Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

Negotiating collective and individual agency : a qualitative study of young women's reproductive health in rural India

The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.

Towards Presidential Rule in Ukraine : Hybrid Regime Dynamics under Semi-Presidentialism

This article sets out to analyse recent regime developments in Ukraine in relation to semi-presidentialism. The article asks: to what extent and in what ways theoretical arguments against semi-presidentialism (premier-presidential and president-parliamentary systems) are relevant for understanding the changing directions of the Ukrainian regime since the 1990s? The article also reviews the by now overwhelming evidence suggesting that President Yanukovych is turning Ukraine into a more authoritarian hybrid regime and raises the question to what extent the president-parliamentary system might serve this end. The article argues that both kinds of semi-presidentialism have, in different ways, exacerbated rather than mitigated institutional conflict and political stalemate. The return to the president-parliamentary system in 2010 – the constitutional arrangement with the most dismal record of democratisation – was a step in the wrong direction. The premier-presidential regime was by no means ideal, but it had at least two advantages. It weakened the presidential dominance and it explicitly anchored the survival of the government in parliament. The return to the 1996 constitution ties in well with the notion that President Viktor Yanukovych has embarked on an outright authoritarian path.

Wind farm construction impacts reindeer migration and movement corridors

Over the last decade, we have seen a massive increase in the construction of wind farms in northern Fennoscandia. Wind farms comprising hundreds of wind turbines are being built, with little knowledge of the possible cumulative adverse effects on the habitat use and migration of semi-domesticated free-ranging reindeer. We assessed how reindeer responded to wind farm construction in an already fragmented landscape, with specific reference to the effects on use of movement corridors and reindeer habitat selection. We used GPS-data from reindeer during calving and post-calving in the MalAyen reindeer herding community in Sweden. We analysed data from the pre-development years compared to the construction years of two relatively small wind farms. During construction of the wind farms, use of original migration routes and movement corridors within 2 km of development declined by 76 %. This decline in use corresponded to an increase in activity of the reindeer measured by increased step lengths within 0-5 km. The step length was highest nearest the development and declining with distance, as animals moved towards migration corridors and turned around or were observed in holding patterns while not crossing. During construction, reindeer avoided the wind farms at both regional and landscape scale of selection. The combined construction activities associated with even a few wind turbines combined with power lines and roads in or close to central movement corridors caused a reduction in the use of such corridors and grazing habitat and increased the fragmentation of the reindeer calving ranges.

Implementação de estratégias de internacionalização de empresas: um processo de aprendizagem organizacional

Este trabalho investigou a implementação de Estratégias de Internacionalização de Empresas instaladas na Região de Curitiba com o objetivo de descobrir como diferentes empresas aumentam seu envolvimento fora de sua base. Para responder a esta questão, considerou-se a literatura sobre Estratégia Empresarial, Processos de Internacionalização de Empresas e Aprendizagem Organizacional, de fonna a construir hipótese orientadora para a pesquisa. Investigou-se a existência de Processos de Aprendizagem Organizacional sustentando o Processo de Internacionalização das Empresas. A pesquisa de campo utilizou o método qualitativo, observacional, tendo a entrevista como ferramenta, identificando as trajetórias de internacionalização das empresas. Em cada uma destas, buscou projetos cujas taxas de crescimento do seu comprometimento com o ambiente externo fossem altas. Explorou as soluções adotadas para as dificuldades geradas pelas incertezas encontradas na implementação desses projetos, com o objetivo de verificar a presença de Processos de Aprendizagem Organizacional. Como resultado da investigação em sete empresas diferentes, com estratégias diferentes, em diferentes estágios de internacionalização, com projetos de naturezas diversas, este estudo concluiu pela existência de um fenômeno comum: em cem por cento das empresas pesquisadas, as altas taxas de crescimento de seu envolvimento fora de suas bases, foram sustentados por uma acentuada dinâmica de Aprendizagem Organizacional. Esta constatação resgata os conceitos da Universidade de Uppsala e introduz a abordagem sistêmica da Aprendizagem Organizacional no estudo do Processo de Internacionalização de Empresas, proporcionando explicação para as Born Global e para a internacionalização através dos network.

Internacionalização da empresa Marcopolo S.A. : um estudo de caso

A experiência internacional de empresas de países em desenvolvimento é relativamente nova, assim como os estudos sobre o desenvolvimento dessas atividades por esses países e, em particular, pelo Brasil. Esta pesquisa visou contribuir para o conhecimento sobre como as empresas brasileiras se internacionalizam e, para tanto, foi realizado um estudo de caso em profundidade com a Marcopolo S. A., uma organização em estágio avançado de operações internacionais. Apoiando-se em vertentes comportamentais e econômicas da literatura sobre o tema, buscou-se investigar o processo de internacionalização dessa empresa – suas motivações, como ela expandiu seus negócios no exterior, quais foram os principais obstáculos enfrentados e fatores facilitadores do processo. Também se estudou a relação entre internacionalização e resultados financeiros obtidos e a influência de políticas públicas. Atuar em mercados externos foi uma forma de ampliação de mercados e de diversificação de riscos para a empresa e hoje é o foco de sua estratégia de crescimento. O processo se desenvolveu de forma incremental, evoluindo de operações de menor comprometimento e em países mais próximos do Brasil, até a instalação de unidades em mercados mais distantes. Obstáculos de natureza econômica e cultural influenciaram suas atividades e o domínio tecnológico de produtos e de processos, assim como parcerias com montadoras, foram facilitadores do seu desenvolvimento internacional. Os resultados da pesquisa confirmaram os pressupostos da abordagem comportamental, reforçando a hipótese gradualista sustentada pela Teoria de Uppsala. O Paradigma Eclético também explicou os investimentos diretos realizados pela empresa, o que levou à constatação de que as duas linhas teóricas se complementam para explicar o caso. As operações da companhia em mercados externos foram historicamente mais rentáveis do que no mercado doméstico e esses resultados tornaram-se mais expressivos com a instalação de unidades no exterior. Por fim, constatou-se que algumas medidas de apoio governamental geraram efeitos positivos para as exportações, mas que não houve influência de políticas públicas para instalação de fábricas em territórios estrangeiros.

Entry mode choice and market selection of born globals in developing countries: a multiple-case study of the ecuadorian software sector

O fenômeno "Born global" refere-se a empresas que consideram o mercado global como seu contexto natural e que iniciam seu processo de internacionalização muito cedo após sua criação. As teorias tradicionais como o modelo de Uppsala não conseguem explicar este processo. Portanto, outras teorias têm surgido, como a perspectiva de redes. Existem alguns estudos relacionados a esta área, principalmente realizados em países desenvolvidos com pequenos mercados e economias abertas. No entanto, poucos estudos têm sido feitos em economias em desenvolvimento. Além disso, o número de pesquisas quanto à escolha do modo de entrada e seleção de mercados das empresas “born global” é bastante limitado. Consequentemente, este estudo pretende descrever os principais fatores que influenciam a escolha do modo de entrada e seleção de mercados das empresas, de economias em desenvolvimento, nascidas globais. O foco da pesquisa é a indústria de software e um estudo de casos múltiplo foi realizado com três empresas no Equador. A metodologia incluiu entrevistas com fundadores, bem como a coleta de dados secundários. Com base na evidência empírica, verificou-se que os principais fatores que influenciam a escolha do modo de entrada são as restrições financeiras, as receitas esperadas, a velocidade de internacionalização, mercados nicho e a experiência empresarial anterior dos fundadores. Por outro lado, a seleção de mercado é influenciada por semelhanças de língua e cultura, mercados nicho e relações em rede.

Análise do estado da arte das teorias da internacionalização: uma revisita às teorias aplicadas aos fatores relacionados ao modo de entrada e à localização de empresas que buscam a atuação em mercados estrangeiros

Estudos sobre a internacionalização de empresas avançam em todos os setores com o objetivo de identificar oportunidades de crescimento e aprendizado para os negócios que possuam características globais. O objetivo desse trabalho está na revisitação das teorias de internacionalização para o entendimento da importância dos aspectos de localização e do modo de entrada no movimento pela busca de mercados estrangeiros de forma a assegurar a permanência nos países que apresentam características diferentes da localidade de origem; consiste também na verificação da necessidade de mitigação de problemas referentes aos custos, da definição do modo de entrada e da decisão sobre o portfólio de produtos que farão parte da nova unidade de negócios. A internacionalização de empresas é um processo de entrada em novos mercados fora da região onde surgiram e implica em estudos que não estão somente relacionados à operação comercial, mas que demandam análises mais abrangentes como o aspecto da distância física. Um estudo de caso, que complementa essa pesquisa, apresenta os fatores de localização e a escolha do modo de entrada considerados para a internacionalização da Klabin na Argentina e seus aspectos decisórios com base na estratégia da empresa brasileira na prospecção de oportunidades ao redor do mundo. Características mercadológicas identificadas no cenário econômico da Argentina também foram considerados para a entrada no país. A pesquisa contempla a teoria de Uppsala, OLI, empreendedorismo internacional e autores como Porter, Dunning, Rugman e Ghemawat que suportam e confrontam as decisões sobre a internacionalização da Klabin. Foram realizadas entrevistas com os principais executivos da empresa responsáveis pela definição do modo de entrada no país e pela gestão na Argentina encerrando-se, essa pesquisa, com a apresentação dos resultados sobre as teorias existentes para a implementação da estratégia de internacionalização.

Estratégias internacionais da fruticultura do RN: o caso finobrasa processo e evolução

The present inquiry has as main objective to understand the process of formation of the international strategies of the exporting companies of fruits of the RN through the theory of the resource dependence. Aiming at to clarify as the companies they can carry through the process of internationalization through this theory had been study the behavior and economic theories of the process of internationalization of companies. Amongst the economic theories they are distinguished the eclectic paradigm of Dunning (1958), Vernon (1669) through the theory of the cycle of the product and Bucley and Casson (1979) with the theory of the international operations. In the mannering boarding they had been investigated the school of Upsala through Johanson and Valnhe (1977) with the concept of the increasing of the markets and in the distance psychic starts and the interaction of the purchaser-salesman of Hallen and Wiedersheim-Paul (1979). In this perspective it observes main the occured changes in the organization in function of this process, following the rules observed by the gradual ingression in the international market, having as base ways of entrances in the external market used by these companies, in view of the frist phase that the company presents of businesses. Ahead of you analyze of these theories the study searches to analyze the convergence of the concepts proclaimed for the theory of the dependence of resources (PFEFFER; SALANCIK, 1978). and strategies of internationalization of the companies. The research is characterized as qualitative case study which adopts and exploratory and analytical type, retrospective matrix. The adopted strategy is of case study and the unit of analysis consisting of the Finobrasa, pertaining company to the Vicunha Group. The main method of collection of data was halfstructuralized interview allied the documentary research that together had presented an empirical perspective of the internationalization process. The analysis and quarrel of the results understand the description and the interpretation of the one of the information through the technique of analyzes of content. Initially the historical of the exportation of fruits of the Rio Grande do Norte with the focus in the region Açu/Mossoró is presented and after that the information of the Finobrasa are presented as base of the study. The main events are identified that had constituted the phases of the strategical model of the company. It was observed that the dimensions most excellent amongst those proclaimed by the School of Uppsala had been the learning, staffs and the step-starts is sufficiently gifts in the reality of the company, as well as the aspects of strategical alliances since the consolidated relationship of the Vicunha Group create a more solid trajectory in the international market allied the conditions created windows of marked . One understands, therefore, that the investigated process still has base the theoretical theories of the internationalization strategies corroborating for the theoretical convergence of the rules proclaimed for the theory of the dependence of resources.

TOWARDS THE JOINT USE OF ICD AND ICF: A CALL FOR CONTRIBUTION

Background: To optimize patient functioning, rehabilitation professionals often rely on measurements of functioning as well as on classifications. Although the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) are used, their joint use has yet to become an established practice. To encourage their joint use in daily practice, the World Health Organization (WHO) has invited all rehabilitation practitioners worldwide to support the ICD-11 revision process by identifying the ICF categories that correspond to specific rehabilitation-relevant health conditions. The first step in completing this task, generating the list of these health conditions, was taken at a February 2012 workshop in Sao Paulo, Brazil. Objectives: The objectives of this paper are to present the results of the Sao Paulo workshop, and to invite practitioners to participate in the ICD-ICF joint use initiative. Discussion: Alternating plenary and small working group sessions were held and 103 rehabilitation-relevant health conditions were identified. With this list available, WHO together with the International Society of Physical and Rehabilitation Medicine (ISPRM), is reaching out to clinicians of all rehabilitation disciplines to take on the challenge of identifying the ICF categories for at least one of the health conditions listed.

Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse

Borges JB, Suarez-Sipmann F, Bohm SH, Tusman G, Melo A, Maripuu E, Sandstrom M, Park M, Costa EL, Hedenstierna G, Amato M. Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse. J Appl Physiol 112: 225-236, 2012. First published September 29, 2011; doi: 10.1152/japplphysiol.01090.2010.-The assessment of the regional match between alveolar ventilation and perfusion in critically ill patients requires simultaneous measurements of both parameters. Ideally, assessment of lung perfusion should be performed in real-time with an imaging technology that provides, through fast acquisition of sequential images, information about the regional dynamics or regional kinetics of an appropriate tracer. We present a novel electrical impedance tomography (EIT)-based method that quantitatively estimates regional lung perfusion based on first-pass kinetics of a bolus of hypertonic saline contrast. Pulmonary blood flow was measured in six piglets during control and unilateral or bilateral lung collapse conditions. The first-pass kinetics method showed good agreement with the estimates obtained by single-photon-emission computerized tomography (SPECT). The mean difference (SPECT minus EIT) between fractional blood flow to lung areas suffering atelectasis was -0.6%, with a SD of 2.9%. This method outperformed the estimates of lung perfusion based on impedance pulsatility. In conclusion, we describe a novel method based on EIT for estimating regional lung perfusion at the bedside. In both healthy and injured lung conditions, the distribution of pulmonary blood flow as assessed by EIT agreed well with the one obtained by SPECT. The method proposed in this study has the potential to contribute to a better understanding of the behavior of regional perfusion under different lung and therapeutic conditions.

A novel microdeletion syndrome at 3q13.31 characterised by developmental delay, postnatal overgrowth, hypoplastic male genitals, and characteristic facial features

Background Congenital deletions affecting 3q11q23 have rarely been reported and only five cases have been molecularly characterised. Genotype. phenotype correlation has been hampered by the variable sizes and breakpoints of the deletions. In this study, 14 novel patients with deletions in 3q11q23 were investigated and compared with 13 previously reported patients. Methods Clinical data were collected from 14 novel patients that had been investigated by high resolution microarray techniques. Molecular investigation and updated clinical information of one cytogenetically previously reported patient were also included. Results The molecular investigation identified deletions in the region 3q12.3q21.3 with different boundaries and variable sizes. The smallest studied deletion was 580 kb, located in 3q13.31. Genotype. phenotype comparison in 24 patients sharing this shortest region of overlapping deletion revealed several common major characteristics including significant developmental delay, muscular hypotonia, a high arched palate, and recognisable facial features including a short philtrum and protruding lips. Abnormal genitalia were found in the majority of males, several having micropenis. Finally, a postnatal growth pattern above the mean was apparent. The 580 kb deleted region includes five RefSeq genes and two of them are strong candidate genes for the developmental delay: DRD3 and ZBTB20. Conclusion A newly recognised 3q13.31 microdeletion syndrome is delineated which is of diagnostic and prognostic value. Furthermore, two genes are suggested to be responsible for the main phenotype.

CHO cell adhesion on modified surfaces of different materials.

Epithelial cells are mainly responsible for the formation of tissues that cover the external and internal surfaces of organs like skin, lining of the lungs and intestines. The cells must adhere to substrates and to each other in compliance with certain stimulus. In this way, adhesion properties can be regulated by the cell which simultaneously senses the chemical and mechanical properties of its environment. Their adhesion and growth on biomaterials depends on substrate properties such as surface wettability, topography and chemistry. The aim of this study is to investigate cell-surface interactions using several materials and different surfaces.