A Reappraisal in Sao Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule"

BACKGROUND AND OBJECTIVES: Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources. METHODS: This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. RESULTS: The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital. CONCLUSIONS: The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations.

The social construction of cooperation: exchange, identification and collective intentions within the organization

My aim is to develop a theory of cooperation within the organization and empirically test it. Drawing upon social exchange theory, social identity theory, the idea of collective intentions, and social constructivism, the main assumption of my work implies that both cooperation and the organization itself are continually shaped and restructured by actions, judgments, and symbolic interpretations of the parties involved. Therefore, I propose that the decision to cooperate, expressed say as an intention to cooperate, reflects and depends on a three step social process shaped by the interpretations of the actors involved. The first step entails an instrumental evaluation of cooperation in terms of social exchange. In the second step, this “social calculus” is translated into cognitive, emotional and evaluative reactions directed toward the organization. Finally, once the identification process is completed and membership awareness is established, I propose that individuals will start to think largely in terms of “We” instead of “I”. Self-goals are redefined at the collective level, and the outcomes for self, others, and the organization become practically interchangeable. I decided to apply my theory to an important cooperative problem in management research: knowledge exchange within organizations. Hence, I conducted a quantitative survey among the members of the virtual community, “www.borse.it” (n=108). Within this community, members freely decide to exchange their knowledge about the stock market among themselves. Because of the confirmatory requirements and the structural complexity of the theory proposed (i.e., the proposal that instrumental evaluations will induce social identity and this in turn will causes collective intentions), I use Structural Equation Modeling to test all hypotheses in this dissertation. The empirical survey-based study found support for the theory of cooperation proposed in this dissertation. The findings suggest that an appropriate conceptualization of the decision to exchange knowledge is one where collective intentions depend proximally on social identity (i.e., cognitive identification, affective commitment, and evaluative engagement) with the organization, and this identity depends on instrumental evaluations of cooperators (i.e., perceived value of the knowledge received, assessment of past reciprocity, expected reciprocity, and expected social outcomes of the exchange). Furthermore, I find that social identity fully mediates the effects of instrumental motives on collective intentions.

L’interpretazione simultanea dal polacco all’italiano: le strategie per affrontare le catene nominali

La presente tesi rappresenta il primo studio dedicato all’interpretazione simultanea dal polacco all’italiano. La presente ricerca cerca di identificare il modo in cui interpreti di comprovata esperienza gestiscono alcune difficoltà tipiche della sintassi polacca fortemente divergenti da quella italiana. La scelta di studiare le catene nominali deriva dal confronto di quanto emerso dalle indagini sulla linguistica contrastiva con un’inchiesta tra gli interpreti accreditati presso le istituzioni europee per quella combinazione. Il primo capitolo è dedicato ad una panoramica sui contatti passati e presenti tra l’Italia e la Polonia e ad una riflessione sulla lingua polacca in chiave contrastiva con l’italiano. Il secondo capitolo si concentra sulla ricerca nell’ambito dell’interpretazione simultanea, in particolare sugli studi contrastivi e sulla discussione delle strategie usate dagli interpreti. Il terzo capitolo approfondisce il contesto di questo studio ovvero le istituzioni europee, il il multilinguismo e il regime linguistico al Parlamento Europeo. Il quarto capitolo include l’indagine del lavoro, condotta su un ampio corpus di dati. Sono stati infatti trascritti e analizzati tutti gli interventi tenuti in lingua polacca in occasione delle sedute parlamentari a Strasburgo e a Bruxelles del 2011 e del primo semestre 2009 e le relative interppretazioni in italiano (per un totale di oltre 9 ore di parlato per lingua). Dall’analisi è risultato che l’interprete nella maggior parte dei casi cerca, nonostante la velocità d’eloquio dell’oratore, di riprodurre fedelmente il messaggio. Tuttavia, qualora questo non risulti possibile, si è notato come gli interpreti ricorrano in maniera consapevole all’omissione di quelle informazioni desumibili o dal contesto o dalle conoscenze pregresse dell’ascoltatore. Di conseguenza la riduzione non rappresenta una strategia di emergenza ma una risorsa da applicare consapevolmente per superare le difficoltà poste da lunghe sequenze di sostantivi.

Bringing results to fruition through publication: An analysis of a peer-reviewed, open access and context-focused journal's editorial practice

When it comes to helping to shape sustainable development, research is most useful when it bridges the science–implementation/management gap and when it brings development specialists and researchers into a dialogue (Hurni et al. 2004); can a peer-reviewed journal contribute to this aim? In the classical system for validation and dissemination of scientific knowledge, journals focus on knowledge exchange within the academic community and do not specifically address a ‘life-world audience’. Within a North-South context, another knowledge divide is added: the peer review process excludes a large proportion of scientists from the South from participating in the production of scientific knowledge (Karlsson et al. 2007). Mountain Research and Development (MRD) is a journal whose mission is based on an editorial strategy to build the bridge between research and development and ensure that authors from the global South have access to knowledge production, ultimately with a view to supporting sustainable development in mountains. In doing so, MRD faces a number of challenges that we would like to discuss with the td-net community, after having presented our experience and strategy as editors of this journal. MRD was launched in 1981 by mountain researchers who wanted mountains to be included in the 1992 Rio process. In the late 1990s, MRD realized that the journal needed to go beyond addressing only the scientific community. It therefore launched a new section addressing a broader audience in 2000, with the aim of disseminating insights into, and recommendations for, the implementation of sustainable development in mountains. In 2006, we conducted a survey among MRD’s authors, reviewers, and readers (Wymann et al. 2007): respondents confirmed that MRD had succeeded in bridging the gap between research and development. But we realized that MRD could become an even more efficient tool for sustainability if development knowledge were validated: in 2009, we began submitting ‘development’ papers (‘transformation knowledge’) to external peer review of a kind different from the scientific-only peer review (for ‘systems knowledge’). At the same time, the journal became open access in order to increase the permeability between science and society, and ensure greater access for readers and authors in the South. We are currently rethinking our review process for development papers, with a view to creating more space for communication between science and society, and enhancing the co-production of knowledge (Roux 2008). Hopefully, these efforts will also contribute to the urgent debate on the ‘publication culture’ needed in transdisciplinary research (Kueffer et al. 2007).

Resocialisation of Disabled Veterans in Former Yugoslavia

The team examined 147 amputated war veterans in the former Yugoslavia between February and December 1998. The official end of the war, substitution of lost body parts and adjustment to the new state of physical disability added extra tasks to these people's efforts to rejoin "normal life". The resocialisation process of amputated persons, i.e. the process of their return into the social environment with the related readjustment and establishment, was observed through its objective and subjective indicators. In addition to obtaining information about socio-demographic characteristics and current working status, the group focused on the psychological dimension, i.e. the individual reality of the disabled persons. In this sense they began with research into the personal, social and professional identity (how they see themselves under these altered circumstances and how they determine their place in the world). To do so they used the model of basic personality supports and observed the resocialisation according to the psychological support systems. They therefore focused on the following topics: body, social identity and belonging, personal identity, working status and engagement, individual responsibility and expectations from the social environment, and orientation towards the future. These were considered with respect to certain significant socio-demographic characteristics of the interviewees. The data were gathered through standardised interviews. Bearing in mind the unpopularity of this subject among experts in the country and the lack of material in specialist literature, the group chose to use descriptive research logic in order to "record" the situation in this field and to establish a framework for future studies which may be methodologically and statistically more complex and thematically more focused.

Immunosuppressive treatment for acquired haemophilia: current practice and future directions in Germany, Austria and Switzerland

Acquired haemophilia is an autoimmune disorder characterised by autoantibody formation against coagulation factor VIII. Immunosuppressive treatments including steroids, cytotoxic drugs, rituximab or combinations thereof have been used to eradicate autoantibodies. Very few prospective studies exist evaluating the use of these treatments. Here, we performed a survey among 73 physicians from 57 haemophilia treatment centres in order to describe current practice patterns and critical issues for future research in acquired haemophilia. The results demonstrate a high diversity of first- and second-line treatments. Factors influencing treatment decision were underlying disorder, severity of bleeding and inhibitor titre. Frequently used first-line treatments were steroids plus cyclophosphamide (44%) and steroids alone (11%). Second-line treatment was most often rituximab (30%), with or without steroids and/or cyclophosphamide. Most participants indicated to change from first- to second-line treatment after 4 weeks in case of failure to obtain partial remission (31%), continued bleeding (40%) or continued severe bleeding requiring bypass treatment (59%). Immunoadsorption was preferred for first- and second-line treatment by 10% and 9% of participants, respectively. These results highlight critical issues in the field. Open questions and directions for future research are discussed.

Issues of spectral quality in clinical 1H-magnetic resonance spectroscopy and a gallery of artifacts

In spite of the facts that magnetic resonance spectroscopy (MRS) is applied as clinical tool in non-specialized institutions and that semi-automatic acquisition and processing tools can be used to produce quantitative information from MRS exams without expert information, issues of spectral quality and quality assessment are neglected in the literature of MR spectroscopy. Even worse, there is no consensus among experts on concepts or detailed criteria of quality assessment for MR spectra. Furthermore, artifacts are not at all conspicuous in MRS and can easily be taken for true, interpretable features. This article aims to increase interest in issues of spectral quality and quality assessment, to start a larger debate on generally accepted criteria that spectra must fulfil to be clinically and scientifically acceptable, and to provide a sample gallery of artifacts, which can be used to raise awareness for potential pitfalls in MRS.

Economic evaluation of varicella vaccination in Swiss children and adolescents

This study explores the effects of three different 2-dose varicella zoster virus (VZV) vaccination strategies in Switzerland. The EVITA model was used to assess clinical benefits and costs of strategies (1) vaccination of 11-15 year old adolescents with a negative or uncertain history for chickenpox, (2) universal vaccination of toddlers at age 1 to 2 years, and (3) strategy 2 plus catch-up vaccination of 11-15 year old susceptible adolescents. The cost-effectiveness analysis compares strategies 2 and 3 versus strategy 1 (current vaccination policy in Switzerland). Probabilities for clinical outcomes and medical resource utilization were derived from a real-world survey among Swiss pediatricians and general practitioners including 236 individuals with VZV infection, published information on varicella complications, and expert opinion. Costs of medical resource utilization represent official Swiss medical tariffs. The model predicts both universal childhood vaccination strategies to be more effective in reducing varicella disease burden compared to strategy 1. Economically, both universal childhood vaccination strategies with or without catch-up result in net savings from the societal perspective reflected by a benefit cost ratio (BCR) of 1.22 or 1.29, respectively. In contrast, the model predicts net costs from the payer perspective (BCR of 0.27 and 0.30, respectively). These economic findings are comparable to those reported from other similar evaluations. However, due to the recent recommendation for using a 2-dose varicella vaccination schedule, our economic results for Switzerland are somewhat less favorable than those for other country analyses in which a less expensive 1-dose vaccination regimen for toddlers has been studied.

Lean-Production-Methods for XXL-Products

This paper discusses the different characteristics used to describe XXL-products and, furthermore, presents fundamental aspects concerning the construction (e.g. principles, methods) of production systems. A survey of experts at XXL-producers is used to identify the most commonly implemented Lean-Production-Methods of production systems. The article presents the survey results and finally concludes with an outlook on further steps.

Using Moodle as a support tool for teaching in Higher Education in Portugal: an exploratory study

The use of virtual learning environments in Higher Education (HE) has been growing in Portugal, driven by the Bologna Process. An example is the use of Learning Management Systems (LMS) that translates an opportunity to leverage the use of technological advances in the educational process. The progress of information and communication technologies (ICT) coupled with the great development of Internet has brought significant challenges to educators that require a thorough knowledge of their implementation process. These field notes present the results of a survey among teachers of a private HE institution in its use of Moodle as a tool to support face-to-face teaching. A research methodology essentially of exploratory nature based on a questionnaire survey, supported by statistical treatment allowed to detect motivations, type of use and perceptions of teachers in relation to this kind of tool. The results showed that most teachers, by a narrow margin (58%), had not changed their pedagogical practice as a consequence of using Moodle. Among those that did 67% attended institutional internal training. Some of the results obtained suggest further investigation and provide guidelines to plan future internal training.

Klimawandel als soziale Konstruktion?

Die Autoren gehen davon aus, dass es soziale und kulturräumliche Unterschiede in den Wahrnehmungsweisen von zukünftigen Klimarisiken gibt und begründen ihre Annahme in theoretischer Hinsicht unter Hinzuziehung der sozialen Konstruktion der Wirklichkeit. Berichtet wird aus einem Forschungsprojekt, das die gesellschaftliche Verarbeitung von Klimarisiken in Küstenstädten der südlichen Nord- und Ostsee im Hinblick darauf untersucht, welche Vorstellungen von einer Vulnerabilität und Resilienz vorliegen. Ausführlich wird das methodische Design der Studie dargestellt. Im Rahmen einer Methodentriangulation wird eine standardisierte Delphi-Expertenbefragung mit einer wissenssoziologischen Diskursanalyse verbunden, um sowohl bisherige als auch zukünftige Vorstellungen von Vulnerabilität und Resilienz zu erheben. Am Beispiel ausgewählter Ergebnisse wird empirisch nachgewiesen, dass Wahrnehmungsunterschiede von Klimarisiken größer sind als angenommen. Die Ergebnisse sind allein aus den Delphi-Daten nicht erklärbar. Ein möglicher Erklärungsansatz ergibt sich ergänzend aus den Erkenntnissen der wissenssoziologischen Diskursanalyse.

Gründungsausbildung und Gründungsabsicht: eine empirische Untersuchung an der TU Dortmund

Für das wirtschaftliche Wachstum und die Innovationskraft einer Volkswirtschaft sind junge Unternehmen von herausragender Bedeutung. Ein wichtiges Ziel von Politik und Wirtschaft muss folglich die Sensibilisierung und Förderung potenzieller Gründer sein. Die vorliegende Untersuchung geht der Frage nach, ob eine universitäre Gründungsausbildung die Gründungsabsicht von Studierenden positiv beeinflussen kann. Aufbauend auf dem intentionsbasierten Modell von Krueger /Carsrud (1993) wurden im Rahmen einer Befragung an der TU Dortmund 111 Studierende der Wirtschaftswissenschaften zu ihren Gründungsabsichten befragt. Es zeigte sich, dass die Gründungsabsicht durch den Besuch von Veranstaltungen zum Gründungsmanagement deutlich gesteigert werden kann. Für die deutsche Wirtschafts- und Bildungspolitik ergibt sich aus den Ergebnissen die Handlungsempfehlung, die universitäre Gründungsausbildung auszubauen und intensiv zu fördern.

Questionnaire-based study to assess the association between management practices and mastitis within tie-stall and free-stall dairy housing systems in Switzerland.

BACKGROUND Prophylactic measures are key components of dairy herd mastitis control programs, but some are only relevant in specific housing systems. To assess the association between management practices and mastitis incidence, data collected in 2011 by a survey among 979 randomly selected Swiss dairy farms, and information from the regular test day recordings from 680 of these farms was analyzed. RESULTS The median incidence of farmer-reported clinical mastitis (ICM) was 11.6 (mean 14.7) cases per 100 cows per year. The median annual proportion of milk samples with a composite somatic cell count (PSCC) above 200,000 cells/ml was 16.1 (mean 17.3) %. A multivariable negative binomial regression model was fitted for each of the mastitis indicators for farms with tie-stall and free-stall housing systems separately to study the effect of other (than housing system) management practices on the ICM and PSCC events (above 200,000 cells/ml). The results differed substantially by housing system and outcome. In tie-stall systems, clinical mastitis incidence was mainly affected by region (mountainous production zone; incidence rate ratio (IRR) = 0.73), the dairy herd replacement system (1.27) and farmers age (0.81). The proportion of high SCC was mainly associated with dry cow udder controls (IRR = 0.67), clean bedding material at calving (IRR = 1.72), using total merit values to select bulls (IRR = 1.57) and body condition scoring (IRR = 0.74). In free-stall systems, the IRR for clinical mastitis was mainly associated with stall climate/temperature (IRR = 1.65), comfort mats as resting surface (IRR = 0.75) and when no feed analysis was carried out (IRR = 1.18). The proportion of high SSC was only associated with hand and arm cleaning after calving (IRR = 0.81) and beef producing value to select bulls (IRR = 0.66). CONCLUSIONS There were substantial differences in identified risk factors in the four models. Some of the factors were in agreement with the reported literature while others were not. This highlights the multifactorial nature of the disease and the differences in the risks for both mastitis manifestations. Attempting to understand these multifactorial associations for mastitis within larger management groups continues to play an important role in mastitis control programs.

How are climate change adaptation strategies put into practice? A case study comparison of natural hazard prevention

Climate change affects increasingly the management of natural resources and has diverse impacts of environmental, social and economic nature. To take this complexity into account, climate change adaptation policies consider the principle of sustainable development. Sustainability is an integrative concept which should insure a long-term and multi-sectoral response to climate change. But the question appears if sustainable development is only retained at the conceptual level or effectively implemented in practice. This paper pursues this question by comparing three projects addressing natural hazard in Swiss mountains. The aim is to investigate how sustainable development is perceived by involved stakeholders and implemented in practice. Two dimensions are thus taken into account: the type of actors participating in these projects and their preferences and interests. The first dimension thus analyzes if diverse actors representing the environmental, economic and social arenas are integrated; the second dimension investigates if different interests and preferences in the sense of sustainability were incorporated in the design and implementation of climate change adaptation. Data were gathered through a standardized survey among all actors involved in the three projects. Preliminary results show that sustainability receives diverse weight and interest in the different cases.

Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.