SMEs and Regional Economic Growth in Brazil

This paper examines the relationship between the Small and Medium Enterprise (SME) sector and economic growth for an annual panel of Brazilian states for the period 1985-2004. We investigate the importance of the relative size of the SME sector measured by the share of the SME employment in total formal employment and the level of human capital in SMEs measured by the average years of schooling of SME employees. The empirical results indicate that the relative importance of SMEs is negatively correlated with economic growth, a result that is consistent with previous studies examining developing countries. In addition, our results also show that human capital embodied in SMEs may be more important for economic growth than the relative size of the SME sector.Firm size, market structure, economic growth, human capital.

Improving the usage of prevention of mother-to-child transmission of HIV services in rural Tanzania

This thesis aims to investigate the use of prevention of mother-to-child transmission (PMTCT) of HIV services in rural Tanzania. Paper A, a systematic literature review of barriers and facilitating factors to the uptake of antiretroviral drugs for PMTCT in sub-Saharan Africa, identified many influencing factors at the level of individuals, their communities and health systems. Paper B discusses the challenges, including lack of unique identification numbers, associated with using routine clinic data for monitoring PMTCT programmes in Africa. Papers C and D use clinic data linked to community HIV cohort data to describe community-level access to PMTCT services among HIVpositive pregnant women. Paper C documented low, but increasing, coverage with PMTCT services in 2005-2012, with weaknesses throughout the PMTCT service continuum. Paper D identified women from remote areas, younger women, and unmarried women as less likely to access PMTCT services. Voluntary counselling and HIV testing before pregnancy, longer duration of HIV-infection, and more recent pregnancies were associated with improved PMTCT service use. Paper E critiques the use of a vignette within a qualitative investigation of barriers to PMTCT service uptake, suggesting that vignettes can be used successfully in rural Africa to draw out barriers to PMTCT service use. The qualitative analysis for paper F revealed a pivotal role for patient-provider interactions in PMTCT service use, through decision-making processes, trust, and features of care. The collective findings highlight the considerable barriers to uptake of PMTCT services that must be tackled in order to successfully eliminate new paediatric HIV infections. Potential positive impacts of ‘Option B+’ (initiating all HIV-positive pregnant women onto life-long antiretroviral therapy) may be limited by these barriers. Addressing health systems issues, particularly stock-outs of HIV test kits, drugs and delivery materials, and improving patient-provider relationships, may have the greatest immediate impact on PMTCT service use in this setting

Development of a diagnostic sensor for measuring blood cell concentrations during haemoconcentration

Background: HemoSep® is a commercial ultrafiltration and haemoconcentration device for the concentration of residual bypass blood following surgery. This technology is capable of reducing blood loss in cardiac and other types of "clean site" procedures, including paediatric surgery. Clinical feedback suggested that the device would be enhanced by including a sensor technology capable of discerning the concentration level of the processed blood product. We sought to develop a novel sensor that can, using light absorption, give an accurate estimate of packed cell volume (PCV). Materials and methods: A sensor-housing unit was 3D printed and the factors influencing the sensor's effectiveness – supply voltage, sensitivity and emitter intensity - were optimised. We developed a smart system, using comparator circuitry capable of visually informing the user when adequate PCV levels (⩾35%) are attained by HemoSep® blood processing, which ultimately indicates that the blood is ready for autotransfusion. Results: Our data demonstrated that the device was capable of identifying blood concentration at and beyond the 35% PCV level. The device was found to be 100% accurate at identifying concentration levels of 35% from a starting level of 20%. Discussion: The sensory capability was integrated into HemoSep's® current device and is designed to enhance the user’s clinical experience and to optimise the benefits of HemoSep® therapy. The present study focused on laboratory studies using bovine blood. Further studies are now planned in the clinical setting to confirm the efficacy of the device

Development of a portable blood salvage and autotransfusion technology to enhance survivability of personnel requiring major medical interventions in austere or military environments

Introduction - Uncontrolled haemorrhage is the leading cause of death on the battlefield, and two-thirds of these deaths result from non-compressible haemorrhage. Blood salvage and autotransfusion represent an alternative to conventional blood transfusion techniques for austere environments, potentially providing blood to the casualty at point of injury. The aim of this paper is to describe the design, development and initial proof-of-concept testing of a portable blood salvage and autotransfusion technology to enhance survivability of personnel requiring major medical interventions in austere or military environments. Method - A manually operable, dual-headed pump was developed that removes blood from site of injury to a collection reservoir (upper pump) and back to casualty (lower pump). Theoretical flow rate calculations determined pump configuration and a three-dimensionally printed peristaltic pump was manufactured. Flow rates were tested with fresh bovine blood under laboratory conditions representative of the predicted clinical environment. Results - Mathematical modelling suggested flow rates of 3.6 L/min and 0.57 L/min for upper and lower pumps. Using fresh bovine blood, flow rates produced were 2.67 L/min and 0.43 L/min. To mimic expected battlefield conditions, upper suction pump flow rate was calculated using a blood/air mixture. Conclusion - The authors believe that this technology can potentially enhance survivability for casualties in austere and deployed military settings through autotransfusion and cell concentration. It reduces negative effects of blood donation on the conventional donor pool, and potentially negates the logistical constraints associated with allogenic transfusions

Regional growth and SMEs in Brazil:a spatial panel approach

Cravo T. A., Becker B. and Gourlay A. Regional growth and SMEs in Brazil: a spatial panel approach, Regional Studies. This paper examines economic growth for a panel of 508 Brazilian micro-regions for the period 1980-2004, using spatial econometrics and paying particular attention to the importance of small and medium-sized enterprises (SMEs). The findings indicate the presence of spatial dependence in the process of economic growth and the existence of two spatial regimes in Brazil. The human capital level of the whole population is an important growth determinant, but does not generate positive spillovers. Furthermore, human capital embodied in SMEs is more important than the size of this sector for regional growth and SME activity generates positive spatial spillovers

Lockdown literacies and semiotic assemblages: academic boundary work in the Covid-19 crisis

In March 2020, populations were forced into home quarantine to curb the spread of the coronavirus. Universities moved the majority of their operations to homeworking, with profound implications for students, academics, and professional services staff. This paper analyses interview and visual data collected as part of a study on the impact of ‘moving online’ on staff at a large UK university. Drawing on sociomaterial perspectives, it considers the status and role of academics’ literacy practices under lockdown, focusing particularly on the ways in which a range of boundaries are negotiated – spatial, temporal, material, digital, professional, personal and emotional – in a setting where conventional boundaries have been profoundly disrupted. We argue that these practices form part of emergent, restless and shifting semiotic assemblages. The paper concludes with a discussion of the implications of this conceptual shift for academic work, meaning-making and academic subjectivities, in lockdown and beyond

Hemodynamics in the pulmonary bifurcation : effect of geometry and boundary conditions

Introduction Pulmonary regurgitation [1] and obstruction in the left pulmonary artery [2], the most common complications affecting adult patients with repaired tetralogy of Fallot, are known to lead to right ventricular dilatation and dysfunction. Long-term pulmonary stenosis is also hypothesized to lead to abnormal lung development and elevated pulmonary vascular resistance [3]. Pulmonary valve replacement is deemed necessary in these patients, but the optimal timing to perform the surgery is still ambiguous [1]. The aim of this study is to numerically investigate the blood flow development in the pulmonary bifurcation of adult patients with congenital heart defects. In this work, we present results from a parametric analysis, where the effect of geometry (branch angle, origin, branch obstruction) and boundary conditions (unsteady flow, Reynolds number, pressure difference at the outlets, and non-Newtonian models) were examined. Methods Blood flow simulations were performed in simplified models of the pulmonary bifurcation, using a validated finite volume scheme in OpenFOAM®. Physiological and pathological conditions were assumed and local velocities, wall shear stress values, velocity and pressure distributions were evaluated. The fluid was considered incompressible and governed by the Newtonian Navier-Stokes equations. The Power Law, CrossPower Law, the Casson, and the Bird-Carreau non-Newtonian models were also investigated. Results & Discussion Blood flow in the pulmonary bifurcation is highly dependent on the local geometrical characteristics and the boundary conditions assumed. Flow separation increases with the branching angle, the branch origin, and stenosis. Branch obstruction and boundary conditions have, further, a significant effect on velocities and shear stresses developed on the vessel wall. The presence of peripheral stenosis and pressure difference at the branch outlets affects significantly the flow splits in the daughter branches. Finally, pressure ratios are considered to provide a good indication of flow discrepancies between the different cases tested. Evaluation of the results on more complex 3D anatomically-correct geometries is necessary. Future work will involve reconstruction of patient-specific models using CT and MRI data from adult patients with congenital heart diseases. More realistic boundary conditions will also be considered, including the pulsatile nature of blood flow and Windkessel models at the branch outlets to account for peripheral resistance. Conclusion Computational fluid dynamics tools have been utilised in this study to investigate the effect of a range of different geometrical characteristics and boundary conditions. The main findings of this study concern a new effect of the branch origin, and a notable branch flow split analysis under conditions of peripheral stenosis and pressure difference in the branch outlets. Acknowledgments This work is supported in part by the University of Strathclyde Research Studentship Scheme (SRSS) Research Excellence Awards (REA), Project No 1208 and the European Union’s Horizon 2020 research and innovation programme, under the Marie Skłodowska-Curie grant agreement No 749185. References 1. Kogon B.E. et al. Seminars in Thoracic and Cardiovascular Surgery 2015; 27:57-64. 2. McElhinney D.B. et al. The Annals of Thoracic Surgery 1998; 65:1120-1126. 3. Harris M.A. et al. Cardiovascular Imaging 2011; 4:506-513

Antimicrobial-related medication safety incidents : a regional retrospective study in West of Scotland hospitals

Medication-related incidents are an important consideration in enhancing patient safety in hospital care. The wide utilisation of antimicrobial therapy in this population renders these medications particularly vulnerable to errors and adverse events. To analyse the characteristics of antimicrobial therapy-related incident reports across a group of secondary care hospitals. Reports for antimicrobial-related incidents from April 2010 to December 2013 were obtained from a regional area of hospitals in National Health Service (NHS) Scotland. Reports were analysed at-large, with subset analyses of incidents resulting in patient harm/injury and those included in a multivariable regression adjusted by occupied bed days (OBD) and defined daily doses (DDD) to better ascertain areas to target for antimicrobial safety. A total of 1345 incidents were reported at a crude rate of 0.98 reports/day (95% CI: 0.93-1.03 reports/day). Penicillins (371 reports; 27.6%), aminoglycosides (358; 26.6%) and glycopeptides (210; 15.6%) were the most commonly involved classes of medications. Most incidents involved no injury/harm (514; 38.2%), but 72 reports (5.4%) did result in patient harm. Rehabilitation/Assessment (RR: 2.61, 95% CI: 1.70-4.03) and Women/Childrens (RR: 2.61, 95% CI: 1.70-4.03) had higher incident reporting rates compared to other hospital services, likely as a function of at-risk patient populations. Among the types of incidents reported, those involving issues with administration/supply were most common (RR: 2.07, 95% CI: 1.51-2.84). Incident reporting for antimicrobials identified several key areas for quality improvement in the hospital setting which can guide safety efforts