Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

Adaptive, Decentralized, And Real-Time Sampling Strategies For Resource Constrained Hydraulic And Hydrologic Sensor Networks

We discuss the development and performance of a low-power sensor node (hardware, software and algorithms) that autonomously controls the sampling interval of a suite of sensors based on local state estimates and future predictions of water flow. The problem is motivated by the need to accurately reconstruct abrupt state changes in urban watersheds and stormwater systems. Presently, the detection of these events is limited by the temporal resolution of sensor data. It is often infeasible, however, to increase measurement frequency due to energy and sampling constraints. This is particularly true for real-time water quality measurements, where sampling frequency is limited by reagent availability, sensor power consumption, and, in the case of automated samplers, the number of available sample containers. These constraints pose a significant barrier to the ubiquitous and cost effective instrumentation of large hydraulic and hydrologic systems. Each of our sensor nodes is equipped with a low-power microcontroller and a wireless module to take advantage of urban cellular coverage. The node persistently updates a local, embedded model of flow conditions while IP-connectivity permits each node to continually query public weather servers for hourly precipitation forecasts. The sampling frequency is then adjusted to increase the likelihood of capturing abrupt changes in a sensor signal, such as the rise in the hydrograph – an event that is often difficult to capture through traditional sampling techniques. Our architecture forms an embedded processing chain, leveraging local computational resources to assess uncertainty by analyzing data as it is collected. A network is presently being deployed in an urban watershed in Michigan and initial results indicate that the system accurately reconstructs signals of interest while significantly reducing energy consumption and the use of sampling resources. We also expand our analysis by discussing the role of this approach for the efficient real-time measurement of stormwater systems.

Microeconomic instability and children's human capital accumulation: the effects of idiosyncratic shocks to father's income on child labor, school drop-outs and repetition rates in Brazil

This paper evaluates the long-run effects of economic instability. In particular, we study the impact of idiosyncratic shocks to father’s income on children’s human capital accumulation variables such as school drop-outs, repetition rates and domestic and non-domestic labor. Although, the problem of child labor in Brazil has declined greatly during the last decade, the number of children working is still substantial. The low levels of educational attainment in Brazil are also a main cause for concern. The large rotating panel data set used allows for the estimation of the impacts of changes in occupational and income status of fathers on changes in his child’s time allocation circumstances. The empirical analysis is restricted to families with fathers, mothers and at least one child between 10 and 15 years of age in the main Brazilian metropolitan areas during the 1982-1999 period. We perform logistic regressions controlling for child characteristics (gender, age, if he/she is behind in school for age), parents characteristics (grade attainment and income) and time and location variables. The main variables analyzed are dynamic proxies of impulses and responses, namely: shocks to household head’s income and unemployment status, on the one hand and child’s probability of dropping out of school, of repeating a grade and of start working, on the other. The findings suggest that father’s income has a significant positive correlation with child’s dropping out of school and of repeating a grade. The findings do not suggest a significant relationship between a father’s becoming unemployed and a child entering the non-domestic labor market. However, the results demonstrate a significant positive relationship between a father becoming unemployed and a child beginning to work in domestic labor. There was also a positive correlation between father becoming unemployed and a child dropping out and repeating a grade. Both gender and age were highly significant with boys and older children being more likely to work, drop-out and repeat grades.

Three essays on local demand for public services

Local provision of public services has the positive effect of increasing the efficiency because each locality has its idiosyncrasies that determine a particular demand for public services. This dissertation addresses different aspects of the local demand for public goods and services and their relationship with political incentives. The text is divided in three essays. The first essay aims to test the existence of yardstick competition in education spending using panel data from Brazilian municipalities. The essay estimates two-regime spatial Durbin models with time and spatial fixed effects using maximum likelihood, where the regimes represent different electoral and educational accountability institutional settings. First, it is investigated whether the lame duck incumbents tend to engage in less strategic interaction as a result of the impossibility of reelection, which lowers the incentives for them to signal their type (good or bad) to the voters by mimicking their neighbors’ expenditures. Additionally, it is evaluated whether the lack of electorate support faced by the minority governments causes the incumbents to mimic the neighbors’ spending to a greater extent to increase their odds of reelection. Next, the essay estimates the effects of the institutional change introduced by the disclosure on April 2007 of the Basic Education Development Index (known as IDEB) and its goals on the strategic interaction at the municipality level. This institutional change potentially increased the incentives for incumbents to follow the national best practices in an attempt to signal their type to voters, thus reducing the importance of local information spillover. The same model is also tested using school inputs that are believed to improve students’ performance in place of education spending. The results show evidence for yardstick competition in education spending. Spatial auto-correlation is lower among the lame ducks and higher among the incumbents with minority support (a smaller vote margin). In addition, the institutional change introduced by the IDEB reduced the spatial interaction in education spending and input-setting, thus diminishing the importance of local information spillover. The second essay investigates the role played by the geographic distance between the poor and non-poor in the local demand for income redistribution. In particular, the study provides an empirical test of the geographically limited altruism model proposed in Pauly (1973), incorporating the possibility of participation costs associated with the provision of transfers (Van de Wale, 1998). First, the discussion is motivated by allowing for an “iceberg cost” of participation in the programs for the poor individuals in Pauly’s original model. Next, using data from the 2000 Brazilian Census and a panel of municipalities based on the National Household Sample Survey (PNAD) from 2001 to 2007, all the distance-related explanatory variables indicate that an increased proximity between poor and non-poor is associated with better targeting of the programs (demand for redistribution). For instance, a 1-hour increase in the time spent commuting by the poor reduces the targeting by 3.158 percentage points. This result is similar to that of Ashworth, Heyndels and Smolders (2002) but is definitely not due to the program leakages. To empirically disentangle participation costs and spatially restricted altruism effects, an additional test is conducted using unique panel data based on the 2004 and 2006 PNAD, which assess the number of benefits and the average benefit value received by beneficiaries. The estimates suggest that both cost and altruism play important roles in targeting determination in Brazil, and thus, in the determination of the demand for redistribution. Lastly, the results indicate that ‘size matters’; i.e., the budget for redistribution has a positive impact on targeting. The third essay aims to empirically test the validity of the median voter model for the Brazilian case. Information on municipalities are obtained from the Population Census and the Brazilian Supreme Electoral Court for the year 2000. First, the median voter demand for local public services is estimated. The bundles of services offered by reelection candidates are identified as the expenditures realized during incumbents’ first term in office. The assumption of perfect information of candidates concerning the median demand is relaxed and a weaker hypothesis, of rational expectation, is imposed. Thus, incumbents make mistakes about the median demand that are referred to as misperception errors. Thus, at a given point in time, incumbents can provide a bundle (given by the amount of expenditures per capita) that differs from median voter’s demand for public services by a multiplicative error term, which is included in the residuals of the demand equation. Next, it is estimated the impact of the module of this misperception error on the electoral performance of incumbents using a selection models. The result suggests that the median voter model is valid for the case of Brazilian municipalities.

Duality with time-changed Lévy processes

In this paper we study the pricing problem of derivatives written in terms of a two dimensional time{changed L¶evy processes. Then, we examine an existing relation between prices of put and call options, of both the European and the American type. This relation is called put{call duality. It includes as a particular case, the relation known as put{call symmetry. Necessary and su±cient conditions for put{call symmetry to hold are shown, in terms of the triplet of local charac- teristic of the Time{changed L¶evy process. In this way we extend the results obtained in Fajardo and Mordecki (2004) to the case of time{changed Lévy processes.

Monopoly rights can reduce income big time

We study a two–sector version of the neoclassical growth model with coalitions of factor suppliers in the capital producing sectors. We show that if the coalitions have monopoly rights, then they block the adoption of the efficient technology. We also show that blocking leads to a decrease in the productivity of each capital producing sector and to an increase in the relative price of capital; as a result the capital stock and the production fall in each sector. We finally show that the implied fall in the level of per–capita income can be large quantitatively.

Roquette-Pinto imortal: constituição, tratamento e usos do Arquivo Roquette-Pinto na Academia Brasileira de Letras

A dissertação apresenta uma análise acerca da produção, custódia e uso do arquivo pessoal de Edgard Roquette-Pinto, hoje sob a guarda definitiva da Academia Brasileira de Letras (ABL). Busca-se evidenciar as representações que circulam o local de guarda deste acervo, sugerir a reconstituição da relação do titular com seu arquivo, iluminar os diversos padrões de acumulação e interferências a que o arquivo teria sido submetido, bem como, possibilitar a reflexão sobre os efeitos das interferências realizadas pelos pesquisadores que antecederam à organização, e pelos arquivistas no momento de sua organização.

Local Field Potentials in the Gustatory Cortex Carry Taste Information

It has been recently shownthat localfield potentials (LFPs)fromthe auditory and visual cortices carry information about sensory stimuli, but whether this is a universal property of sensory cortices remains to be determined. Moreover, little is known about the temporal dynamics of sensory information contained in LFPs following stimulus onset. Here we investigated the time course of the amount of stimulus information in LFPs and spikes from the gustatory cortex of awake rats subjected to tastants and water delivery on the tongue. We found that the phase and amplitude of multiple LFP frequencies carry information about stimuli, which have specific time courses after stimulus delivery. The information carried by LFP phase and amplitude was independent within frequency bands, since the joint information exhibited neither synergy nor redundancy. Tastant information in LFPs was also independent and had a different time course from the information carried by spikes. These findings support the hypothesis that the brain uses different frequency channels to dynamically code for multiple features of a stimulus.

Physicochemical Stability of Poly(lactide-co-glycolide) Nanocapsules Containing the Local Anesthetic Bupivacaine

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Desenvolvimento (in) sustentável das indústrias cerâmicas da microrregião do Vale-do-Açu/RN

A great discussion of this work refers to development that is related to the common census of economic growth, in addition, another component of this discussion is related to socio-cultural and environmental impacts of this conception of progress. Giving economic progress is not necessary, since the development in its fullness, that progress depends, but what is sought is a harmony between capital accumulation and environmental limits and social interactions between men and between them and nature. The presence or absence of this harmonious relationship can be observed in various industrial activities, more punctual can cite the example of the developed ceramic activity in the meso-Valley-Acu in Rio Grande do Norte where such activity has great economic representativeness for the region, but that does not have good relations with social and environmental issues and is more focused on the accumulation of capital by increasing its level of industrial activity. Given this debate, the present paper aims to present the profile of a ceramic tile Valley-of-Acu and impacts, ecosocioambientais generated as a result of this activity as well. Methodologically the research will be conducted through literature research papers in books and other work carried out on the same theme, the second time will be held the empirical part of the research through interviews with managers of industries (selected through sample with the criteria set later ) as well as with employees working on the factory floor and city managers in the region under analysis and other agencies responsible for regulation and control of activity potter in the state

Identidade e participação da comunidade rural nos processos de desenvolvimento local:desafios e competências do regulado de Nhambita-Moçambique

This thesis is defined as a reflection on the mechanisms of expression and insertion of the homo situs in the participatory governance in Mozambique. For a better understanding of this social fact, it was settled a periodization which covered the decline of colonialism at the time of the independence, which was proclaimed in June 1975, the civil war that lasted over 16 years and the period of the democratic State, further established. Therefore, we sought to understand the mechanisms and failures of the participation of the homo situs in local development projects that absorbed the needs and problems of these peasants, not mobilizing the skills and social competences of these communities. It would be essential for the homo situs a genuine democratic practice involving a political culture based on the social construction of the territories of the traditional man which was characterized by being procedural and historical, finding in participation its higher base. In this context, it would be desirable that the community development in Mozambique could contemplate and respect the choices of the homo situs. For this purpose, it would be fundamental the consistency between theory and practice, which builds and rebuilds, continually the competence of the peasants, facilitating the possibility of realization of their primordial aspirations. In the research, it became apparent that there is not a continuous process of participation of the rural communities, which appear as participants, only at the time of the implementation of the activities. Therefore, even having the participation of the communities expected by the law, with predictable moments of discussion and necessary conditions for that, the State failed to establish an ongoing process of democratic dialogue with traditional populations, as well as it failed to organize, properly, accurate informational bases to help solve the problems of rural areas. These facts have led to obstacles to the process of conquest of the human and civil rights of the traditional communities

Ativação local da rota da quinurenina por moduladores inflamatórios durante a meningite bacteriana.

Activation of the kynurenine (KYN) pathway (KP) by modulators of immune system has been observed during several neurological diseases. Here we assessed the association of chemo-/cytokine levels with the concentration of KP metabolites in cerebrospinal fluid (CSF) and plasma samples from patients with bacterial meningitis (BM). All samples were collected from 42 patients diagnosed with acute bacterial meningitis (ABM), aseptic meningitis, tuberculous meningitis and patients without infection neurological disorders. CSF and plasma concentration of metabolites from the KP was assessed by high pressure liquid chromatography (HPLC) and cytokines and chemokines by Bio-plex 200 suspension array system. Concentrations of the KP metabolites KYN and kynurenic acid (KYNA) were significantly higher in CSF of patients with ABM compared to other groups. Tryptophan (TRP), anthranilic acid (AA), 3-hydroxykynurenine (3HK) and 3-hydroxyanthranilic acid (3HAA) did not show statistical significance, although some of them presented a good accumulation during ABM. The expression of TNF-alpha, IL-6, IL-1beta, IFN-gamma, IL-10, IL-1 receptor antagonist (IL-1Ra), MIP-1alpha, MIP-1beta, MCP-1 and G-CSF was about 100-fold higher in CSF from ABM patients than other infected groups. In all CSF and plasma samples, the concentration of IL-2, IL-12(p70), IL-4, IL-8 and GM-CSF was not significant. ABM still showed significant concentrations of IL-6, IL-10, IL-1Ra and MCP-1 in plasma samples. Based on the comparison of KP metabolites concentrations between plasma and CSF samples we conclude that the activation of the tryptophan pathway upon BM occurs within the brain. This increase in KP metabolites is most due to activation of the KP by molecules as IFN-gamma and TNF-alpha in response to infection.

Dinâmica Costeira dos Campos petrolíferos Macau/Serra, litoral setentrional do Estado do Rio Grande do Norte

This thesis describes the general behavior of the northern shore of the State of Rio Grande do Norte relating beach profile morphology with hydrodynamic and sedimentological parameters. The Macau and Serra Oil Field are inserted on this area and are under accelerated coastal erosion. At these oil fields are installed oil wells from PETROBRAS, nowadays located directly in the shoreline, under constant attacks of coastal processes (e.g. waves, tides and currents), which promote an intense morphodynamic variability of this sandy coast. The area was monitored for 24 months in three different stations (P01, P02 and P03). The methodology applied involved current techniques of beach profiles, hydrodynamical processes, remote sensing and geophysics. A synthesis of results obtained through the use of different time scales (monthly, lunar cycle, seasonal, annual) from a coastal dynamics study is presented. The average wind direction corresponded to 77ºAz (NE). The steepness of the berm and of the shoreface, as well as coastal current direction, do not present major changes, with an average of 36º for the steepness of the berm, 15º for the shoreface and 15º for the coastal current direction. This data set allows us to infer that the months of larger coastal erosion were November/2000 and April/2001, because of the largest wave parameter during this time. The months of worse coastal erosion in this area are related with the increasing wavy energy. This in turn, seems to be related to seasonal climatic variations, with the wave energy and tide currents speed increasing during months of minor precipitations (June to January). The months of worse coastal erosion were September and November, when the largest wave parameters and speed currents are measured in the area. Since these months are included on the period of minor precipitations, we related the coastal erosion to seasonal climatic variations. The results obtained during these 24 months of monitoring confirms a situation of accentuated erosion, mainly in Profile 03 (Barra do Corta-Cachorro), where the wave height, period, and coastal current speed are always larger than the values found in Profile 02 (Macau5). Probably these values are more expressive in Profile 03, because it does not present any natural structure of protection against the wave impacts, as the barrier island located at Ponta do Tubarão, or the sand banks in front of Macau5. The transport of the sediments occurs from East to West, and the sand accumulation is more pronounced on Profile 03 intertidal zone, where there are embrionary dunes in dryer months. The tidal currents speed, on the other hand, is more accentuated in the Macau5 area (Profile 02). At Ponta do Tubarão, the tidal currents presented a preferential direction for NE, at times of flood, currents and for NW, at times of ebb current; at Barra do Corta-Cachorro the direction of the currents were predominantly for NW, independent of the tide phase, coinciding with the preferential direction of the longshore current. This currents inversion at Ponta do Tubarão is attributed to the presence of the Ponta do Tubarão island barrier and by the communication channel of the lagoon with the sea. The tide currents are better observed in protected areas, as in the Ponta do Tubarão, when they present inversion in their direction accordingly to the flood and ebb tide. In open areas, as in Barra do Corta-Cachorro, the tide currents are overprinted by the longshore currents. Sediment analysis does not show important modifications in grain size related to seasonality (dry- and rainy seasons). On the foreshore and backshore zones, the sediments vary from fine to medium sand, while in the shoreface they very from fine to very sands. The grains are mostly spheres, varying from sub rounded to sub angled. Quartz is the main component alongside Feldspat and heavy minerals as accessory components. Biogenic content is also present and mainly represented by mollusks fragments. The calculated sediment transport show values around 100 m3/day. The morphodynamic studies indicated that this is a reflexive area from October to April, and intermediate from May to September. The Relative Tide Range-RTR for this area is 4 < RTR < 15, and so classified in the mixed wave-tide group. Having this exposed we can affirm that the more active natural factors in this area are the currents, followed by the tides and the winds. The anthropic factors are exclusively local and punctual (Macau and Serra Oil Field). Taking in account the economic importance of the area, as well as the intensity of coastal processes acting on this shore, it is important a continuity of the monthly environmental monitoring looking for variations on longer-period cycles. These data have been stored on the geo-referenced database of the projects MARPETRO and PETRORISCO (REDE 05), aiming to model the coastal and sea environment, susceptible to oil spills and their derivatives

Cloning, sequencing and expression analysis of the equine hepcidin gene by real-time PCR

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)