915 resultados para Health Sciences, Medicine and Surgery|Health Sciences, Public Health
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Includes bibliography
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Includes bibliography
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The main purpose of this paper is to explore and analyze the contributions that publicprivate partnerships and public policy have made in the development of tourism in the Caribbean as tools for enhancing competitiveness in the Caribbean tourism industry. The paper explores these contributions mainly in the context of the upgrading strategies that Caribbean countries have pursued over the past 15 years or so and using the lens of the tourism value chain and tourism cluster approach. The paper also analyzes the potential roles that public-private partnerships and public policy will continue to play in the future especially in the process of building linkages between the tourism sector and other sectors in order to increase net benefits from tourism to the Region. This paper is divided into five sections. In Section I, we define public-private partnerships (PPP) and describe the areas in tourism where PPP are most widely used, the tools used to implement PPP in tourism and the various forms of PPP. Economic arguments are then laid to motivate PPP as a determinant of tourism competitiveness using the tourism value-chain and tourism cluster approach. Specific case examples illustrating the contributions of PPP and public policy towards increasing tourism competitiveness are provided at a regional level and for specific areas in Sections II and III respectively. Section IV summarizes findings from the previous two sections and discusses ways to enhance the effectiveness of PPP and public policy in Caribbean tourism for increased competitiveness. Section V analyzes a few of the challenges that the Caribbean tourism sector is facing. The final section proposes new areas of intervention for PPP and public policy as tools for enhancing competitiveness in the Caribbean tourism sector in order to assist the region in addressing these challenges.
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The main purpose of this paper is to explore and analyze the contributions that publicprivate partnerships and public policy have made in the development of tourism in the Caribbean as tools for enhancing competitiveness in the Caribbean tourism industry. The paper explores these contributions mainly in the context of the upgrading strategies that Caribbean countries have pursued over the past 15 years or so and using the lens of the tourism value chain and tourism cluster approach. The paper also analyzes the potential roles that public-private partnerships and public policy will continue to play in the future especially in the process of building linkages between the tourism sector and other sectors in order to increase net benefits from tourism to the Region. This paper is divided into five sections. In Section I, we define public-private partnerships (PPP) and describe the areas in tourism where PPP are most widely used, the tools used to implement PPP in tourism and the various forms of PPP. Economic arguments are then laid to motivate PPP as a determinant of tourism competitiveness using the tourism value-chain and tourism cluster approach. Specific case examples illustrating the contributions of PPP and public policy towards increasing tourism competitiveness are provided at a regional level and for specific areas in Sections II and III respectively. Section IV summarizes findings from the previous two sections and discusses ways to enhance the effectiveness of PPP and public policy in Caribbean tourism for increased competitiveness. Section V analyzes a few of the challenges that the Caribbean tourism sector is facing. The final section proposes new areas of intervention for PPP and public policy as tools for enhancing competitiveness in the Caribbean tourism sector in order to assist the region in addressing these challenges.
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Latin America’s fiscal accounts deteriorated slightly during 2015, registering an average deficit of 3.0% of GDP and average gross public debt of 34.7% of GDP. Of the 19 countries considered, the fiscal deficit and public debt as a share of GDP both increased in 11. The region started to build up public debt, most of it domestic, after the 2008 international financial crisis to meet the growing financing needs resulting from the worsening growth situation.
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Background: Despite the focus on facial photoaging ratings, there are few classifications developed for forearm skin aging assessment.Objective: To develop and validate a clinical scale for the evaluation of forearm skin aging.Methods: Three clinical dermatology faculty members selected, discussed, and appraised the main signs of forearm photoaging. The validation of the resulting scale was performed by 5 assessors who were previously trained to classify 102 photographs of forearms with different degrees of aging. Retests were performed in 15 days.Results: There was significant correlation between the selected variables and the subjective global aging scale. The developed scale showed high internal consistency (Cronbach's alpha = 0.87) and high correlation with the global photoaging scale (rho = 0.92). Inter- and intraobserver final scores showed high agreement.Conclusion: A validated clinical photoaging scale for forearms with internal consistency, reliability, and validity was developed.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Objective: The objective of this study was to evaluate the effect of Er: YAG laser on the formation of CaF2, after the application of acidulated phosphate fluoride (APF), and its influence on the anti-cariogenic action in human dental enamel. Background Data: Er:YAG laser was designed to promote ablation of the enamel. However, the possibility of using this energy to increase the enamel's resistance to caries has hardly been explored, and neither has its interaction with the use of fluorides. Materials and Methods: One hundred and twenty blocks of enamel were allocated to four groups of 30 blocks each: (1) C, control group; (2) Er:YAG, laser; (3) APF; and (4) Er:YAG+APF. Of these, 80 blocks were submitted to pH cycling for 14 days. In the other 40 blocks, fluoride (CaF2) was measured before cycling. After pH cycling, surface microhardness (SMH), microhardness in cross-section (converted to mineral contents % vol. min.), and fluoride after cycling (40 blocks) were also determined. Results: SMH decreased in all groups. The control group showed the highest decrease, and Er:YAG+APF showed the lowest decrease (p < 0.05). Groups APF and Er:YAG showed the same results (p > 0.05). Mineral content at depths 10, 20, and 40 μm was lower in the control and Er:YAG groups, and higher in groups APF and Er:YAG+APF. CaF2 (μgF/cm2) deposited before pH cycling was higher in the APF group when compared to the Er:YAG+APF group. Control and Er:YAG groups showed the lowest values (p > 0.05). Conclusion: It was concluded that Er:YAG laser influenced the deposition of CaF2 on the enamel and showed a superficial anti-cariogenic action, but not in depth.
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Rationale: The excessive intake of vitamin A in the form of vitamin concentrate, supplement or vitamin-rich liver can result in hypervitaminosis A in man and animals. Although osteopathologies resulting from chronic vitamin A intoxication in cats are well characterized, no information is available concerning feline hypervitaminosis A-induced liver disease. Clinical summary: We report the first case of hepatic stellate cell lipidosis and hepatic fibrosis in a domestic cat that had been fed a diet based on raw beef liver. Radiographic examination revealed exostoses and ankylosis between vertebrae C1 and T7, compatible with deforming cervical spondylosis. Necropsy showed a slightly enlarged and light yellow to bronze liver. Microscopic and ultrastructural analyses of liver tissues revealed diffuse and severe liver fibrosis associated with hepatic stellate cell hyperplasia and hypertrophy. These cells showed immunopositive staining for α-smooth muscle actin and desmin markers. The necropsy findings of chronic liver disease coupled with osteopathology supported the diagnosis of hypervitaminosis A. Practical relevance: As in human hepatology, if there is dietary evidence to support increased intake of vitamin A, then hypervitaminosis A should be considered in the differential diagnosis of chronic liver disease in cats.
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The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.
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Investigating parents’ formal engagement opportunities in public schools serves well to characterize the relationship between states and societies. While the relationship between parental involvement and students’ academic success has been thoroughly investigated, rarely has it been seen to indicate countries’ governing regimes. The researcher was curious to see whether and how does parents’ voice differ in different democracies. The hypothesis was that in mature regimes, institutional opportunities for formal parental engagement are plenty and parents are actively involved; while in young democracies there are less opportunities and the engagement is lower. The assumption was also that parental deliberation in expressing their dissatisfaction with schools differs across democracies: where it is more intense, there it translates to higher engagement. Parents’ informedness on relevant regulations and agendas was assumed to be equally average, and their demographic background to have similar effects on engagement. The comparative, most different systems design was employed where public middle schools last graders’ parents in Tartu, Estonia and in Huntsville, Alabama the United States served as a sample. The multidimensional study includes the theoretical review, country and community analyses, institutional analysis in terms of formal parental involvement, and parents’ survey. The findings revealed sizeable differences between parents’ engagement levels in Huntsville and Tartu. The results indicate passivity in both communities, while in Tartu the engagement seems to be alarmingly low. Furthermore, Tartu parents have much less institutional opportunities to engage. In the United States, multilevel efforts to engage parents are visible from local to federal level, in Estonia similar intentions seem to be missing and meaningful parental organizations do not exist. In terms of civic education there is much room for development in both countries. The road will be longer for a young democracy Estonia in transforming its institutional systems from formally democratic to inherently inclusive.
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The primary objective was to determine the efficacy of a newly designed preoperative chemotherapy regimen in an attempt to improve the cure rate of children with high-risk hepatoblastoma.
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The conclusion of the Doha Round negotiations is likely to influence Swiss agricultural policy substantially. The same goes for a free trade agreement in agriculture and food with the European Communities. Even though neither of them will bring about duty-free and quota-free market access, or restrict domestic support measures to green box compatible support, both would represent a big step in that direction. There is no empirical evidence on the effect of such a counterfactual scenario for Swiss agriculture. We therefore use a normative mathematical programming model to illustrate possible effects for agricultural production and the corresponding agricultural income. Moreover, we discuss the results with respect to the provision of public goods under the assumption of continuing green box-compatible direct payments. The aim of our article is to bring more transparency into the discussion on the effects of freer and less distorted trade on the income generation by a multifunctional agriculture. The article will be organized as follows. In the first Section we specify the background of our study. In the second section, we focus on the problem statement and our research questions. In Section 3, we describe in detail a counterfactual scenario of “duty-free, quota-free and price support-free” agriculture from an economic as well as a legal perspective. Our methodology and the results are presented in Section 4 and 5 respectively. In Section 6, we discuss our results with respect to economic and legal aspects of multifunctional agriculture.