Search

Analysts predict impending shortages in the health care workforce, yet wages for health care workers already account for over half of U.S. health expenditures. It is thus increasingly important to adequately plan to meet health workforce demand at reasonable cost. Using infinite linear programming methodology, we propose an infinite-horizon model for health workforce planning in a large health system for a single worker class, e.g. nurses. We give a series of common-sense conditions any system of this kind should satisfy, and use them to prove the optimality of a natural lookahead policy. We then use real-world data to examine how such policies perform in more complex systems; in particular, our experiments show that a natural extension of the lookahead policy performs well when incorporating stochastic demand growth.

Prédiction du gène au phénotype par une approche couplant génétique quantitative et écophysiologie. (rapport de stage) Nous proposons une nouvelle approche permettant d’identifier les combinaisons alléliques pouvant apporter un gain génétique dans des conditions de cultures données. En alliant un modèle génétique d’association avec un modèle de culture, nous pouvons ainsi prédire des traits phénotypiques complexes à partir du génotype. Pour cela, 14 marqueurs génétiques ont été sélectionnés par association sur 7 caractères phénotypiques d’entrée du modèle de culture SUNFLO mesurés sur 5 expériences en champ et une en conditions contrôlées. Les effets des allèles à ces marqueurs sont utilisés pour construire les caractères phénotypiques potentiels utilisés en variable d’entrée du modèle de culture. Ce modèle prédit des traits complexes (rendement et contenu en huile) en fonction de l’environnement et de la conduite de culture dans trois dispositifs : les environnements ayant servi à l’analyse génétique, un environnement indépendant et une population d’environnements virtuels représentant l’aire de culture du tournesol ces dix dernières années. La comparaison des données simulées et des données observées à mis en évidence une bonne capacité prédictive du modèle SUNFLO sur la population utilisée en génétique pour le contenu en huile à l’inverse du rendement. La prédiction du rendement sur la population d’environnements virtuels permet de mettre en évidence le lien fort entre rendement et stabilité. Trois SNPs sont plus fréquents dans les génotypes avec de forts rendements, les deux associés à l’indic de récolte et un à la date de maturité. Nous avons également identifié dix SNPs permettant un compromis optimal entre rendement et stabilité. Les caractères phénotypiques importants pour ce compromis sont l’indice de récolte, la précocité (date de floraison et date de maturité) et l’architecture (nombre de feuilles et position de la plus grande

Prédiction du gène au phénotype par une approche couplant génétique quantitative et écophysiologie. (rapport de stage) Nous proposons une nouvelle approche permettant d’identifier les combinaisons alléliques pouvant apporter un gain génétique dans des conditions de cultures données. En alliant un modèle génétique d’association avec un modèle de culture, nous pouvons ainsi prédire des traits phénotypiques complexes à partir du génotype. Pour cela, 14 marqueurs génétiques ont été sélectionnés par association sur 7 caractères phénotypiques d’entrée du modèle de culture SUNFLO mesurés sur 5 expériences en champ et une en conditions contrôlées. Les effets des allèles à ces marqueurs sont utilisés pour construire les caractères phénotypiques potentiels utilisés en variable d’entrée du modèle de culture. Ce modèle prédit des traits complexes (rendement et contenu en huile) en fonction de l’environnement et de la conduite de culture dans trois dispositifs : les environnements ayant servi à l’analyse génétique, un environnement indépendant et une population d’environnements virtuels représentant l’aire de culture du tournesol ces dix dernières années. La comparaison des données simulées et des données observées à mis en évidence une bonne capacité prédictive du modèle SUNFLO sur la population utilisée en génétique pour le contenu en huile à l’inverse du rendement. La prédiction du rendement sur la population d’environnements virtuels permet de mettre en évidence le lien fort entre rendement et stabilité. Trois SNPs sont plus fréquents dans les génotypes avec de forts rendements, les deux associés à l’indic de récolte et un à la date de maturité. Nous avons également identifié dix SNPs permettant un compromis optimal entre rendement et stabilité. Les caractères phénotypiques importants pour ce compromis sont l’indice de récolte, la précocité (date de floraison et date de maturité) et l’architecture (nombre de feuilles et position de la plus grande

Most theories of legislative behaviour explain the behaviour of MPs through electoral incentives. However, they fail to explain variation in parliamentary activity when individual electoral incentives are largely absent. This article studies MPs’ activity in such a parliament: the Dutch Tweede Kamer. It examines four clusters of incentives that may drive parliamentarians to be active. Party and committee environments provide the best explanation for the level of activity of individual MPs. Reselection and promotion prospects explain MPs’ behaviour, but only under more particular specifications. Re-election prospects were not found to affect activity levels.

The contribution advances a theoretical conceptualization of the bureaucratic autonomy of international secretariats and suggests an empirical yardstick for its measurement. The proposed concept of bureaucratic autonomy focuses on administrative structures and provides an indicator-based approximation for the bureaucratic capacities of international organizations in order to systematically reveal variation in intra-organizational potential for autonomous bureaucratic behaviour. The usefulness and limitations of the concept are discussed in light of an empirical examination of 15 international secretariats.

Although we find considerable literature on international organizations and their bureaucratic interior, there has been little effort to systematically synthesize empirical research across the different academic disciplines examining how international bureaucracies affect policy-making at an international level. This contribution reviews existing research on the policy influence of international bureaucracies published during the past 50 years. Applying a keyword-based search strategy allows us to identify a core body of 83 books and articles. We find a general consensus in the literature that international bureaucrats do influence policy-making, though this influence varies with the political salience and scope of the decision at question. Yet there is still much disagreement about other context factors, including mechanisms and behavioural assumptions. The contribution advances the state of the art by extracting major disputes – mostly linked to diverging disciplinary perspectives – and existing gaps in the literature, and by suggesting areas for future research.

Objective: This article aims to evaluate the safety performance of cable median barriers on freeways in Florida. Method: The safety performance evaluation was based on the percentages of barrier and median crossovers by vehicle type, crash severity, and cable median barrier type (Trinity Cable Safety System [CASS] and Gibraltar system). Twenty-three locations with cable median barriers totaling about 101 miles were identified. Police reports of 6,524 crashes from years 2005–2010 at these locations were reviewed to verify and obtain detailed crash information. A total of 549 crashes were determined to be barrier related (i.e., crashes involving vehicles hitting the cable median barrier) and were reviewed in further detail to identify crossover crashes and the manner in which the vehicles crossed the barriers; that is, by either overriding, underriding, or penetrating the barriers. Results: Overall, 2.6% of vehicles that hit the cable median barrier crossed the median and traversed into the opposite travel lane. Overall, 98.1% of cars and 95.5% of light trucks that hit the barrier were prevented from crossing the median. In other words, 1.9% of cars and 4.5% of light trucks that hit the barrier had crossed the median and encroached on the opposite travel lanes. There is no significant difference in the performance of cable median barrier for cars versus light trucks in terms of crossover crashes. In terms of severity, overrides were more severe compared to underrides and penetrations. The statistics showed that the CASS and Gibraltar systems performed similarly in terms of crossover crashes. However, the Gibraltar system experienced a higher proportion of penetrations compared to the CASS system. The CASS system resulted in a slightly higher percentage of moderate and minor injury crashes compared to the Gibraltar system. Conclusions: Cable median barriers are successful in preventing median crossover crashes; 97.4%

AIM: To describe the use of antimicrobial drugs for food animals in New Zealand, based on sales data reported to government, changes over time, and in comparison with other countries and human use. METHODS: Data were sourced from official government and industry reports covering 26 European countries, Australia, Canada, New Zealand and the United States of America in 2012, the last year data were available for all countries. The data included antimicrobial sales, and animal and human populations. Antimicrobial use was estimated based on the amount of active ingredient sold, per standardised biomass (population correction unit). RESULTS: The estimated usage of antimicrobials for food animals in New Zealand for 2012 was 9.4 mg active ingredient/kg biomass. Total sales of antimicrobials between 2005–14 increased on average by 2.5% or 1.5 tonnes per year. Over the same time total animal biomass decreased by an estimated 4.3%, with the main decrease being in sheep (25%) and beef cattle (17%), while dairy cattle increased (28%). In the countries examined, the estimated usage of antimicrobials in food producing animals in 2012 varied from 3.8 to 341 mg active ingredient/kg biomass, in Norway and Italy, respectively, with use in New Zealand being the third lowest. Usage of antimicrobials for human health in New Zealand in 2012 was estimated at 121 mg active ingredient/kg biomass, being ranked sixteenth of the countries compared. Use in humans was 12.9 times the use in animals. CONCLUSIONS: New Zealand was the third lowest user of antimicrobials in animal production and used much less than in human medicine. This is the first report of baseline data which may be used by the New Zealand animal health industry to develop, and measure success in, approaches to maximise the life of antimicrobials for animal health and welfare. CLINICAL RELEVANCE: New Zealand veterinarians will soon have to make changes to adopt the World Health Organisation’s globa

Despite extensive molecular investigation of adrenal pheochromocytomas, no information is available on their molecular and mismatch repair (MMR) profiles by topographic compartments. Microdissected samples from the peripheral and internal zones of 143 pheochromocytomas from a referral hospital (95 sporadic and 48 associated with multiple endocrine neoplasia type 2A) were selected for loss of heterozygosity and single nucleotide polymorphism analyses. Five polymorphic DNA regions from TP53, RB1, WT1, and NF1 were systematically studied by PCR-denaturing gradient gel electrophoresis. PATIENTS, OUTCOME MEASURES, AND INTERVENTIONS: Pheochromocytomas were classified as malignant (16 sporadic tumors with distant metastases), locally invasive (30 sporadic tumors showing retroperitoneal infiltration only), and benign (all remaining tumors). Statistical differences were evaluated using Fisher's exact test. MMR was assessed by MLH1/MSH2 sequencing and immunostaining in pheochromocytomas with two or more abnormal microsatellites. No interventions were performed in this study. Loss of heterozygosity/single nucleotide polymorphism involved TP53 in 40 of 134 informative cases (29.9%), RB1 in 22 of 106 informative cases (20.8%), WT1 in 32 of 120 informative cases (26.7%), and NF1 in 32 of 80 informative cases (40.0%). More genetic abnormalities involving the peripheral compartment were revealed in 34 pheochromocytomas (23.8%): 12 of 16 malignant, 10 of 30 locally invasive, and 12 of 97 benign. Multiple and coexistent genetic abnormalities characterized malignant pheochromocytomas (P < 0.001), whereas locally invasive pheochromocytomas showed a significantly higher incidence of NF1 alterations (P < 0.001). No mutations were identified in MLH1/MSH2, but MMR proteins significantly decreased in peripheral compartments. Multiple microsatellite alterations and topographic intratumor heterogeneity characterize malignant pheochromocytomas, suggesting a multistep tumorigenes

Zhabenko N, Zhabenko O (2012) Attitudes toward people with HIV/AIDS among medical practitioners and nonmedical specialists in Ukraine. Tobacco Control and Public Health in Eastern Europe 2 (Supplement 1, 2nd conference 'Economics, sociology, theory and practice of public health'):s31-s32 INTRODUCTION: AIDS is the disease that has been stigmatized since its development; stigmatization of people living with HIV is an important barrier to using HIV testing and treatment. It is well known, that stigma is associated with mental disorders including depression and anxiety. Ukraine is a country with one of the highest number of annual HIV infection cases. GOALS: The goal of this study was to evaluate medical practitioners’ (surgeons, psychiatrists, therapists and students) and nonmedical specialists’ attitude toward people with HIV/AIDS. METHODS: A total of 180 individuals participated in the study. Acceptance of people who have AIDS or are infected with HIV was assessed with the help of the “Attitudes toward people with HIV or AIDS”. Total scores range from 50 to 10, higher scores indicate high acceptance of persons with HIV/AIDS. RESULTS: Younger participants reported higher acceptance of persons with HIV or AIDS (p.05). Medical practitioners showed greater total score, compare to nonmedical specialists (38.0 ± 6.0 vs. 34.0 ± 5.5, respectively, p CONCLUSION: In this study we evaluated the level of attitudes toward people with HIV or AIDS in Ukraine. Young age and medical education were significantly associated with the positive attitudes toward people with HIV and AIDS. Our findings are important for the programs reducing the stigma and discrimination that should be addressed to the wide layers of the society.

Superficial transitional cell carcinomas (TCC) of the urinary bladder have been shown to be monoclonal. However, no combined study of clonality and tumor suppressor genes (TSG) is available to date for muscle-invasive TCC. Forty-four muscle-invasive TCC of the urinary bladder selected from women were included in this study. Tumor cells located above and below the muscularis mucosa zone were systematically microdissected and used for DNA extraction. Hha-I digested and undigested samples were used to study the methylation pattern of androgen receptor alleles and undigested samples were used for microsatellite analysis of TSG (TP53, RB1, WT1, and NF1). Both loss of heterozygosity (LOH) and single nucleotide polymorphism (SNP) analyses were performed using optimized denaturing gradient gel electrophoresis. The expression of p53, pRB, and p21WAF1 was assessed by immunohistochemistry. Appropriate controls were run in every case. All except two TCC showed a monoclonal pattern with the same allele inactivated in both compartments. Microsatellite analysis of TSG revealed the same LOH/SNP pattern in both tumor compartments in 30 cases (involving more than 1 TSG locus in 8) and genetic heterogeneity in 14 cases. From the latter group, 9 cases expressed more genetic changes in the deep compartment (involving TP53 gene in all cases, WT1 gene in 2, and NF1 in 1), whereas in 4 cases the superficial compartment showed more genetic changes (three involving NF1 and one involving both RB and TP53). No statistical difference in the immunoexpression was detected, although it tended to be higher in the superficial compartment than in the deep compartment. These concordant data in polymorphic DNA regions indicate that bladder-muscle-invasive TCC are monoclonal proliferations with homogeneous tumor cell selection. Heterogeneous tumor cell selection by topography defined two different genetic compartments: superficial, NF1-defective, and deep, TP53-defective. No differences in the immuno

Despite extensive molecular investigation of adrenal pheochromocytomas, no information is available on their molecular and mismatch repair (MMR) profiles by topographic compartments. Microdissected samples from the peripheral and internal zones of 143 pheochromocytomas from a referral hospital (95 sporadic and 48 associated with multiple endocrine neoplasia type 2A) were selected for loss of heterozygosity and single nucleotide polymorphism analyses. Five polymorphic DNA regions from TP53, RB1, WT1, and NF1 were systematically studied by PCR-denaturing gradient gel electrophoresis. PATIENTS, OUTCOME MEASURES, AND INTERVENTIONS: Pheochromocytomas were classified as malignant (16 sporadic tumors with distant metastases), locally invasive (30 sporadic tumors showing retroperitoneal infiltration only), and benign (all remaining tumors). Statistical differences were evaluated using Fisher's exact test. MMR was assessed by MLH1/MSH2 sequencing and immunostaining in pheochromocytomas with two or more abnormal microsatellites. No interventions were performed in this study. Loss of heterozygosity/single nucleotide polymorphism involved TP53 in 40 of 134 informative cases (29.9%), RB1 in 22 of 106 informative cases (20.8%), WT1 in 32 of 120 informative cases (26.7%), and NF1 in 32 of 80 informative cases (40.0%). More genetic abnormalities involving the peripheral compartment were revealed in 34 pheochromocytomas (23.8%): 12 of 16 malignant, 10 of 30 locally invasive, and 12 of 97 benign. Multiple and coexistent genetic abnormalities characterized malignant pheochromocytomas (P < 0.001), whereas locally invasive pheochromocytomas showed a significantly higher incidence of NF1 alterations (P < 0.001). No mutations were identified in MLH1/MSH2, but MMR proteins significantly decreased in peripheral compartments. Multiple microsatellite alterations and topographic intratumor heterogeneity characterize malignant pheochromocytomas, suggesting a multistep tumorigenes

Iakunchykova, O. and T. Andreeva (2012). "Suboptimal parenting practices as a risk factor for adolescent alcohol consumption in Ukraine." Tobacco Control and Public Health in Eastern Europe 2(1): 33-42. BACKGROUND: The objective of this study was to investigate the association between alcohol use by adolescents and relationships with parents/ parenting practices in Ukraine. For this analysis, the nested case-control study design was used with pooled data from 1999, 2003, and 2007 surveys of repeated cross-sectional study “European School Survey Project on Alcohol and other Drugs”. METHODS: Nationally representative sample of classes in Ukrainian secondary schools was used. The target population consisted of all 15-16-year-old students in Ukraine. Complete data were available for 10,494 participants. Main exposures were perceptions of the relationships with one’s mother and father; rule-setting, control, and support provided by parents. Outcome measures were: regular use of alcohol, drinking to the point of intoxication, and age when students start consuming alcohol. Associations between the determinants and outcome measures were analyzed using multivariate binary logistic regression analysis. RESULTS: Adolescents who were not so satisfied with the relationships with their mothers were nearly twice as likely (OR=1.7; 95%CI=1.2-2.5) to have used alcohol 10 or more times during the last 30 days. Adolescents who were not at all satisfied with their relationships with father were at risk of drinking to the point of intoxication at least once during last year (OR=1.4, 95%CI=1.2-1.8). Adolescents whose parents never know whom he/she spends evenings with were nearly twice as likely (OR=1.8, 95%CI =1.3-2.4) to have used alcohol 10 or more times during the last 30 days. However, the relationships between rule-setting by parents, perceived support and alcohol use were not consistent. CONCLUSION(s): This study supports the hypothesis that t

Zenchenko Y, Semigina T, Zhogov I (2012) Policy on donation of blood and its components: the European dimension. Tobacco Control and Public Health in Eastern Europe 2 (Supplement 1, 2nd conference 'Economics, sociology, theory and practice of public health'):s9-s10 policy, donation, blood safety, the EU directives

Zhabenko N, Zhabenko O (2012) Attitudes toward people with HIV/AIDS among medical practitioners and nonmedical specialists in Ukraine. Tobacco Control and Public Health in Eastern Europe 2 (Supplement 1, 2nd conference 'Economics, sociology, theory and practice of public health'):s31-s32 INTRODUCTION: AIDS is the disease that has been stigmatized since its development; stigmatization of people living with HIV is an important barrier to using HIV testing and treatment. It is well known, that stigma is associated with mental disorders including depression and anxiety. Ukraine is a country with one of the highest number of annual HIV infection cases. GOALS: The goal of this study was to evaluate medical practitioners’ (surgeons, psychiatrists, therapists and students) and nonmedical specialists’ attitude toward people with HIV/AIDS. METHODS: A total of 180 individuals participated in the study. Acceptance of people who have AIDS or are infected with HIV was assessed with the help of the “Attitudes toward people with HIV or AIDS”. Total scores range from 50 to 10, higher scores indicate high acceptance of persons with HIV/AIDS. RESULTS: Younger participants reported higher acceptance of persons with HIV or AIDS (p.05). Medical practitioners showed greater total score, compare to nonmedical specialists (38.0 ± 6.0 vs. 34.0 ± 5.5, respectively, p CONCLUSION: In this study we evaluated the level of attitudes toward people with HIV or AIDS in Ukraine. Young age and medical education were significantly associated with the positive attitudes toward people with HIV and AIDS. Our findings are important for the programs reducing the stigma and discrimination that should be addressed to the wide layers of the society.