Priority setting in healthcare: from arbitrariness to societal values

This paper develops an account of the normative basis of priority setting in health care as combining the values which a given society holds for the common good of its members, with the universal provided by a principle of common humanity. We discuss national differences in health basket in Europe and argue that health care decision-making in complex social and moral frameworks is best thought of as anchored in such a principle by drawing on the philosophy of need. We show that health care needs are ethically ‘thick’ needs whose psychological and social construction can best be understood in terms of David Wiggins's notion of vital need: a person's need is vital when failure to meet it leads to their harm and suffering. The moral dimension of priority setting which operates across different societies’ health care systems is located in the demands both of and on any society to avoid harm to its members.

Body mass index values for newborns according to gestational age

Objective: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. Methods: Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction aof a normal smoothed percentile curve, the 3(rd) 5(th), 10(th), 25(th), 5(th), 75(th), 90(th) and 95(th) percentiles were determined and a statistical procedure based on the mathematical model ""sinosuoidal fit"" was applied to establish a curve that estimates biological growth parameters. Results: The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40(th) week, followed by a slight decrease to the 42(nd) week in both genders. Conclusion: The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Peak expiratory flow values are higher in older and taller healthy male children: An observational study

Purpose: Peak expiratory flow (PEF) was measured in healthy children aged five to ten years in order to provide baseline values and to determine correlations between PEF and factors such as gender, age and type of school. Methods: After the Ethical Committee of Research in Human of the School of Medicine of ABC - FMABC approval, PEF and height were measured in 1942 children between five and ten years old from nine public schools and nine private schools throughout Sao Bernardo do Campo City. PEF was measured using the Mini-Wright Peak Flow Meter (Clement Clarke International Ltd.) and. height was measured using a Sanny professional stadiometer. Results: Significant differences were found in values for PEF: higher values were seen in older students in comparison with younger students, in males in comparison with females and in students from private schools in comparison with public schools, with average values ranging from 206 L/min to 248 L/min,. Linear correlations were seen for PEF values with both height and age (Spearman Coefficient). Conclusions: Differences were seen for PEF between genders and between types of school, and a linear correlation was seen for PEF with both age and height in healthy children from five to ten years old.

Comparison of signal-to-cutoff values in first, second, and third generation enzyme immunoassays for the diagnosis of HTLV-1/2 infection in ""at-risk"" individuals from Sao Paulo, Brazil

Data obtained during routine diagnosis of human T-cell lymphotropic virus type 1 (HTLV-1) and 2 (HTLV-2) in ""at-risk"" individuals from Sao Paulo, Brazil using signal-to-cutoff (S/C) values obtained by first, second, and third generation enzyme immunoassay (EIA) kits, were compared. The highest S/C values were obtained with third generation EIA kits, but no correlation was detected between these values and specific antibody reactivity to HTLV-1, HTLV-2, or untyped HTLV (p = 0.302). In addition, use of these third generation kits resulted in HTLV-1/2 false-positive samples. In contrast, first and second generation EIA kits showed high specificity, and the second generation EIA kits showed the highest efficiency, despite lower S/C values. Using first and second generation EIA kits, significant differences in specific antibody detection of HTLV-1, relative to HTLV-2 (p = 0.019 for first generation and p < 0.001 for second generation EIA kits) and relative to untyped HTLV (p = 0.025 for first generation EIA kits), were observed. These results were explained by the composition and format of the assays. In addition, using receiver operating characteristics (ROC) analysis, a slight adjustment in cutoff values for third generation EIA kits improved their specificities and should be used when HTLV ""at-risk"" populations from this geographic area are to be evaluated. (C) 2009 Elsevier B.V. All rights reserved.

Production of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) P(3HB-co-3HV) with a broad range of 3HV content at high yields by Burkholderia sacchari IPT 189

The biosynthesis of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) from sucrose and propionic acid by Burkholderia sacchari IPT 189 was studied using a two-stage bioreactor process. In the first stage, this bacterium was cultivated in a balanced culture medium until sucrose exhaustion. In the second stage, a solution containing sucrose and propionic acid as carbon source was fed to the bioreactor at various sucrose/propionic acid (s/p) ratios at a constant specific flow rate. Copolymers with 3HV content ranging from 40 down to 6.5 (mol%) were obtained with 3HV yield from propionic acid (Y-3HV/prop) increasing from 1.10 to 1.34 g g(-1). Copolymer productivity of 1 g l(-1) h(-1) was obtained with polymer biomass content rising up to 60% by increasing a specific flow rate at a constant s/p ratio. Increasing values of 3HV content were obtained by varying the s/p ratios. A simulation of production costs considering Y-3HV/prop obtained in the present work indicated that a reduction of up to 73% can be reached, approximating US$ 1.00 per kg which is closer to the value to produce P3HB from sucrose (US$ 0.75 per kg).

Evolutionary tuning of SVM parameter values in multiclass problems

Support vector machines (SVMs) were originally formulated for the solution of binary classification problems. In multiclass problems, a decomposition approach is often employed, in which the multiclass problem is divided into multiple binary subproblems, whose results are combined. Generally, the performance of SVM classifiers is affected by the selection of values for their parameters. This paper investigates the use of genetic algorithms (GAs) to tune the parameters of the binary SVMs in common multiclass decompositions. The developed GA may search for a set of parameter values common to all binary classifiers or for differentiated values for each binary classifier. (C) 2008 Elsevier B.V. All rights reserved.

Modeling Adsorption Processes of Poly-p-phenylenevinylene Precursor and Sodium Acid Dodecylbenzenesulfonate onto Layer-by-Layer Films Using a Langmuir-type Metastable Equilibrium Model

The adsorption kinetics curves of poly(xylylidene tetrahydrothiophenium chloride) (PTHT), a poly-p-phenylenevinylene (PPV) precursor, and the sodium salt of dodecylbenzene sulfonic acid (DBS), onto (PTHT/DBS)(n) layer-by-layer (LBL) films were characterized by means of UV-vis spectroscopy. The amount of PTHT/DBS and PTHT adsorbed on each layer was shown to be practically independent of adsorption time. A Langmuir-type metastable equilibrium model was used to adjust the adsorption isotherms data and to estimate adsorption/desorption coefficients ratios, k = k(ads)/k(des), values of 2 x 10(5) and 4 x 10(6) for PTHT and PTHT/DBS layers, respectively. The desorption coefficient has been estimated, using literature values for poly(o-methoxyaniline) desorption coefficient, as was found to be in the range of 10(-9) to 10(-6) s(-1), indicating that quasi equilibrium is rapidly attained.

OSCILLATOR STRENGTHS AND LIFETIMES FOR THE P XII

Semi-empirical weighted oscillator strengths (gf) and lifetimes presented in this work for all experimentally known electric dipole P XII spectral lines and energy levels were computed within a multiconfiguration Hartree-Fock relativistic approach. In this calculation, the electrostatic parameters were optimized by a least-squares procedure in order to improve the adjustment to experimental energy levels. The method produces lifetime and gf values that are in agreement with intensity observations used for the interpretation of spectrograms of solar and laboratory plasmas.

P-T-Fluid evolution and graphite deposition during retrograde metamorphism in Ribeira Fold Belt, SE Brazil: Oxygen fugacity, fluid inclusions and C-O-H isotopic evidence

Combined fluid inclusion (FI) microthermometry, Raman spectroscopy, X-ray diffraction, C-O-H isotopes and oxygen fugacities of granulites from central Ribeira Fold Belt, SE Brazil, provided the following results: i) Magnetite-Hematite fO(2) estimates range from 10(-11.5) bar (QFM + 1) to 10(-18.3) bar (QFM - 1) for the temperature range of 896 degrees C-656 degrees C, implying fO(2) decrease from metamorphic peak temperatures to retrograde conditions; ii) 5 main types of fluid inclusions were observed: a) CO(2) and CO(2)-N(2) (0-11 mol%) high to medium density (1.01-0.59 g/cm(3)) FI; b) CO(2) and CO(2)-N(2) (0-36 mol%) low density (0.19-0.29 g/cm(3)) FI; c) CO(2) (94-95 mol%)-N(2) (3 mol%)-CH(4) (2-3 mol%)-H(2)O (water phi(v) (25 degrees C) = 0.1) FI; d) low-salinity H(2)O-CO(2) FI; and e) late low-salinity H(2)O FI; iii) Raman analyses evidence two graphite types in khondalites: an early highly ordered graphite (T similar to 450 degrees C) overgrown by a disordered kind (T similar to 330 degrees C); iv) delta(18)O quartz results of 10.3-10.7 parts per thousand, imply high-temperature CO(2) delta(18)O values of 14.4-14.8 parts per thousand, suggesting the involvement of a metamorphic fluid, whereas lower temperature biotite delta(18)O and delta D results of 7.5-8.5 parts per thousand and -54 to -67 parts per thousand respectively imply H(2)O delta(18)O values of 10-11 parts per thousand and delta D(H2O) of -23 to -36 parts per thousand suggesting delta(18)O depletion and increasing fluid/rock ratio from metamorphic peak to retrograde conditions. Isotopic results are compatible with low-temperature H(2)O influx and fO(2) decrease that promoted graphite deposition in retrograde granulites, simultaneous with low density CO(2), CO(2)-N(2) and CO(2)-N(2)-CH(4)-H(2)O fluid inclusions at T = 450-330 degrees C. Graphite delta(13)C results of -10.9 to -11.4 parts per thousand imply CO(2) delta(13)C values of -0.8 to -1.3 parts per thousand suggesting decarbonation of Cambrian marine carbonates with small admixture of lighter biogenic or mantle derived fluids. Based on these results, it is suggested that metamorphic fluids from the central segment of Ribeira Fold Belt evolved to CO(2)-N(2) fluids during granulitic metamorphism at high fO(2), followed by rapid pressure drop at T similar to 400-450 degrees C during late exhumation that caused fO(2) reduction induced by temperature decrease and water influx, turning carbonic fluids into CO(2)-H(2)O (depleting biotite delta(18)O and delta D values), and progressively into H(2)O. When fO(2) decreased substantially by mixture of carbonic and aqueous fluids, graphite deposited forming khondalites. (C) 2010 Elsevier Ltd. All rights reserved.

Performance of balanced two-stage empirical predictors of realized cluster latent values from finite populations: A simulation study

Predictors of random effects are usually based on the popular mixed effects (ME) model developed under the assumption that the sample is obtained from a conceptual infinite population; such predictors are employed even when the actual population is finite. Two alternatives that incorporate the finite nature of the population are obtained from the superpopulation model proposed by Scott and Smith (1969. Estimation in multi-stage surveys. J. Amer. Statist. Assoc. 64, 830-840) or from the finite population mixed model recently proposed by Stanek and Singer (2004. Predicting random effects from finite population clustered samples with response error. J. Amer. Statist. Assoc. 99, 1119-1130). Predictors derived under the latter model with the additional assumptions that all variance components are known and that within-cluster variances are equal have smaller mean squared error (MSE) than the competitors based on either the ME or Scott and Smith`s models. As population variances are rarely known, we propose method of moment estimators to obtain empirical predictors and conduct a simulation study to evaluate their performance. The results suggest that the finite population mixed model empirical predictor is more stable than its competitors since, in terms of MSE, it is either the best or the second best and when second best, its performance lies within acceptable limits. When both cluster and unit intra-class correlation coefficients are very high (e.g., 0.95 or more), the performance of the empirical predictors derived under the three models is similar. (c) 2007 Elsevier B.V. All rights reserved.

Lärares beskrivningar av evolution som undervisningsinnehåll i biologi på gymnasiet

Biological evolution is part of the syllabi for Biology and Science in Swedish upper secondary school. In the syllabi, evolution is not only presented as a topic in Biology courses, but is also regarded as a unifying theme. The teacher has a fundamental role in deciding how the national curriculum is translated into the educational situation. This thesis investigates teachers’ accounts of their teaching of evolution in Swedish upper secondary school, describing their understandings of the purpose of teaching and learning evolution as part of biology education. The thesis is based on interviews of teachers teaching the course Biology A, which is compulsory as dictated by the Natural Science Program. The interviews were supplemented with questionnaires. The interviews were orientated towards questions about selection of course content and the reasons for choosing this content. The interviews were focused on teachers experiences based on their own practice. Two aspects of content were examined: (1) the scientific content taught in terms of themes and (2) the socializing value-laden aspects, such as priorities taken by the teachers and the teachers´ overarching aims.   The results showed that teachers described different teaching contents with regard to values, even when the core content of themes was similar. Four different selective traditions for choosing content were identified among teachers. The results are discussed in relation to the context and conditions that the teachers identify as influential on the content chosen. Teachers’ interactions with their students as well as their world views are important for their selection and adjustment of content. There are also indications that teachers’ personal views about purposes are important for selecting the teaching content.

Patriarchal values : girls are more apt to change

Patriarchal values: girls are more apt to change How has the family value system changed between generations, especially when taking into account the gender dimension? This article presents some results from a study carried outin 2007 in one village of the Gourani tribe where the people are followers of Ahle Hagh in Islamabad Gharb (west of Iran). The differences between generations (those born and raised before and after the Islamic Revolution) in patriarchal values in the family are statistically significant. The older generation opts for the man of the family to make most of the decisions; on children’s education, marriage, naming, the families expenditure, the place for residence, the social network of the family and even the number of children. The younger generation has a different value system and it has moved towards a more egalitarian type of family. With the gender variable included in the findings we see that although the values of the younger male population have evolved toward a less patriarchal decision making structure inthe family, the degree of changes among the young women is much higher. Looking into the preferences for male sex for the first child as well as a larger number of boys in the family, the difference between generations is significant. However data on the differences analyzed with the gender variable proves that the changes concerning the equality of sexes are mainly due to drastic changes in the young women’s value system. That is, the male population, young or old, still prefer to have a boy as their first born and to have more sons in the family. But the young female generation in the rural area sees less difference in having boys or girls in the family. It is concluded that reforms in the old value system is an evolving process of everyday life and that the girls are the main social force for change.

"Men skolan kan inte bara lägga sig platt på rygg" : Attityder till värdegrundsarbetet inom vuxenutbildningen

Syftet med denna studie är att belysa attityder som finns hos lärare i svenska för invandrare (SFI) och svenska som andraspråk (SVA) till integreringen av värdegrundsuppdraget i vuxenutbildningen och i det sammanhanget även uppmärksamma deras berättelser om yrkesetiska konflikter som de upplevt i värdegrundsarbetet. Studien söker att svara på följande frågeställningar: Hur definierar SFI- och SVA-lärarna vuxenutbildningens värdegrund? Hur förhåller sig lärarna till integreringen av värdegrundsfrågor i undervisningen? På vilket sätt integrerar SFI- och SVA-lärarna värdegrundensmålen i sin dagliga verksamhet? Vilka svårigheter möter lärarna och vilka yrkesetiska konflikter uppstår i deras arbete med värdegrundsfrågor? och Vad styrs lärarna av när de löser yrkesetiska konflikter som uppstår i värdegrundsarbetet? Metoden som används i undersökningen är kvalitativ och bygger på intervjuer med totalt sex SFI- och SVA-lärare. Intervjuerna kompletteras med en enkätundersökning som genomförts med samma lärare. Studiens resultat diskuteras utifrån en teori om sociala attityder och dess antagande att individers kunskaper om, och positiva känslor till, en social företeelse kommer att manifesteras i deras handlingar. Resultatanalysen visar att SFI- och SVA-lärarna förknippar skolans värdegrund med demokrati, jämställdhet mellan kvinnor och män, alla människors lika värde och trygg inlärningsmiljö och har ett positivt förhållningssätt till värdegrundsarbetet, som de medvetet integrerar i språkundervisningen.

Hälsofrämjande arbete på SSAB i Borlänge : Hälsofrämjande processer i arbetslivet och ledarskapets betydelse för medarbetarens hälsa

Problem: Arbetsmiljön är viktig för människors välbefinnande. Hälsofrämjande faktorer antas inte bara styrka individens fysiska och psykiska hälsa, utan även företagets konkurrenskraft och lönsamhet. I uppsatsen undersöker vi hur företaget SSAB i Borlänge arbetar med hälsa genom att tillämpa ett hälsofrämjande perspektiv och utgå från teorin om Känslan av sammanhang (KASAM). Ledarskapsvärderingar har betydelse för medarbetares hälsa (Hanson, 2004) och vi undersöker vilken uppfattning ett antal chefer har om sina roller i det hälsofrämjande arbetet och deras syn på medarbetarundersökningen HälsoSAM som företagshälsovården på SSAB bedriver. Arbetsbelastningen på medarbetare och chefer ökar till följd av sparkrav, samtidigt som resurserna minskar (Gatu, 2003). Följden blir en större risk för ohälsa och ett sätt att minska sjukfrånvaron är att genomföra hälsofrämjande insatser (Prevent, 2001). Syfte: Syftet med studien är att utifrån ett hälsofrämjande perspektiv förklara vad chefer har för möjligheter att skapa förutsättningar för att främja medarbetarnas hälsa på SSAB i Borlänge. Metod: Den metod som ligger till grund för uppsatsen baseras på ett kvalitativt angreppssätt där semistrukturerade intervjuer samt litteraturstudier genomförts för att samla information. Analys: Ledarens beteende påverkar medarbetarna. Hög arbetsbelastning på SSABs chefer leder till lägre närvaro bland medarbetarna, vilket i sin tur ger sämre förutsättningar för att främja hälsan. HälsoSAM kartlägger medarbetarnas hälsoläge, både välbefinnande och arbetskapacitet. Resultaten är vägledande i det hälsofrämjande arbetet men överbelastning, tidsbrist och kunskapsbrist hos cheferna bidrar till att uppföljningen inte blir systematisk. För ett väl fungerande hälsoarbete krävs systematik. Slutsats: Hälsofrämjande processer i arbetslivet skapas genom balans mellan krav och resurser. På SSAB i Borlänge hindras hälsoarbetet av tidsbrist och kunskapsbrist hos cheferna. Kostnadsbesparingar påverkar hälsoarbetet negativt och systematiken i uppföljningsarbetet blir lidande. Ansvaret för hälsoarbetet läggs på företagshälsovården, men utan stöd från chefer blir inte hälsoarbetet en naturlig del i verksamheten. Det är viktigt att i rådande situation se vad främjande av hälsa kan ge tillbaka till företaget i både ekonomiska och kvalitativa termer. Insikt om detta ökar chefernas incitament att prioritera hälsofrämjande processer och organisera arbetet så att människor har förutsättningar att hantera, kontrollera och klara av sina uppgifter.

Från ord till handling : En kvalitativ studie om värdegrund och socialt innehåll för äldre på särskilt boende

Socialstyrelsens brukarundersökning visar att äldre som bor på särskilt boende är mest missnöjda med de aktiviteter och den sociala samvaron som verksamheten erbjuder. Äldreomsorgen bygger på den nationella värdegrunden som innefattar att den äldre ska få leva ett värdigt liv och känna välbefinnande, men det är inte klart hur denna värdegrund påverkar personalens arbetssätt eller de sociala aktiviteter som erbjuds. Vår studie angriper denna fråga. Fem särskilda boenden var representerade både från kommunala och privata vårdgivare i två olika kommuner. Semistrukturerade intervjuer genomfördes med de särskilda boendes enhetschefer, som sedan transkriberades och tematiskt analyserades. Vårt resultat tyder på att den nationella värdegrunden inom äldreomsorgen tolkas olika på alla de särskilda boendena. Alla enhetschefer la stor vikt på personcentrerad vård, men trots det så erbjöd man liknade sociala aktiviteter ofta då som gruppaktivitet. Resultaten diskuterar vi med hänvisning till Aktivitetsteorin och Gerotranscendenceteorin.