The role of time pressure and different psychological safety climate referents in the prediction of nurses’ hand hygiene compliance

In this study of 638 Australian nurses, compliance to hand hygiene (HH), as defined by the “five moments” recommended by the World Health Organisation (2009), was examined. Hypotheses focused on the extent to which time pressure reduces compliance and safety climate (operationalised in relation to HH using colleagues, manager, and hospital as referents) increases compliance. It also was proposed that HH climate would interact with time pressure, such that the negative effects of time pressure would be less marked when HH climate is high. The extent to which the three HH climate variables would interact among each other, either in the form of boosting or compensatory effects, was tested in an exploratory manner. A prospective research design was used in which time pressure and the HH climate variables were assessed at Time 1 and compliance was assessed by self-report two weeks later. Compliance was high but varied significantly across the 5 HH Moments, suggesting that nurses make distinctions between inherent and elective HH and also seemed to engage in some implicit rationing of HH. Time pressure dominated the utility of HH climate to have its positive impact on compliance. The most conducive workplace for compliance was one low in time pressure and high in HH climate. Colleagues were very influential in determining compliance, more so than the manager and hospital. Manager and hospital support for HH enhanced the positive effects of colleagues on compliance. Providing training and enhancing knowledge was important, not just for compliance, but for safety climate.

Petusta pitsaan : Ruokahuollon järjestelyt kriisiaikojen Suomessa

From bark bread to pizza - Food and exceptional circumstances: reactions of Finnish society to crises of food supply This study on the food supply under exceptional circumstances lies within the nutritional, historical and social sciences. The perspective and questions come under nutrition science, but are part of social decision-making. The study focuses on the first and second world wars as well as on contemporary society at the beginning of the 21st century. The main purpose of this study is to explore how Finnish society has responded to crises and what measures it has taken to sustain institutional food services and the food supply of households. The particular study interests include the school catering and food services in hospitals during the world wars. The situation in households is reflected in the counseling work carried out by state-run or civic organisations. Interest also focuses on the action of the scientific community. The decisions made in Finland are projected onto the solutions developed in some other European countries. The study is based primarily on the archive documents and annual reports prepared by food and health care authorities. Major source materials include scientific and professional publications. The evaluation of the situation in contemporary Finnish society is based on corresponding emergency plans and guidelines. The written material is supplemented by discussions with experts. Food rationing during the WWI and WWII differed in extent, details and unity. The food intake of some population groups was occasionally inadequate both in quantity, quality and safety. The counseling of the public focused on promoting self-sufficiency, improving cooking skills and widening food habits. One of the most vulnerable groups in regard to nutrition was long-term patients in institutions. As for future development, the world wars were never-theless important periods for public food services and counseling practices. WWII was also an important period for product development in the food industry. Significant work on food substitutes was carried out by Professor Carl Tigerstedt during WWI. The research of Professors A. I. Virtanen and Paavo Simola during WWII focused on vitamins. Crises threatening societies now differ from those faced a hundred years ago. Finland is bet-ter prepared, but in many ways more vulnerable to and dependent on other actors. Food rationing is a severe means of handling the scarcity of food, which is why contemporary society relies primarily on preparedness planning. Civic organisations played a key role during the world wars, and establishing an emergency food supply remains on their agenda. Although the objective of protecting the population remains the same for nutrition, food production, and food consumption, threat scenarios and the knowledge and skill levels of citizens are constantly changing. Continuous monitoring and evaluation is therefore needed.

Nachman Zonabend 1939-1944

The records reflect the organizational structure of the Jewish ghetto administration and consist of the following: Correspondence with German government agencies, 1939-1941, including the Police and Gestapo, the *Oberburgermeister* of Litzmannstadt (German name for Lodz), the *Gettoverwaltung* (German administration of the ghetto). The correspondence pertains to the establishment of the ghetto, expropriation of Jewish property, resettlement of Lodz Jews into the ghetto, sanitary conditions, ghetto industry, anti-Jewish ordinances. Announcements issued by Rumkowski, 1940-1944. A complete set of daily communications to the ghetto population on all subjects pertinent to ghetto life such as: confiscations of Jewish property, food rationing, availability of work, relief distribution, deportations, liquidation of the ghetto. Files of various departments of the Jewish ghetto administration including labor divisions and workshops, the Jewish police (*Ordnungsdienst*), Statistics Department, Ghetto Court, Archives, Resettlement Department, Deportation Commission. Of special interest are the Archives files which contain essays and reports written by the Archives staff expressly for the purpose of historical record on subjects related to ghetto life. Outstanding in this group are reports and literary sketches by Joseph Zelkowicz, including his extensive account about the *Gesperre* (Yid. Shpere) - the deportation of the children, the old and the infirm in September, 1942. In addition, the Archives files contain bulletins of the *Daily Chronicle* of the Lodz Ghetto, transcripts of speeches by Rumkowski, and issues of the *Geto-tsaytung*, a short-lived official publication of the Eldest of the Jews. Iconographic materials, including photographs and albums. The photographs taken by Mendel Grossman, Henryk Ross, Maliniak, Zonabend and others, provide an extensive visual record of ghetto life.

Health-Related Quality of Life and Mental Disorders in Finland

Quality of life (QoL) and Health-related quality of life (HRQoL) are becoming one of the key outcomes of health care due to increased respect for the subjective valuations and well-being of patients and an increasing part of the ageing population living with chronic, non-fatal conditions. Preference-based HRQoL measures enable estimation of health utility, which can be useful for rational rationing, evidence-based medicine and health policy. This study aimed to compare the individual severity and public health burden of major chronic conditions in Finland, including and focusing on reliably diagnosed psychiatric conditions. The study is based on the Health 2000 survey, a representative general population survey of 8028 Finns aged 30 and over. Depressive, anxiety and alcohol use disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI). HRQoL was measured with the 15D and the EQ-5D, with 83% response rate. This study found that people with psychiatric disorders had the lowest 15D HRQoL scores at all ages, in comparison to other main groups of chronic conditions. Considering 29 individual conditions, three of the four most severe (on 15D) were psychiatric disorders; the most severe was Parkinson s disease. Of the psychiatric disorders, chronic conditions that have sometimes been considered relatively mild - dysthymia, agoraphobia, generalized anxiety disorder and social phobia - were found to be the most severe. This was explained both by the severity of the impact of these disorders on mental health domains of HRQoL, and also by the fact that decreases were widespread on most dimensions of HRQoL. Considering the public health burden of conditions, musculoskeletal disorders were associated with the largest burden, followed by psychiatric disorders. Psychiatric disorders were associated with the largest burden at younger ages. Of individual conditions, the largest burden found was for depressive disorders, followed by urinary incontinence and arthrosis of the hip and knee. The public health burden increased greatly with age, so the ageing of the Finnish population will mean that the disease burden caused by chronic conditions will increase by a quarter up to year 2040, if morbidity patterns do not change. Investigating alcohol consumption and HRQoL revealed that although abstainers had poorer HRQoL than moderate drinkers, this was mainly due to many abstainers being former drinkers and having the poorest HRQoL. Moderate drinkers did not have significantly better HRQoL than abstainers who were not former drinkers. Psychiatric disorders are associated with a large part of the non-fatal disease burden in Finland. In particular anxiety disorders appear to be more severe and have a larger public health burden than previously thought.

Modelling electricity demand with representative load curves

Models for electricity planning require inclusion of demand. Depending on the type of planning, the demand is usually represented as an annual demand for electricity (GWh), a peak demand (MW) or in the form of annual load-duration curves. The demand for electricity varies with the seasons, economic activities, etc. Existing schemes do not capture the dynamics of demand variations that are important for planning. For this purpose, we introduce the concept of representative load curves (RLCs). Advantages of RLCs are demonstrated in a case study for the state of Karnataka in India. Multiple discriminant analysis is used to cluster the 365 daily load curves for 1993-94 into nine RLCs. Further analyses of these RLCs help to identify important factors, namely, seasonal, industrial, agricultural, and residential (water heating and air-cooling) demand variations besides rationing by the utility. (C) 1999 Elsevier Science Ltd. All rights reserved.

Groundwater Management in India:Physical, Institutional and Policy Alternatives

Groundwater constitutes a vital natural resource for sustaining India’s agricultural economy and meeting the country’s social, ecological and environmental goals. It is a unique resource, widely available, providing security against droughts and yet it is closely linked to surface-water resources and the hydrological cycle. Its availability depends on geo-hydrological conditions and characteristics of aquifers, from deep to alluvium, sediment crystalline rocks to basalt formations; and agro-climate from humid to subhumid and semi-arid to arid. Its reliable supply, uniform quality and temperature, relative turbidity, pollution-safe, minimal evaporation losses, and low cost of development are attributes making groundwater more attractive compared to other resources. It plays a key role in the provision of safe drinking water to rural populations. For example, already almost 80% of domestic water use in rural areas in India is groundwater-supplied, and much of it is being supplied to farms, villages and small towns. Inadequate control of the use of groundwater, indiscriminate application of agrochemicals and unrestrained pollution of the rural environment by other human activities make groundwater usage unsustainable, necessitating proper management in the face of the twin demand for water of good quality for domestic supply and adequate supply for irrigation, ensuring equity, efficiency and sustainability of the resource. Groundwater irrigation has overtaken surface irrigation in the early 1980s, supported by well energization. It is estimated that there are about 24 million energised wells and tube wells now and it is driven by demand rather than availability, evident through the greater occurrence of wells in districts with high population densities. Apart from aquifer characteristics, land fragmentation and landholding size are the factors that decide the density of wells. The ‘rise and fall’ of local economies dependent on groundwater can be summarized as: the green revolution of 1980s, groundwaterbased agrarian boom, early symptoms of groundwater overdraft, and decline of the groundwater socio-ecology. The social characteristics and policy interventions typical of each stage provide a fascinating insight into the human-resource dynamics. This book is a compilation of nine research papers discussing various aspects of groundwater management. It attempts to integrate knowledge about the physical system, the socio-economic system, the institutional set-up and the policy environment to come out with a more realistic analysis of the situation with regard to the nature, characteristics and intensity of resource use, the size of the economy the use generates, and the negative socioeconomic consequences. Complex variables addressed in this regard focusing on northern Gujarat are the stock of groundwater available in the region, its hydrodynamics, its net outflows against inflows, the economics of its intensive use (particularly irrigation in semi-arid and arid regions), its criticality in the regional hydroecological regime, ethical aspects and social aspects of its use. The first chapter by Dinesh Kumar and Singh, dwells on complex groundwater socio-ecology of India, while emphasizing the need for policy measures to address indiscriminate over-exploitation of dwindling resources. The chapter also explores the nature of groundwater economy and the role of electricity prices on it. The next chapter on groundwater issue in north Gujarat provides a description of groundwater resource characteristics followed by a detailed analysis of the groundwater depletion and quality deterioration problems in the region and their undesirable consequences on the economy, ecosystem health and the society. Considering water-buyers and wellowning farmers individually, a methodology for economic valuation of groundwater in regions where its primary usage is in agriculture, and as assessment of the groundwater economy based on case studies from north Gujarat is presented in the fourth chapter. The next chapter focuses on the extent of dependency of milk production on groundwater, which includes the water embedded in green and dry fodder and animal feed. The study made a realistic estimate of irrigation water productivity in terms of the physics and economics of milk production. The sixth chapter analyses the extent of reduction in water usage, increase in yield and overall increase in physical productivity of alfalfa with the use of the drip irrigation system. The chapter also provides a detailed synthesis of the costs and benefits associated with the use of drip irrigation systems. A linear programmingbased optimization model with the objective to minimize groundwater use taking into account the interaction between two distinct components – farming and dairying under the constraints of food security and income stability for different scenarios, including shift in cropping pattern, introduction of water-efficient crops, water- saving technologies in addition to the ‘business as usual’ scenario is presented in the seventh chapter. The results show that sustaining dairy production in the region with reduced groundwater draft requires crop shifts and adoption of water-saving technologies. The eighth chapter provides evidences to prove that the presence of adequate economic incentive would encourage farmers to adopt water-saving irrigation devices, based on the findings of market research with reference to the level of awareness among farmers of technologies and the factors that decide the adoption of water-saving technologies. However, now the marginal cost of using electricity for agricultural pumping is almost zero. The economic incentives are strong and visible only when the farmers are either water-buyers or have to manage irrigation with limited water from tube-well partnerships. The ninth chapter explores the socio-economic viability of increasing the power tariff and inducing groundwater rationing as a tool for managing energy and groundwater demand, considering the current estimate of the country’s annual economic loss of Rs 320 billion towards electricity subsidy in the farm sector. The tenth chapter suggests private tradable property rights and development of water markets as the institutional tool for achieving equity, efficiency and sustainability of groundwater use. It identifies the externalities for local groundwater management and emphasizes the need for managing groundwater by local user groups, supported by a thorough analysis of groundwater socio-ecology in India. An institutional framework for managing the resource based on participatory approach that is capable of internalizing the externalities, comprising implementation of institutional and technical alternatives for resource management is also presented. Major findings of the analyses and key arguments in each chapter are summarized in the concluding chapter. Case studies of the social and economic benefits of groundwater use, where that use could be described as unsustainable, are interesting. The benefits of groundwater use are outlined and described with examples of social and economic impacts of groundwater and the negative aspects of groundwater development with the compilation of environmental problems based on up-to-date research results. This publication with a well-edited compilation of case studies is informative and constitutes a useful publication for students and professionals.

A potential approach to claims problems

Hart and Mas Colell (1989) introduce the potential function for cooperative TU games. In this paper, we extend this approach to claims problems, also known as bankruptcy or rationing problems. We show that for appropriate subproblems, the random arrival rule, the rules in the TAL-family (which include the uniform gains rule, the uniform losses rule and the Talmud rule), the minimal overlap rule, and the proportional rule admit a potential. We also study the balanced contributions property for these rules. By means of a potential, we introduce a generalization of the random arrival rule and mixtures of the minimal overlap rule and the uniform losses rule.

Teorias Keynesianas sobre bancos e crédito: Tobin, Stiglitz e os pós-keynesianos

O presente trabalho tem por objetivo analisar os modelos da firma bancária e crédito a partir de uma visão keynesiana. Inicialmente são apresentadas as proposições teóricas de Keynes e as derivações dessa a partir dos velhos e novos keynesianos. Na 2 parte os modelos representativos da firma bancária dessas escolas são descritos através de Tobin e Stiglitz, sendo neste último caso introduzido o conceito de assimetria de informação. No 3 capítulo é desenvolvida a abordagem pós-keynesiana de endogeneidade da oferta de moeda, sendo apresentados os modelos horizontalista de Moore, bem como as críticas da visão estruturalista, além do modelo de estratégia bancária de Alves, Dymski e Paula, desenvolvido a partir da hipótese de fragilidade financeira de Minsky. No capítulo 4 efetua-se uma discussão, feita por autores pós-keynesianos, sobre a possibilidade de compatibilizar em alguma medida o modelo de Tobin e o modelo de racionamento de crédito com a concepção pós-keynesiana de banco e crédito.

Commercial Whaling, Especially for Gray Whales, Eschrichtius robustus, and Humpback Whales, Megaptera novaeangliae, at California and Baja California Shore Stations in the 19th Century (1854–1899)

Shore whaling along North America’s California and Baja California coasts during 1854–99 was ancillary to the offshore and alongshore American whale fishery, which had begun in the North Pacific in the early 1800’s and was flourishing by the 1840’s. From its inception at Monterey, Calif., in the mid 1850’s, the shore fishery, involving open boats deployed from land to catch and tow whales for processing, eventually spread from Monterey south to San Diego and Baja California and north to Crescent City near the California–Oregon border. It had declined to a relict industry by the 1880’s, although sporadic efforts continued into the early 20th century. The main target species were gray whales, Eschrichtius robustus, and humpback whales, Megaptera novaeangliae, with the valuable North Pacific right whale, Eubalaena japonica, also pursued opportunistically. Catch data are grossly incomplete for most stations; no logbooks were kept for these operations as they were for high-seas whaling voyages. Even when good information is available on catch levels, usually as number of whales landed or quantity of oil produced, it is rarely broken down by species. Therefore, we devised methods for extrapolation, interpolation, pro rationing, correction, and informed judgment to produce time series of catches. The resulting estimates of landings from 1854 to 1899 are 3,150 (SE = 112) gray whales and 1,637 (SE = 62) humpback whales. The numbers landed should be multiplied by 1.2 to account for hunting loss (i.e. whales harpooned or shot but not recovered and processed).

Effect of stocking density on growth of tiger shrimp (Penaeus monodon Fab.) fed on commercial formulated diets

Three different stocking rates in a semi-intensive pilot shrimp project was adopted in duplicates of three treatments designated as T1, T2 and T3 having initial per meter square stocking density of shrimp of 40, 44 and 51 respectively of 0.025g size post larva. The study was conducted for 84 days. Commercial pelleted diets designated as starter - 1, 2, 3 and grower were fed at a satiation level during the study period with a feeding frequency of 4 to 5 times per day. Feed rationing was based on the survivability, body weight and tray checking. 5-25% of the pond water was exchanged daily. Sampling was done for growth after every 2nd week. Monthly sampling was done for mortality in the ponds. Mean weight gain of the shrimp in treatments T1, T2 and T3 were 16.96 ± 1.14, 16.04 ± 1.38 and 14.08 ± 1.17g respectively and T1 with a low stocking density showed a significantly best growth among the treatments. Total mortality in treatments T1, T2 and T3 were as 30.00, 39.77 and 31.37% respectively. Significantly higher feed conversion ratio (FCR) of 1.87 was obtained with shrimp in treatment T3 followed by shrimp in T1 and T2 with FCR values of 1.70 and 1.41 respectively. A positive correlation of growth and salinity was observed during the study. Total production per unit area was the highest in the treatment T3 (4928 kg/ha) and followed by T1 (4747 kg/ha) and T2 (4251 kg/ha). The result show significantly negative correlation between individual growth and density.

The providing resources to enhance African American patients' readiness to make decisions about kidney disease (PREPARED) study: protocol of a randomized controlled trial.

BACKGROUND: Living related kidney transplantation (LRT) is underutilized, particularly among African Americans. The effectiveness of informational and financial interventions to enhance informed decision-making among African Americans with end stage renal disease (ESRD) and improve rates of LRT is unknown. METHODS/DESIGN: We report the protocol of the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED) Study, a two-phase study utilizing qualitative and quantitative research methods to design and test the effectiveness of informational (focused on shared decision-making) and financial interventions to overcome barriers to pursuit of LRT among African American patients and their families. Study Phase I involved the evidence-based development of informational materials as well as a financial intervention to enhance African American patients' and families' proficiency in shared decision-making regarding LRT. In Study Phase 2, we are currently conducting a randomized controlled trial in which patients with new-onset ESRD receive 1) usual dialysis care by their nephrologists, 2) the informational intervention (educational video and handbook), or 3) the informational intervention in addition to the option of participating in a live kidney donor financial assistance program. The primary outcome of the randomized controlled trial will include patients' self-reported rates of consideration of LRT (including family discussions of LRT, patient-physician discussions of LRT, and identification of a LRT donor). DISCUSSION: Results from the PREPARED study will provide needed evidence on ways to enhance the decision to pursue LRT among African American patients with ESRD.

Impact of coverage-dependent marginal costs on optimal HPV vaccination strategies.

The effectiveness of vaccinating males against the human papillomavirus (HPV) remains a controversial subject. Many existing studies conclude that increasing female coverage is more effective than diverting resources into male vaccination. Recently, several empirical studies on HPV immunization have been published, providing evidence of the fact that marginal vaccination costs increase with coverage. In this study, we use a stochastic agent-based modeling framework to revisit the male vaccination debate in light of these new findings. Within this framework, we assess the impact of coverage-dependent marginal costs of vaccine distribution on optimal immunization strategies against HPV. Focusing on the two scenarios of ongoing and new vaccination programs, we analyze different resource allocation policies and their effects on overall disease burden. Our results suggest that if the costs associated with vaccinating males are relatively close to those associated with vaccinating females, then coverage-dependent, increasing marginal costs may favor vaccination strategies that entail immunization of both genders. In particular, this study emphasizes the necessity for further empirical research on the nature of coverage-dependent vaccination costs.

Rheumatologists' judgements about the efficacy of anti-TNF therapy in two neighbouring regions

Objectives: The requirement in Northern Ireland to prescribe biologic agents according to NICE/BSR guidelines and within a fixed budget has created a waiting list for treatment that has no parallel in the Republic of Ireland. The study investigated the bearing this situation may have on had on the consultants’ judgements in the respective areas.

Methods: 78 case vignettes created from the data on real patients with RA treated with biologics in the north and south of Ireland were appraised by 9 southern and 8 northern consultants who judged the clinical benefit and significance of the patients’ condition after a trial of therapy. Quantitative (Clinical Judgement Analysis) and Qualitative (Focus groups) techniques were used.

Results: Northern consultants perceived a slightly greater degree of clinical benefit after a trial of therapy than southern consultants. Judgment models of northern and southern consultants were broadly comparable. The latter tended to be more uniform in their judgments than the southern group. Focus group discussions with consultants largely validated the findings of the quantitative analysis but revealed how clinical judgment analysis might be misled by gaming strategies.

Conclusions: Despite the absence of overt rationing in the south of Ireland, as far as the judgment of therapeutic benefit from biologics was concerned, the clinical judgment policies of practitioners were very similar to those in the north. The adoption of NICE/BSR guidelines in the north may have improved the uniformity of clinical practice in Northern Ireland.

Der deutsche Lebensstandard während des Ersten Weltkrieges in historischer Perspektive: Welche Rolle spielten Konsumentenpräferenzen?

After the outbreak of war in 1914 and the subsequent blockade implemented by British navy, the German economy faced serious food shortages leading to famine-like conditions, especially towards the end of the war. As a response to these shortages, the German authorities introduced and implemented socialist policies such as price ceilings and food rations. This study focuses on the inefficient use of high-quality foodstuffs by members of lower social strata by discussing consumer decisions during the First World War from a microeconomic perspective. The German rationing system provided small, but valuable – measured by black market prices – quantities of superior foodstuffs. Especially meat could have been traded on flourishing black markets for greater quantities of inferior staple foods such as bread and potatoes. In this paper I argue that a more efficient use of rations by the poor could have improved their nutritional situation.

The Economics of Total War and Reconstruction, 1914-1922

This chapter features a discussion of the economy and mobilization for the First World War. The authors analyse the implications and cost of total war, concluding with an examination of its contradictory legacies. In studying the war’s impact on Germany in particular, the chapter provides an in-depth look at the consequences of war on Europe’s strongest pre-war economy, without the complications of separating out the issues of a developing country, which can mimic those faced in wartime. The economic challenges that warring parties faced during the war included mobilization, warfare, labour shortage, impaired domestic economic activity, restricted international trade, a systematic redistribution of resources towards the war economy, food rationing, the predictable emergence of black markets, and a drop in living standards. The authors also discuss strategies to meet the significant financial demands associated with the war, and its tumultuous economic and political aftermath.