Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double-blind placebo-controlled trial.

OBJECTIVE: To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. SETTING: Twenty-nine centres in Switzerland and Argentina. POPULATION: A total of 385 women with preterm labour (24(0/7) to 33(6/7)  weeks of gestation) treated with acute tocolysis. METHODS: Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis. MAIN OUTCOME MEASURES: Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis. RESULTS: Preterm birth occurred in 42.5% of women in the progesterone group versus 35.5% in the placebo group (relative risk [RR] 1.2; 95% confidence interval [95% CI] 0.93-1.5). Delivery at <32 and <34 weeks did not differ between the two groups (12.9 versus 9.7%; [RR 1.3; 95% CI 0.7-2.5] and 19.7 versus 12.9% [RR 1.5; 95% CI 0.9-2.4], respectively). The duration of tocolysis, hospitalisation, and recurrence of preterm labour were comparable between groups. Neonatal morbidity occurred in 44 (22.8%) cases on progesterone versus 35 (18.8%) cases on placebo (RR: 1.2; 95% CI 0.82-1.8), whereas there were 4 (2%) neonatal deaths in each study group. CONCLUSION: There is no evidence that the daily administration of 200 mg vaginal progesterone decreases preterm birth or improves neonatal outcome in women with preterm labour.

Insects associated with the composting process of solid urban waste separated at the source

Sarcosaprophagous macroinvertebrates (earthworms, termites and a number of Diptera larvae) enhance changes in the physical and chemical properties of organic matter during degradation and stabilization processes in composting, causing a decrease in the molecular weights of compounds. This activity makes these organisms excellent recyclers of organic matter. This article evaluates the succession of insects associated with the decomposition of solid urban waste separated at the source. The study was carried out in the city of Medellin, Colombia. A total of 11,732 individuals were determined, belonging to the classes Insecta and Arachnida. Species of three orders of Insecta were identified, Diptera, Coleoptera and Hymenoptera. Diptera corresponding to 98.5% of the total, was the most abundant and diverse group, with 16 families (Calliphoridae, Drosophilidae, Psychodidae, Fanniidae, Muscidae, Milichiidae, Ulidiidae, Scatopsidae, Sepsidae, Sphaeroceridae, Heleomyzidae, Stratiomyidae, Syrphidae, Phoridae, Tephritidae and Curtonotidae) followed by Coleoptera with five families (Carabidae, Staphylinidae, Ptiliidae, Hydrophilidae and Phalacaridae). Three stages were observed during the composting process, allowing species associated with each stage to be identified. Other species were also present throughout the whole process. In terms of number of species, Diptera was the most important group observed, particularly Ornidia obesa, considered a highly invasive species, and Hermetia illuscens, both reported as beneficial for decomposition of organic matter.

Organisational innovations and health care decentralisation: A perspective from Spain

Recent policy developments in public health care systems lead to a greater diversity in health care. Decentralisation, either geographically or at an institutional level, is the key force, because it encourages innovation and local initiatives in health care provision. The devolution of responsibilities allows for a sort of de-construction of the status quo by changing both organizational forms and service provision. The new organizations enjoy greater freedom in the way they pay their staff, and are judged according to their results. These organizations may retain financial surpluses, develop spin-off companies and commission a range of specialised services (such as Diagnostic and Treatment Centres in UK) from providers outside the institutional setting in order to have more access to capital markets. However this diversity may generate a feeling of lack of commitment to a national health service and ultimately a loss of social cohesion. By fiscal decentralisation to regional authorities or planned delegation of financial agreements to the providers, financial incentives are more explicit and may seem to place profit-making above a commitment to better health care. An evaluation of the myths and realities of the decentralization process is needed. Here, I offer an assessment pros and cons of the decentralization process of health care in Spain, drawing on the experience of regional reforms from the pioneering organisational innovations implemented in Catalonia in 1981, up to the observed dispersion of health care spending per capita among regions at present.

A process approach to the utility for gambling

This paper argues that any specific utility or disutility for gamblingmust be excluded from expected utility because such a theory is consequentialwhile a pleasure or displeasure for gambling is a matter of process, notof consequences. A (dis)utility for gambling is modeled as a process utilitywhich monotonically combines with expected utility restricted to consequences.This allows for a process (dis)utility for gambling to be revealed. Asan illustration, the model shows how empirical observations in the Allaisparadox can reveal a process disutility of gambling. A more general modelof rational behavior combining processes and consequences is then proposedand discussed.

The impact of firing costs on turnover and unemployment: Evidence from the Colombian labour market reform

Reductions in firing costs are often advocated as a way of increasingthe dynamism of labour markets in both developed and less developed countries. Evidence from Europe and the U.S. on the impact of firing costs has, however, been mixed. Moreover, legislative changes both in Europe and the U.S. have been limited. This paper, instead, examines the impact of the Colombian Labour Market Reform of 1990, which substantially reduced dismissal costs. I estimate the incidence of a reduction in firing costs on worker turnover by exploiting the temporal change in the Colombian labour legislation as well as the variability in coverage between formal and informal sector workers. Using a grouping estimator to control for common aggregate shocks and selection, I find that the exit hazard rates into and out of unemployment increased after the reform by over 1% for formal workers (covered by the legislation) relative to informal workers (uncovered). The increase of the hazards implies a net decrease in unemployment of a third of a percentage point, which accounts for about one quarter of the fall in unemployment during the period of study.

Demand for pharmaceutical drugs: A choice modelling experiment

Despite the importance of supplier inducement and brand loyalty inthe drug purchasing process, little empirical evidence is to be foundwith regard to the influence that these factors exert on patients decisions. Under the new scenario of easier access to information,patients are becoming more demanding and even go as far asquestioning their physicians prescription. Furthermore, newregulation also encourages patients to adopt an active role in thedecision between brand-name and generic drugs. Using a statedpreference model based on a choice survey, I have found evidenceof how significant physicians prescription and pharmacists recommendation become throughout the drug purchase process and,to what extent, brand loyalty influences the final decision. Asfar as we are aware, this paper is the first to explicitlytake consumers preferences into account rather than focusingon the behavior of health professionals.

Employee referrals and the inter-industry wage structure

This paper investigates the role of employee referrals in the labor market.Using an original data set, I find that industries that pay wage premia andhave characteristics associated with high-wage sectors rely mainly on employeereferrals to fill jobs. Moreover, unemployment rates are higher in industries which use employee referrals more extensively. This paper develops an equilibrium matching model which can explain these empirical regularities. Inthis model, the matching process sorts heterogeneous firms and workers into two distinct groups: referrals match "good" jobs to "good" workers, while formalmethods (e.g., newspaper ads and employment agencies) match less-attractive jobs to disadvantaged workers. Thus, well-connected workers who learn quickly aboutjob opportunities use referrals to jump job queues, while those who are less well placed in the labor market search for jobs through formal methods. The split of firms and workers between referrals and formal search is, however, not necessarily efficient. Congestion externalities in referral search imply that unemployment would be closer to the optimal rate if firms and workers 'at themargin' searched formally.

Informal care and labour force participation among middle-aged women in Spain

Informal care is today the form of support most commonly used by those who need other peoplein order to carry out certain activities that are considered basic (eating, dressing, taking a shower,etc.), in Spain and in most other countries in the region. The possible labour opportunity costsincurred by these informal carers, the vast majority of whom are middle-aged women, have not asyet been properly quantified in Spain. It is, however, crucially important to know these quantities ata time when public authorities appear to be determined to extend the coverage offered up to nowas regards long-term care.In this context, we use the Spanish subsample of the European Community Household Panel (1994-2001) to estimate a dynamic ordered probit and so attempt to examine the effects of various typesof informal care on labour behaviour. The results obtained indicate the existence of labouropportunity costs for those women who live with the dependent person they care for, but not forthose who care for someone outside the household. Furthermore, whereas caregiving for morethan a year has negative effects on labour force participation, the same cannot be said of those who start caregiving and stop caregiving .

Patentes, regulación de precios e innovación en la industria farmacéutica

The trade-off between property rights/price regulation and innovation depends on countrycharacteristics and drug industry specificities. Access to drugs and innovation can bereconciled by seven ways that, among others, include: public health strengthening in thecountries with the largest access problems (those among the poor with the weakestinstitutions); public and private aid to make attractive R&D on neglected diseases; pricediscrimination with market segmentation; to require patent owners to choose eitherprotection in the rich countries or protection in the poor countries (but not both).Regarding price regulation, after a review of theoretical arguments and empirical evidence,seven strategies to reconcile health and industrial considerations are outlined, including:mitigation of the medical profession dependence on the pharmaceutical industry; considerationof a drug as an input of a production process; split drug authorization from public fundingdecisions; establish an efficiency minimum for all health production inputs; and stop theEuropean R&D hemorrhagia.

Regional diversity in the fruit sector in the European Union

This article aims to identify the key groups of regions with respectto farms oriented to fruit and citrus production.Twenty variables of fruit and citrus oriented farms corresponding toforty-one regions of the European Union were analyzed. Seven groupsemerged from cluster analysis. Only two of them showed good perspectives. Regions in the South of the Community need an important modernisation and restructuring process, which entails serious social consequences.

Adapting the Process Writing Approach to English Language Learners with Special Needs: Using Visuals

The available literature on the writing characteristics and best practices to teach writing to English Language Learners who also present some disability is scarce. In order to understand and provide some insight on the developments in this field, I propose an adaptation of the Process Writing Approach based on a literature review of the existing bibliography about the writing characteristics of English Language Learners, Special Needs Learners, and English Language Learners with Special Needs’ writing, the effects of the Process Writing Approach in teaching writing to these groups, and the use of visuals in writing instruction. The main assumptions of this study are: a) The Process Writing Approach provides an opportunity to differentiate instruction to ELLs with special needs and gives them additional opportunities to bring their funds of knowledge to the classroom, improving their writing, and b) By allowing students to rely on visuals in different phases of the writing process teachers will be addressing the needs of both visual and verbal learners, therefore allowing students more options to develop writing skills. The main pedagogical implication is that by dividing writing in recursive stages and inserting visuals as scaffolding throughout the entire writing process, teachers will provide an alternative approach to writing instruction that may be more effective to English Language Learners with Special Needs.

Use of NIR spectroscopy and multivariate process spectra calibration methodology for pharmaceutical solid samples analysis

Accomplish high quality of final products in pharmaceutical industry is a challenge that requires the control and supervision of all the manufacturing steps. This request created the necessity of developing fast and accurate analytical methods. Near infrared spectroscopy together with chemometrics, fulfill this growing demand. The high speed providing relevant information and the versatility of its application to different types of samples lead these combined techniques as one of the most appropriated. This study is focused on the development of a calibration model able to determine amounts of API from industrial granulates using NIR, chemometrics and process spectra methodology.