Comparing potentially avoidable hospitalization rates related to ambulatory care sensitive conditions in Switzerland: the need to refine the definition of health conditions and to adjust for population health status.

BACKGROUND: Regional rates of hospitalization for ambulatory care sensitive conditions (ACSC) are used to compare the availability and quality of ambulatory care but the risk adjustment for population health status is often minimal. The objectives of the study was to examine the impact of more extensive risk adjustment on regional comparisons and to investigate the relationship between various area-level factors and the properly adjusted rates. METHODS: Our study is an observational study based on routine data of 2 million anonymous insured in 26 Swiss cantons followed over one or two years. A binomial negative regression was modeled with increasingly detailed information on health status (age and gender only, inpatient diagnoses, outpatient conditions inferred from dispensed drugs and frequency of physician visits). Hospitalizations for ACSC were identified from principal diagnoses detecting 19 conditions, with an updated list of ICD-10 diagnostic codes. Co-morbidities and surgical procedures were used as exclusion criteria to improve the specificity of the detection of potentially avoidable hospitalizations. The impact of the adjustment approaches was measured by changes in the standardized ratios calculated with and without other data besides age and gender. RESULTS: 25% of cases identified by inpatient main diagnoses were removed by applying exclusion criteria. Cantonal ACSC hospitalizations rates varied from to 1.4 to 8.9 per 1,000 insured, per year. Morbidity inferred from diagnoses and drugs dramatically increased the predictive performance, the greatest effect found for conditions linked to an ACSC. More visits were associated with fewer PAH although very high users were at greater risk and subjects who had not consulted at negligible risk. By maximizing health status adjustment, two thirds of the cantons changed their adjusted ratio by more than 10 percent. Cantonal variations remained substantial but unexplained by supply or demand. CONCLUSION: Additional adjustment for health status is required when using ACSC to monitor ambulatory care. Drug-inferred morbidities are a promising approach.

Ethnic conflicts and international politics : an analysis of the communal regional, and global dimensions of the Cyprus problem

The thesis assesses the impact of international factors on relations between Greek and Turkish Cypriots during and after the Cold War. Through an analysis of the Cyprus problem it explores both why external actors intervene in communal conflicts and how they influence relations between ethnic groups in plural societies. The analytical framework employed throughout the study draws on contributions of International Relations theorists and students of ethnic conflict. The thesis argues that, as in the global political system, relations between ethnic groups in unranked communal systems are anarchic; that is, actors within the system do not recognize a sovereign political authority. In bipolar communal systems dominated by two relatively equal groups, the struggle for security and power often leads to appeals for assistance from external actors. The framework notes that neighboring states and Great Powers may heed calls for assistance, or intervene without a prior request, if it is in their interest to do so. The convergence of regional and global interests in communal affairs exacerbates ethnic conflicts and precludes the development of effective political institutions. The impact of external intervention in ethnic conflicts has the potential to alter the basis of communal relations. The Cyprus problem is examined both during and after the Cold War in order to gauge how global and regional actors and the structure of their respective systems have affected relations between ethnic groups in Cyprus. The thesis argues that Cyprus's descent into civil war in 1963 was due in part to the entrenchment of external interests in the Republic's constitution. The study also notes that power politics involving the United States, Soviet Union, Greece and Turkey continued to affect the development of communal relations throughout the 1960s, 70s, and, 80s. External intervention culminated in July and August 1974, after a Greek sponsored coup was answered by Turkey's invasion and partition of Cyprus. The forced expulsion of Greek Cypriots from the island's northern territories led to the establishment of ethnically homogeneous zones, thus altering the context of communal relations dramatically. The study also examines the role of the United Nations in Cyprus, noting that its failure to settle the dispute was due in large part to a lack of cooperation from Turkey, and the United States' and Soviet Union's acceptance of the status quo following the 1974 invasion and partition of the island. The thesis argues that the deterioration of Greek-Turkish relations in the post-Cold War era has made a solution to the dispute unlikely for the time being. Barring any dramatic changes in relations between communal and regional antagonists, relations between Greek and Turkish Cypriots will continue to develop along the lines established in July/August 1974. The thesis concludes by affirming the validity of its core hypotheses through a brief survey of recent works touching on international politics and ethnic conflict. Questions requiring further research are noted as are elements of the study that require further refinement.

Project Business: a quasi-experimental study of co- operative interaction between schools and industry

This project is a quasi-experimental study involving eight classrooms in two senior elementary schools in St. Catharines, Ontario which received a Project Business Program and were pre- and post-tested to determine the growth of knowledge acquisition in the area of business concepts. Four classrooms received a Project Business treatment while four classrooms acted as a control. The Project Business Program is sponsored by Junior Achievement of Canada; it occurred during a twelveweek period, February to May 1981, and is run by business consultants who, through Action, Dialogue and Career Exploration, teach children about economics and business related topics. The consultants were matched with teacher co-ordinators in whose classrooms they taught and with whom they discussed field trips, students, lesson planning, etc. The statistical analysis of pre- and post-test means revealed a significant statistical growth in the area of knowledge acquisition on the part of those students who received the Project Business Program. This confirms that Project Business makes a difference. A search of the literature appears to advocate economic programs like Project Business, whfch are broadly based, relevant and processoriented. This program recommends itself as a model for other areas of co-operative curricular interactions and as a bridge to future trends and as a result several fruitful areas of research are suggested.

Geodynamics of the Andaman - Sumatra - Java Trench - Arc System Based on Gravity and Seismotectonic Study

This work aims to study the variation in subduction zone geometry along and across the arc and the fault pattern within the subducting plate. Depth of penetration as well as the dip of the Benioff zone varies considerably along the arc which corresponds to the curvature of the fold- thrust belt which varies from concave to convex in different sectors of the arc. The entire arc is divided into 27 segments and depth sections thus prepared are utilized to investigate the average dip of the Benioff zone in the different parts of the entire arc, penetration depth of the subducting lithosphere, the subduction zone geometry underlying the trench, the arctrench gap, etc.The study also describes how different seismogenic sources are identified in the region, estimation of moment release rate and deformation pattern. The region is divided into broad seismogenic belts. Based on these previous studies and seismicity Pattern, we identified several broad distinct seismogenic belts/sources. These are l) the Outer arc region consisting of Andaman-Nicobar islands 2) the back-arc Andaman Sea 3)The Sumatran fault zone(SFZ)4)Java onshore region termed as Jave Fault Zone(JFZ)5)Sumatran fore arc silver plate consisting of Mentawai fault(MFZ)6) The offshore java fore arc region 7)The Sunda Strait region.As the Seismicity is variable,it is difficult to demarcate individual seismogenic sources.Hence, we employed a moving window method having a window length of 3—4° and with 50% overlapping starting from one end to the other. We succeeded in defining 4 sources each in the Andaman fore arc and Back arc region, 9 such sources (moving windows) in the Sumatran Fault zone (SFZ), 9 sources in the offshore SFZ region and 7 sources in the offshore Java region. Because of the low seismicity along JFZ, it is separated into three seismogenic sources namely West Java, Central Java and East Java. The Sunda strait is considered as a single seismogenic source.The deformation rates for each of the seismogenic zones have been computed. A detailed error analysis of velocity tensors using Monte—Carlo simulation method has been carried out in order to obtain uncertainties. The eigen values and the respective eigen vectors of the velocity tensor are computed to analyze the actual deformation pattem for different zones. The results obtained have been discussed in the light of regional tectonics, and their implications in terms of geodynamics have been enumerated.ln the light of recent major earthquakes (26th December 2004 and 28th March 2005 events) and the ongoing seismic activity, we have recalculated the variation in the crustal deformation rates prior and after these earthquakes in Andaman—Sumatra region including the data up to 2005 and the significant results has been presented.ln this chapter, the down going lithosphere along the subduction zone is modeled using the free air gravity data by taking into consideration the thickness of the crustal layer, the thickness of the subducting slab, sediment thickness, presence of volcanism, the proximity of the continental crust etc. Here a systematic and detailed gravity interpretation constrained by seismicity and seismic data in the Andaman arc and the Andaman Sea region in order to delineate the crustal structure and density heterogeneities a Io nagnd across the arc and its correlation with the seismogenic behaviour is presented.

A study of the information seeking bebavior of science and technology teachers and researchers of Cocbin University of Science and Technology and University of Kerala in the cbanged library environment

Information communication technology (IC T) has invariably brought about fundamental changes in the way in which libraries gather. preserve and disseminate information. The study was carried out with an aim to estimate and compare the information seeking behaviour (ISB) of the academics of two prominent universities of Kerala in the context of advancements achieved through ICT. The study was motivated by the fast changing scenario of libraries with the proliferation of many high tech products and services. The main purpose of the study was to identify the chief source of information of the academics, and also to examine academics preference upon the form and format of information source. The study also tries to estimate the adequacy of the resources and services currently provided by the libraries.The questionnaire was the central instrument for data collection. An almost census method was adopted for data collection engaging various methods and tools for eliciting data.The total population of the study was 957, out of which questionnaire was distributed to 859 academics. 646 academics responded to the survey, of which 564 of them were sound responses. Data was coded and analysed using Statistical Package for Social Sciences (SPSS) software and also with the help of Microsofl Excel package. Various statistical techniques were engaged to analyse data. A paradigm shift is evident by the fact that academies push themselves towards information in internet i.e. they prefer electronic source to traditional source and the very shift is coupled itself with e-seeking of information. The study reveals that ISB of the academics is influenced priman'ly by personal factors and comparative analysis shows that the ISB ofthc academics is similar in both universities. The productivity of the academics was tested to dig up any relation with respect to their ISB, and it is found that productivity of the academics is extensively related with their ISB. Study also reveals that the users ofthe library are satisfied with the services provided but not with the sources and in conjunction, study also recommends ways and means to improve the existing library system.

“Urban Water Supply Management: A Study Of Centralised And Community Based Systems In Calicut City

Studies in urban water supply system are few in the state of Kerala. It is a little researched area. In the case of water pricing a number of studies are available. In Kerala state, exception to Jacob John’s study on “Economics of Public Water Supply System”, which is a case study of Trivandrum Water Supply System in 1997, no exhaustive research work has so far come out in this field. loreover no indepth research study has come up, so far, relating to household ater demand analysis and the distribution system of urban piped water supply. he proposed study is first of its kind, which focuses on the distributional and Iailability problems of piped water supply in an urban centre in Kerala state. Hence there is a felt need for enquiring into the sufficiency of )table water supplied to people in urban areas and the efficiency maintained in roviding the scarce resource and preventing its misuse by the consumers. It is in llS backdrop that this study was undertaken and its empirical part was conducted |Calicut city in the state of Kerala. Study is confined to the water supply system ithe city of Calicut

Evaluación de la siniestralidad en pequeñas y medianas empresas en los sectores económicos de la regional centro de una aseguradora de riesgos laborales, Colombia, 2014.

Introducción: Las estadísticas de siniestralidad laboral son el negativo de las condiciones de trabajo de la economía de un país. Las indeseables condiciones de trabajo que predominan en la actualidad probablemente sean consecuencia de las crecientes contrataciones temporales lo cual conduce a que se incrementen los accidentes de trabajo, debido a la pobre inversión en el área de riesgos laborales. Objetivo: Evaluación de la siniestralidad en pequeñas y medianas empresas de los sectores económicos de la regional centro en una aseguradora de riesgos laborales, Colombia, 2014. Materiales y métodos: Estudio tipo observacional descriptivo, retrospectivo, realizado a 14.994 eventos calificados como accidentes de trabajo en una aseguradora de riesgos laborales dela regional centro durante Enero a Diciembre del años 2014. Resultados: La mayor incidencia de accidentalidad fue en el sector económico de establecimientos financieros, seguros, actividades inmobiliarias y servicios a las empresas, con un 36.9%. Se encontró que el riesgo que genero mayor accidentalidad fue caída a nivel con un 17.2%. El grupo diagnostico que predomino fue el de heridas superficiales y heridas abiertas con un 77.4%. El tipo de atención que genero mayores atenciones fue la atención ambulatoria con 93.1%. Conclusión: El sector económico que se vio mayormente afectado en accidentalidad laboral fue el de establecimientos financieros, seguros, actividades inmobiliarias y servicios a las empresas. Al asociar dicho sector económico con el tipo de riesgo se determinó que el riesgo por lesión en accidente deportivo fue de un 61%, predisponiendo este al desarrollo de accidentalidad laboral. Por lo anterior se deben hacerr estrategias de intervención de prevención y promoción en las pequeñas y medianas empresas y como consecuencia disminuir las tasas de siniestralidad e impactar de manera positiva en la salud de los trabajadores, en las tasas de ausentismo laboral y el costo asistencial.

Temperamental Dimension and Anxiety Problems in a Clinical Sample of Three- to Six-year old Children: A Study of Variables

In the last few years, many researchers have studied the presence of common dimensions of temperament in subjects with symptoms of anxiety. The aim of this study is to examine the association between temperamental dimensions (high negative affect and activity level) and anxiety problems in clinical preschool children. A total of 38 children, ages 3 to 6 years, from the Infant and Adolescent Mental Health Center of Girona and the Center of Diagnosis and Early Attention of Sabadell and Olot were evaluated by parents and psychologists. Their parents completed several screening scales and, subsequently, clinical child psychopathology professionals carried out diagnostic interviews with children from the sample who presented signs of anxiety. Findings showed that children with high levels of negative affect and low activity level have pronounced symptoms of anxiety. However, children with anxiety disorders do not present different temperament styles from their peers without these pathologies

Liability of country foreignness and liability of regional foreignness: their effects on geographic diversification and firm performance

The costs of inter- and intra-regional diversification have been widely discussed in the existing international business literature, but the findings are mixed. Explanations for the mixed findings have important managerial implications, because business managers have to estimate accurately the costs of doing business within and across regions before they make their internationalization decisions. To explain the existing mixed findings, this study differentiates between liabilities of foreignness at the country and regional levels, and explores the joint effects of liability of country foreignness (LCF) and liability of regional foreignness (LRF) on the performance of internationalizing firms. Using data from 167 Canadian firms, we find that LCF may not necessarily be negatively correlated with intra-regional diversification, but LRF is positively correlated with inter-regional diversification. LCF moderates the relationship between LRF and inter-regional diversification, and also mediates the relationship between intra-regional diversification and firm performance. LRF mediates the relationship between inter-regional diversification and firm performance. Missing one or more of these variables may result in different cost estimates. Identification of the relationships between these variables helps to improve the accuracy of estimating the costs of doing business aboard.

Retail multinationals and globalization: the evidence is regional

This paper reports an empirical study of the world’s 49 largest retail multinational enterprises (MNEs). Of these only one MNE is found to be a ‘global’ MNE, while five are ‘bi-regional’, i.e. with at least 20 per cent of sales in two parts of the ‘triad’ of the European Union, North America (NAFTA) and Asia. The remaining MNEs are either purely domestic or have sales in only their home-triad market. Thus, we conclude that the retail MNEs neither operate globally nor do they need global strategies. Instead, they are mainly regional MNEs and their focus is local, home-triad market-oriented.

Protocol for a feasibility study of a self help cognitive behavioural therapy resource for the reduction of dental anxiety in young people

Background Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety. Methods/design The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource. Discussion This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT.

Regional atmospheric circulation over Europe during the Last Glacial Maximum and its links to precipitation

The Last Glacial Maximum (LGM) exhibits different large-scale atmospheric conditions compared to present-day climate due to altered boundary conditions. The regional atmospheric circulation and associated precipitation patterns over Europe are characterized for the first time with a weather typing approach (circulation weather types, CWT) for LGM paleoclimate simulations. The CWT approach is applied to four representative regions across Europe. While the CWTs over Western Europe are prevailing westerly for both present-day and LGM conditions, considerable differences are identified elsewhere: Southern Europe experienced more frequent westerly and cyclonic CWTs under LGM conditions, while Central and Eastern Europe was predominantly affected by southerly and easterly flow patterns. Under LGM conditions, rainfall is enhanced over Western Europe but is reduced over most of Central and Eastern Europe. These differences are explained by changing CWT frequencies and evaporation patterns over the North Atlantic Ocean. The regional differences of the CWTs and precipitation patterns are linked to the North Atlantic storm track, which was stronger over Europe in all considered models during the LGM, explaining the overall increase of the cyclonic CWT. Enhanced evaporation over the North Atlantic leads to higher moisture availability over the ocean. Despite the overall cooling during the LGM, this explains the enhanced precipitation over southwestern Europe, particularly Iberia. This study links large-scale atmospheric dynamics to the regional circulation and associated precipitation patterns and provides an improved regional assessment of the European climate under LGM conditions.

Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

Pompidou & Pompeia: a parallel between the management strategies of two cultural institutions in the French and Brazilian contexts

A presente pesquisa foi conduzida na forma de um estudo de caso de duas instituições culturais no contexto francês e brasileiro. O Centro Pompidou é um projeto presidencial de museu financiado pelo Estado, com a missão de tornar a arte moderna em todas as suas expressões acessíveis ao público em geral. O Sesc Pompeia é um centro multidisciplinar de cultura e esporte - financiado pelo dinheiro dos impostos e administrado pela Federação do Comércio . O Sesc Pompéia é dedicado à oferta de educação informal através do cultivo da mente e do corpo. O estudo examina se as teorias de dependência de recursos e de poder podem ser utilizadas para conceituar a relação que o Centro Pompidou e do Sesc Pompéia tem com seus stakeholders financeiros. Mais especificamente, será discutido em que medida o grau de dependência influencia a estratégia de gestão das instituições. O objetivo é de responder a pergunta seguinte: quais são as estratégias que as instituições adotam para reduzir sua dependência com relação a seus principais stakeholders financeiros? Finalmente algumas implicações práticas de gestão serão elaboradas a partir do paralelo entre as estratégias das duas instituições.

Strong violet-blue light photoluminescence emission at room temperature in SrZrO3: Joint experimental and theoretical study

Ultrafine ordered and disordered SrZrO3 powders were prepared by the polymeric precursor method. The structural evolution from structural disorder to order was monitored by X-ray diffraction and X-ray absorption near-edge spectroscopy. Complex cluster vacancies [ZrO5 center dot V-O(Z)] and [SrOII center dot V-O(Z)] (where V-O(Z) = V-O(X), V-O(center dot) and V-O(center dot center dot)) were proposed for disordered powders. The intense violet-blue light photoluminescence emission measured at room temperature in the disordered powders was attributed to complex cluster vacancies. High-level quantum mechanical calculations within the density functional theory framework were used to interpret the experimental results. (C) 2008 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.