Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study

International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.

Anatomy at a Glance

The study of anatomy has changed enormously in the last few decades. No longer do medical students have to spend long hours in the dissecting room searching fruitlessly for the otic ganglion or tracing the small arteries that form the anastomosis round the elbow joint. They now need to know only the basic essentials of anatomy with particular emphasis on their clinical relevance and this is a change that is long overdue. However, students still have examinations to pass and in this book the authors, a surgeon and an anatomist, have tried to provide a means of rapid revision without any frills. To this end, the book follows the standard format of the at a Glance series and is arranged in short, easily digested chapters, written largely in note form, with the appropriate illustrations on the facing page. Where necessary, clinical applications are included in italics and there are a number of clinical illustrations. We thus hope that this book will be helpful in revising and consolidating the knowledge that has been gained from the dissecting room and from more detailed and explanatory textbooks.

How Much “Safety” Is Available under the U.S. Proposal to the WTO?, November 2005

Critics of the U.S. proposal to the World Trade Organization (WTO) made in October 2005 are correct when they argue that adoption of the proposal would significantly reduce available support under the current farm program structure. Using historical prices and yields from 1980 to 2004, we estimate that loan rates would have to drop by 9 percent and target prices would have to drop by 10 percent in order to meet the proposed aggregate Amber Box and Blue Box limits. While this finding should cheer those who think that reform of U.S. farm programs is long overdue, it alarms those who want to maintain a strong safety net for U.S. agriculture. The dilemma of needing to reform farm programs while maintaining a strong safety net could be resolved by redesigning programs so that they target revenue rather than price. Building on a base of 70 percent Green Box income insurance, a program that provides a crop-specific revenue guarantee equal to 98 percent of the product of the current effective target price and expected county yield would fit into the proposed aggregate Amber and Blue Box limits. Payments would be triggered whenever the product of the season-average price and county average yield fell below this 98 percent revenue guarantee. Adding the proposed crop-specific constraints lowers the coverage level to 95 percent. Moving from programs that target price to ones that target revenue would eliminate the rationale for ad hoc disaster payments. Program payments would automatically arrive whenever significant crop losses or economic losses caused by low prices occurred. Also, much of the need for the complicated mechanism (the Standard Reinsurance Agreement) that transfers most risk of the U.S. crop insurance to the federal government would be eliminated because the federal government would directly assume the risk through farm programs. Changing the focus of federal farm programs from price targeting to revenue targeting would not be easy. Farmers have long relied on price supports and the knowledge that crop losses are often adequately covered by heavily subsidized crop insurance or by ad hoc disaster payments. Farmers and their leaders would only be willing to support a change to revenue targeting if they see that the current system is untenable in an era of tight federal budgets and WTO limits.

Determinants of credit risk in secured loans – Evidence from the auto loan industry

The purpose of this study is to examine attributes which have explanation power to the probability of default or serious overdue in secured auto loans. Another goal is to find out differences between defaulted loans and loans which have had payment difficulties but survived without defaulting. 19 independent variables used in this study reflect information available at the time of credit decision. These variables were tested with logistic regression and backward elimination procedure. The data includes 8931 auto loans from a Finnish finance company. 1118 of the contracts were taken by company customers and 7813 by private customers. 130 of the loans defaulted and 584 had serious payment problems but did not default. The maturities of those loans were from one month to 60 months and they have ended during year 2011. The LTV (loan-to-value) variable was ranked as the most significant explainer because of its strong positive relationship with probability of payment difficulties. Another important explainer in this study was the credit rating variable which got a negative relationship with payment problems. Also maturity and car age performed well having both a positive relationship with the probability of payment problems. When compared default and serious overdue situations, the most significant differences were found in the roles of LTV, Maturity and Gender variables.

Child labour in India

This thesis entitled “Child labour in india”Children are "supremely important assets" of the nation, India proudly asserts in the National Policy for Children (1974) gracefully acknowledging that they are future citizens on whose shoulders the destiny of our nation rests.Childhood is a time of discovery as the world and all it contains are new to children. It is a time of excitement and anticipation. lt is a time of dreams and fantasies. And it is a time of receiving love and appreciation. Paradoxically, a picture of contrast is a common experience in India as a vast majority of children who are starved of basic needs of nutrition, health and education are made to work at an early age in exploitative conditions. The specter of child labour is a glaring anomaly in a country graciously adorning human right. In an exposition of the problem involving human rights abuse, Chapters from Two to Five of this study have shot into focus the human rights jurisprudence with special reference to the rights of children. Children have a particular identity as children and they also have a universal identity as human beings.The concern for mankind expressed unequivocally and transcending the globe will be real and moving and not mere rhetoric and ritual if and only when it begins with children, as, to quote the words of Nehru, the human being counts much more as a child than as a grown up.The first three of these rights namely right to health, right to nutritive food and right to education are dealt with in Chapter Four. Finally, the positive effects of education have been sketched in that chapter to impress upon its significance in the development of human capitals.legitimization. The theme of legitimacy was rationalised on the ground of poverty as a strategy for achieving eradication of child labour ultimately by enforcing minimum wages, shorter working hours, leave compensation, non-formal education etc., as the employer would soon discover that child labour is not cheap and would be obliged to substitute adult labour. However, humanising the work life is only a promise to the detriment of children as the Act of 1986 enacted as a part of the new strategy is nearingcompletion of a decade of existence but nowhere near the fulfilment of the mission.As similar urge is more necessary and overdue, it has been suggested that a special body be established with all powers for cognisance of human rights abuse of children.It is proposed to conclude this study with a brief summary of the inferences drawn from the foregoing chapters along with a few suggestions emerging out of those inferences

What are the baselines for protein fold recognition?

What constitutes a baseline level of success for protein fold recognition methods? As fold recognition benchmarks are often presented without any thought to the results that might be expected from a purely random set of predictions, an analysis of fold recognition baselines is long overdue. Given varying amounts of basic information about a protein—ranging from the length of the sequence to a knowledge of its secondary structure—to what extent can the fold be determined by intelligent guesswork? Can simple methods that make use of secondary structure information assign folds more accurately than purely random methods and could these methods be used to construct viable hierarchical classifications?

Benchmarks and the accuracy of GARCH model estimation

This paper reviews nine software packages with particular reference to their GARCH model estimation accuracy when judged against a respected benchmark. We consider the numerical consistency of GARCH and EGARCH estimation and forecasting. Our results have a number of implications for published research and future software development. Finally, we argue that the establishment of benchmarks for other standard non-linear models is long overdue.

Valor percebido e o comportamento do consumidor de supermercado: um estudo exploratório em uma média cidade brasileira

Este estudo esteve envolvido com o desenvolvimento de um modelo para avaliação de valor de supermercado, sob a perspectiva do consumidor. O conceito de valor empregado neste trabalho parte da idéiade que um comportamento somente deve ser levado adiante caso o prazer decorrente seja superior à dor relacionada à obtenção desse prazer. Em Marketing, isto quer dizer que o consumo de determinado bem ou serviço exige do indivíduo uma certa quantidade de sacrifício (sacrifício percebido) para gozar dos benefícios associados (qualidade percebida). Em outras palavras, o consumidor precisa levar em consideração uma série de fatores numa situação de n avaliação e escolha. Para tanto, foram feitas duas consultas a clientes de supermercado do sexo feminino, pertencentes às classes A e B, na cidade de Campo Grande (MS), sendo uma qualitativa (n = 25) e outra quantitativa (n = 200). Os resultados indicam que valor percebido (VP) é uma função linear de qualidade percebida (QP), mas não de sacrifício percebido (SP). Portanto, duas das quatro hipóteses do estudo não foram confirmadas. Cerca de três quartos das mulheres preferem fazer ·uma compra pesada por mês e várias avulsas", aliás comportamento mais evidente nas faixa etárias mais elevadas. Para metade das entrevistadas, fazer compra em supermercado dá mais prazer do que trabalho. A maioria das mulheres que não trabalha fora sente prazer em fazer compra, ao contrário das mulheres que trabalham fora que acham isso uma obrigação. Por último, as mulheres que não trabalham fora, as de idade mais elevada e aquelas que consideram a compra um prazer, valorizam melhor o seu supermercado. O estudotambém permitiu verificar as características determinantes do supermercado que o cliente leva em consideração. Os atributos mais valorizados pelas entrevistadas foram substituiçao de produtos estragados e/ou vencidos e limpeza da loja. No entanto, elas usaram exposiçêo e organizaçao dos produtos, limpeza da loja e qualidade dos produtos hortifrutícolas para perceber valor. Os resultados dos testes de hipóteses parecem indicar que não é necessário o uso de variáveis de baixo nível de percepção (atributos de qualidade e de custo) para medir VP de supermercado. Os três atributos que permaneceram no modelo para explicar VP, através de QP (limpeza da loja, exposiçêo e organizaçao dos produtos e qualidade dos produtos hortifrutlcolas), o fazem moderadamente (R2 = 24,7%). Por outro lado, na avaliação global que as entrevistadas fizeram das lojas, QP (agora como variável independente) apresenta um coeficiente de explicação R 2 = 37,4%, resultadosuperior aoverificado quando a relação se deu com atributos específicos. Entretanto, se os clientes percebem valor apenas se valendo de QP (avaliação global), a formação da percepção de qualidade é feita usando sinais específicos associados ao produto "supermercado", sinais estes que incluem os três atributos que permaneceram no modelo. Assim, um modelo que inclui variáveis de percepção mais elevada (QP e SP) para inferir VP permite responder à seguinte questão: qual é a avaliação global que os clientes fazem de seu supermercado? Por outro lado, um modelo que julga VP a partir de atributos especificos (variáveis de baixo nível de percepção) deve responder à seguinte indagação: como se dá a percepção de valor do cliente em relação ao seu supermercado? Outros resultados são discutidos e também são apresentadas sugestões para futuras pesquisas e as principais implicações acadêmicas e empresariais .

Impactos da regulamentação do pagamento mínimo de cartões de crédito no mercado brasileiro

No Brasil, até junho de 2011, cada banco emissor de cartões de crédito estipulava, por critérios próprios, o percentual mínimo da fatura que deveria ser pago pelo cliente. A partir de julho daquele mesmo ano, o Banco Central do Brasil – BACEN, estabeleceu o percentual de 15% do total da fatura, como valor de pagamento mínimo. Em vista disso, este estudo busca analisar as consequências dessa alteração na política de cartões de crédito. Do ponto de vista teórico, uma política desse tipo pode ter os seguintes efeitos: aumento da inadimplência de curto prazo, alteração do volume financiado e diferentes impactos em anchoring. Para investigar empiricamente esse efeito são utilizadas informações de fatura e pagamento destes clientes, nos momentos anteriores e posteriores à implantação da regulamentação do BACEN. Tal mudança institucional permite identificar, através do método de diferenças em diferenças, os efeitos da nova lei na inadimplência e alteração de volume financiado no curto prazo, provocados pela restrição ao crédito, e anchoring. As estimações indicam que a alteração do mínimo impactou no número de clientes em atraso, também é observada uma redução no volume financiado dos clientes que pagavam mais que 20% da fatura. Por outro lado, não são observadas variações na quantidade de clientes que pagaram mais que o mínimo exigido na regulamentação. Este resultado indica que a elevação do mínimo está positivamente correlacionada com o volume de pagamento para clientes que costumam fazer pagamentos superiores a 20% e aumenta a inadimplência no curto prazo, causada pela elevação do pagamento mínimo.

Agrobiodivesificacion de playas y barreales y su función en la economia familiar ribereña de la Amazônia Peruana

La agrobiodiversidad presente en playas y barreales de la Amazonía Peruana fue estudiada en Muyuy, sector ubicado a tres horas de la ciudad de Iquitos, capital de La Región Loreto. El objetivo de trabajo fue orientado a medir la agrobiodiversidad en estos ambientes dinámicos y su contribución en la economía familiar ribereña. Primeramente, vemos que la actividad agrícola practicada en playas y barreales se da a través de un rol de producción con cultivos de corto periodo vegetativo (arroz, caupí, maní, etc.); esto para disminuir el riesgo provocado por los repiquetes o el nuevo ciclo anual de inundación. Datos levantados en las campañas agrícolas de 1999 y 2004, permiten identificar el establecimiento de 9 y 2 cultivos respectivamente, esta variación se debe al diferente comportamiento de inundación; variación que a la vez influencia la formación de diferentes ambientes como playas y barreales: altos, medios, y bajos. A continuación, vemos que el ambiente de barreal óptimo para la producción de arroz, fue promocionado con créditos agrícolas - 2004; esto implicó consecuentemente la incursión de variedades certificadas o tardías (Inti, Ecoarroz, Jar, Capirona, y Amor 107), sensibles a una inundabilidad rápida como la sucedida en la campaña agrícola 2004. Los resultados muestran que las comunidades SPC, ODN, TPZ, CON y DDM beneficiadas con los créditos y afectadas por la inundabilidad, consiguieron rescatar hasta un 10% de la producción esperada del arroz; aquí, también se encuentran casos de agricultores de las comunidades DDM y MAZ empleando variedades precoces no promocionadas como el Milagrito, consiguiendo rescatar de 50 a 60 % de la producción. Los agricultores que establecieron caupí en playas consiguieron aprovechar aproximadamente 10% de la producción esperada. La inundación que afectó los cultivos cerca al periodo de cosecha creó ambientes propicios para la alimentación y protección de algunas especies de peces y tortugas, esto a la vez aumentó los factores o recursos de aprovechamiento para los agricultores; aquí, se ejecutó la labor de pesca tanto para el consumo general y la comercialización por parte de algunos casos encontrados en las comunidades estudiadas, el más representativo como la familia 11 muestra que a partir de esta labor de pesca consiguió el 2.9% de recuperación en base al cálculo rentable de los cultivos establecidos; y de la captura de tortugas el 3.1%. Se concluye que los cultivos perdidos por inundabilidad pueden ser recuperados en porcentajes más significativos, si se usara manejos adecuados sin alterar los ambientes de producción como ocurre con la aplicación de agroquímicos.

Das moderne Buch: Harry Graf Kesslers Ästhetik der Lebenskunst im Spiegel der Großherzog Wilhelm Ernst Ausgabe deutscher Klassiker

Die Großherzog Wilhelm Ernst Ausgabe deutscher Klassiker wurde seit 1904 bis in die Zwanziger Jahre hinein im Insel Verlag in Leipzig publiziert. Die Buchreihe hat nicht nur für den Verlag und die Druckerei Poeschel in der sie gedruckt wurde eine ganze Reihe von Neuerungen nach sich gezogen, auch für den deutschen Buchmarkt hat die Klassikerausgabe einen Meilenstein bedeutet. Sie hat einige Eigenschaften des Taschenbuches vorweggenommen. Sie orientierte sich an der Qualität bibliophiler Buchpublikationen, aber war dennoch preislich erschwinglich. Zeitgenössische Klassikerausgaben erschienen zumeist mit einem Kommentar. Nicht so die Großherzog Wilhelm Ernst Ausgabe. Der Text wurde zwar von führenden Wissenschaftlern editiert, aber sie war dennoch unkommentiert. Der Text war in einer Jenson-Antiqua gesetzt obwohl die Debatte um individuell gestaltete Künstlerschriften und die Diskussion um die als deutsche Schrift begriffene Fraktur unter den wichtigsten Protagonisten des deutschen Buchgewerbes ihren Höhepunkt noch nicht erreicht hatte. Ziel für die Klassikerausgabe war darüber hinaus, das zur Jahrhundertwende leicht angestaubte Image der Stadt Weimar aufzupolieren. Über das Patronat des Großherzogs hinaus hätte man die Gewinne aus dem Verkauf der Bücher der Permanenten Ausstellung für die Anschaffung von modernen Kunstobjekten zur Verfügung stellen wollen, die unter der Leitung von Harry Graf Kessler stand. Sieht man den Inhalt der Werke der in der Klassikerreihe erschienen Dichter Goethe, Schiller und Körner in einem ästhetischen Kontext mit dem der Philosophen Schopenhauer und Kant, wird im Spiegel der Formalästhetik der Klassikerausgabe Graf Kesslers Bildungs- und Kulturbegriff erkennbar, der sich in den Jahren nach der Jahrhundertwende zu seinem Lebenskunstideal verdichtete. Der zerrütteten Existenz der Zeitgenossen, wie Friedrich Nietzsche sie beschrieben hatte, sollte der Inhalt der Ausgabe in seiner modernen Form eine moderne Wertehaltung entgegensetzen. Die Lektüre der Klassiker sollte den deutschen Philister „entkrampfen“ und ihm ein Stück der verloren geglaubten Lebensfreude wieder zurück bringen, in dem dieser auch die Facetten des Lebensleids als normal hinnehmen und akzeptieren lernte. Die Klassikerausgabe repräsentierte aus diesem Grund auch den kulturellen und politischen Reformwillen und die gesellschaftlichen Vorstellungen die der Graf für ein modernes Deutschland als überfällig erachtete. Die Buchreihe war aus diesem Grund auch ein politisches Statement gegen die Beharrungskräfte im deutschen Kaiserreich. Die Klassikerreihe wurde in der buchhistorischen Forschung zwar als bedeutender Meilenstein charakterisiert und als „wichtiges“ oder gar „revolutionäres“ Werk der Zeit hervorgehoben, die Ergebnisse der Forschung kann man überspitzt aber in der Aussage zusammenfassen, dass es sich bei der Großherzog Wilhelm Ernst Ausgabe um einen „zufälligen Glückstreffer“ deutscher Buchgestaltung zu handeln scheint. Zumindest lassen die Aussagen, die bisher in dieser Hinsicht gemacht wurden, keine eindeutige Einordnung zu, außer vielleicht der, dass die Klassiker von der englischen Lebensreform inspiriert wurden und Henry van de Velde und William Morris einen Einfluss auf ihre äußere Form hatten. Gerade die Gedankenansätze dieser Beiden nutzte Graf Kessler aber für eigene Überlegungen, die ihn schließlich auch zu eigenen Vorstellungen von idealer Buchgestaltung brachten. Da für Kessler auch Gebrauchsgegenstände Kunst sein konnten, wird das Konzept der Klassikerausgabe bis zur Umsetzung in ihrer `bahnbrechenden´ Form in das ideengeschichtliche und ästhetische Denken des Grafen eingeordnet. Die Klassiker werden zwar in buchhistorischen Einzeluntersuchungen bezüglich ihrer Komponenten, dem Dünndruckpapier, ihrem Einband oder der Schrifttype exponiert. In buchwissenschaftlichen Überblicksdarstellungen wird ihr Einfluss hingegen weniger beachtet, denn verschiedene Kritiker bezogen sie seit ihrem ersten Erscheinen nicht als deutsches Kulturgut mit ein, denn sie lehnten sowohl die englischen Mitarbeiter Emery Walker, Edward Johnston, Eric Gill und Douglas Cockerell wie auch ihre Gestaltung als „welsche“ Buchausgabe ab. Richtig ist, die Großherzog Wilhelm Ernst Ausgabe hatte dieselbe Funktion wie die von Graf Kessler in Weimar konzipierten Kunstausstellungen und die dortige Kunstschule unter der Leitung seines Freundes Henry van de Velde. Auch das für Weimar geplante Theater, das unter der Leitung von Hugo von Hofmannsthal hätte stehen sollen und die Großherzog Wilhelm Ernst Schule, hätten dieselben Ideen der Moderne mit anderen Mitteln transportieren sollen, wie die Großherzog Wilhelm Ernst Ausgabe deutscher Klassiker.

The Challenge of Preventing Teen Pregnancy in Texas

A reduction in teen pregnancy and subsequent reduction in teen births correlates to myriad improvements in personal (e.g., high school completion, experience of abuse and neglect, etc); social (e.g., number of children in single parent families, life-long poverty, incarceration rates, etc); and economic (e.g., Medicaid costs, decreased tax revenue, etc) outcomes. In 2005, over 73,000 teen girls in Texas age 15-19 became pregnant, a number significantly higher than any other state. Given the severity of the issue the formation of a statewide organization in Texas devoted to addressing the prevention of teen pregnancy is long overdue. The challenge of reducing teen pregnancy is daunting yet there is momentum and a cadre of committed individuals who have formally put together an organization to provide guidance, oversight and a statewide voice of leadership - all things needed to be successful reducing teen pregnancy in Texas. This commentary provides reactions to proposed strategies and to-date lessons learned.