Reprodução assistida: a organização da atenção às infertilidades e o acesso às técnicas reprodutivas em dois serviços público-universitários no Estado do Rio de Janeiro.

Nesta tese foram analisadas iniciativas e ações individuais e coletivas de gestores e profissionais de dois Hospitais Público-Universitários de Saúde, que mantêm serviços de referência no atendimento às infertilidades, no Estado do Rio de Janeiro. É visada a implementação de tecnologias de reprodução assistida (RA) pelo SUS, no Estado. O estudo constou de entrevistas com profissionais de saúde destes serviços e especialistas na área que ali atuam, leitura de prontuários e pesquisa documental no Departamento de Serviço Social de um dos serviços, além de atualização bibliográfica no campo estudado. Os resultados obtidos de material primário e documental evidenciam a não priorização da reprodução assistida em políticas públicas de saúde no Brasil. No entanto, foi possível encontrar importantes iniciativas dos próprios profissionais de saúde para a ampliação da atenção em infertilidade e do acesso às tecnologias reprodutivas no Rio de Janeiro. Em geral, foram mobilizações individuais, que dependeram do empenho direto dos médicos responsáveis dos serviços. As motivações para estas ações incluíam aspectos acadêmicos, assistenciais, de direitos reprodutivos, além de interesses público-privados. A única mobilização interinstitucional, organizada inicialmente pelo Serviço Social, não conseguiu garantir o acesso à assistência integral em reprodução assistida no Rio de Janeiro. No caso da reprodução assistida, há uma forte desigualdade de base socioeconômica, já que mulheres e casais pobres são excluídos, ou quase, do acesso à IIU, Fiv e ICSI, pois não têm condições econômicas para tentar um tratamento particular, onde se encontram concentradas mais de 90% da assistência no país. Este segmento populacional não encontra recursos, nem tecnológicos, nem humanos, nos serviços públicos de saúde. Este quadro aumenta sua vulnerabilidade e reduz sua autonomia reprodutiva pela falta de acesso.

An ecological characterization of the marine resources of Vieques, Puerto Rico Part II: Field studies of habitats, nutrients, contaminants, fish, and benthic communities

Since the 1940s, portions of the Island of Vieques, Puerto Rico have been used by the United States Navy (USN) as an ammunition support detachment and bombing and maneuver training range. In April 2001, the USN began phasing out military activities on the island and transferring military property to the U.S. Department of the Interior, the Municipality of Vieques, and the Puerto Rico Conservation Trust. A small number of studies have been commissioned by the USN in the past few decades to assess selected components of the coral reef ecosystem surrounding the island; however, these studies were generally of limited geographic scope and short duration. The National Oceanic and Atmospheric Administration’s (NOAA) National Centers for Coastal Ocean Science (NCCOS), in consultation with NOAA’s Office of Response and Restoration (OR&R) and other local and regional experts, conducted a more comprehensive characterization of coral reef ecosystems, contaminants, and nutrient distribution patterns around Vieques. This work was conducted using many of the same protocols as ongoing monitoring work underway elsewhere in the U.S. Caribbean and has enabled comparisons among coral reef ecosystems in Vieques and other locations in the region. This characterization of Vieques’ marine ecosystems consists of a two part series. First, available information on reefs, fish, birds, seagrasses, turtles, mangroves, climate, geology, currents, and human uses from previous studies was gathered and integrated into a single document comprising Part I of this two part series (Bauer et al. 2008). For Part II of the series, presented in this document, new field studies were conducted to fill data gaps identified in previous studies, to provide an island-wide characterization, and to establish baseline values for the distribution of habitats, nutrients, contaminants, fish, and benthic communities. An important objective underlying this suite of studies was to quantify any differences in the marine areas adjacent to the former and current land-use zoning around Vieques. Specifically of interest was the possibility that either Naval (e.g., practice bombing, munitions storage) or civilian activities (e.g., sewage pollutants, overfishing) could have a negative impact on adjacent marine resources. Measuring conditions at this time and so recently after the land transfer was essential because present conditions are likely to be reflective of past land-use practices. In addition, the assessment will establish benchmark conditions that can be influenced by the potentially dramatic future changes in land-use practices as Vieques considers its development. This report is organized into seven chapters that represent a suite of interrelated studies. Chapter 1 provides a short introduction to the island setting, the former and current land-use zoning, and how the land zoning was used to spatially stratify much of the sampling. Chapter 2 is focused on benthic mapping and provides the methods, accuracy assessment, and results of newly created benthic maps for Vieques. Chapter 3 presents the results of new surveys of fish, marine debris, and reef communities on hardbottom habitats around the island. Chapter 4 presents results of flora and fauna surveys in selected bays and lagoons. Chapter 5 examines the distribution of nutrients in lagoons, inshore, and offshore waters around the island. Chapter 6 is focused on the distribution of chemical contaminants in sediments and corals. Chapter 7 is a brief summary discussion that highlights key findings of the entire suite of studies.

Distribution of persistent organic contaminants in canyons and on the continental shelf off central California

The National Status and Trends (NS&T) Program has conducted studies to determine the spatial extent and severity of chemical contamination and associated adverse biological effects in coastal bays and estuaries of the United States since 1991. Sediment contamination in U.S. coastal areas is a major environmental issue because of its potential toxic effects on biological resources and often, indirectly, on human health. Thus, characterizing and delineating areas of sediment contamination and toxicity and demonstrating their effect(s) on benthic living resources are therefore important goals of coastal resource management at NOAA. The National Centers for Coastal Ocean Science, and the Office of National Marine Sanctuaries, in cooperation with the U.S. Geological Survey (USGS), University of California Moss Landing Marine Lab (MLML), and the Monterey Bay Aquarium Research Institute (MBARI), conducted ecosystem monitoring and characterization studies within and between marine sanctuaries along the California coast in 2002 and 2004 on the NOAA RV McArthur. One of the objectives was to perform a systematic assessment of the chemical and physical habitats and associated biological communities in soft bottom habitats on the continental shelf and slope in the central California region. This report addresses the magnitude and extent of chemical contamination, and contaminant transport patterns in the region. Ongoing studies of the benthic community are in progress and will be reported in an integrated assessment of habitat quality and the parameters that govern natural resource distributions on the continental margin and in canyons in the region.

Some major unsolved aspects of the dynamics of African fisheries as related to questions of rational development and management

Studies of fish and fisheries in Africa fall in to four phases: the period of fisheries expeditions, ecological investigations, the development phase, and the period of mechanized exploitation. There is need to establish the taxonomic status and ecology of the varied components of the potentially important Haplochromis in Lake Victoria. A comprehensive study of their bionomics and life history, population structure, natality, recruitment and mortality coefficients should be undertaken. Emphasis lo be laid on the study of the ecology, especially breeding behaviour of the economically important c1upeids (Stolothrissa tanganciae and Limnothrissa miodon), in Lake Tanganyika. A comprehensive investigation into the migratory and shoaling behaviour of the Lake Victoria Tilapia to be initiated. Pre-impoundment studies to be undertaken to assess effects of hydroelectric projects of fisheries. Studies on parasites of economically important fishes to be stepped up to assess pathological effects and the biological basis for their control. The role of predators, e.g., Hydrocyon, Lates and Micropterus salmoides in commercial fish populations should be evaluated, and the knowledge gaincd used to effectively manage the fisheries in favour of the more desirable fish stocks.

Developing a toolkit for assessing the impact of health library services on patient care

Urquhart,C., Spink, S., Thomas, R. & Weightman, A. (2007). Developing a toolkit for assessing the impact of health library services on patient care. Report to LKDN (Libraries and Knowledge Development Network). Aberystwyth: Department of Information Studies, Aberystwyth University. Sponsorship: Libraries and Knowledge Development Network/ NHS

MUES (Mid Wales - Users - Ethnic Services) Ethnic services provision 2007-08. Policy guidance for Libraries for Life: Delivering the entitlement agenda for library users in Wales 2007-09

Urquhart, C., Thomas, R., Crossan, S. & Hines, B. (2008). MUES (Mid Wales - Users - Ethnic Services) Ethnic services provision 2007-08. Policy guidance for Libraries for Life: Delivering the entitlement agenda for library users in Wales 2007-09. Aberystwyth: Department of Information Studies, Aberystwyth University. Relates to report of same title - http://hdl.handle.net/2160/609 Sponsorship: CyMAL

Assessing the impact of a health library service. Best practice guidance

Urquhart, C. & Weightman, A. (2008). Assessing the impact of a health library service. Best Practice Guidance. Based on research originally funded by LKDN, now sponsored by National Library for Health. Aberystwyth: Department of Information Studies, Aberystwyth University. The guidance relates to a project report, Developing a toolkit for assessing the impact of health library services on patient care (also available in CADAIR). A version of this item is available as an online appendix to a paper in Health Information and Libraries Journal entitled: The value and impact of information provided through library services for patient care: developing guidance for best practice (Weightman, A., Urquhart, C. et al) available electronically prepublication Sponsorship: LKDN/NLH

Implications of Selfish Neighbor Selection in Overlay Networks

In a typical overlay network for routing or content sharing, each node must select a fixed number of immediate overlay neighbors for routing traffic or content queries. A selfish node entering such a network would select neighbors so as to minimize the weighted sum of expected access costs to all its destinations. Previous work on selfish neighbor selection has built intuition with simple models where edges are undirected, access costs are modeled by hop-counts, and nodes have potentially unbounded degrees. However, in practice, important constraints not captured by these models lead to richer games with substantively and fundamentally different outcomes. Our work models neighbor selection as a game involving directed links, constraints on the number of allowed neighbors, and costs reflecting both network latency and node preference. We express a node's "best response" wiring strategy as a k-median problem on asymmetric distance, and use this formulation to obtain pure Nash equilibria. We experimentally examine the properties of such stable wirings on synthetic topologies, as well as on real topologies and maps constructed from PlanetLab and AS-level Internet measurements. Our results indicate that selfish nodes can reap substantial performance benefits when connecting to overlay networks composed of non-selfish nodes. On the other hand, in overlays that are dominated by selfish nodes, the resulting stable wirings are optimized to such great extent that even non-selfish newcomers can extract near-optimal performance through naive wiring strategies.

An empirical examination of risk equalisation in a regulated community rated health insurance market

Despite universal access entitlements to the public healthcare system in Ireland, over half the population is covered by voluntary private health insurance. The market operates on the basis of community rating, open enrolment and lifetime cover. A set of minimum benefits also exists, and two risk equalisation schemes have been put in place but neither was implemented. These schemes have proved highly controversial. To date, the debate has primarily consisted of qualitative arguments. This study adds a quantitative element by analysing a number of pertinent issues. A model of a community rated insurance market is developed, which shows that community rating can only be maintained in a competitive market if all insurers in the market have the same risk profile as the market overall. This has relevance to the Irish market in the aftermath of a Supreme Court decision to set aside risk equalisation. Two reasons why insurers’ risk profiles might differ are adverse selection and risk selection. Evidence is found of the existence of both forms of selection in the Irish market. A move from single rate community rating to lifetime community rating in Australia had significant consequences for take-up rates and the age profile of the insured population. A similar move has been proposed in Ireland. It is found that, although this might improve the stability of community rating in the short term, it would not negate the need for risk equalisation. If community rating were to collapse then risk rating might result. A comparison of the Irish, Australian and UK health insurance markets suggests that community rating encourages higher take-up among older consumers than risk rating. Analysis of Irish hospital discharge figures suggests that this yields significant savings for the Irish public healthcare system. This thesis has implications for government policy towards private health insurance in Ireland.

The effect of positive psychological interventions on psychological and physical well-being during pregnancy

Prenatal well-being can have significant effects on the mother and developing foetus. Positive psychological interventions, including gratitude and mindfulness, consistently demonstrate benefits for well-being in diverse populations. No research has been conducted on gratitude during pregnancy; the few studies of prenatal mindfulness interventions have demonstrated well-being benefits. The current study examined the effects of gratitude and mindfulness interventions on prenatal maternal well-being, cortisol and birth outcomes. Five studies were conducted. Study 1 was a systematic review of mindfulness intervention effects on cortisol; this highlighted potential benefits of mindfulness but the need for rigorous protocols in future research. In Study 2 a gratitude and a mindfulness intervention were developed and evaluated; findings indicate usefulness of two 3 week interventions. Study 3 examined the effects of these interventions in a randomised controlled trial (RCT) of non-pregnant women, before examining a pregnant group. No significant intervention effects were found in this study, potentially due to insufficient power and poor protocol adherence. Changes in expected directions were observed for most outcomes and the potential utility of a combined gratitude and mindfulness intervention was noted. In Study 4 a gratitude during pregnancy (GDP) scale was developed and the reliability of an existing mindfulness measure (MAAS) was examined in a pregnant group. Both scales were found to be suitable and reliable measures in pregnancy. Study 5 incorporated the findings of the previous four studies to examine of the effect of a combined mindfulness and gratitude intervention with a group of pregnant women. Forty-six participants took part in a 5-week RCT that examined intervention effects on prenatal gratitude, mindfulness, happiness, satisfaction with life, social support, prenatal stress, depression and sleep. Findings indicated that the intervention improved sleep quality and that effects for prenatal distress were approaching significance. Issues of attrition and non-compliance to study protocols were problematic and are discussed. In summary, the current thesis highlights the need for robust measurement, and intervention and cortisol sampling protocols in future research, particularly with pregnant groups. Findings also demonstrate tentative benefits of a gratitude and mindfulness intervention during pregnancy.

Design Optimization and Security For Communication Networks

In this work we introduce a new mathematical tool for optimization of routes, topology design, and energy efficiency in wireless sensor networks. We introduce a vector field formulation that models communication in the network, and routing is performed in the direction of this vector field at every location of the network. The magnitude of the vector field at every location represents the density of amount of data that is being transited through that location. We define the total communication cost in the network as the integral of a quadratic form of the vector field over the network area. With the above formulation, we introduce a mathematical machinery based on partial differential equations very similar to the Maxwell's equations in electrostatic theory. We show that in order to minimize the cost, the routes should be found based on the solution of these partial differential equations. In our formulation, the sensors are sources of information, and they are similar to the positive charges in electrostatics, the destinations are sinks of information and they are similar to negative charges, and the network is similar to a non-homogeneous dielectric media with variable dielectric constant (or permittivity coefficient). In one of the applications of our mathematical model based on the vector fields, we offer a scheme for energy efficient routing. Our routing scheme is based on changing the permittivity coefficient to a higher value in the places of the network where nodes have high residual energy, and setting it to a low value in the places of the network where the nodes do not have much energy left. Our simulations show that our method gives a significant increase in the network life compared to the shortest path and weighted shortest path schemes. Our initial focus is on the case where there is only one destination in the network, and later we extend our approach to the case where there are multiple destinations in the network. In the case of having multiple destinations, we need to partition the network into several areas known as regions of attraction of the destinations. Each destination is responsible for collecting all messages being generated in its region of attraction. The complexity of the optimization problem in this case is how to define regions of attraction for the destinations and how much communication load to assign to each destination to optimize the performance of the network. We use our vector field model to solve the optimization problem for this case. We define a vector field, which is conservative, and hence it can be written as the gradient of a scalar field (also known as a potential field). Then we show that in the optimal assignment of the communication load of the network to the destinations, the value of that potential field should be equal at the locations of all the destinations. Another application of our vector field model is to find the optimal locations of the destinations in the network. We show that the vector field gives the gradient of the cost function with respect to the locations of the destinations. Based on this fact, we suggest an algorithm to be applied during the design phase of a network to relocate the destinations for reducing the communication cost function. The performance of our proposed schemes is confirmed by several examples and simulation experiments. In another part of this work we focus on the notions of responsiveness and conformance of TCP traffic in communication networks. We introduce the notion of responsiveness for TCP aggregates and define it as the degree to which a TCP aggregate reduces its sending rate to the network as a response to packet drops. We define metrics that describe the responsiveness of TCP aggregates, and suggest two methods for determining the values of these quantities. The first method is based on a test in which we drop a few packets from the aggregate intentionally and measure the resulting rate decrease of that aggregate. This kind of test is not robust to multiple simultaneous tests performed at different routers. We make the test robust to multiple simultaneous tests by using ideas from the CDMA approach to multiple access channels in communication theory. Based on this approach, we introduce tests of responsiveness for aggregates, and call it CDMA based Aggregate Perturbation Method (CAPM). We use CAPM to perform congestion control. A distinguishing feature of our congestion control scheme is that it maintains a degree of fairness among different aggregates. In the next step we modify CAPM to offer methods for estimating the proportion of an aggregate of TCP traffic that does not conform to protocol specifications, and hence may belong to a DDoS attack. Our methods work by intentionally perturbing the aggregate by dropping a very small number of packets from it and observing the response of the aggregate. We offer two methods for conformance testing. In the first method, we apply the perturbation tests to SYN packets being sent at the start of the TCP 3-way handshake, and we use the fact that the rate of ACK packets being exchanged in the handshake should follow the rate of perturbations. In the second method, we apply the perturbation tests to the TCP data packets and use the fact that the rate of retransmitted data packets should follow the rate of perturbations. In both methods, we use signature based perturbations, which means packet drops are performed with a rate given by a function of time. We use analogy of our problem with multiple access communication to find signatures. Specifically, we assign orthogonal CDMA based signatures to different routers in a distributed implementation of our methods. As a result of orthogonality, the performance does not degrade because of cross interference made by simultaneously testing routers. We have shown efficacy of our methods through mathematical analysis and extensive simulation experiments.

Altered ultrasonic vocalization and impaired learning and memory in Angelman syndrome mouse model with a large maternal deletion from Ube3a to Gabrb3.

Angelman syndrome (AS) is a neurobehavioral disorder associated with mental retardation, absence of language development, characteristic electroencephalography (EEG) abnormalities and epilepsy, happy disposition, movement or balance disorders, and autistic behaviors. The molecular defects underlying AS are heterogeneous, including large maternal deletions of chromosome 15q11-q13 (70%), paternal uniparental disomy (UPD) of chromosome 15 (5%), imprinting mutations (rare), and mutations in the E6-AP ubiquitin ligase gene UBE3A (15%). Although patients with UBE3A mutations have a wide spectrum of neurological phenotypes, their features are usually milder than AS patients with deletions of 15q11-q13. Using a chromosomal engineering strategy, we generated mutant mice with a 1.6-Mb chromosomal deletion from Ube3a to Gabrb3, which inactivated the Ube3a and Gabrb3 genes and deleted the Atp10a gene. Homozygous deletion mutant mice died in the perinatal period due to a cleft palate resulting from the null mutation in Gabrb3 gene. Mice with a maternal deletion (m-/p+) were viable and did not have any obvious developmental defects. Expression analysis of the maternal and paternal deletion mice confirmed that the Ube3a gene is maternally expressed in brain, and showed that the Atp10a and Gabrb3 genes are biallelically expressed in all brain sub-regions studied. Maternal (m-/p+), but not paternal (m+/p-), deletion mice had increased spontaneous seizure activity and abnormal EEG. Extensive behavioral analyses revealed significant impairment in motor function, learning and memory tasks, and anxiety-related measures assayed in the light-dark box in maternal deletion but not paternal deletion mice. Ultrasonic vocalization (USV) recording in newborns revealed that maternal deletion pups emitted significantly more USVs than wild-type littermates. The increased USV in maternal deletion mice suggests abnormal signaling behavior between mothers and pups that may reflect abnormal communication behaviors in human AS patients. Thus, mutant mice with a maternal deletion from Ube3a to Gabrb3 provide an AS mouse model that is molecularly more similar to the contiguous gene deletion form of AS in humans than mice with Ube3a mutation alone. These mice will be valuable for future comparative studies to mice with maternal deficiency of Ube3a alone.

Evaluating the effectiveness of Z: The claims made about CICS and where we go from here

There have been few genuine success stories about industrial use of formal methods. Perhaps the best known and most celebrated is the use of Z by IBM (in collaboration with Oxford University's Programming Research Group) during the development of CICS/ESA (version 3.1). This work was rewarded with the prestigious Queen's Award for Technological Achievement in 1992 and is especially notable for two reasons: 1) because it is a commercial, rather than safety- or security-critical, system and 2) because the claims made about the effectiveness of Z are quantitative as well as qualitative. The most widely publicized claims are: less than half the normal number of customer-reported errors and a 9% savings in the total development costs of the release. This paper provides an independent assessment of the effectiveness of using Z on CICS based on the set of public domain documents. Using this evidence, we believe that the case study was important and valuable, but that the quantitative claims have not been substantiated. The intellectual arguments and rationale for formal methods are attractive, but their widespread commercial use is ultimately dependent upon more convincing quantitative demonstrations of effectiveness. Despite the pioneering efforts of IBM and PRG, there is still a need for rigorous, measurement-based case studies to assess when and how the methods are most effective. We describe how future similar case studies could be improved so that the results are more rigorous and conclusive.

Capturing teachers' experience of learning design through case studies

This article distinguishes three dimensions to learning design: a technological infrastructure, a conceptual framework for practice that focuses on the creation of structured sequences of learning activities, and a way to represent and share practice through the use of mediating artefacts. Focusing initially on the second of these dimensions, the article reports the key findings from an exploratory study, eLIDA CAMEL. This project examined a hitherto under-researched aspect of learning design: what teachers who are new to the domain perceive to be its value as a framework for practice in the design of both flexible and classroom-based learning. Data collection comprised 13 case studies constructed from participants' self-reports. These suggest that providing students with a structured sequence of learning activities was the major value to teachers. The article additionally discusses the potential of such case studies to function as mediating artefacts for practitioners who are considering experimenting with learning design.

Interprofessional attitudes amongst undergraduate students in the health professions: a longitudinal questionnaire survey

Background: Interprofessional education (IPE) introduced at the beginning of pre-registration training for healthcare professionals attempts to prevent the formation of negative interprofessional attitudes which may hamper future interprofessional collaboration. However, the potential for IPE depends, to some extent, on the readiness of healthcare students to learn together. Objectives: To measure changes in readiness for interprofessional learning, professional identification, and amount of contact between students of different professional groups; and to examine the influence of professional group, student characteristics and an IPE course on these scores over time. Design: Annual longitudinal panel questionnaire survey at four time-points of pre-registration students (n = 1683) drawn from eight healthcare groups from three higher education institutions (HEIs) in the UK. Results: The strength of professional identity in all professional groups was high on entry to university but it declined significantly over time for some disciplines. Similarly students’ readiness for interprofessional learning was high at entry but declined significantly over time for all groups, with the exception of nursing students. A small but significant positive relationship between professional identity and readiness for interprofessional learning was maintained over time. There was very minimal contact between students from different disciplines during their professional education programme. Students who reported gaining the least from an IPE course suffered the most dramatic drop in their readiness for interprofessional learning in the following and subsequent years; however, these students also had the lowest expectations of an IPE course on entry to their programme of study. Conclusion: The findings provide support for introducing IPE at the start of the healthcare students’ professional education to capitalise on students’ readiness for interprofessional learning and professional identities, which appear to be well formed from the start. However, this study suggests that students who enter with negative attitudes towards interprofessional learning may gain the least from IPE courses and that an unrewarding experience of such courses may further reinforce their negative attitudes.