using Nd isotopes. Both conclusions will prove useful for future studies attempting to understand changes in Mediterranean-Atlantic exchange. Excursions to high values, with precessional frequency, are also observed in the radiogenic Pb isotope record for the Sorbas Basin (Ch. 5). Widening the scope to include locations further away from the gateways, records were produced for late Miocene sections on Sicily and Northern Italy, and similar precessional frequency cyclicity was observed in the Pb isotope records for these sites as well. Comparing these records to proxies for Saharan dust and available whole rock data indicates that, while further analysis is necessary to draw strong conclusions, enhanced dust production during insolation minima may be driving the observed signal. These records also have implications for astronomical tuning; peaks in Pb isotope records driven by Saharan dust may be easier to connect directly to the insolation cycle, providing improved astronomical tuning points. Finally, a Pb isotope record derived using in-situ laser ablation performed on ferromanganese crust 3514-6 from the Lion Seamount, located west of Gibraltar within the MO plume, has provided evidence that plume depth shifted during the Pliocene. The record also suggests that Pb isotopes may not be a suitable proxy for changes in late Miocene Mediterranean-Atlantic exchange, since the Pb isotope signatures of regional water masses are too similar. To develop this record, the first published instance of laser ablation derived 230Thexcess measurements are combined with 10Be dating.