"The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology.

BACKGROUND Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. METHODOLOGY/PRINCIPAL FINDINGS Pre-post intervention study of HH performance at baseline (October 2007-December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: "3/3 strategy"); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2-80.7) vs 84.6% (95% CI:83.8-85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time ("positive": 90.1% as highest HH compliance coinciding with the "World hygiene day"; and "negative":73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). CONCLUSIONS/SIGNIFICANCE CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers.

The effects of structural reforms on productivity and profitability enhancing reallocation: Evidence from Colombia

Estimates for the U.S. suggest that at least in some sectors productivity enhancing reallocationis the dominant factor in accounting for producitivity growth. An open question, particularlyrelevant for developing countries, is whether reallocation is always productivity enhancing. Itmay be that imperfect competition or other barriers to competitive environments imply that thereallocation process is not fully e?cient in these countries. Using a unique plant-levellongitudinal dataset for Colombia for the period 1982-1998, we explore these issues byexamining the interaction between market allocation, and productivity and profitability.Moreover, given the important trade, labor and financial market reforms in Colombia during theearly 1990's, we explore whether and how the contribution of reallocation changed over theperiod of study. Our data permit measurement of plant-level quantities and prices. Takingadvantage of the rich structure of our price data, we propose a sequential mehodology to estimateproductivity and demand shocks at the plant level. First, we estimate total factor productivity(TFP) with plant-level physical output data, where we use downstream demand to instrumentinputs. We then turn to estimating demand shocks and mark-ups with plant-level price data, usingTFP to instrument for output in the inversedemand equation. We examine the evolution of thedistributions of TFP and demand shocks in response to the market reforms in the 1990's. We findthat market reforms are associated with rising overall productivity that is largely driven byreallocation away from low- and towards highproductivity businesses. In addition, we find thatthe allocation of activity across businesses is less driven by demand factors after reforms. Wefind that the increase in aggregate productivity post-reform is entirely accounted for by theimproved allocation of activity.

On heuristic and linear models of judgment: Mapping the demand for knowledge

Research on judgment and decision making presents a confusing picture of human abilities. For example, much research has emphasized the dysfunctional aspects of judgmental heuristics, and yet, other findings suggest that these can be highly effective. A further line of research has modeled judgment as resulting from as if linear models. This paper illuminates the distinctions in these approaches by providing a common analytical framework based on the central theoretical premise that understanding human performance requires specifying how characteristics of the decision rules people use interact with the demands of the tasks they face. Our work synthesizes the analytical tools of lens model research with novel methodology developed to specify the effectiveness of heuristics in different environments and allows direct comparisons between the different approaches. We illustrate with both theoretical analyses and simulations. We further link our results to the empirical literature by a meta-analysis of lens model studies and estimate both human andheuristic performance in the same tasks. Our results highlight the trade-off betweenlinear models and heuristics. Whereas the former are cognitively demanding, the latterare simple to use. However, they require knowledge and thus maps of when andwhich heuristic to employ.

Monetary policy and rational asset price bubbles

I examine the impact of alternative monetary policy rules on arational asset price bubble, through the lens of an overlapping generations model with nominal rigidities. A systematic increase in interestrates in response to a growing bubble is shown to enhance the fluctuations in the latter, through its positive effect on bubble growth. Theoptimal monetary policy seeks to strike a balance between stabilization of the bubble and stabilization of aggregate demand. The paper'smain findings call into question the theoretical foundations of the casefor "leaning against the wind" monetary policies.

Human Resource Training and National Sport Organization Managers: Examining the Impact of Training on Individual and Organizational Performance

Within sport, a tremendous amount of effort is committed to the on-the-field performance of athletes and coaches, neglecting the off-the-field performance and development of sport managers. This study examines the impact of human resource training on the performance of five Canadian national sport organizations (NSO) and their managers (N=22). Data were collected on three outcome variables (learning, individual performance, organizational performance) and three mediating variables (motivation to transfer, training design, organizational climate) at three time measures (pre-training, post-training1, post-training2). Results indicate that training improves the learning and individual performance of sport managers, as well as the organizational performance of NSOs. Varying relationships were found at each of the three time measures, demonstrating that a progression to training-related performance change exists, while providing support for three levels of analysis (individual, organizational, systemic). Implications and future research directions are discussed and highlight the need for on-going training opportunities for Canadian sport managers.

Inter-temporal Price Discrimination when Imports are Restricted by Quotas

A dominant firm holding import quota engages in inter-temporal price discrimination when facing a competitive fringe engaged in seasonal production. This causes a welfare loss that comes in addition the loss attributable to limitation of imports below the free trade level.

Essays on education and family planning

Le capital humain d’un pays est un facteur important de sa croissance et de son développement à long terme. Selon l’Unicef, ce capital humain est constitué en donnant à chaque enfant un bon départ dans la vie : non seule- ment la possibilité de survivre, mais aussi les conditions nécessaires pour se développer et réaliser tout son potentiel. Malheureusement, cet état de fait est loin d’être une réalité en Afrique Subsaharienne. En effet, selon toujours l’Unicef et sur la base d’enquêtes ménages dans 21 pays d’Afrique de l’Ouest et du Centre, c’est près de 32 millions d’enfants qui ont l’âge officiel d’être scolarisés, mais qui ne le sont pas. A ces chiffres, il faut ajouter 17 millions d’enfants scolarisés qui risquent fortement l’exclusion. De son Côté, l’OMS pointe du doigt la mauvaise santé des enfants dans cette région. Ainsi, les décès d’enfants sont de plus en plus concentrés en Afrique subsaharienne où les enfants ont plus de 15 fois plus de risques de mourir avant l’âge de cinq ans que les enfants des régions développées. Les difficultés économiques apparaissent comme la première explication des obstacles à l’amélioration du bien être des enfants aussi bien du côté de l’offre que de la demande. Cette thèse relie trois essais sur d’une part le lien entre conflit armés, l’éducation et la mortalité des enfants et d’autre part sur le lien entre fertilité et éducation des enfants en milieu urbain. Le premier chapitre identifie l’impact de la crise politico-militaire de la Côte d’Ivoire sur le bien être des enfants, en particulier sur l’éducation et la mor- talité infanto-juvénile en exploitant la variation temporelle et géographique de la crise. Il ressort de cette analyse que les individus qui vivaient dans les régions de conflit et qui ont atteint durant la crise, l’âge officiel d’entrer à l’école ont 10% moins de chance d’être inscrits à l’école. Les élèves qui habitaient dans des régions de conflit pendant la crise ont subit une diminu- tion du nombre d’années scolaire d’au moins une année. Les élèves les plus v vi âgés et qui sont susceptibles d’être au secondaire ont connu une décroissance du nombre d’année scolaire d’au moins deux années. Il ressort également que la crise ivoirienne a accru la mortalité infanto-juvénile d’au moins 3%. Mes résultats suggèrent également que la détérioration des conditions de vie et la limitation de l’utilisation des services de santé au cours du conflit con- tribuent à expliquer ces effets négatifs. Des tests de robustesse incluant un test de placebo suggèrent que les résultats ne sont pas dus à des différences préexistantes entre les régions affectées par le conflit et celles non affectées. Le deuxième chapitre étudie les disparités intra-urbaines en matière d’arbitrage entre le nombre d’enfant et la scolarisation des enfants en se focalisant sur le cas de Ouagadougou (Capitale du Burkina Faso). Dans cette ville, au moins 33% des deux millions d’habitants vivent dans des zones informelles (appelées localement des zones non-loties). Cette sous-population manque d’infrastructures socioéconomiques de base et a un niveau d’éducation très bas. Dans ce chapitre, prenant en compte la possible endogénéité du nombre d’enfants et en utilisant une approche "two-step control function" avec des modèles Probit, nous investiguons les différences de comportement des mé- nages en matière de scolarisation entre zones formelles et zones informelles. Nous nous focalisons en particulier sur l’arbitrage entre la "quantité" et la "qualité" des enfants. Compte tenu de l’hétérogénéité des deux types de zones, nous utilisons les probabilités prédites pour les comparer. Nos princi- pales conclusions sont les suivantes. Tout d’abord, nous trouvons un impact négatif de la taille de la famille sur le niveau de scolarisation dans les deux types de zone. Cependant, nous constatons que l’impact est plus aigu dans les zones informelles. Deuxièmement, si nous supposons que le caractère en- dogène du nombre d’enfants est essentiellement due à la causalité inverse, les résultats suggèrent que dans les zones formelles les parents tiennent compte de la scolarisation des enfants dans la décision de leur nombre d’enfants, mais ce ne est pas le cas dans les zones informelles. Enfin, nous constatons que, pour des familles avec les mêmes caractéristiques observables, la probabilité d’atteindre le niveau post-primaire est plus élevée dans les zones formelles que dans les zones informelles. En terme d’implications politique, selon ces résultats, les efforts pour améliorer la scolarisation des enfants ne doivent pas être dirigées uniquement vers les zones rurales. En plus de réduire les frais de scolarité dans certaines zones urbaines, en particulier les zones informelles, un accent particulier devrait être mis sur la sensibilisation sur les avantages de l’éducation pour le bien-être des enfants et leur famille. Enfin, du point vii de vue méthodologique, nos résultats montrent l’importance de tenir compte de l’hétérogénéité non observée entre les sous-populations dans l’explication des phénomènes socio-économiques. Compte tenu du lien négatif entre la taille de la famille et la scolarisation des enfants d’une part et les différences intra-urbaines de comportement des ménages en matière de scolarisation, le trosième chapitre étudie le rôle des types de méthodes contraceptives dans l’espacement des naissances en mi- lieu urbain. Ainsi, en distinguant les méthodes modernes et traditionnelles et en utilisant l’histoire génétique des femmes, ce chapitre fait ressortir des différences de comportement en matière de contraception entre les femmes des zones formelles et informelles à Ouagadougou (capitale du Burkina Faso). Les résultats montrent que les deux types de méthodes contraceptives aug- mentent l’écart des naissances et diminuent la probabilité qu’une naissance se produise moins de 24 mois après la précédente. Prendre en compte les caractéristiques non observées mais invariants avec le temps ne modifie pas significativement l’amplitude du coefficient de l’utilisation de la contracep- tion moderne dans les deux types de zone. Toutefois, dans la zone informelle, la prise en compte les effets fixes des femmes augmentent significativement l’effet des méthodes traditionnelles. Les normes sociales, la perception de la planification familiale et le rôle du partenaire de la femme pourraient expli- quer ces différences de comportement entre les zones formelles et informelles. Par conséquent, pour améliorer l’utilisation de la contraception et de leur efficacité, il est essentiel de hiérarchiser les actions en fonction du type de sous-population, même dans les zones urbaines.

Changes of traditional farming systems and their effects on land degradation and socio-economic conditions in the Inle Lake region, Myanmar

At many locations in Myanmar, ongoing changes in land use have negative environmental impacts and threaten natural ecosystems at local, regional and national scales. In particular, the watershed area of Inle Lake in eastern Myanmar is strongly affected by the environmental effects of deforestation and soil erosion caused by agricultural intensification and expansion of agricultural land, which are exacerbated by the increasing population pressure and the growing number of tourists. This thesis, therefore, focuses on land use changes in traditional farming systems and their effects on socio-economic and biophysical factors to improve our understanding of sustainable natural resource management of this wetland ecosystem. The main objectives of this research were to: (1) assess the noticeable land transformations in space and time, (2) identify the typical farming systems as well as the divergent livelihood strategies, and finally, (3) estimate soil erosion risk in the different agro-ecological zones surrounding the Inle Lake watershed area. GIS and remote sensing techniques allowed to identify the dynamic land use and land cover changes (LUCC) during the past 40 years based on historical Corona images (1968) and Landsat images (1989, 2000 and 2009). In this study, 12 land cover classes were identified and a supervised classification was used for the Landsat datasets, whereas a visual interpretation approach was conducted for the Corona images. Within the past 40 years, the main landscape transformation processes were deforestation (- 49%), urbanization (+ 203%), agricultural expansion (+ 34%) with a notably increase of floating gardens (+ 390%), land abandonment (+ 167%), and marshlands losses in wetland area (- 83%) and water bodies (- 16%). The main driving forces of LUCC appeared to be high population growth, urbanization and settlements, a lack of sustainable land use and environmental management policies, wide-spread rural poverty, an open market economy and changes in market prices and access. To identify the diverse livelihood strategies in the Inle Lake watershed area and the diversity of income generating activities, household surveys were conducted (total: 301 households) using a stratified random sampling design in three different agro-ecological zones: floating gardens (FG), lowland cultivation (LL) and upland cultivation (UP). A cluster and discriminant analysis revealed that livelihood strategies and socio-economic situations of local communities differed significantly in the different zones. For all three zones, different livelihood strategies were identified which differed mainly in the amount of on-farm and off-farm income, and the level of income diversification. The gross margin for each household from agricultural production in the floating garden, lowland and upland cultivation was US$ 2108, 892 and 619 ha-1 respectively. Among the typical farming systems in these zones, tomato (Lycopersicon esculentum L.) plantation in the floating gardens yielded the highest net benefits, but caused negative environmental impacts given the overuse of inorganic fertilizers and pesticides. The Revised Universal Soil Loss Equation (RUSLE) and spatial analysis within GIS were applied to estimate soil erosion risk in the different agricultural zones and for the main cropping systems of the study region. The results revealed that the average soil losses in year 1989, 2000 and 2009 amounted to 20, 10 and 26 t ha-1, respectively and barren land along the steep slopes had the highest soil erosion risk with 85% of the total soil losses in the study area. Yearly fluctuations were mainly caused by changes in the amount of annual precipitation and the dynamics of LUCC such as deforestation and agriculture extension with inappropriate land use and unsustainable cropping systems. Among the typical cropping systems, upland rainfed rice (Oryza sativa L.) cultivation had the highest rate of soil erosion (20 t ha-1yr-1) followed by sebesten (Cordia dichotoma) and turmeric (Curcuma longa) plantation in the UP zone. This study indicated that the hotspot region of soil erosion risk were upland mountain areas, especially in the western part of the Inle lake. Soil conservation practices are thus urgently needed to control soil erosion and lake sedimentation and to conserve the wetland ecosystem. Most farmers have not yet implemented soil conservation measures to reduce soil erosion impacts such as land degradation, sedimentation and water pollution in Inle Lake, which is partly due to the low economic development and poverty in the region. Key challenges of agriculture in the hilly landscapes can be summarized as follows: fostering the sustainable land use of farming systems for the maintenance of ecosystem services and functions while improving the social and economic well-being of the population, integrated natural resources management policies and increasing the diversification of income opportunities to reduce pressure on forest and natural resources.

El mercado móvil de telecomunicaciones en Colombia ante externalidades de red

Si bien la generalidad de los mercados de telefonía móvil se consideran suficientemente competidos, los mercados en los que el operador más grande supera ampliamente en participación de mercado a sus seguidores constituyen un motivo de preocupación para sus respectivas autoridades regulatorias y de competencia. El análisis económico del problema ha llevado a que exista una cantidad creciente de literatura relacionada, principalmente con el propósito de analizar la persistencia de la asimetría en las cuotas de mercado. Tal es el caso del mercado móvil de telecomunicaciones en Colombia, donde la Comisión de Regulación de Comunicaciones ha sostenido que a la luz del problema de competencia que se origina por la unión de una participación de mercado considerablemente asimétrica y el diferencial de precios, el operador más grande adquiere una ventaja competitiva considerable frente a los demás operadores en el mercado, y por lo tanto es un operador con poder significativo de mercado, u operador con posición dominante. Por lo anterior, el presente trabajo evalúa la imposición de algunas medidas regulatorias con el fin de verificar si estas contribuyen a generar una mayor competencia en el mercado, y mejores condiciones para los operadores competidores.

Antecedentes de la lealtad en los entornos on line y off line: un análisis empírico aplicado al sector de la aviación civil

El objetivo de esta investigación es analizar la lealtad de los usuarios de líneas aéreas tanto en el entorno online como en el entorno offline. La revisión bibliográfica ha identificado tres antecedentes: la satisfacción, la confianza y el valor percibido. Se ha llevado a cabo un estudio empírico realizándose un total de 1710 entrevistas personales en el aeropuerto del Prat (Barcelona) a usuarios de dos compañías aéreas tradicionales, Iberia y British Airways, y a una compañía low cost, Easyjet. Se trata de las tres compañías que operan con vuelos directos Barcelona-Londres. En el análisis de los datos se han utilizado modelos de ecuaciones estructurales y en particular la técnica utilizada fue el análisis factorial confirmatorio. Los resultados revelan que tanto la satisfacción, como la confianza y el valor percibido explican las relaciones de lealtad entre los pasajeros y las compañías aéreas.

On intentional and social agents with graded attitudes

La principal contribución de esta Tesis es la propuesta de un modelo de agente BDI graduado (g-BDI) que permita especificar una arquitetura de agente capaz de representar y razonar con actitudes mentales graduadas. Consideramos que una arquitectura BDI más exible permitirá desarrollar agentes que alcancen mejor performance en entornos inciertos y dinámicos, al servicio de otros agentes (humanos o no) que puedan tener un conjunto de motivaciones graduadas. En el modelo g-BDI, las actitudes graduadas del agente tienen una representación explícita y adecuada. Los grados en las creencias representan la medida en que el agente cree que una fórmula es verdadera, en los deseos positivos o negativos permiten al agente establecer respectivamente, diferentes niveles de preferencias o de rechazo. Las graduaciones en las intenciones también dan una medida de preferencia pero en este caso, modelan el costo/beneficio que le trae al agente alcanzar una meta. Luego, a partir de la representación e interacción de estas actitudes graduadas, pueden ser modelados agentes que muestren diferentes tipos de comportamiento. La formalización del modelo g-BDI está basada en los sistemas multi-contextos. Diferentes lógicas modales multivaluadas se han propuesto para representar y razonar sobre las creencias, deseos e intenciones, presentando en cada caso una axiomática completa y consistente. Para tratar con la semántica operacional del modelo de agente, primero se definió un calculus para la ejecución de sistemas multi-contextos, denominado Multi-context calculus. Luego, mediante este calculus se le ha dado al modelo g-BDI semántica computacional. Por otra parte, se ha presentado una metodología para la ingeniería de agentes g-BDI en un escenario multiagente. El objeto de esta propuesta es guiar el diseño de sistemas multiagentes, a partir de un problema del mundo real. Por medio del desarrollo de un sistema recomendador en turismo como caso de estudio, donde el agente recomendador tiene una arquitectura g-BDI, se ha mostrado que este modelo es valioso para diseñar e implementar agentes concretos. Finalmente, usando este caso de estudio se ha realizado una experimentación sobre la flexibilidad y performance del modelo de agente g-BDI, demostrando que es útil para desarrollar agentes que manifiesten conductas diversas. También se ha mostrado que los resultados obtenidos con estos agentes recomendadores modelizados con actitudes graduadas, son mejores que aquellos alcanzados por los agentes con actitudes no-graduadas.

Transport impacts on atmosphere and climate: shipping

Emissions of exhaust gases and particles from oceangoing ships are a significant and growing contributor to the total emissions from the transportation sector. We present an assessment of the contribution of gaseous and particulate emissions from oceangoing shipping to anthropogenic emissions and air quality. We also assess the degradation in human health and climate change created by these emissions. Regulating ship emissions requires comprehensive knowledge of current fuel consumption and emissions, understanding of their impact on atmospheric composition and climate, and projections of potential future evolutions and mitigation options. Nearly 70% of ship emissions occur within 400 km of coastlines, causing air quality problems through the formation of ground-level ozone, sulphur emissions and particulate matter in coastal areas and harbours with heavy traffic. Furthermore, ozone and aerosol precursor emissions as well as their derivative species from ships may be transported in the atmosphere over several hundreds of kilometres, and thus contribute to air quality problems further inland, even though they are emitted at sea. In addition, ship emissions impact climate. Recent studies indicate that the cooling due to altered clouds far outweighs the warming effects from greenhouse gases such as carbon dioxide (CO2) or ozone from shipping, overall causing a negative present-day radiative forcing (RF). Current efforts to reduce sulphur and other pollutants from shipping may modify this. However, given the short residence time of sulphate compared to CO2, the climate response from sulphate is of the order decades while that of CO2 is centuries. The climatic trade-off between positive and negative radiative forcing is still a topic of scientific research, but from what is currently known, a simple cancellation of global mean forcing components is potentially inappropriate and a more comprehensive assessment metric is required. The CO2 equivalent emissions using the global temperature change potential (GTP) metric indicate that after 50 years the net global mean effect of current emissions is close to zero through cancellation of warming by CO2 and cooling by sulphate and nitrogen oxides.

The effect of financiaI repression & enforcernent on entrepreneurship and economic deveIopment

This paper studies the effect of financiaI repression and contract enforcement on entrepreneurship and economic development. We construct and solve a general equilibrium mo deI with heterogeneous agents, occupational choice and two financiaI frictions: intermediation costs and financiaI contract enforcement. Occupational choice and firm size are determined endogenously, and depend on agent type (wealth and ability) and the credit market frictions. The mo deI shows that differences across countries in intermediation costs and enforcement generate differences in occupational choice, firm size, credit, output and inequality. Counterfactual experiments are performed for Latin American, European, transition and high growth Asian countries. We use empirical estimates of each country's financiaI frictions, and United States values for all other parameters. The results allow us to isolate the quantitative effect of these financiaI frictions in explaining the performance gap between each country and the United States. The results depend critically on whether à general equilibrium factor price effect is operative, which in turn depends on whether financiaI markets are open or closed. This yields a positive policy prescription: If the goal is to maximize steady-state efficiency, financial reforms should be accompanied by measures to increase financiaI capital mobility.

Essays on cartels and market distortions

This dissertation is a conjunction of three essays on the Industrial Organization field, this empirical work is applied to the Brazilian retail gasoline market. The first essay investigates the existence of spillover effects from cartel activity. The second essay relates the well-known economic puzzle of asymmetric cost pass through to prices with the existence of horizontal coordination - cartels - in the relevant market. Finally, the third essay investigates the effectiveness of antitrust interventions inside the offenders and the consequences of its disclosure in related markets.

Digging effort in leaf-cutting ant queens (Atta sexdens rubropilosa) and its effects on survival and colony growth during the claustral phase

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