The political economy of healthcare litigation : model and empirical application to Uruguay

The political economy of health care is complex, as stakeholders have conflicting preferences over efficiency and equity. This paper formally models the preferences of consumer and producer groups involved in priority setting and judicialization in public health care. It uses a unique dataset of stakeholder perceptions, from Uruguay, to test whether these hypotheses are consistent with empirical evidence. The results suggest that the expectations of the political economy literature are supported: 1) regulators of public healthcare are less concerned with efficiency considerations than consumers; and 2) less organized groups are more concerned about equity than more organized interest groups. With respect to the consequences of health litigation, the findings are only partially consistent with the health care governance literature. Consumers perceive litigation as more beneficial than health care providers and regulators do. Counter-intuitively, powerful interest groups seem less willing to use litigation to shape policy outcomes.Health Systems Development&Reform,Health Monitoring&Evaluation,Health Economics&Finance,Economic Theory&Research,Population Policies

Protective Efficacy of Centralized and Polyvalent Envelope Immunogens in an Attenuated Equine Lentivirus Vaccine

Lentiviral Envelope (Env) antigenic variation and related immune evasion present major hurdles to effective vaccine development. Centralized Env immunogens that minimize the genetic distance between vaccine proteins and circulating viral isolates are an area of increasing study in HIV vaccinology. To date, the efficacy of centralized immunogens has not been evaluated in the context of an animal model that could provide both immunogenicity and protective efficacy data. We previously reported on a live-attenuated (attenuated) equine infectious anemia (EIAV) virus vaccine, which provides 100% protection from disease after virulent, homologous, virus challenge. Further, protective efficacy demonstrated a significant, inverse, linear relationship between EIAV Env divergence and protection from disease when vaccinates were challenged with viral strains of increasing Env divergence from the vaccine strain Env. Here, we sought to comprehensively examine the protective efficacy of centralized immunogens in our attenuated vaccine platform. We developed, constructed, and extensively tested a consensus Env, which in a virulent proviral backbone generated a fully replication-competent pathogenic virus, and compared this consensus Env to an ancestral Env in our attenuated proviral backbone. A polyvalent attenuated vaccine was established for comparison to the centralized vaccines. Additionally, an engineered quasispecies challenge model was created for rigorous assessment of protective efficacy. Twenty-four EIAV-naïve animals were vaccinated and challenged along with six-control animals six months post-second inoculation. Pre-challenge data indicated the consensus Env was more broadly immunogenic than the Env of the other attenuated vaccines. However, challenge data demonstrated a significant increase in protective efficacy of the polyvalent vaccine. These findings reveal, for the first time, a consensus Env immunogen that generated a fully-functional, replication-competent lentivirus, which when experimentally evaluated, demonstrated broader immunogenicity that does not equate to higher protective efficacy

Envelope Determinants of Equine Lentiviral Vaccine Protection

Lentiviral envelope (Env) antigenic variation and associated immune evasion present major obstacles to vaccine development. The concept that Env is a critical determinant for vaccine efficacy is well accepted, however defined correlates of protection associated with Env variation have yet to be determined. We reported an attenuated equine infectious anemia virus (EIAV) vaccine study that directly examined the effect of lentiviral Env sequence variation on vaccine efficacy. The study identified a significant, inverse, linear correlation between vaccine efficacy and increasing divergence of the challenge virus Env gp90 protein compared to the vaccine virus gp90. The report demonstrated approximately 100% protection of immunized ponies from disease after challenge by virus with a homologous gp90 (EV0), and roughly 40% protection against challenge by virus (EV13) with a gp90 13% divergent from the vaccine strain. In the current study we examine whether the protection observed when challenging with the EV0 strain could be conferred to animals via chimeric challenge viruses between the EV0 and EV13 strains, allowing for mapping of protection to specific Env sequences. Viruses containing the EV13 proviral backbone and selected domains of the EV0 gp90 were constructed and in vitro and in vivo infectivity examined. Vaccine efficacy studies indicated that homology between the vaccine strain gp90 and the N-terminus of the challenge strain gp90 was capable of inducing immunity that resulted in significantly lower levels of post-challenge virus and significantly delayed the onset of disease. However, a homologous N-terminal region alone inserted in the EV13 backbone could not impart the 100% protection observed with the EV0 strain. Data presented here denote the complicated and potentially contradictory relationship between in vitro virulence and in vivo pathogenicity. The study highlights the importance of structural conformation for immunogens and emphasizes the need for antibody binding, not neutralizing, assays that correlate with vaccine protection. © 2013 Craigo et al

Measuring Population Care Performance: Development of the Population-Patient Satisfaction Survey for Use with Community Groups

Background: Assessing the satisfaction of the “population-patient” requires conceptualizing the dimensions of satisfaction differently from that of individual patients. Purpose: The focus of this study was to develop and pilot test a short questionnaire that can reliably assess satisfaction with the care provided by public health nurses (PHNs) carrying out population-level activities in their communities. Methods: An instrument-development approach was used. With input from five experts, items were developed to assess seven dimensions of population-patient satisfaction, and then refined before use in the community with a convenience sample of community participants recruited by PHNs in six counties across two states. The pilot yielded 134 surveys collected on 28 different dates over 5 years. Analysis included calculating the means and alpha reliability of each satisfaction dimension and the overall satisfaction. Results: All dimensions except communication (alpha 0.68) had an alpha reliability above 0.80. The enthusiasm dimension received the highest rating (mean=4.6, SD=0.60). The respect dimension had the lowest rating (mean=4.3, SD=0.80). Significant differences between the two states (n=32, n=97) were found for values (p=0.02) and communication (p=0.03). Analysis of variance showed significant differences by local health departments (LHDs) on values (p=0.001), enthusiasm (p=0.002), and communication (p=0.02). Although the enthusiasm subscale seemed to be the highest for most LHDs, no clear pattern of strengths and weaknesses per LHD emerged. Implications: Data from using the Population Patient Satisfaction Survey can be used to identify perceptions of the community regarding the quality of population-focused activities and thus areas for improvement which would then enhance community health

P03-01. The relationship of envelope evolution to lentiviral persistence and vaccine efficacy

We recently reported a direct, inverse, significant linear correlation of Env divergence from our live-attenuated vaccine strain (EIAVD9) and protection from disease. This marked effect of Env variation or viral evolution on vaccine efficacy begged the current questions: what is the relationship of Env variation and viral evolution to vaccine efficacy and does the evolution of virus in inapparent carriers differ from the evolution of attenuated vaccine viruses? Hence we further examined this relationship of Env divergence, evolution, and vaccine efficacy via investigations into Env evolution during inapparent infections, the elimination of ancestral viral species in infected ponies, and EIAVD9 day of challenge (DOC) evolution association with vaccine protection

The incidence of Escherichia coli in dairy products from retail markets in the Stellenbosch region

Thesis (MScFoodSc)--Stellenbosch University, 2024.ENGLISH ABSTRACT: Several foodborne outbreaks linked to Escherichia coli (E. coli) have been reported and documented internationally and the source of many of the outbreaks were milk and milk products. Milk from the mammary gland is normally sterile, however, it can contain microorganisms from various sources during production, processing and distribution. The purpose of this research project was to investigate the incidence of E. coli in some of the dairy products sold at retail markets in the Stellenbosch region and to identify any risk factors. A total of 83 samples were sourced and analysed to determine the microbial load and the presence of coliforms and incidence and presence of Escherichia coli in raw milk, pasteurised milk, fresh cream and plain yoghurt. Standard methods were used to determine the microbial load and presence of coliforms and E. coli in the products. The products were chosen according to predetermined criteria. Standard Plate Count was used to determine the microbial load and International Dairy Federation method 73A of 1985 was used for the coliforms and E. coli enumeration. Coliform and E. coli plates were examined under UV light after incubation and all fluorescent colonies were regarded as positive for E. coli. The incidence of E. coli was 50% in the raw milk samples (n=20) and absent in all other products (pasteurised milk, fresh cream and plain yoghurt). However, plain yoghurt was the only product that contained no coliforms or E. coli in any of the samples analysed. When evaluated according to the standards prescribed in the Foodstuffs, Cosmetics and Disinfectant’s Act, 1972 (Act No. 54 of 1972), published under Government Notice No. R.1555 of 21 November 1997, 85%, 25% and 47% of samples were non-compliant to coliform standards for raw milk, pasteurised milk and fresh cream respectively. The incidence of E. coli in milk and milk products can be attributed to several risk factors like animal health, housing and husbandry practices, cleaning of equipment, hygiene of personnel, cooling conditions and transport, processing and distribution conditions. The results indicate more emphasis should be placed on hygienic and cooling conditions during all stages of production, processing and distribution.AFRIKAANSE OPSOMMING: Verskeie voedselgebaseerde uitbrake wat aan Escherichia coli (E. coli) gekoppel kan word, is internasionaal aangemeld en gedokumenteer, en die bron van baie van die uitbrake is melk en melkprodukte. Melk vanuit die melkklier is gewoonlik steriel, maar dit kan mikroorganismes vanaf verskeie bronne bevat tydens produksie, verwerking en verspreiding. Die doel van hierdie navorsingsprojek was om die voorkoms van E. coli in sommige van die suiwelprodukte wat by kleinhandel markte in die Stellenbosch area verkoop word te ondersoek en dan enige risikofaktore te identifiseer. ‘n Totaal van 83 monsters is verkry en ontleed om die mikrobiese lading en die teenwoordigheid van kolivorme en voorkoms en teenwoordigheid van Escherichia coli in rou melk, gepasteuriseerde melk, vars room en gewone jogurt te bepaal. Standaardmetodes is gebruik om die mikrobiese lading te bepaal asook die teenwoordigheid van kolivorme en E. coli en die produkte is volgens voorafbepaalde kriteria gekies. Standaardplaattelling is gebruik om die mikrobiese lading te bepaal en die Internationale Suiwelfederasie metode 73A van 1985 is gebruik vir die kolivorme en E. coli analises. Kolivorm en E. coli plate is onder UV-lig ondersoek na inkubasie en alle fluoresserende kolonies is as positief vir E. coli beskou. Die voorkoms van E. coli was 50% in die rou melkmonsters (n=20) en afwesig in alle ander produkte (gepasteuriseerde melk, vars room en gewone jogurt). Gewone jogurt was die enigste produk wat geen kolivorme of E. coli bevat het in enige van die monsters wat ontleed is nie. Wanneer geevalueer volgens die standaarde voorgeskryf in die Wet op Voedsel, Skoonheidsmiddels en Ontsmettingsmiddels, 1972 (Wet No. 54 van 1972), gepubliseer onder Goewermentskennisgewing No. R1555 van 21 November 1997, het 85%, 25% en 47% van die monsters nie voldoen aan die kolivorm standaarde vir rou melk, gepasteuriseerde melk en vars room, onderskeidelik nie. Die voorkoms van E. coli in melk en melkprodukte kan toegeskryf word aan verskeie risikofaktore soos dieregesondheid, behuising en boerderypraktyke, skoonmaak van toerusting, higiëne van personeel, verkoelings en vervoertoestande, asook verwerkings en verspreidingstoestande. Die resultate dui daarop dat meer klem op higiëniese en verkoelingstoestande tydens alle stadiums van produksie, verwerking en verspreiding geplaas moet word.Master

Burnout estudiantil y calidad de vida en estudiantes de la facultad de ciencias económicas de una universidad privada de Trujillo

Se ha realizado un estudio correlacional entre burnout estudiantil y calidad de vida en estudiantes de la Facultad de Ciencias Económicas de una universidad privada de Trujillo. Para ello se trabajó con una muestra de 247 estudiantes de las carreras de Administración, Contabilidad y Economía y negocios internacionales, varones y mujeres, con edades entre 18 y 23 años, con matricula vigente en el ciclo académico 2017-II., empleando para su evaluación la Escala unidimensional del burnout estudiantil (EUBE) de Barraza (2009) y la Escala de Calidad de Vida de Olson y Barnes (1982). Los resultados muestran, que en los estudiantes predomina un nivel medio de Burnout Estudiantil y sus dimensiones, con porcentajes que oscilan entre 37.7% y 40.5%. Asimismo, predomina un nivel medio de Calidad de Vida y sus dimensiones, con porcentajes que oscilan entre 49.8% y 55.1%. En cuanto al análisis relacional, se encontró una correlación muy significativa, negativa y en grado medio, entre Burnout Estudiantil y Calidad de Vida en los sujetos de estudio. Por otro lado, existe correlación muy significativa (p<.01), negativa y en grado medio, entre la dimensión Indicadores Comportamentales del Burnout Estudiantil y las dimensiones Hogar y Bienestar Económico, Amigos, Vecindario y Comunidad, Vida familiar y Familia Extensa, Educación y Ocio y Salud de la Calidad de Vida. De igual manera, se encontró una correlación muy significativa (p<.01), negativa y en grado medio, entre la dimensión Indicadores Actitudinales del Burnout Estudiantil y las dimensiones de la Calidad de Vida.A correlational study has been conducted between student burnout and quality of life in students of the Faculty of Economics of a private university in Trujillo. To this end, a sample of 247 students from the Administration, Accounting and Economics and international business courses, male and female, aged between 18 and 23 years old, with current enrollment in the academic year 2017-II. Was employed evaluation of the one-dimensional Scale of student burnout (EUBE) of Barraza (2009) and the Quality of Life Scale of Olson and Barnes (1982). The results show that in the students there predominates an average level of Student Burnout and its dimensions, with percentages ranging between 37.7% and 40.5%. Likewise, an average level of Quality of Life and its dimensions predominate, with percentages ranging between 49.8% and 55.1%. Regarding the relational analysis, a very significant, negative and medium degree correlation was found between Student Burnout and Quality of Life in the study subjects. On the other hand, there is a very significant correlation (p <.01), negative and in medium degree, between the Behavioral Indicators of Student Burnout dimension and the dimensions Home and Economic Wellbeing, Friends, Neighborhood and Community, Family Life and Extended Family, Education and Leisure and Health of the Quality of Life. Similarly, a very significant (p <.01), negative and medium grade correlation was found between the Attitudinal Indicators of Student Burnout dimension and the Quality of Life dimensions.Tesi

« For both Cross and Flag »

IntroductionThe separation of church and state has been a central principle of American life since the Bill of Rights became part of the Constitution in 1791. However, the interconnection of politics and religion predated the Constitution by more than a century, and today Americans continue to debate the extent to which religious faith should guide public policy. This essay seeks to recover a forgotten chapter of this aspect of American cultural history by telling the story of the origins, de..

Liberal and Conservative Visions in United States Politics since 1945: Cultural Politics, the Politics of Inclusion, and Two California Cases

Contemporary American political culture is filled with complexity, defies simple characterizations, and manifests an uneasy tension between recognizing (even honoring) cultural diversity and practicing (even celebrating) class inequality.  The belief in social inclusivity has increased and so has the belief in direct democracy, while at the same time increasing numbers of Americans have lost faith in government and converted to the religion of the free market. The half century since the beginning of the Sixties, a decade associated with hyper-liberalism, has witnessed a steady increase in the appeal of conservatism.  In the name of individual freedom, some Americans question government’s right to monitor racial discrimination, while others challenge government’s right to legalize same-sex marriages.  This paper will begin with a review of cultural politics and conservatism in American political culture, and then it will analyze recent research on the use of direct democracy by the opponents and proponents of affirmative action and same sex marriage, with a particular focus on the California experience.  The paper will conclude with a reflection on how these contests may relate to the theory and practice of multicultural citizenship in the United States and other pluralist democracies. La culture politique américaine contemporaine est pleine de complexité, elle met au défi les classifications simples et manifeste une tension forte entre reconnaître (voire honorer) la diversité culturelle et pratiquer (voire célébrer) l’inégalité de classe. La croyance dans l’absence de discrimination sociale, de même que la croyance dans la démocratie directe, ont augmenté, alors que dans le même temps un nombre croissant d’Américains ont perdu la foi dans le gouvernement et se sont convertis à la religion du marché libre. Le demi-siècle qui a suivi les années 1960, une décennie associée à l’hyper-libéralisme, a été le témoin d’une montée constante de l’attrait pour le conservatisme. Au nom de la liberté individuelle, des Américains mettent en cause le droit du gouvernement à contrôler la discrimination raciale, tandis que d’autres contestent le droit du gouvernement à légaliser le mariage homosexuel. Cet article étudie, dans un premier temps, les politiques culturelles et le conservatisme dans la culture politique américaine, puis il analyse, dans un second temps, les recherches récentes sur l’usage de la démocratie directe par les opposants et les partisans de la discrimination positive et du mariage homosexuel, en s’attachant plus particulièrement à l’expérience californienne. En conclusion est proposée une réflexion sur les liens pouvant exister entre ces contestations et la théorie et pratique de la citoyenneté multiculturelle aux États-Unis et dans les autres démocraties pluralistes

Pool spacing in San Gregorio Creek, California

Field surveys in pool-riffle channel types within mainstem San Gregorio Creek show that pool formation is driven in large part by flow obstructions that were exposed as a result of channel incision and widening, such as exposed bedrock outcrops and undercut banks hardened with exposed root systems. The depth, cover and complexity of these pools are generally much lower than the pools formed by Large Woody Debris in the study reaches. The pool spacing for the three sites is relatively high, averaging 3.5 pools per channel width which can be attributed in part to the low LWD frequency which averages 0.06 LWD pieces per meter across the three sites. When observed pool spacing and LWD frequency values in San Gregorio Creek are compared with those predicted using a regression equation based on a variety of Washington and southeast Alaskan stream channel types, the pool spacing is overestimated and LWD frequency is underestimated by a factor of roughly 3. This is due in part to the high proportion of often low quality pools formed by obstructions rather than LWD