Procedure for the identification of population characteristics for targeting intervention services on the basis of outcome-goal priorities: Case management services for the chronic mentally ill

Although the processes involved in rational patient targeting may be obvious for certain services, for others, both the appropriate sub-populations to receive services and the procedures to be used for their identification may be unclear. This project was designed to address several research questions which arise in the attempt to deliver appropriate services to specific populations. The related difficulties are particularly evident for those interventions about which findings regarding effectiveness are conflicting. When an intervention clearly is not beneficial (or is dangerous) to a large, diverse population, consensus regarding withholding the intervention from dissemination can easily be reached. When findings are ambiguous, however, conclusions may be impossible.^ When characteristics of patients likely to benefit from an intervention are not obvious, and when the intervention is not significantly invasive or dangerous, the strategy proposed herein may be used to identify specific characteristics of sub-populations which may benefit from the intervention. The identification of these populations may be used both in further informing decisions regarding distribution of the intervention and for purposes of planning implementation of the intervention by identifying specific target populations for service delivery.^ This project explores a method for identifying such sub-populations through the use of related datasets generated from clinical trials conducted to test the effectiveness of an intervention. The method is specified in detail and tested using the example intervention of case management for outpatient treatment of populations with chronic mental illness. These analyses were applied in order to identify any characteristics which distinguish specific sub-populations who are more likely to benefit from case management service, despite conflicting findings regarding its effectiveness for the aggregate population, as reported in the body of related research. However, in addition to a limited set of characteristics associated with benefit, the findings generated, a larger set of characteristics of patients likely to experience greater improvement without intervention. ^

Notas sobre la experiencia

Muchas lecturas, textos, debates, programas de investigación en teoría de la comunicación, cultura y arte incluyen un tópico recurrente que pasa desapercibido ante las distintas interpretaciones. Éste comenzó a inquietarnos lo suficiente como para prestar mayor atención a los planteos que de él teníamos. Por esta razón decidimos ensayar en estas líneas algunas ideas recuperadas en ciertas lecturas sobre la experiencia. ¿Por qué ocuparnos de la experiencia? Desde hace un tiempo cierto discurso contemporáneo (a veces caracterizado como posmoderno) repite/repetimos que la experiencia, el sentir en el presente, cambió en una dirección totalmente nueva. No pocos debates se concentran en describir este nuevo escenario, intentando responder la pregunta disparada por la línea anterior: ¿qué direcciones tomó la experiencia contemporánea? Y por supuesto el interrogante es acompañado por otra duda con una mirada más escéptica: la experiencia contemporánea ¿es más rica o profunda que en el pasado?

El subdesarrollo del macrosistema eléctrico en la costa atlántica de la Provincia de Buenos Aires

El macrosistema eléctrico de la costa atlántica bonaerense muestra un desarrollo divergente respecto de las tracciones y expectativas del proceso productivo global y de las condiciones generales de la reproducción social que puede ser calificado como subdesarrollo. Desde 2003, al producirse el sostenido repunte del consumo eléctrico, la problemática del abastecimiento de electricidad se agravó y el territorio local comenzó a atravesar un estado de emergencia energética. El trabajo analiza los principales factores explicativos de dicha situación: la reestructuración capitalista del sector eléctrico llevada a cabo durante los noventa y los funcionamientos impuestos por el marco regulatorio, los cambios político-económicos de la Posconvertibilidad, la aplicación de una estrategia anticrisis basada en medidas paliativas y la marcada estacionalidad de la demanda eléctrica local inducida por la enorme afluencia turística de la zona

El subdesarrollo del macrosistema eléctrico en la costa atlántica de la Provincia de Buenos Aires

El macrosistema eléctrico de la costa atlántica bonaerense muestra un desarrollo divergente respecto de las tracciones y expectativas del proceso productivo global y de las condiciones generales de la reproducción social que puede ser calificado como subdesarrollo. Desde 2003, al producirse el sostenido repunte del consumo eléctrico, la problemática del abastecimiento de electricidad se agravó y el territorio local comenzó a atravesar un estado de emergencia energética. El trabajo analiza los principales factores explicativos de dicha situación: la reestructuración capitalista del sector eléctrico llevada a cabo durante los noventa y los funcionamientos impuestos por el marco regulatorio, los cambios político-económicos de la Posconvertibilidad, la aplicación de una estrategia anticrisis basada en medidas paliativas y la marcada estacionalidad de la demanda eléctrica local inducida por la enorme afluencia turística de la zona

El subdesarrollo del macrosistema eléctrico en la costa atlántica de la Provincia de Buenos Aires

El macrosistema eléctrico de la costa atlántica bonaerense muestra un desarrollo divergente respecto de las tracciones y expectativas del proceso productivo global y de las condiciones generales de la reproducción social que puede ser calificado como subdesarrollo. Desde 2003, al producirse el sostenido repunte del consumo eléctrico, la problemática del abastecimiento de electricidad se agravó y el territorio local comenzó a atravesar un estado de emergencia energética. El trabajo analiza los principales factores explicativos de dicha situación: la reestructuración capitalista del sector eléctrico llevada a cabo durante los noventa y los funcionamientos impuestos por el marco regulatorio, los cambios político-económicos de la Posconvertibilidad, la aplicación de una estrategia anticrisis basada en medidas paliativas y la marcada estacionalidad de la demanda eléctrica local inducida por la enorme afluencia turística de la zona

Seawater carbonate chemistry and carbon allocation, growth and morphology of the coccolithophore Emiliania huxleyi (calcifying strain CCMP 371) during experiments, 2011

Coccolithophores are unicellular phytoplankton that produce calcium carbonate coccoliths as an exoskeleton. Emiliania huxleyi, the most abundant coccolithophore in the world's ocean, plays a major role in the global carbon cycle by regulating the exchange of CO2 across the ocean-atmosphere interface through photosynthesis and calcium carbonate precipitation. As CO2 concentration is rising in the atmosphere, the ocean is acidifying and ammonium (NH4) concentration of future ocean water is expected to rise. The latter is attributed to increasing anthropogenic nitrogen (N) deposition, increasing rates of cyanobacterial N2 fixation due to warmer and more stratified oceans, and decreased rates of nitrification due to ocean acidification. Thus future global climate change will cause oceanic phytoplankton to experience changes in multiple environmental parameters including CO2, pH, temperature and nitrogen source. This study reports on the combined effect of elevated pCO2 and increased NH4 to nitrate (NO3) ratio (NH4/NO3) on E. huxleyi, maintained in continuous cultures for more than 200 generations under two pCO2 levels and two different N sources. Here we show that NH4 assimilation under N-replete conditions depresses calcification at both low and high pCO2, alters coccolith morphology, and increases primary production. We observed that N source and pCO2 synergistically drive growth rates, cell size and the ratio of inorganic to organic carbon. These responses to N source suggest that, compared to increasing CO2 alone, a greater disruption of the organic carbon pump could be expected in response to the combined effect of increased NH4/NO3 ratio and CO2 level in the future acidified ocean. Additional experiments conducted under lower nutrient conditions are needed prior to extrapolating our findings to the global oceans. Nonetheless, our results emphasize the need to assess combined effects of multiple environmental parameters on phytoplankton biology in order to develop accurate predictions of phytoplankton responses to ocean acidification.

Seawater carbonate chemistry and shell weights of Laternula elliptica, Yoldia eightsi, Nacella concinna and Liothyrella uva during experiments, 2009

Antarctic calcified macroorganisms are particularly vulnerable to ocean acidification because many are weakly calcified, the dissolution rates of calcium carbonate are inversely related to temperature, and high latitude seas are predicted to become undersaturated in aragonite by the year 2100. We examined the post-mortem dissolution rates of aragonitic and calcitic shells from four species of Antarctic benthic marine invertebrates (two bivalves, one limpet, one brachiopod) and the thallus of a limpet shell-encrusting coralline alga exposed to acidified pH (7.4) or non-acidified pH (8.2) seawater at a constant temperature of 4 C. Within a period of only 14-35 days, shells of all four species held in pH 7.4 seawater had suffered significant dissolution. Despite calcite being 35% less soluble in seawater than aragonite, there was surprisingly, no consistent pattern of calcitic shells having slower dissolution rates than aragonitic shells. Outer surfaces of shells held in pH 7.4 seawater exhibited deterioration by day 35, and by day 56 there was exposure of aragonitic or calcitic prisms within the shell architecture of three of the macroinvertebrate species. Dissolution of coralline algae was confirmed by differences in weight loss in limpet shells with and without coralline algae. By day 56, thalli of the coralline alga held in pH 7.4 displayed a loss of definition of the conceptacle pores and cracking was evident at the zone of interface with limpet shells. Experimental studies are needed to evaluate whether there are adequate compensatory mechanisms in these and other calcified Antarctic benthic macroorganisms to cope with anticipated ocean acidification. In their absence, these organisms, and the communities they comprise, are likely to be among the first to experience the cascading impacts of ocean acidification.

Early life stages of the Arctic copepod Calanus glacialis are unaffected by increased seawater pCO2

As the world's oceans continue to absorb anthropogenic CO2 from the atmosphere, the carbonate chemistry of seawater will change. This process, termed ocean acidification, may affect the physiology of marine organisms. Arctic seas are expected to experience the greatest decreases in pH in the future, as changing sea ice dynamics and naturally cold, brackish water, will accelerate ocean acidification. In this study, we investigated the effect of increased pCO2 on the early developmental stages of the key Arctic copepod Calanus glacialis. Eggs from wild-caught C. glacialis females from Svalbard, Norway (80°N), were cultured for 2 months to copepodite stage C1 in 2°C seawater under four pCO2 treatments (320, 530, 800, and 1700 ?atm). Developmental rate, dry weight, and carbon and nitrogen mass were measured every other day throughout the experiment, and oxygen consumption rate was measured at stages N3, N6, and C1. All endpoints were unaffected by pCO2 levels projected for the year 2300. These results indicate that naupliar development in wild populations of C. glacialis is unlikely to be detrimentally affected in a future high CO2 ocean.

Interactive effects of light, nitrogen source, and carbon dioxide on energy metabolism in the diatom Thalassiosira pseudonana

Due to the ongoing effects of climate change, phytoplankton are likely to experience enhanced irradiance, more reduced nitrogen, and increased water acidity in the future ocean. Here, we used Thalassiosira pseudonana as a model organism to examine how phytoplankton adjust energy production and expenditure to cope with these multiple, interrelated environmental factors. Following acclimation to a matrix of irradiance, nitrogen source, and CO2 levels, the diatom's energy production and expenditures were quantified and incorporated into an energetic budget to predict how photosynthesis was affected by growth conditions. Increased light intensity and a shift from inline image to inline image led to increased energy generation, through higher rates of light capture at high light and greater investment in photosynthetic proteins when grown on inline image. Secondary energetic expenditures were adjusted modestly at different culture conditions, except that inline image utilization was systematically reduced by increasing pCO2. The subsequent changes in element stoichiometry, biochemical composition, and release of dissolved organic compounds may have important implications for marine biogeochemical cycles. The predicted effects of changing environmental conditions on photosynthesis, made using an energetic budget, were in good agreement with observations at low light, when energy is clearly limiting, but the energetic budget over-predicts the response to inline image at high light, which might be due to relief of energetic limitations and/or increased percentage of inactive photosystem II at high light. Taken together, our study demonstrates that energetic budgets offered significant insight into the response of phytoplankton energy metabolism to the changing environment and did a reasonable job predicting them.

Migration and Wellbeing at the Lower Echelons of the Economy: A Study of Delhi Slums

This paper based on a primary survey of households (2004-05) in the slum clusters of Delhi examines whether migrants are likely to experience upward mobility in their place of destination or alternatively, if they merely transfer their poverty from rural areas to large cities. First, a simple bifurcation of population in terms of poor and non-poor sub-groups is examined along with the incidence of poverty across different categories of occupations and non-workers. Then, an explanation of the variations in per capita expenditure across households is provided, and a binomial logit model (poor/non-poor) is developed identifying the variables which raise (or reduce) the probability of being non-poor (or poor). Next, an estimate of the wellbeing (deprivation) index is derived from factor analysis of a large number of variables including demographic and economic aspects of households. Empirical findings suggest that while duration of migration and the wellbeing index do not have a definite relationship, migrant households who have been in the city for a very long time have a higher wellbeing index on average than those who migrated in the last ten years. This tends to support the view that migrants do not merely transfer rural poverty to urban areas, and further that population mobility yields improvement in the living standard, if only in the very long term. Implementation of "employment-cum-shelter" support schemes in the urban areas may contribute to their wellbeing.

A proposal for improving safety in construction projects by strengthening coordinators’ competencies in health and safety issues

The figure of the coordinator in health and safety issues in the construction sector first appeared in our legislation through the incorporation of the European Directives (in our case Royal Decree 1627/97 on the minimum health and safety regulations in construction works), and is viewed differently in different countries of the European Union regarding the way they are hired and their role in the construction industry. Coordinating health and safety issues is also a management process that requires certain competencies that are not only based on technical or professional training, but which, taking account of the work environment, require the use of strategies and tools that are related to experience and personal skills. Through a piece of research that took account of expert opinions in the matter, we have found which competencies need to be possessed by the health and safety coordinator in order to improve the safety in the works they are coordinating. The conclusions of the analyses performed using the appropriate statistical methods (comparing means and multivariate analysis techniques), will enable training programmes to be designed and ensure that the health and safety coordinators selected have the competencies required to carry out their duties.

The role of a firm's absorptive capacity and the technology transfer process in clusters: How effective are technology centres in low-tech clusters?

This paper analyses how the internal resources of small- and medium-sized enterprises determine access (learning processes) to technology centres (TCs) or industrial research institutes (innovation infrastructure) in traditional low-tech clusters. These interactions basically represent traded (market-based) transactions, which constitute important sources of knowledge in clusters. The paper addresses the role of TCs in low-tech clusters, and uses semi-structured interviews with 80 firms in a manufacturing cluster. The results point out that producer–user interactions are the most frequent; thus, the higher the sector knowledge-intensive base, the more likely the utilization of the available research infrastructure becomes. Conversely, the sectors with less knowledge-intensive structures, i.e. less absorptive capacity (AC), present weak linkages to TCs, as they frequently prefer to interact with suppliers, who act as transceivers of knowledge. Therefore, not all the firms in a cluster can fully exploit the available research infrastructure, and their AC moderates this engagement. In addition, the existence of TCs is not sufficient since the active role of a firm's search strategies to undertake interactions and conduct openness to available sources of knowledge is also needed. The study has implications for policymakers and academia.

A proposal for improving safety in construction projects by strengthening coordinators’ competencies in health and safety issues

The figure of the coordinator in health and safety issues in the construction sector first appeared in our legislation through the incorporation of the European Directives (in our case Royal Decree 1627/97 on the minimum health and safety regulations in construction works), and is viewed differently in different countries of the European Union regarding the way they are hired and their role in the construction industry. Coordinating health and safety issues is also a management process that requires certain competencies that are not only based on technical or professional training, but which, taking account of the work environment, require the use of strategies and tools that are related to experience and personal skills. Through a piece of research that took account of expert opinions in the matter, we have found which competencies need to be possessed by the health and safety coordinator in order to improve the safety in the works they are coordinating. The conclusions of the analyses performed using the appropriate statistical methods (comparing means and multivariate analysis techniques), will enable training programmes to be designed and ensure that the health and safety coordinators selected have the competencies required to carry out their duties.

Lateral orbitofrontal cortex involvement in initial negative aesthetic impression formation

It is well established that aesthetic appreciation is related with activity in several different brain regions. The identification of the neural correlates of beauty or liking ratings has been the focus of most prior studies. Not much attention has been directed towards the fact that humans are surrounded by objects that lead them to experience aesthetic indifference or leave them with a negative aesthetic impression. Here we explore the neural substrate of such experiences. Given the neuroimaging techniques that have been used, little is known about the temporal features of such brain activity. By means of magnetoencephalography we registered the moment at which brain activity differed while participants viewed images they considered to be beautiful or not. Results show that the first differential activity appears between 300 and 400 ms after stimulus onset. During this period activity in right lateral orbitofrontal cortex (lOFC) was greater while participants rated visual stimuli as not beautiful than when they rated them as beautiful. We argue that this activity is associated with an initial negative aesthetic impression formation, driven by the relative hedonic value of stimuli regarded as not beautiful. Additionally, our results contribute to the understanding of the nature of the functional roles of the lOFC.

Modelo para la certificación del coordinador en materia de seguridad y salud basado en sus competencias

La figura del coordinador en materia de seguridad y salud en el sector de la construcción, aparecida en nuestra legislación a través de las trasposiciones de las Directivas Europeas, (en nuestro caso en el RD 1627/97 sobre disposiciones mínimas de seguridad y salud en las obras de construcción), se encuentra identificada, en cuanto a su posible contratación y actuación dentro de este sector, de forma diferente en distintos países de la Unión Europea. La coordinación en materia de seguridad y salud también es un proceso de gestión que requiere de unas competencias, no solamente basadas en la formación técnica o profesional, si no que, considerando el entorno de trabajo, precisan de la aplicación de estrategias y herramientas relacionadas con la experiencia y con las habilidades personales. A través de una primera fase de investigación realizada y considerando la opinión de expertos en la materia, se han detectado cuáles son estas competencias que debe poseer el coordinador en materia de seguridad y salud para fortalecer el cumplimiento de sus obligaciones y así, mejorar su actividad de coordinación. El resultado de los análisis realizados permitirá construir un modelo que sirva de referencia para la certificación de los coordinadores en materia de seguridad y salud basado en sus competencias. Las conclusiones recogidas en esta Tesis doctoral proporcionarán criterios para establecer el diseño de programas formativos y construir metodologías para la selección de los coordinadores en materia de seguridad y salud en base a sus competencias. ABSTRACT The figure of the health and safety coordinator in the construction sector appeared in our legislation through the incorporation of the European Directives. In our case, Royal Decree 1627/97 on the minimum health and safety regulations in construction works. This figure is viewed differently, in terms of recruitment and performance, in different countries of the European Union. The coordination of health and safety issues is a management process that requires certain competencies not only based on technical or professional training. It is also necessary, depending on the work environment, the implementation of strategies and tools that are related to experience and personal skills. The skill requirements for the health and safety coordinator have been defined considering the opinion of experts in this field, gained through the realization of a first phase of research. These competences should be used to strengthen the performance of their duties and thereby improve their coordination activity.