Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer

In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.

For better or for worse, till the human development index do us part?

This paper describes the results of research intended to explore the volatility inherent in the United Nations Development Programme's (UNDP) Human Development Index (HDI). The HDI is intended to be a simple and transparent device for comparing progress in human development, and is an aggregate of life expectancy, education and GDP per capita. Values of the HDI for each country are presented in the Human Development Reports (HDRs), the first being published in 1990. However, while the methodology is consistent for all countries in each year there are notable differences between years that make temporal comparisons of progress difficult. The paper presents the results of recalculating the HDI for a simplified sample of 114 countries using various methodologies employed by the UNDP. The results are a set of deviations of recalculated HDI ranks compared to the original ranks given in the HDRs. The volatility that can result from such recalculation is shown to be substantial (+/-10-15 ranks), yet reports in the popular press are frequently sensitive to movements of only a few ranks. Such movement can easily be accounted for by changes in the HDI methodology rather than genuine progress in human development. While the HDRs often carry warnings about the inadvisability of such year-on-year comparisons, it is argued that the existence of such a high-profile index and the overt presentation within league tables do encourage such comparison. Assuming that the HDI will be retained as a focal point within the HDRs, then it is suggested that greater focus be upon more meaningful and robust categories of human development (e.g. low, medium and high) rather than league tables where shifts of a few places, perhaps as a result of nothing more than a methodological or data artefact, may be highlighted in the press and by policy makers. (C) 2003 Elsevier Science B.V. All rights reserved.

Effect of restricted suckling of calves on the productivity of crossbred dairy cattle

An experiment on restricted suckling of crossbred dairy cows was conducted at the Livestock Research Centre, Tanga in north-east Tanzania. The objective of the experiment was to evaluate the comparative productivity of Bos taurus x Bos indicus cows of medium and high levels of Bos taurus inheritance, whose calves were either bucket-reared or suckled residual milk. Lactation milk yield, length and persistency were 1563 L, 289 days, and 1.0, respectively, for the bucket-reared and 1592 L, 289 days and 1.4, respectively, for the suckling group. Days to observed oestrus, first insemination and conception for cows whose calves were bucket-reared were 47, 74 and 115 days, respectively, and 57, 81 and 126 days, respectively, for the suckling cows. The calf weights were similar at 1 year of age. The productivity of the cows, measured as the annual milk offtake, was not significantly higher for those that suckled their calves than for those whose calves were bucket-reared.

In vitro fermentation of chitosan derivatives by mixed cultures of human faecal bacteria

Stirred, pH controlled batch cultures were carried out with faecal inocula and various chitosans to investigate the fermentation of chitosan derivatives by the human gut flora. Changes in bacterial levels and short chain fatty acids were measured over time. Low, medium and high molecular weight chitosan caused a decrease in bacteroides, bifidobacteria, clostridia and lactobacilli. A similar pattern was seen with chitosan oligosaccharide (COS). Butyrate levels also decreased. A three-stage fermentation model of the human colon was used for investigation of the metabolism of COS. In a region representing the proximal colon, clostridia decreased while lactobacilli increased. In the region representing the transverse colon, bacteroides and clostridia increased. Distally a small increase in bacteroides occurred. Butyrate levels increased. Under the highly competitive conditions of the human colon, many members of the microflora, are unable to compete for chitosans of low, medium or high molecular weight. COS were more easily utilised and when added to an in vitro colonic model led to increased production of butyrate, but some populations of potentially detrimental bacteria also increased. (c) 2005 Elsevier Ltd. All rights reserved.

The genotypic variation of the antioxidant potential of different tomato varieties

There is increasing interest in the ability of diets rich in polyphenols to modulate age-related diseases and promote healthy ageing. We have conducted a pilot experiment with eight tomato varieties to correlate the total antioxidant capacity of the tomato variants with the specific constituent flavonoids present. A strong correlation was observed with the flavonol rhamnoglucoside rutin but not with other flavonoids, such as naringenin chalcone, or hydroxycinnamates, such as chlorogenic, which are also present in the tomato. To test the rigor of this correlation a second study was undertaken with a further 37 tomato varieties selected for low, medium and high rutin levels. We show that the flavonol rutin contributes to the greatest extent to the antioxidant capacity of tomatoes and suggest that this flavonoid may be a useful target for up-regulation in tomatoes in order to improve their antioxidant status.

Determination of digesta flow entering the omasal canal of dairy cows using different marker systems

Four studies were conducted to compare the effect of four indigestible markers (LiCoEDTA, Yb-acetate, Cr-mordanted straw and indigestible neutral-detergent fibre (INDF)) and three marker systems on the flow of digesta entering the omasal canal of lactating dairy cows. Samples of digesta aspirated from the omasal canal were pooled and separated using filtration and high-speed centrifugation into three fractions defined as the liquid phase, small particulate and large particulate matter. Co was primarily associated with the liquid phase, Yb was concentrated in small particulate matter, whilst Cr and INDF were associated with large particles. Digesta flow was calculated based on single markers or using the reconstitution system based on combinations of two (Co + Yb, Co + Cr and Co + INDF) or three markers (Co + Yb + Cr and Co + Yb + INDF). Use of single markers resulted in large differences between estimates of organic matter (OM) flow entering the omasal canal suggesting that samples were not representative of true digesta. Digesta appeared to consist of at least three phases that tended to separate during sampling. OM was concentrated in particulate matter, whilst the liquid phase consisted mainly of volatile fatty acids and inorganic matter. Yb was intimately associated with nitrogenous compounds, whereas Cr and INDF were concentrated in fibrous material. Current data indicated that marker systems based on Yb in combination with Cr or INDF are required for the accurate determination of OM, N and neutral-detergent fibre flow. In cases where the flow of water-soluble nutrients entering the omasal canal is also required, the marker system should also include Co.

Biorefinery strategies for upgrading Distillers’ Dried Grains with Solubles (DDGS)

Distillers’ Dried Grains with Solubles (DDGS) is the major by-product of bioethanol and distillery plants. Due to its high content of proteins, water-soluble vitamins and minerals, DDGS has been long marketed as animal feed for livestock. EU legislation on liquid biofuels could raise the demand on bioethanol production in Europe, with a resulting increase in DDGS availability. DDGS contains a spectrum of complex organic macromolecules, particularly polysaccharides, in addition to proteins and vitamins, and its use as a starting raw material within a biomass-based biorefining strategy could lead to the development of multi-stream processes for the production of commodities, platform molecules or speciality chemicals, with concomitant economic benefits and waste reduction for bioethanol plants. The present review aims to outline the compositional characteristics of DDGS and evaluate its potential utilisation as a starting material for the production of added-value products. Parameters of influence on the chemical and physical characteristics of DDGS are discussed. Moreover, various pre-treatment strategies are outlined in terms of efficient DDGS fractionation into several added value streams. Additional processing steps for the production of medium and high added value compounds from DDGS are evaluated and their potential applications in the food and chemical industry sector are identified.

Competition of sicklepod, cassia obtusifolia l., densities on soybean, glycine max (l.) merr., at variable row distance

Competition studies with soybeans, Glycine max (L.) Merr. "Bragg." and sicklepod, Cassia obtusifolia L., were conducted at the Agricultural Research and Education Center of the University of Florida in Quincy, Florida. Two field experiments were established, one on May 22, 1975. and the other four weeks later, on June 19, 1975, to determine the competitive effects of various sicklepod densities and the influences of soybean row distances on weed dry matter, soybear plant characteristics, yield components and seed yield, and on soil nutrient content. Control, low, medium, and high sicklepod densities in the first experiment were O, 25,000, 53,000, and 77,000 p1ants/ha, respectively; while the second experiment presented control, low, medium, and high sicklepod densities of O, 36,000, 68,000, and 122,000 plants/ha, respectively. Three soybean row distance treatments were tested using a constant pattern of 90-, 60-, and 45-cm widths throughout the growing season. Three other treatments, evaluated in a variable patern, were initially seeded in 30-cm row widths. Five weeks after planting, an appropriate number of soybean rows were harvested from the 30"cm pattern to establish row distances of 90, 60, and 30-60 cm for the remainder of the season. ln the greenhouse a test was conducted to evaluate the effects af those variables on seed germination and seedling vigor for the next soybean generation. As a result of full-season sicklepod competition, soybean plants were less branched, set fewer leaves, and presented thinner stems as compared to the control. However, height of soybean plants was not affected by the presence of sicklepod. ln one of the two experiments, number of nodes decreased for soybeans under weed campetition. The yield components--number of pods; number of seeds, and seed yield per soybean plant--were all similarly reduced due to weed competition. Seeds per pod were decreased to a lesser extent. Soybean seed yields per unit area were significantly diminished by increasing levels af sicklepod ínfestation. While the control produced 3120 kg/ha, the sicklepod densities of 25,000, 53,000, and 77,000 plants/ha reduced seed yíelds 47, 65, and 73%, respectively. As soybean row distances decreased, number of branches, number of leaves, and stem diameter of soybeans decreased. However, the height of soybean plants increased with narrwing of row width. The components of seed yield--number of pods, number of seeds, and seed yield per soybean plant--diminished as row spacing was reduced. Maximum difference between row distances for these attributes was attained for soybean plants under weed-free conditions. Generally, as row width decreased, soybean seed yield per unit area increased. Specifically, soybear.s in 90-cm rows, either in constant or variable row pattern, yielded less than soybeans in 60- and 30-60-cm rows in the variable pattern. Soil contents of phosphorus, potassium, calcium, and magnesium were not affected by the various levels of sicklepod and soybean populalions. Neither the sicklepod densities nor the soybean row distances influenced seed germination and seedling vigor in the next soybean generation. Sicklepod was a strong competitor with soybeans at all density ranges investigated. Because sicklepod grows taller than soybeans during the reproductive stages of the crop, limited success can be reached by varying row spacing alone. However, this practice is considered an integral measure to complement other methods of sicklepod control. Compared to constant rows, the soybean cropping system using variable row spacings presents the choice of planting soybeans at close row spacings to provide early competition with weeds and the possibility of obtaining a forage crop after the first month of growth, without any decreases on the final seed yields.

Avaliação de projetos de investimento em cogeração de energia utilizando bagaço de cana-de-açúcar em biorrefinarias a partir do uso da teoria das opções reais

O cenário de continuo aumento do consumo de derivados do petróleo aliado a conscientização de que é necessário existir um equilíbrio com relação a exploração de recursos naturais e preservação do meio ambiente, vem impulsionando a busca por fontes alternativas de energia. Esse crescente interesse vem se aplicando a geração de energia a partir de biomassa da cana de açúcar, que vem se tornando cada vez mais comuns no Brasil, porém ainda existe um imenso potencial a ser explorado. Dentro deste contexto, se torna relevante a tomada de decisão de investimentos em projetos de cogeração e este trabalho busca incrementar a analise e tomada de decisão com a utilização da Teoria das Opções Reais, uma ferramenta de agregação de valor às incertezas, cabendo perfeitamente ao modelo energético brasileiro, onde grandes volatilidades do preço de energia são observadas ao longo dos anos. O objetivo do trabalho é determinar o melhor momento para uma biorrefinaria investir em unidades de cogeração. A estrutura do trabalho foi dividida em três cenários de porte de biorrefinarias, as de 2 milhões de capacidade de moagem de cana-de-açúcar por ano, as de 4 milhões e as de 6 milhões, visando assim ter uma representação amostral das biorrefinarias do país. Além disso, analisaram-se três cenários de volatilidade atrelados ao preço futuro de energia, dado que a principal variável de viabilização deste tipo de projeto é o preço de energia. As volatilidades foram calculadas de acordo com histórico do ambiente regulado, o dobro do ambiente regulado e projeção de PLD, representando, respectivamente, níveis baixos, médios e altos, de volatilidade do preço de energia. Após isso, foram elaboradas as nove árvores de decisão, que demonstram para os gestores de investimento que em um cenário de baixa volatilidade cria-se valor estar posicionado e ter a opção real de investir ou adiar investimento para qualquer porte de usina. No cenário de média volatilidade de preço, aconselha-se ao gestor estar posicionado em usinas de médio a grande porte para viabilização do investimento. Por fim, quando o cenário de preços é de grande volatilidade, tem-se um maior risco e existe a maior probabilidade de viabilização do investimento em usinas de grande porte.

The influence of the supply chain agents on the new product development's performance: an analysis based on the multi-group moderation

Este estudo buscou verificar a influencia dos agentes da cadeia de suprimentos no desempenho do desenvolvimento de novos produtos quando os agentes são analisados em conjunto. A motivação desta pesquisa veio de estudos que alertaram para a consideração da integração da cadeia de suprimentos como um constructo multidimensional, englobando o envolvimento da manufatura, fornecedores e clientes no desenvolvimento de novos produtos; e devido à falta de informação sobre as influencias individuais destes agentes no desenvolvimento de novos produtos. Sob essas considerações, buscou-se construir um modelo analítico baseado na Teoria do Capital Social e Capacidade Absortiva, construir hipóteses a partir da revisão da literatura e conectar constructos como cooperação, envolvimento do fornecedor no desenvolvimento de novos produtos (DNP), envolvimento do cliente no DNP, envolvimento da manufatura no DNP, antecipação de novas tecnologias, melhoria contínua, desempenho operacional do DNP, desempenho de mercado do NPD e desempenho de negócio do DNP. Para testar as hipóteses foram consideradas três variáveis moderadoras, tais como turbulência ambiental (baixa, média e alta), indústria (eletrônicos, maquinários e equipamentos de transporte) e localização (América, Europa e Ásia). Para testar o modelo foram usados dados do projeto High Performance Manufacturing que contém 339 empresas das indústrias de eletrônicos, maquinários e equipamentos de transporte, localizadas em onze países. As hipóteses foram testadas por meio da Análise Fatorial Confirmatória (AFC) incluindo a moderação muti-grupo para as três variáveis moderadoras mencionadas anteriormente. Os principais resultados apontaram que as hipóteses relacionadas com cooperação foram confirmadas em ambientes de média turbulência, enquanto as hipóteses relacionadas ao desempenho no DNP foram confirmadas em ambientes de baixa turbulência ambiental e em países asiáticos. Adicionalmente, sob as mesmas condições, fornecedores, clientes e manufatura influenciam diferentemente no desempenho de novos produtos. Assim, o envolvimento de fornecedores influencia diretamente no desempenho operacional e indiretamente no desempenho de mercado e de negócio em baixos níveis de turbulência ambiental, na indústria de equipamentos de transporte em países da Americanos e Europeus. De igual forma, o envolvimento do cliente influenciou diretamente no desempenho operacional e indiretamente no desempenho de mercado e do negócio em médio nível de turbulência ambiental, na indústria de maquinários e em países Asiáticos. Fornecedores e clientes não influenciam diretamente no desempenho de mercado e do negócio e não influenciam indiretamente no desempenho operacional. O envolvimento da manufatura não influenciou nenhum tipo de desempenho do desenvolvimento de novos produtos em todos os cenários testados.

Autoeficácia, características sociodemográficas e capacitação profissional: um estudo com servidores de uma Universidade Federal

Self-efficacy, the construct developed by Albert Bandura in 1977 and widely studied around the world, means the individual's belief in his own capacity to successfully perform a certain activity. This study aims to determine the degree of association between sociodemographic characteristics and professional training to the levels of Self-Efficacy at Work (SEW) of the Administrative Assistants in a federal university. This is a descriptive research submitted to and approved by the Ethics Committee of UFRN. The method of data analysis, in quantitative nature, was accomplished with the aid of the statistical programs R and Minitab. The instrument used in research was a sociodemographic data questionnaire, variables of professional training and the General Perception of Self-efficacy Scale (GPSES), applied to the sample by 289 Assistants in Administration. Statistical techniques for data analysis were descriptive statistics, cluster analysis, reliability test (Cronbach's alpha), and test of significance (Pearson). Results show a sociodemographic profile of Assistants in Administration of UFRN with well-distributed characteristics, with 48.4% men and 51.6% female; 59.9% of them were aged over 40 years, married (49.3%), color or race white (58%) and Catholics (67.8%); families are composed of up to four people (75.8%) with children (59.4%) of all age groups; the occupation of the mothers of these professionals is mostly housewives (51.6%) with high school education up to parents (72%) and mothers (75.8%). Assistants in Administration have high levels of professional training, most of them composed two groups of servers: the former, recently hired public servants (30.7%) and another with long service (59%), the majority enter young in career and it stays until retirement, 72.4% of these professionals have training above the minimum requirement for the job. The analysis of SEW levels shows medium to high levels for 72% of assistants in administration; low SEWclassified people have shown a high average of 2.7, considered close to the overall mean presented in other studies, which is 2.9. The cluster analysis has allowed us to say that the characteristics of the three groups (Low, Medium and High SEW) are similar and can be found in the three levels of SEW representatives with all the characteristics investigated. The results indicate no association between the sociodemographic variables and professional training to the levels of self-efficacy at work of Assistants in Administration of UFRN, except for the variable color or race. However, due to the small number of people who declared themselves in color or black race (4% of the sample), this result can be interpreted as mere coincidence or the black people addressed in this study have provided a sense of efficacy higher than white and brown ones. The study has corroborated other studies and highlighted the subjectivity of the self-efficacy construct. They are needed more researches, especially with public servants for the continuity and expansion of studies on the subject, making it possible to compare and confirm the results

Obtenção de uma porcelana dielétrica a partir de matérias-primas do Rio Grande do Norte

The dielectric porcelain is usually obtained by mixing various raw materials proportions and is used in the production of electronic equipment for various applications, from capacitors of high and low Power to insulators for low, medium, high and extra high voltage, which are used in distribution lines and transmission of electricity.This work was directed to the s tudy of technological properties of technic porcelain, made from raw materials extracted from pegmatites found in the regions of Seridó and the Alto Oeste of Rio Grande do Norte, which are made of kaolin, quartz and feldspar, abundant and high quality in these regions. The technic ceramics were obtained by mixing in appropriate levels, kaolin, feldspar, quartz and clay, the last item from a pottery in the city of Sao Gonçalo do Amarante, Rio Grande do Norte. During the development the following characterizations correlated to raw materials were made: laser particle sizing, x-ray diffraction, DTA and TG. The compositions studied were formed by uniaxial pressing at a pressure of 50 MPa and sintered at temperatures ranging from 1150 to 1350ºC and levels (times) of sintering between 30, 60, 90 and 120 minutes. The characterization of the samples were taken from the analysis of weight loss, linear shrinkage, porosity, stoneware curve, bulk density, flexural strength of three points, SEM and X-ray diffraction, TMA, Dielectric and cross Resistivity. The studied materials can be employed in producing the objects used in electrical engineering such as: insulators for low, medium and high-voltage electrical systems, command devices, bushing insulation for transformers, power capacitors, spark plugs, receptacles for fluorescent and incandescent light bulbs and others

Influência de fatores ambientais na incidência do vírus da infecção hipodermal e necrose hematopoiética (IHHNV) no camarão Litopenaeus vannamei cultivado em fazendas do Estado do Rio Grande do Norte (RN)

The shrimp farming industry is the most profitable area of the aquaculture at Rio Grande do Norte (RN) state, which is one of the largest producers in Brazil. However the infections that affect the shrimp cause major economic losses. The infection is a result of the interaction between the shrimp, the environment and pathogen. The change of these factors may lead to a condition of stress and susceptibility to opportunistic infections. One of these infections caused by Infectious Hypodermal and Hematopoietic Necrosis Virus (IHHNV) is widely distributed in several countries and affects a wide range of hosts. To optimize conditions for production of Litopenaeus vannamei shrimp, the more species cultivated in Brazil, it is necessary to understand the effects of environmental factors in the susceptibility of this species to infections. The aim of this study was to determine the IHHNV prevalence and to investigate the influence of environmental factors as salinity, temperature, stocking density, dissolved oxygen and rainfall in the IHHNV incidence in L. vannamei grown in farms, in the RN state. To determine the IHHNV prevalence were used 1089 samples of L. vannamei collected in seven farms. To perform the study about the influence of environmental factors, 525 samples of L. vannamei shrimp were collected in eight farms located in regions of low (0-1 ), medium (21-30 ) and high (38-57 ) salinity, using extensive (≤15 shrimp/m2 ), semi-intensive (18-33 shrimp/m2) or intensive (>36 shrimp/m2) stocking density systems. The IHHNV infection was determined in pleopod and hemolymph using the polymerase chain reaction (PCR). The environmental factors were recorded during the collection of animals, using a refractometer to measure the salinity and a multi-parameter meter to measure the temperature and concentration of dissolved oxygen in the water. The IHHNV prevalence in RN was 43% (468 infected shrimp out of 1089), varying on different farms. On the seven farms studied, IHHNV prevalence ranged from 18.6% to 54.8%. The infection rates in the shrimp cultured in low, medium and high salinity were respectively 43.10% (125/290), 31.2% (15/48) and 24.6% (46/187) and was significantly higher in shrimp grown in low salinity (P<0.001). The infection rates in ponds of extensive, semi-intensive and intensive systems were respectively, 28.7%, 28.28% and 47.84%, and was significantly higher in high stocking densities (P<0.001). This study indicated a high IHHNV prevalence and a significant effect of salinity and stocking density, but not of the temperature, rainfall and dissolved oxygen on the IHHNV infection rate in the L. vannamei shrimp cultured in the northeastern Brazil

Atividades educativas aos portadores de periodontite crônica: escuta e troca de saberes no autocuidado em saúde bucal

This research aimed at evaluating oral health education activities for Periodontitis carriers, emphasizing the motivation for self-care and understanding the cultural aspects involved. This was a qualitative and quantitative study. Based on the qualitative referential, 20 interviews were done, in which differences between scientific and popular explicative models of the health-illness process were verified, besides the increased knowledge and motivation in relation to the use of preventive measures and also the fails in the understanding of the chronic character of periodontitis, enhancing frustration and guilty feelings in the patients. Two groups were structured: intervention and control. The intervention group was submitted to clinical attendance and education activities, while the control group undergone the traditional clinical attendance only. The sample consisted of 51 participants of intervention group and 47 of control group. Structured interviews were conducted at the beginning and at the end of the treatment in order to evaluate the knowledge and motivation for self-care in both groups. For comparison between the previous and post moments in both groups, there were applied McNemar tests with a probability of p < 0.05. In intervention group there was an increase in knowledge related to the name, the causes and related factors of the disease (p < 0.05). In control group there wasn t a rise in the understanding of the diseases chronic character, unlike in intervention group. However, in what concerns self-care, a greatest frequency in medium and high scores was observed in both groups. By this study, it is conclude that there is a common sense knowledge about the importance of preventive techniques and poor oral health as causing periodontitis; clinical interventions for bearers of chronic Periodontitis do not add values to the patients, regarding the illness, its causes and its chronic character; popular beliefs stay in their imagination, and the patients have a increased motivational capacity for self-care

Características químicas e fisiológicas de sementes de feijão em função do teor de fósforo na semente e doses de fósforo no solo

Para avaliar o efeito da combinação de teores de fósforo na semente com doses de fósforo aplicadas via solo sobre as características químicas e fisiológicas de semente de feijão, foram avaliadas sementes das cultivares Carioca Precoce e IAC-Carioca Tybatã, produzidas em cultivo da seca. Na produção das sementes utilizou-se o delineamento experimental em blocos casualizados em esquema fatorial 3x3, correspondente a três teores de fósforo na semente (baixo, médio e alto) e três doses de fósforo, na forma de superfosfato triplo, aplicadas no sulco de semeadura (zero, 90 e 150 kg P2O5 . ha-1), totalizando nove tratamentos para cada cultivar, com cinco repetições. Foram determinados o teor de água e as características químicas (teores de proteína, açúcares total, N, P, K, Ca, Mg, S, Cu, Fe, Mn e Zn) e fisiológicas da semente (germinação e vigor). Os dados obtidos foram submetidos à análise de variância e as médias comparadas pelo teste Tukey, a 5% de probabilidade. A qualidade fisiológica da semente não é favorecida pelos teores de fósforo na semente e no solo, embora esses ocasionem algumas alterações nos teores de nutrientes da semente.