Oral cleft prevention program (OCPP)

Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917

Rafael Moneo: la complessità del vuoto. Dalle matrici formali dell'opera di Oteiza e Chillida

The experience of void, essential to the production of forms and to make use them, can be considered as the base of the activities that attend to the formative processes. If void and matter constitutes the basic substances of architecture. Their role in the definition of form, the symbolic value and the constructive methods of it defines the quality of the space. This job inquires the character of space in the architecture of Moneo interpreting the meaning of the void in the Basque culture through the reading of the form matrices in the work of Jorge Oteiza and Eduardo Chillida. In the tie with the Basque culture a reading key is characterized by concurring to put in relation some of the theoretical principles expressed by Moneo on the relationship between place and time, in an unique and specific vision of the space. In the analysis of the process that determines the genesis of the architecture of Moneo emerges a trajectory whose direction is constructed on two pivos: on the one hand architecture like instrument of appropriation of the place, gushed from an acquaintance process who leans itself to the reading of the relations that define the place and of the resonances through which measuring it, on the other hand the architecture whose character is able to represent and to extend the time in which he is conceived, through the autonomy that is conferred to them from values. Following the trace characterized from this hypothesis, that is supported on the theories elaborated from Moneo, surveying deepens the reading of the principles that construct the sculptural work of Oteiza and Chillida, features from a search around the topic of the void and to its expression through the form. It is instrumental to the definition of a specific area that concurs to interpret the character of the space subtended to a vision of the place and the time, affine to the sensibility of Moneo and in some way not stranger to its cultural formation. The years of the academic formation, during which Moneo enters in contact with the Basque artistic culture, seem to be an important period in the birth of that knowledge that will leads him to the formulation of theories tied to the relationship between time, place and architecture. The values expressed through the experimental work of Oteiza and Chillida during years '50 are valid bases to the understanding of such relationships. In tracing a profile of the figures of Oteiza and Chillida, without the pretension that it is exhaustive for the reading of the complex historical period in which they are placed, but with the needs to put the work in a context, I want to be evidenced the important role carried out from the two artists from the Basque cultural area within which Moneo moves its first steps. The tie that approaches Moneo to the Basque culture following the personal trajectory of the formative experience interlaces to that one of important figures of the art and the Spanish architecture. One of the more meaningful relationships is born just during the years of his academic formation, from 1958 to the 1961, when he works like student in the professional office of the architect Francisco Sáenz de Oiza, who was teaching architectural design at the ETSAM. In these years many figures of Basque artists alternated at the professional office of Oiza that enjoys the important support of the manufacturer and maecenas Juan Huarte Beaumont, introduced to he from Oteiza. The tie between Huarte and Oteiza is solid and continuous in the years and it realizes in a contribution to many of the initiatives that makes of Oteiza a forwarder of the Basque culture. In the four years of collaboration with Oiza, Moneo has the opportunity to keep in contact with an atmosphere permeated by a constant search in the field of the plastic art and with figures directly connected to such atmosphere. It’s of a period of great intensity as in the production like in the promotion of the Basque art. The collective “Blanco y Negro”, than is held in 1959 at the Galería Darro to Madrid, is only one of the many times of an exhibition of the work of Oteiza and Chillida. The end of the Fifties is a period of international acknowledgment for Chillida that for Oteiza. The decade of the Fifties consecrates the hypotheses of a mythical past of the Basque people through the spread of the studies carried out in the antecedent years. The archaeological discoveries that join to a context already rich of signs of the prehistoric era, consolidate the knowledge of a strong cultural identity. Oteiza, like Chillida and other contemporary artists, believe in a cosmogonist conception belonging to the Basques, connected to their matriarchal mythological past. The void in its meaning of absence, in the Basque culture, thus as in various archaic and oriental religions, is equivalent to the spiritual fullness as essential condition to the revealing of essence. Retracing the archaic origins of the Basque culture emerges the deep meaning that the void assumes as key element in the religious interpretation of the passage from the life to the death. The symbology becomes rich of meaningful characters who derive from the fact that it is a chthonic cult. A representation of earth like place in which divine manifest itself but also like connection between divine and human, and this manipulation of the matter of which the earth it is composed is the tangible projection of the continuous search of the man towards God. The search of equilibrium between empty and full, that characterizes also the development of the form in architecture, in the Basque culture assumes therefore a peculiar value that returns like constant in great part of the plastic expressions, than in this context seem to be privileged regarding the other expressive forms. Oteiza and Chillida develop two original points of view in the representation of the void through the form. Both use of rigorous systems of rules sensitive to the physics principles and the characters of the matter. The last aim of the Oteiza’s construction is the void like limit of the knowledge, like border between known and unknown. It doesn’t means to reduce the sculptural object to an only allusive dimension because the void as physical and spiritual power is an active void, that possesses that value able to reveal the being through the trace of un-being. The void in its transcendental manifestation acts at the same time from universal and from particular, like in the atomic structure of the matter, in which on one side it constitutes the inner structure of every atom and on the other one it is necessary condition to the interaction between all the atoms. The void can be seen therefore as the action field that concurs the relations between the forms but is also the necessary condition to the same existence of the form. In the construction of Chillida the void represents that counterpart structuring the matter, inborn in it, the element in absence of which wouldn’t be variations neither distinctive characters to define the phenomenal variety of the world. The physics laws become the subject of the sculptural representation, the void are the instrument that concurs to catch up the equilibrium. Chillida dedicate himself to experience the space through the senses, to perceive of the qualities, to tell the physics laws which forge the matter in the form and the form arranges the places. From the artistic experience of the two sculptors they can be transposed, to the architectonic work of Moneo, those matrices on which they have constructed their original lyric expressions, where the void is absolute protagonist. An ambit is defined thus within which the matrices form them drafts from the work of Oteiza and Chillida can be traced in the definition of the process of birth and construction of the architecture of Moneo, but also in the relation that the architecture establishes with the place and in the time. The void becomes instrument to read the space constructed in its relationships that determine the proportions, rhythms, and relations. In this way the void concurs to interpret the architectonic space and to read the value of it, the quality of the spaces constructing it. This because it’s like an instrument of the composition, whose role is to maintain to the separation between the elements putting in evidence the field of relations. The void is that instrument that serves to characterize the elements that are with in the composition, related between each other, but distinguished. The meaning of the void therefore pushes the interpretation of the architectonic composition on the game of the relations between the elements that, independent and distinguished, strengthen themselves in their identity. On the one hand if void, as measurable reality, concurs all the dimensional changes quantifying the relationships between the parts, on the other hand its dialectic connotation concurs to search the equilibrium that regulated such variations. Equilibrium that therefore does not represent an obtained state applying criteria setting up from arbitrary rules but that depends from the intimate nature of the matter and its embodiment in the form. The production of a form, or a formal system that can be finalized to the construction of a building, is indissolubly tied to the technique that is based on the acquaintance of the formal vocation of the matter, and what it also can representing, meaning, expresses itself in characterizing the site. For Moneo, in fact, the space defined from the architecture is above all a site, because the essence of the site is based on the construction. When Moneo speaks about “birth of the idea of plan” like essential moment in the construction process of the architecture, it refers to a process whose complexity cannot be born other than from a deepened acquaintance of the site that leads to the comprehension of its specificity. Specificity arise from the infinite sum of relations, than for Moneo is the story of the oneness of a site, of its history, of the cultural identity and of the dimensional characters that that they are tied to it beyond that to the physical characteristics of the site. This vision is leaned to a solid made physical structure of perceptions, of distances, guideline and references that then make that the process is first of all acquaintance, appropriation. Appropriation that however does not happen for directed consequence because does not exist a relationship of cause and effect between place and architecture, thus as an univocal and exclusive way does not exist to arrive to a representation of an idea. An approach that, through the construction of the place where the architecture acquires its being, searches an expression of its sense of the truth. The proposal of a distinction for areas like space, matter, spirit and time, answering to the issues that scan the topics of the planning search of Moneo, concurs a more immediate reading of the systems subtended to the composition principles, through which is related the recurrent architectonic elements in its planning dictionary. From the dialectic between the opposites that is expressed in the duality of the form, through the definition of a complex element that can mediate between inside and outside as a real system of exchange, Moneo experiences the form development of the building deepening the relations that the volume establishes in the site. From time to time the invention of a system used to answer to the needs of the program and to resolve the dual character of the construction in an only gesture, involves a deep acquaintance of the professional practice. The technical aspect is the essential support to which the construction of the system is indissolubly tied. What therefore arouses interest is the search of the criteria and the way to construct that can reveal essential aspects of the being of the things. The constructive process demands, in fact, the acquaintance of the formative properties of the matter. Property from which the reflections gush on the relations that can be born around the architecture through the resonance produced from the forms. The void, in fact, through the form is in a position to constructing the site establishing a reciprocity relation. A reciprocity that is determined in the game between empty and full and of the forms between each other, regarding around, but also with regard to the subjective experience. The construction of a background used to amplify what is arranged on it and to clearly show the relations between the parts and at the same time able to tie itself with around opening the space of the vision, is a system that in the architecture of Moneo has one of its more effective applications in the use of the platform used like architectonic element. The spiritual force of this architectonic gesture is in the ability to define a place whose projecting intention is perceived and shared with who experience and has lived like some instrument to contact the cosmic forces, in a delicate process that lead to the equilibrium with them, but in completely physical way. The principles subtended to the construction of the form taken from the study of the void and the relations that it concurs, lead to express human values in the construction of the site. The validity of these principles however is tested from the time. The time is what Moneo considers as filter that every architecture is subordinate to and the survival of architecture, or any of its formal characters, reveals them the validity of the principles that have determined it. It manifests thus, in the tie between the spatial and spiritual dimension, between the material and the worldly dimension, the state of necessity that leads, in the construction of the architecture, to establish a contact with the forces of the universe and the intimate world, through a process that translate that necessity in elaboration of a formal system.

Dall'involucro all'invaso. Lo spazio a pianta centrale nell'opera architettonica di Adalberto Libera

An archetype selected over the centuries Adalberto Libera wrote little, showing more inclination to use the project as the only means of verification. This study uses a survey of the project for purely compositional space in relation to the reason that most other returns with continuity and consistency throughout his work. "The fruit of a type selected over centuries", in the words of Libera, is one of the most widely used and repeated spatial archetypes present in the history of architecture, given its nature as defined by a few consolidated elements and precisely defined with characters of geometric precision and absoluteness, the central space is provided, over the course of evolution of architecture, and its construction aspects as well as symbolic, for various uses, from historical period in which it was to coincide with sacred space for excellence, to others in which it lends itself to many different expressive possibilities of a more "secular". The central space was created on assumptions of a constructive character, and the same exact reason has determined the structural changes over the centuries, calling from time to time with advances in technology, the maximum extent possible and the different applications, which almost always have coincided with the reason for the monumental space. But it’s in the Roman world that the reason for the central space is defined from the start of a series of achievements that fix the character in perpetuity. The Pantheon was seen maximum results and, simultaneously, the archetype indispensable, to the point that it becomes difficult to sustain a discussion of the central space that excludes. But the reason the space station has complied, in ancient Rome, just as exemplary, monuments, public spaces or buildings with very different implications. The same Renaissance, on which Wittkower's proving itself once and for all, the nature and interpretation of sacred space station, and thus the symbolic significance of that invaded underlying interpretations related to Humanism, fixing the space-themed drawing it with the study and direct observation by the four-sixteenth-century masters, the ruins that in those years of renewed interest in the classical world, the first big pieces of excavation of ancient Rome brought to light with great surprise of all. Not a case, the choice to investigate the architectural work of Libera through the grounds of the central space. Investigating its projects and achievements, it turns out as the reason invoked particularly evident from the earliest to latest work, crossing-free period of the war which for many authors in different ways, the distinction between one stage and another, or the final miss. The theme and the occasion for Libera always distinct, it is precisely the key through which to investigate her work, to come to discover that the first-in this case the central plan-is the constant underlying all his work, and the second reason that the quota with or at the same time, we will return different each time and always the same Libera, formed on the major works remained from ancient times, and on this building method, means consciously, that the characters of architectural works, if valid, pass the time, and survive the use and function contingent. As for the facts by which to formalize it, they themselves are purely contingent, and therefore available to be transferred from one work to another, from one project to another, using also the loan. Using the same two words-at-issue and it becomes clear now how the theme of this study is the method of Libera and opportunity to the study of the central space in his work. But there is one aspect that, with respect to space a central plan evolves with the progress of the work of Libera on the archetype, and it is the reason behind all the way, just because an area built entirely on reason centric. It 'just the "center" of space that, ultimately, tells us the real progression and the knowledge that over the years has matured and changed in Libera. In the first phase, heavily laden with symbolic superstructure, even if used in a "bribe" from Free-always ill-disposed to sacrifice the idea of architecture to a phantom-center space is just the figure that identifies the icon represents space itself: the cross, the flame or the statue are different representations of the same idea of center built around an icon. The second part of the work of clearing the space station, changed the size of the orders but the demands of patronage, grows and expands the image space centric, celebratory nature that takes and becomes, in a different way, this same symbol . You see, one in all, as the project of "Civiltà Italiana" or symbolic arch are examples of this different attitude. And at the same point of view, you will understand how the two projects formulated on the reuse of the Mausoleum of Augustus is the key to its passage from first to second phase: the Ara Pacis in the second project, making itself the center of the composition "breaks" the pattern of symbolic figure in the center, because it is itself an architecture. And, in doing so, the transition takes place where the building itself-the central space-to become the center of that space that itself creates and determines, by extending the potential and the expressiveness of the enclosure (or cover) that defines the basin centered. In this second series of projects, which will be the apex and the point of "crisis" in the Palazzo dei Congressi all'E42 received and is no longer so, the symbol at the very geometry of space, but space itself and 'action' will be determined within this; action leading a movement, in the case of the Arco simbolico and the "Civiltà Italiana" or, more frequently, or celebration, as in the great Sala dei Recevimenti all’E42, which, in the first project proposal, is represented as a large area populated by people in suits, at a reception, in fact. In other words, in this second phase, the architecture is no longer a mere container, but it represents the shape of space, representing that which "contains". In the next step-determining the knowledge from which mature in their transition to post-war-is one step that radically changes the way centric space, although formally and compositionally Libera continues the work on the same elements, compounds and relationships in a different way . In this last phase Freedom, center, puts the man in human beings, in the two previous phases, and in a latent, were already at the center of the composition, even if relegated to the role of spectators in the first period, or of supporting actors in the second, now the heart of space. And it’s, as we shall see, the very form of being together in the form of "assembly", in its different shades (up to that sacred) to determine the shape of space, and how to relate the parts that combine to form it. The reconstruction of the birth, evolution and development of the central space of the ground in Libera, was born on the study of the monuments of ancient Rome, intersected on fifty years of recent history, honed on the constancy of a method and practice of a lifetime, becomes itself, Therefore, a project, employing the same mechanisms adopted by Libera; the decomposition and recomposition, research synthesis and unity of form, are in fact the structure of this research work. The road taken by Libera is a lesson in clarity and rationality, above all, and this work would uncover at least a fragment.

Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): multisite comparison of different clinical decision support systems

BACKGROUND: The adequacy of thromboprophylaxis prescriptions in acutely ill hospitalized medical patients needs improvement. OBJECTIVE: To prospectively assess the efficacy of thromboprophylaxis adequacy of various clinical decision support systems (CDSS) with the aim of increasing the use of explicit criteria for thromboprophylaxis prescription in nine Swiss medical services. METHODS: We randomly assigned medical services to a pocket digital assistant program (PDA), pocket cards (PC) and no CDSS (controls). In centers using an electronic chart, an e-alert system (eAlerts) was developed. After 4 months, we compared post-CDSS with baseline thromboprophylaxis adequacy for the various CDSS and control groups. RESULTS: Overall, 1085 patients were included (395 controls, 196 PC, 168 PDA, 326 eAlerts), 651 pre- and 434 post-CDSS implementation: 472 (43.5%) presented a risk of VTE justifying thromboprophylaxis (31.8% pre, 61.1% post) and 556 (51.2%) received thromboprophylaxis (54.2% pre, 46.8% post). The overall adequacy (% patients with adequate prescription) of pre- and post-CDSS implementation was 56.2 and 50.7 for controls (P = 0.29), 67.3 and 45.3 for PC (P = 0.002), 66.0 and 64.9 for PDA (P = 0.99), 50.5 and 56.2 for eAlerts (P = 0.37), respectively, eAlerts limited overprescription (56% pre, 31% post, P = 0.01). CONCLUSION: While pocket cards and handhelds did not improve thromboprophylaxis adequacy, eAlerts had a modest effect, particularly on the reduction of overprescription. This effect only partially contributes to the improvement of patient safety and more work is needed towards institution-tailored tools.

Effect of Frame Size and Hormone Implant on Performance and Carcass Characteristics of Finishing Yearling Heifers: Returns to a Value-Based Market

Four groups of yearling heifers representing different frame sizes—small, medium, and large Angus and medium Simmental—were fed high-grain finishing diets to average Low Choice quality grade. Half the heifers were implanted with estrogen and trenbolone acetate. Backfat and ribeye area were measured by ultrasound four times during the study to assess growth of muscle and fat. Increasing frame size resulted in increased feed intake, greater rates of gain, and a trend towards reduced feed conversion. Greater returns would have been realized from each of the four groups had they been sold in a premium market based on yield grade rather than the conventional grade and yield market. Increasing frame size resulted in greater returns to the value-based market. Implants increased rate of gain and improved feed conversion but did not result in significantly greater returns to the value-based market compared with the grade and yield market. Ribeye area and backfat increased with body weight and time on feed. Increase in ribeye area was linear with time, whereas accumulation of backfat was exponential. Rate of increase in area of ribeye tended to increase and backfat tended to decrease as frame size increased. Implants increased rate of increase in ribeye area but had no effect on rate of deposition of subcutaneous fat. Equations describing growth of ribeye area and backfat for each group predicted average growth for the heifers but did not predict growth of individual heifers. Final carcass yield grade was related to initial thickness of backfat but not to initial ribeye area. These results indicate that the type of cattle selected to be fed for a premium market based on yield grade is important to the success of the program. More work is needed to develop growth equations from ultrasound measurements, but ultrasound will likely be a useful tool in selecting feeder cattle for a value-based market.

Health Care Providers' Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene

Human trafficking is a complex and multifaceted problem that takes the form of economic, physical and sexual exploitation of people, both adults and children, who are reduced to simple products for commerce. Human trafficking in the United States also has both a domestic and an international aspect. Health care providers are in a unique position to screen for victims of trafficking and may provide important medical and psychological care for victims while in captivity and thereafter. Trafficked persons are likely to suffer a wide spectrum of health risks that reflect the unique circumstances and experiences in a trafficked victim’s life. Although trafficked victims typically have experienced inadequate medical care, once contact is made by the victim with the health care professionals, the opportunity then exists to identify, treat, and assist such victims. The range of services and supports required to appropriately respond to human trafficking victims once identified is broad and typically goes beyond just what is immediately provided by the health care professional and includes safe housing, legal advice, income support, and, for international victims, immigration status related issues. An informed and responsive community is necessary to serve both the international and domestic victims of human trafficking, and needs assessments demonstrated a number of barriers that hindered the delivery of effective services to human trafficking victims. One of the consistent needs identified to combat these barriers was enhanced training among all professionals who might come in contact with human trafficking victims. We highlight the efforts of the Houston Rescue and Restore Coalition (HRRC), a local grassroots non-profit organization whose mission focuses on raising awareness of human trafficking in the Greater Houston Metropolitan area. HRRC responded to the consistent recommendation from various community needs assessments for additional training of front line professionals who would have the opportunity to identify human trafficking victims and supported the design and pilot testing of a health professions training program around human trafficking. Dissemination of this type of training along with careful evaluation and continued refinement will be one way for health care professionals to engage in a positive manner with human trafficking victims.

The Effects of Smolt Stocking Strategies on Migratory Path Selection of Adult Atlantic Salmon in the Penobscot River, Maine

Understanding the homing behavior of Atlantic salmon Salmo salar is vital to the restoration program employed on the Penobscot River, Maine. To produce significant adult returns, managers currently stock hatchery-raised smolts in specific river sections, providing smolts the opportunity to imprint on chemical signals and enabling their return to productive spawning and rearing habitat as adults. In this study, we used observational evidence from passive integrated transponder telemetry to determine whether adults returning from smolt stockings behaved in a way that suggested strong homing to smolt stocking locations. Adults returning from smolt stocking locations located in or at the mouth of the Piscataquis River were more likely to be detected as entering the Piscataquis River than were adults returning from the upper Penobscot River smolt stocking locations. In general, returning adult Atlantic salmon that had been stocked near or in tributaries as smolts chose a path more quickly than those that had been stocked in more downstream or main-stem locations. These results suggest that Atlantic salmon smolts should be stocked at specific sites with superior habitat for spawning kind juvenile survival to capitalize on the strong homing tendency in adults. This technique call also be utilized to allow for natural selection and the development of localized stocks.

A path analysis of an after-school health and exercise program for elementary school children in El Paso, Texas

As schools are pressured to perform on academics and standardized examinations, schools are reluctant to dedicate increased time to physical activity. After-school exercise and health programs may provide an opportunity to engage in more physical activity without taking time away from coursework during the day. The current study is a secondary data analysis of data from a randomized trial of a 10-week after-school program (six schools, n = 903) that implemented an exercise component based on the CATCH physical activity component and health modules based on the culturally-tailored Bienestar health education program. Outcome variables included BMI and aerobic capacity, health knowledge and healthy food intentions as assessed through path analysis techniques. Both the baseline model (χ2 (df = 8) = 16.90, p = .031; RMSEA = .035 (90% CI of .010–.058), NNFI = 0.983 and the CFI = 0.995) and the model incorporating intervention participation proved to be a good fit to the data (χ2 (df = 10) = 11.59, p = .314. RMSEA = .013 (90% CI of .010–.039); NNFI = 0.996 and CFI = 0.999). Experimental group participation was not predictive of changes in health knowledge, intentions to eat healthy foods or changes in Body Mass Index, but it was associated with increased aerobic capacity, β = .067, p < .05. School characteristics including SES and Language proficiency proved to be significantly associated with changes in knowledge and physical indicators. Further effects of school level variables on intervention outcomes are recommended so that tailored interventions can be developed aimed at the specific characteristics of each participating school. ^

Has implementation of integrated mental health services in primary care programs positively impacted health outcomes among the mentally ill in developing countries?

Objective. The World Health Organization (WHO) estimates that nearly 450 million people suffer from a mental disorder in the world. Developing countries do not have the health system structure in place to support the demand of mental health services. This study will conduct a review of mental health integration in primary care research that is carried out in low-income countries identified as such from the World Bank economic analysis. The research follows the standard of care that WHO has labeled appropriate in treatment of mental health populations. Methods. This study will use the WHO 10 principles of mental health integration into primary care as the global health standard of care for mental health. Low-income countries that used these principles in their national programs will be analyzed for effectiveness of mental health integration in primary care. Results. This study showed that mental health service integration in primary care did have an effect on health outcomes of low-income countries. However, information did not lead to significant quantitative results that determined how positive the effect was. Conclusion. More ethnographic research is needed in low-income countries to truly assess how effective the program is in integrating with the health system currently in place.^ ^

Identifying characteristics of mentally ill homeless individuals who are successfully linked to health and social services post-incarceration via the jail inreach project

Healthcare for the Homeless—Houston (HHH) received a research grant from The Medallion Foundation, Inc. in March 2006 to pilot The Jail Inreach Project, an intensive “inreach” initiative to assess the impact of providing continuity of mental and primary health care services for homeless individuals who suffer from mental illness and/or substance abuse being released from jail. This pilot project was initiated by HHH, in collaboration with the Harris County Sheriff’s Office and the Mental Health Mental Retardation Authority of Harris County (MHMRA). Those who are flagged as “frequent flyers” and who are diagnosed with a mental illness are referred to the Jail Inreach Project. In order to maximize the effectiveness of the discharge plan, case managers offer the option of meeting the client at the time of release and bring them to the HHH clinic located four blocks from the jail. Participation in both the program and the option for direct release to the care of a case manager are voluntary.^ The purpose of this study is to determine the outcomes of the Jail Inreach Project and addresses the following objectives: (1) to evaluate the characteristics of inmates that chose to be released from jail to the direct care of an HHH case manager versus those who opt for self release and (2) to determine the number and percent of inmates that are linked to services and relationship with type of release (direct versus indirect), (3) to determine if there is a relationship between outcomes and characteristics and (4) to determine what outcomes are a function of release, controlling for characteristics. Statistical analysis, including frequencies, cross tabulations, chi-square and logistical regression, found that those who opt for self release are six times less likely to be successfully linked to services and that gender is the most significant predictor of choosing self release. Men are far more likely to opt for self release than women engaged in this program. These findings help inform policy and program design and development that addresses the difference in service utilization and successful linkage to services post-incarceration. Successful linkage to services, thus continuity of and access to care, further impact the effects of the revolving door phenomenon of mentally ill homeless individuals cycling between the streets, jails and hospital emergency centers.^

Analysis of participation in the federally mandated coal workers' health surveillance program

The Federal Coal Mine Health and Safety Act of 1969 required that periodic chest radiographs be offered to underground coal miners to protect the miners from the development of Coal Workers' Pneumoconiosis (CWP) and progression of the disease to progressive massive fibrosis (PMF). These examinations are administered by the National Institute for Occupational Safety and Health (NIOSH) through the Coal Workers' Health Surveillance Program (CWHSP). The mine operator is required to provide each miner with the opportunity to have the chest radiograph at no cost to the miner.^ Three rounds of examinations have been conducted since 1969 and the fourth is underway. The decrease in participation over rounds is of great concern if the incidence and progression of CWP are to be understood and controlled.^ This study developed rates of participation for each of 558 West Virginia underground coal mines who submitted or had NIOSH assigned plans for making chest radiographs available during the third round, July 1978 through December 1980. These rates were analyzed in relation to desired levels of participation and to reinforcing, predisposing and enabling factors presumed to affect rates of participation in disease prevention and surveillance programs.^ Two reinforcing factors, size of mine and inclusion of the mine in the National Coal Study (NCS) epidemiology research program, and the enabling factor, use of an on-site radiograph facility, demonstrated highly significant relationships to participation rates.^ The major findings of the study were: (1) Participation in the CWHSP is even lower than previously estimated; (2) CWHSP program evaluation is not systematic and program data base is not complete and comprehensive; and (3) NIOSH program policy is not clear and administration of the CWHSP is fragmented and lacks adequate fiscal and personnel resources. ^

Use of empowerment evaluation to determine a sustainability plan for a community-based preconception care program

Women With IMPACT (WWI) is a community-based preconception care educational intervention. WWI is being implemented by the Impacting Maternal and Prenatal Care Together (IMPACT) Collaborative and targets zip codes in Harris County, Texas at high risk for infant mortality, low birthweight, and preterm birth. WWI started March 2012 and continues through August 2013. Three workshop series are planned. This study was conducted with participants and facilitators from the first workshop series. This study aimed to 1) evaluate the WWI program using empowerment evaluation, 2) engage all WWI stakeholders in an empowerment evaluation so the method could be adopted as a participatory evaluation process for future IMPACT activities, and 3) develop recommendations for sustainability of the WWI intervention, based on empowerment evaluation findings and results from the pre/post program evaluation completed by WWI participants. Study participants included WWI participants and facilitators and IMPACT Collaborative Steering Committee members. WWI participants were female, 18-35 year-old, non-pregnant residents of zip codes at high risk of adverse birth outcomes. All other study participants were 18 years or older. A two-phased empowerment evaluation (EE) was utilized in this study. Sessions 1-4 were conducted independently of one another – 3 with participants at different sites and one with the facilitators. The fifth session included WWI participant and facilitator representatives, and IMPACT Steering Committee members. Session 5 built upon the work of the other sessions. Observation notes were recorded during each session. Thematic content analysis was conducted on all EE tables and observation notes. Mission statements drafted by each group focused on improvement of physical and mental health through behavior change and empowerment of all participants. The top 5 overall program components were: physical activity, nutrition, self-worth, in-class communication, and stress. Goals for program improvement were set by EE participants for each of these components. Through thematic content analysis of the tables and observation notes, social support emerged as an important theme of the program among all participant groups. Change to a healthy lifestyle emerged as an important theme in terms of program improvement. Two-phased EE provided an opportunity for all program stakeholders to provide feedback regarding important program components and provide suggestions for program improvement. EE, thematic content analysis, pre/post evaluation results, and inherent program knowledge were triangulated to make recommendations to sustain the program once the initial funding ends. ^

Conservation Reserve Program to Row Crop Demonstration

The demonstration project was designed to examine one way of preparing Conservation Reserve Program (CRP) land for row crop production. Many producers have successfully converted CRP land for this purpose; additionally, there was an opportunity for the research farm to gain experience in this area. The goal of the project was to document one way of going through the process.

Returns to migration : the role of educational attainment in rural Tanzania

Given the migration premium previously identified in an impact evaluation approach, this paper asks the question of why migration is not more prominent, given such high premium associated with it. Using long-term household panel data drawn from rural Tanzania, Kagera for the period 1991-2004, this study aims to answer this question by exploring the contribution of education in the migration premium. By separating migrants into those that moved out of original villages but remained within Kagera and those who left the region, this study finds that, in consumption, the return on investment in education is higher at both destinations. However, whilst the higher return on education fully explains the gains associated with migration within Kagera, it only partly explains those of external migration. These findings suggest that welfare opportunities are higher at the destination and that an individual's limited investment in education plays a major role in preventing short-distance migration from becoming a significant source of raising welfare, which is not the case for long-distance migration. While education plays a role, it appears that other mechanisms may prohibit rural agents from exploiting the arbitrage opportunity when they migrate to the destination at a great distance from the source.

Un modelo de relación entre los programas de innovación abierta y la creación de valor

En un mundo donde el cambio es constante y cada vez más vertiginoso, la innovación es el combustible que utilizan las empresas que permite su renovación constante y, como consecuencia, su supervivencia en el largo plazo. La innovación es sin dudas un elemento fundamental para determinar la capacidad de las empresas en crear valor a lo largo del tiempo, y por ello, las empresas suelen dedicar esfuerzos considerables y recursos de todo tipo para identificar nuevas alternativas de innovación que se adapten a su estrategia, cultura, objetivos y ambiciones corporativas. Una forma específica para llevar a cabo la innovación es la innovación abierta. Esta se entiende como la innovación que se realiza de manera conjunta con otras empresas o participantes del ecosistema. Cabe la aclaración que en este documento se toma la definición de ecosistema referida al conjunto de clientes, proveedores, competidores y otros participantes que interactúan en un mismo entorno donde existen posiciones de liderazgo que pueden cambiar a lo largo del tiempo (Moore 1996). El termino de innovación abierta fue acuñado por Henry Chesbrough hace algo mas de una década para referirse a esta forma particular de organizar la innovación corporativa. Como se observa en el presente trabajo la innovación abierta es un nuevo paradigma que ha capturado el interés académico y empresarial desde algo más de una década. Se verán varios casos de innovación abierta que se están llevando a cabo en diversos países y sectores de la economía. El objetivo principal de este trabajo de investigación es el de desarrollar y explicar un modelo de relación entre la innovación abierta y la creación de valor en las empresas. Para ello, y como objetivos secundarios, se ha investigado los elementos de un Programa de Innovación Abierta, los impulsores 1 de creación de valor, el proceso de creación de valor y, finalmente, la interacción entre estos tres elementos. Como producto final de la investigación se ha desarrollado un marco teórico general para establecer la conexión entre la innovación abierta y la creación de valor que facilita la explicación de la interacción entre ambos elementos. Se observa a partir de los casos de estudio que la innovación abierta puede abarcar todos los sectores de la economía, múltiples geografías y empresas de distintos tamaños (grandes empresas, pequeñas y medianas empresas, incluso empresas de reciente creación) cada una de ellas con distinta relevancia dentro del ecosistema en el que participan. Elementos de un Programa de Innovación Abierta La presente investigación comienza con la enumeración de los distintos elementos que se encuentran presentes en los Programas de Innovación Abierta. De esta manera, se describen los diversos elementos que se han identificado a través de la revisión de la literatura académica que se ha llevado a cabo. En función de una serie de características comunes, los distintos elementos se agrupan en cuatro niveles diferentes para lograr un mejor entendimiento de los Programas de Innovación Abierta. A continuación se detallan estos elementos § Organización del Programa. En primer lugar se menciona la existencia de una estructura organizativa capaz de cumplir una serie de objetivos establecidos previamente. Por su naturaleza de innovación abierta deberá existir cierto grado de interacción entre los distintos miembros que participen en el proceso de innovación. § Talento Interno. El talento interno asociado a los programas de innovación abierta juega un rol fundamental en la ejecución y éxito del programa. Bajo este nivel se asocian elementos como la cultura de innovación abierta y el liderazgo como mecanismo para entender uno de los elementos que explica el grado de adopción de innovación en una empresa. Estrechamente ligados al liderazgo se encuentran los comportamientos organizacionales como elementos diferenciadores para aumentar las posibilidades de creación de innovación abierta. § Infraestructura. En este nivel se agrupan los elementos relacionados con la infraestructura tecnológica necesaria para llevar a cabo el programa incluyendo los procesos productivos y las herramientas necesarias para la gestión cotidiana. § Instrumentos. Por último, se mencionan los instrumentos o vehículos que se utilizan en el entorno corporativo para implementar innovación abierta. Hay varios instrumentos disponibles como las incubadoras corporativas, los acuerdos de licenciamiento o las áreas de capital de riesgo corporativo. Para este último caso se hará una mención especial por el creciente y renovado interés que ha despertado tanto en el entorno académico como empresarial. Se ha identificado al capital de riesgo corporativo como un de los elementos diferenciales en el desarrollo de la estrategia de innovación abierta de las empresas ya que suele aportar credibilidad, capacidad y soporte tecnológico. Estos cuatro elementos, interactuando de manera conjunta y coordinada, tienen la capacidad de crear, potenciar e incluso desarrollar impulsores de creación de valor que impactan en la estrategia y organización de la empresa y partir de aquí en su desempeño financiero a lo largo del tiempo. Los Impulsores de Creación de Valor Luego de identificar, ordenar y describir los distintos elementos presentes en un Programa de Innovación Abierta se ha avanzado en la investigación con los impulsores de creación de valor. Estos pueden definirse como elementos que potencian o determinan la capacidad de crear valor dentro del entorno empresarial. Como se puede observar, se detallan estos impulsores como punto de interacción entre los elementos del programa y el proceso de creación de valor corporativo. A lo largo de la presente investigación se han identificado 6 impulsores de creación de valor presentes en un Programa de Innovación Abierta. § Nuevos Productos y Servicios. El impulsor de creación de valor más directo y evidente en un Programa de Innovación Abierta es la capacidad de crear nuevos productos y servicios dado que se relacionan directamente con el proceso de innovación de la empresa § Acceso a Mercados Adyacentes. El proceso de innovación también puede ser una fuente de valor al permitir que la empresa acceda a mercados cercanos a su negocio tradicional, es decir satisfaciendo nuevas necesidades de sus clientes existentes o de nuevos clientes en otro mercado. § Disponibilidad de Tecnologías. La disponibilidad de tecnologías es un impulsor en si mismo de la creación de valor. Estas pueden ser tanto complementarias como de apalancamiento de tecnologías ya existentes dentro de la empresa y que tengan la función de transformar parte de los componentes de la estrategia de la empresa. § Atracción del Talento Externo. La introducción de un Programa de Innovación Abierta en una empresa ofrece la oportunidad de interactuar con otras organizaciones del ecosistema y, por tanto, de atraer el talento externo. La movilidad del talento es una característica singular de la innovación abierta. § Participación en un Ecosistema Virtuoso. Se ha observado que las acciones realizadas en el entorno por cualquiera de los participantes también tendrán un claro impacto en la creación de valor para el resto de participantes por lo tanto la participación en un ecosistema virtuoso es un impulsor de creación de valor presente en la innovación abierta. § Tecnología “Dentro--‐Fuera”. Como último impulsor de valor es necesario comentar que la dirección que puede seguir la tecnología puede ser desde la empresa hacia el resto del ecosistema generando valor a partir de disponibilizar tecnologías que no son de utilidad interna para la empresa. Estos seis impulsores de creación de valor, presentes en los procesos de innovación corporativos, tienen la capacidad de influir en la estrategia y organización de la empresa aumentando su habilidad de crear valor. El Proceso de Creación de Valor en las Empresas Luego se ha investigado la práctica de la gestión basada en valor que sostiene la necesidad de alinear la estrategia corporativa y el diseño de la organización con el fin de obtener retornos financieros superiores al resto de los competidores de manera sostenida, y finalmente crear valor a lo largo del tiempo. Se describe como los impulsores de creación de valor influyen en la creación y fortalecimiento de las ventajas competitivas de la empresa impactando y alineando su estrategia y organización. Durante la investigación se ha identificado que las opciones reales pueden utilizarse como una herramienta para gestionar entornos de innovación abierta que, por definición, tienen altos niveles de incertidumbre. Las opciones reales aportan una capacidad para la toma de decisiones de forma modular y flexible que pueden aplicarse al entorno corporativo. Las opciones reales han sido particularmente diseñadas para entender, estructurar y gestionar entornos de múltiples incertidumbres y por ello tienen una amplia aplicación en los entornos de innovación. Se analizan los usos potenciales de las opciones reales como complemento a los distintos instrumentos identificados en los Programas de Innovación Abierta. La Interacción Entre los Programas de Innovación Abierta, los Impulsores de Creación de Valor y el Proceso de Creación de Valor A modo de conclusión del presente trabajo se puede mencionar que se ha desarrollado un marco general de creación de valor en el entorno de los Programas de Innovación Abierta. Este marco general incluye tres elementos fundamentales. En primer lugar describe los elementos que se encuentran presentes en los Programas de Innovación Abierta, en segundo lugar como estos programas colaboran en la creación de los seis impulsores de creación de valor que se han identificado y finalmente en tercer lugar como estos impulsores impactan sobre la estrategia y la organización de la empresa para dar lugar a la creación de valor de forma sostenida. A través de un Programa de Innovación Abierta, se pueden desarrollar los impulsores de valor para fortalecer la posición estratégica de la empresa y su capacidad de crear de valor. Es lo que denominamos el marco de referencia para la creación de valor en un Programa de Innovación Abierta. Se presentará la idea que los impulsores de creación de valor pueden colaborar en generar una estrategia óptima que permita alcanzar un desempeño financiero superior y lograr creación de valor de la empresa. En resumen, se ha desarrollado un modelo de relación que describe el proceso de creación de valor en la empresa a partir de los Programas de Innovación Abierta. Para ello, se han identificado los impulsores de creación de valor y se ha descripto la interacción entre los distintos elementos del modelo. ABSTRACT In a world of constant, accelerating change innovation is fuel for business. Year after year, innovation allows firms to renew and, therefore, advance their long--‐term survival. Undoubtedly, innovation is a key element for the firms’ ability to create value over time. Companies often devote considerable effort and diverse resources to identify innovation alternatives that could fit into their strategy, culture, corporate goals and ambitions. Open innovation refers to a specific approach to innovate by collaborating with other firms operating within the same business ecosystem.2 The term open innovation was pioneered by Henry Chesbrough more than a decade ago to refer to this particular mode of driving corporate innovation. Open innovation is a new paradigm that has attracted academic and business interest for over a decade. Several cases of open innovation from different countries and from different economic sectors are included and reviewed in this document. The main objective of this study is to explain and develop a relationship model between open innovation and value creation. To this end, and as secondary objectives, we have explored the elements of an Open Innovation Program, the drivers of value creation, the process of value creation and, finally, the interaction between these three elements. As a final product of the research we have developed a general theoretical framework for establishing the connection between open innovation and value creation that facilitates the explanation of the interaction between the two. From the case studies we see that open innovation can encompass all sectors of the economy, multiple geographies and varying businesses – large companies, SMEs, including (even) start--‐ups – each with a different relevance within the ecosystem in which they participate. Elements of an Open Innovation Program We begin by listing and describing below the items that can be found in an Open Innovation Program. Many of such items have been identified through the review of relevant academic literature. Furthermore, in order to achieve a better understanding of Open Innovation, we have classified those aspects into four different categories according to the features they share. § Program Organization. An organizational structure must exist with a degree of interaction between the different members involved in the innovation process. This structure must be able to meet a number of previously established objectives. § Internal Talent. Internal talent plays a key role in the implementation and success of any Open Innovation program. An open innovation culture and leadership skills are essential for adopting either radical or incremental innovation. In fact, leadership is closely linked to organizational behavior and it is essential to promote open innovation. § Infrastructure. This category groups the elements related to the technological infrastructure required to carry out the program, including production processes and daily management tools. § Instruments. Finally, we list the instruments or vehicles used in the corporate environment to implement open innovation. Several instruments are available, such as corporate incubators, licensing agreements or venture capital. There has been a growing and renewed interest in the latter, both in academia and business circles. The use of corporate venture capital to sustain the development of the open innovation strategy brings ability, credibility, and technological support to the process. The combination of elements from these four categories, interacting in a coordinated way, makes it possible to create, enhance and develop value creation drivers that may impact the company’s strategy and organization and affect its financial performance over time. The Drivers of Value Creation After identifying describing and categorizing the different elements present in an Open Innovation Program our research examines the drivers of value creation. These can be defined as elements that enhance or determine the ability to create value in the business environment. As can be seen, these drivers can act as interacting points between the elements of the program and the process of value creation. The study identifies six drivers of value creation that might be found in an Open Innovation Program. § New Products and Services. The more direct and obvious driver of value creation in any Open Innovation Program is the ability to create new products and services. This is directly related to the company’s innovation process. § Access to Adjacent Markets. The innovation process can also serve as a source of value by granting access to adjacent markets through satisfying new needs for existing customers or attracting new customers from other markets. § Availability of Technologies. The availability of technology is in itself a driver for value creation. New technologies can either be complementary and/or can leverage existing technologies within the firm. They can partly transform certain elements of the company’s strategy. § External Talent Strategy. Incorporating an Open Innovation Program offers the opportunity to interact with other organizations operating in the same ecosystem and can therefore attract external skilled resources. Talent mobility is a unique feature of open innovation. § Becoming Part of a Virtuous Circle. The actions carried out in the environment by any of its members will also have a clear impact on value creation for the other participants. Participation in a virtuous ecosystem is thus a driver for value creation in an open innovation strategy. § Inside--‐out Technology. Value creation may also evolve by allowing other firms in the ecosystem to incorporate internally developed under--‐utilized technologies into their own innovation processes. These six drivers that are present in the innovation process can influence the strategy and the organization of the company, increasing its ability to create value. The Value Creation Process Value--‐based management is the management approach that requires aligning the corporate strategy and the organizational design to create value and obtain sustained financial returns (at least, higher returns than its competitors). We describe how the drivers of value creation can enhance corporate advantages by aligning its strategy and organization. During this study, we were able to determine that real options can be used as managing tools in open innovation environments which, by definition, have high uncertainty levels. Real options provide capability for flexible and modular decision--‐making in the business environment. In particular, real options have been designed for uncertainty management and, therefore, they may be widely applied in innovation environments. We analyze potential uses of real options to supplement the various instruments identified in the Open Innovation programs. The Interaction Between Open Innovation Programs, Value Creation drivers and Value Creation Process As a result of this study, we have developed a general framework for value creation in Open Innovation Programs. This framework includes three key elements. We first described the elements that are present in Open Innovation Programs. Next, we showed how these programs can boost six drivers of value creation that have been identified. Finally, we analyzed how the drivers impact on the strategy and organization of the company in order to lead to the creation of sustainable value. Through an Open Innovation Program, value drivers can be developed to strengthen a company’s strategic position and its ability to create value. That is what we call the framework for value creation in the Open Innovation Program. Value drivers can collaborate in generating an optimal strategy that helps foster a superior financial performance and a sustained value creation process. In sum, we have developed a relationship model that describes the process of creating value in a firm with an Open Innovation Program. We have identified the drivers of value creation and described how the different elements of the model interact with each other.