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.

Meeting the Standards: An Analysis of Eight Grade Educational Assesment Test Scores in Maine

This paper examines the impact of socioeconomic factors on eighth grade achievement test scores in the face of federal and state initiatives for educational reform in Maine. We use student-level data over a five year period to provide a framework for understanding the policy implications of these initiatives. We model performance on standardized tests using a seemingly unrelated regressions approach and then determine the likelihood of meeting the standards defined by the adequate yearly progress requirements of the No Child Left Behind Act and Maine Learning Results initiatives. Our results indicate that the key factors influencing a student’s test scores include the education of a student’s parents, special services received for learning disabilities, and alternative measures of academic achievement.

The Adequacy of Health Care Services for the Elderly in China

This study examines the adequacy of health care services for the elderly in China, specifically focusing on the influence of location, method of payment, living situation, and financial status. The study finds that rural residents, respondents living alone and respondents unable to meet all of their daily costs have a lower probability of reporting the availability of adequate health care. It also investigates the reasons why elderly respondents do not visit the hospital when it is necessary, concluding that financial and distance constraints are main deterrents. Finally, changes in the reported adequacy of health care over time are taken into consideration, and are found to follow a likely pattern given the history of the health care system in China. This is an important investigation given the historical background of health care in China, the current cost problems facing residents, and, consequently, the policy changes that will need to be implemented by the Chinese government in the near future.

Commitment of the Mentally Ill in Maine: a History of Public Policy

This paper traces the historical development in the State of Maine of the procedures by which persons found to be mentally unsound can be committed to institutional care against their will. Beginning in 1820 and continuing to the present, specific changes in the statutes governing this area are noted. Both the criminal and civil commitment procedures are dealt with. Following the historical trace, pending legislation relating to the criminal commitment process is examined in detail. Finally, consideration is given to the need for a complete reexamination of the practice of involuntary commitment involving ethical and constitutional issues.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Analysis Of Semi-Distributed And Global Hydrological Models In The Central Tropical Basins Of The Gulf Of Mexico To The Effects Of Extreme Hydrometeorological Phenomena

In the last years extreme hydrometeorological phenomena have increased in number and intensity affecting the inhabitants of various regions, an example of these effects are the central basins of the Gulf of Mexico (CBGM) that they have been affected by 55.2% with floods and especially the state of Veracruz (1999-2013), leaving economic, social and environmental losses. Mexico currently lacks sufficient hydrological studies for the measurement of volumes in rivers, since is convenient to create a hydrological model (HM) suited to the quality and quantity of the geographic and climatic information that is reliable and affordable. Therefore this research compares the semi-distributed hydrological model (SHM) and the global hydrological model (GHM), with respect to the volumes of runoff and achieve to predict flood areas, furthermore, were analyzed extreme hydrometeorological phenomena in the CBGM, by modeling the Hydrologic Modeling System (HEC-HMS) which is a SHM and the Modèle Hydrologique Simplifié à I'Extrême (MOHYSE) which is a GHM, to evaluate the results and compare which model is suitable for tropical conditions to propose public policies for integrated basins management and flood prevention. Thus it was determined the temporal and spatial framework of the analyzed basins according to hurricanes and floods. It were developed the SHM and GHM models, which were calibrated, validated and compared the results to identify the sensitivity to the real model. It was concluded that both models conform to tropical conditions of the CBGM, having MOHYSE further approximation to the real model. Worth mentioning that in Mexico there is not enough information, besides there are no records of MOHYSE use in Mexico, so it can be a useful tool for determining runoff volumes. Finally, with the SHM and the GHM were generated climate change scenarios to develop risk studies creating a risk map for urban planning, agro-hydrological and territorial organization.

Comparative Analysis of Adolescent Pregnancy in Central America, Mexico and South Carolina

This paper addresses the issue of adolescent pregnancy in Mexico, Central America and South Carolina and implications for social work practice with immigrant communities. The paper is based on current literature and on cross-national, on-line survey of local and international pregnancy prevention programs. The paper analyzes and discusses various psychosocial causes of pregnancy in adolescents, including: limited opportunities for formal education, infrequent open discussions about sexual health, rising costs of adequate birth control, and difficulty in obtaining contraceptives in remote locations. This research paper analyzes current statistics on the effectiveness of existing projects and programs and compares and contrasts research about the validity and efficacy of these programs in both South Carolina and abroad. Finally, the paper addresses implications for social work practice with adolescents in immigrant communities.

An analysis of quit and dismissal determinants between 1988 and 1999 using the bivariate probit model

Excessive labor turnover may be considered, to a great extent, an undesirable feature of a given economy. This follows from considerations such as underinvestment in human capital by firms. Understanding the determinants and the evolution of turnover in a particular labor market is therefore of paramount importance, including policy considerations. The present paper proposes an econometric analysis of turnover in the Brazilian labor market, based on a partial observability bivariate probit model. This model considers the interdependence of decisions taken by workers and firms, helping to elucidate the causes that lead each of them to end an employment relationship. The Employment and Unemployment Survey (PED) conducted by the State System of Data Analysis (SEADE) and by the Inter-Union Department of Statistics and Socioeconomic Studies (DIEESE) provides data at the individual worker level, allowing for the estimation of the joint probabilities of decisions to quit or stay on the job on the worker’s side, and to maintain or fire the employee on the firm’s side, during a given time period. The estimated parameters relate these estimated probabilities to the characteristics of workers, job contracts, and to the potential macroeconomic determinants in different time periods. The results confirm the theoretical prediction that the probability of termination of an employment relationship tends to be smaller as the worker acquires specific skills. The results also show that the establishment of a formal employment relationship reduces the probability of a quit decision by the worker, and also the firm’s firing decision in non-industrial sectors. With regard to the evolution of quit probability over time, the results show that an increase in the unemployment rate inhibits quitting, although this tends to wane as the unemployment rate rises.

Public debt and the limits of fiscal policy to increase economic growth

Research that seeks to estimate the effects of fiscal policies on economic growth has ignored the role of public debt in this relationship. This study proposes a theoretical model of endogenous growth, which demonstrates that the level of the public debt-to-gross domestic product (GDP) ratio should negatively impact the effect of fiscal policy on growth. This occurs because government indebtedness extracts part of the savings of the young to pay interest on the debts of the older generation, who are no longer saving. Therefore, the payment of debt interest assumes an allocation exchange role between generations that is similar to a pay-as-you-go pension system, which results in changes in the savings rate of the economy. The major conclusions of the theoretical model were tested using an econometric model to provide evidence for the validity of this conclusion. Our empirical analysis controls for timeinvariant, country-specific heterogeneity in the growth rates. We also address endogeneity issues and allow for heterogeneity across countries in the model parameters and for cross-sectional dependence.

Brazil and Turkey, a comparative analysis of both countries' economic development and institutional design from the Great Depression to the early 21st century

Apos uma década de rápido crescimento econômico na primeira década do século 21, Brasil e Turquia foram considerados duas das economias emergentes mais dinâmicas e promissoras. No entanto, vários sinais de dificuldades econômicas e tensões políticas reapareceram recentemente e simultaneamente nos dois países. Acreditamos que esses sinais e a sua simultaneidade podem ser entendidos melhor com um olhar retrospectivo sobre a história econômica dos dois países, que revela ser surpreendentemente paralela. Numa primeira parte, empreendemos uma comparação abrangente da história econômica brasileira e turca para mostrar as numerosas similaridades entre os desafios de política econômica que os dois países enfrentaram, assim como entre as respostas que eles lhes deram desde a virada da Grande Depressão até a primeira década do século 21. Essas escolhas de política econômica comuns dão forma a uma trajetória de desenvolvimento notavelmente análoga, caracterizada primeiro pela adoção do modelo de industrialização por substituição das importações (ISI) no contexto da recessão mundial dos anos 1930; depois pela intensificação e crise final desse modelo nos anos 1980; e finalmente por duas décadas de estabilização e transição para um modelo econômico mais liberal. Numa segunda parte, o desenvolvimento das instituições econômicas e políticas, assim como da economia política subjacente nos dois países, são analisados comparativamente a fim de prover alguns elementos de explicação do paralelo observado na primeira parte. Sustentamos que o marco institucional estabelecido nos dois países durante esse período também têm varias características fundamentais em comum e contribui a explicar as escolhas de política econômica e as performances econômicas comparáveis, detalhadas na primeira parte. Este estudo aborda elementos do contexto histórico úteis para compreender a situação econômica e política atual nos dois países. Potencialmente também constitui uma tentativa de considerar as economias emergentes numa perspectiva histórica e comparativa mais ampla para entender melhor as suas fraquezas institucionais e adotar um olhar mais equilibrado sobre seu potencial econômico.

Applying negotiation skills in the design of public policies: analysis of the city of São Paulo’s invoice program

The author argues that by applying problem-solving negotiation skills in the design of public policies, public administrators benefit from more effective and wide-ranging outcomes in the realization of their goals. In order to demonstrate this idea, the author analyzes how negotiation skills – such as identifying key actors and their interests, recognizing hardbargaining tactics and changing the players, knowing your best alternative, creating value and building trust – permeated and contributed to the success of the City of São Paulo’s Invoice Program (“Programa Nota Fiscal Paulistana”), a public policy aimed at combating tax evasion of service tax in the City of São Paulo.

Food waste in lower-middle income households: a qualitative analysis of antecedents and a typology of food wasters

Esta dissertação doutoral, com base em dados empíricos coletados com 50 mães distribuídas no Brasil (n = 30) e nos EUA (n = 20), tem como objetivo fornecer uma melhor compreensão do desperdício de alimento no contexto da baixa renda. A tese é composta por três artigos, que combinados, cumprem os objetivos de identificar os antecedentes do desperdício de alimento e delinear uma tipologia dos desperdiçadores de alimento. Adicionalmente, contextualiza o desperdício global e um capítulo propõe uma agenda futura para estudos sobre desperdício de alimento no âmbito do consumidor. O desperdício de alimento nas famílias, enquanto tema de pesquisa, oferece a oportunidade para o trabalho acadêmico em marketing cumprir os critérios de relevância social, gerencial e para políticas públicas. No primeiro estudo, descrevem-se os fatores do chamado "paradoxo do desperdício de alimento", a identificação e análise do desperdício de alimento em famílias com restrições orçamentárias, enquanto apresentam-se o itinerário do consumo de alimentos e os antecedentes do desperdício. Este primeiro artigo, elaborado com dados coletados em famílias brasileiras, ilustra também o papel das normas culturais, tais como o preparo abundante de alimento para mostrar hospitalidade ou como forma de não ser percebido como pobre, no aumento do desperdício. No segundo artigo, uma grounded-theory (teoria fundamentada nos dados) destaca o papel do afeto e da abundância no desperdício de alimento familiar. Para enriquecer as contribuições teóricas, este segundo estudo apresenta um framework com seis dimensões do desperdício de alimento (1. Afeto; 2. Abundância; 3. Multiplicidade de escolhas; 4. Conveniência; 5. Procrastinação; 6. Rotina sem planejamento). Baseado em dados empíricos coletados em famílias americanas, este estudo proporciona novas explicações, a exemplo de como o estoque abundante de comfort foods - uma forma de impulsionar tanto emoções positivas para si quanto mostrar afeto para crianças – pode gerar mais desperdício de alimentos. Em síntese, o segundo artigo identifica uma consequência negativa do afeto e da abundância de alimentos no contexto familiar, e apresenta um framework teoricamente relevante. Finalmente, o terceiro artigo, a partir do conjunto de dados dos estudos anteriores e de nova coleta com dez famílias, propõe uma tipologia comportamental do desperdício de alimento, uma contribuição original aos estudos de comportamento do consumidor. A identificação de cinco tipos de desperdiçadores de alimentos - (1) Mães carinhosas; (2) Cozinheiras abundantes; (3) Desperdiçadoras de sobras; (4) Procrastinadoras; (5) Mães versáteis - contribui para a teoria, enquanto implicações potenciais para educadores nutricionais e agentes públicos são exploradas a partir dos resultados. Como uma forma de explicar as características de cada um dos cinco tipos identificados, compara-se aspectos das amostras brasileira e norte-americana, que apresentam similaridades no comportamento de desperdício de alimento. Os níveis de desperdício percebidos por país também são comparados. Em suma, os achados dos três artigos podem contribuir para maximizar os resultados de campanhas de conscientização voltadas à mitigação do desperdício de alimento, e apresentam ideias para varejistas interessados em iniciativas de sustentabilidade. Mais abrangentemente, os resultados apresentados também podem ser aplicados para incrementar programas de combate à fome e projetos de educação nutricional realizados pelo setor público ou ONGs.

Analysis of the different forms of application and types of cutting fluid used in plunge cylindrical grinding using conventional and superabrasive CBN grinding wheels

The work reported here involved an investigation into the grinding process, one of the last finishing processes carried out on a production line. Although several input parameters are involved in this process, attention today focuses strongly on the form and amount of cutting fluid employed, since these substances may be seriously pernicious to human health and to the environment, and involve high purchasing and maintenance costs when utilized and stored incorrectly. The type and amount of cutting fluid used directly affect some of the main output variables of the grinding process which are analyzed here, such as tangential cutting force, specific grinding energy, acoustic emission, diametrical wear, roughness, residual stress and scanning electron microscopy. To analyze the influence of these variables, an optimised fluid application methodology was developed (involving rounded 5, 4 and 3 turn diameter nozzles and high fluid application pressures) to reduce the amount of fluid used in the grinding process and improve its performance in comparison with the conventional fluid application method (of diffuser nozzles and lower fluid application pressure). To this end, two types of cutting fluid (a 5% synthetic emulsion and neat oil) and two abrasive tools (an aluminium oxide and a superabrasive CBN grinding wheel) were used. The results revealed that, in every situation, the optimised application of cutting fluid significantly improved the efficiency of the process, particularly the combined use of neat oil and CBN grinding wheel. (c) 2005 Elsevier Ltd. All rights reserved.

Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

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

Knowledge and attitudes of health care workers from intensive care units regarding nosocomial transmission of influenza: a study on the immediate pre-pandemic period

The transmission of influenza in health care settings is a major threat to patients, especially those with severe diseases. The attitude of health care workers (HCWs) may influence the transmission of countless infections. The current study aimed to quantify knowledge and identify attitudes of HCWs involved in intensive care units (ICUs) regarding the risk of nosocomial influenza transmission. A questionnaire was applied through interviews to HCWs who worked in one of the five ICUs from a teaching hospital. Questions about influenza were deliberately dispersed among others that assessed several infectious agents. Forty-two HCWs were interviewed: nine physicians, ten nurses and 23 nursing technicians or auxiliaries. Among the 42 HCWs, 98% were aware of the potential transmission of influenza virus in the ICUs, but only 31% would indicate droplet precautions for patients with suspected infection. Moreover, only 31% of them had been vaccinated against influenza in the last campaign (2008). Nursing technicians or auxiliaries were more likely to have been vaccinated, both by univariate and multivariable analysis. When asked about absenteeism, only 10% of the study subjects stated that they would not go to work if they had an influenza-like illness. Those findings suggest that, in non-pandemic periods, influenza control in hospitals requires strategies that combine continuous education with changes in organizational culture.