Land Reform, Efficiency and Rural Institutional Change: theory and stochastic frontier analysis with panel data (1998-2006)

This work deals with land reform in Brazil through an evolutionary and new institutional economics theoretical framework. Firstly, this theoretical underpinning delineates the existence of an intrinsic relation between asset equality and economic efficiency, going against the neoclassical trade-off. From this relation it is established that the utilization of society’s productive forces depends directly on institutional structures and propriety relations. In this sense, the way land reallocations are done, through different land redistribution policies, affects directly the level of agricultural product. The product is dependent on the level of allocative and technical efficiency society is submitted to. However, albeit static effects, society is susceptible to dynamic effects of institutional change. Insofar we develop analytical schematics where land reform is related to rural institutional change. From this schematics we derive the hypothesis that the market based land reform executed in Brazil, as a way to redistribute assets supposedly with a governance structure, system of incentives and complementary institutions to the factor markets, there is a gain in systemic productive efficiency at the microeconomic level. To test this hypothesis we develop a stochastic frontier econometric model with time-varying technical inefficiency effects and panel data. We analyze 106 projects of the Cédula da Terra Program in the states of Bahia, Maranhão, North of Minas Gerais, Pernambuco and Ceará, for the years 2000 and 2006. We conclude that this land reform has partial success in establishing productive organizations that evolve constantly their efficiency, wherein learning-by-doing is fundamental. Additionally, the governance effects are limited – the structure was not devised for institutional change – effects of transaction costs and conventions remain, causing market failure and persistence of inefficient forms of organization.land reform, cédula da terra, brazil, stochastic frontier analysis, evolutionary, institutional economics

Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia

BACKGROUND: Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA. METHODS: A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators' difficulties were defined as secondary outcomes. RESULTS: Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 ± 1.0 vs. 1.7 ± 1.0, p = 0.472) and punctures per station (6.9 ± 3.1 vs. 6.0 ± 2.5, p = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (p = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties. CONCLUSIONS: The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients' comfort and satisfaction.info:eu-repo/semantics/publishedVersio

Reforma Agrária, Eficiência e Mudança Institutional no Campo: análise teórica e de fronteira estocástica com dados em painel (1998-2006)

This work deals with land reform in Brazil through an evolutionary and new institutional economics theoretical framework. Firstly, this theoretical underpinning delineates the existence of an intrinsic relation between asset equality and economic efficiency, going against the neoclassical trade-off. From this relation it is established that the utilization of society’s productive forces depends directly on institutional structures and propriety relations. In this sense, the way land reallocations are done, through different land redistribution policies, affects directly the level of agricultural product. The product is dependent on the level of allocative and technical efficiency society is submitted to. However, albeit static effects, society is susceptible to dynamic effects of institutional change. Insofar we develop analytical schematics where land reform is related to rural institutional change. From this schematics we derive the hypothesis that the market based land reform executed in Brazil, as a way to redistribute assets supposedly with a governance structure, system of incentives and complementary institutions to the factor markets, there is a gain in systemic productive efficiency at the microeconomic level. To test this hypothesis we develop a stochastic frontier econometric model with time-varying technical inefficiency effects and panel data. We analyze 106 projects of the Cédula da Terra Program in the states of Bahia, Maranhão, North of Minas Gerais, Pernambuco and Ceará, for the years 2000 and 2006. We conclude that this land reform has partial success in establishing productive organizations that evolve constantly their efficiency, wherein learning-by-doing is fundamental. Additionally, the governance effects are limited – the structure was not devised for institutional change – effects of transaction costs and conventions remain, causing market failure and persistence of inefficient forms of organization

Reforma Agrária, Eficiência e Mudança Institutional no Campo: análise teórica e de fronteira estocástica com dados em painel (1998-2006)

This work deals with land reform in Brazil through an evolutionary and new institutional economics theoretical framework. Firstly, this theoretical underpinning delineates the existence of an intrinsic relation between asset equality and economic efficiency, going against the neoclassical trade-off. From this relation it is established that the utilization of society’s productive forces depends directly on institutional structures and propriety relations. In this sense, the way land reallocations are done, through different land redistribution policies, affects directly the level of agricultural product. The product is dependent on the level of allocative and technical efficiency society is submitted to. However, albeit static effects, society is susceptible to dynamic effects of institutional change. Insofar we develop analytical schematics where land reform is related to rural institutional change. From this schematics we derive the hypothesis that the market based land reform executed in Brazil, as a way to redistribute assets supposedly with a governance structure, system of incentives and complementary institutions to the factor markets, there is a gain in systemic productive efficiency at the microeconomic level. To test this hypothesis we develop a stochastic frontier econometric model with time-varying technical inefficiency effects and panel data. We analyze 106 projects of the Cédula da Terra Program in the states of Bahia, Maranhão, North of Minas Gerais, Pernambuco and Ceará, for the years 2000 and 2006. We conclude that this land reform has partial success in establishing productive organizations that evolve constantly their efficiency, wherein learning-by-doing is fundamental. Additionally, the governance effects are limited – the structure was not devised for institutional change – effects of transaction costs and conventions remain, causing market failure and persistence of inefficient forms of organization

Anemia grave como apresentação de linfoma T Angioimunoblástico : um caso clínico

Introdução: O linfoma T Angioimunoblástico é uma entidade rara, que representa 1 a 2% dos linfomas não Hodgkin, com envolvimento sistémico associado a fenómenos auto-imunes.1,2 Caracteriza-se por um comportamento agressivo e clinicamente por uma apresentação súbita de sintomas constitucionais, adenomegálias generalizadas, hepatoesplenomegália, anemia e hipergamaglobulinemia.2 Objetivos: Partilhar apresentação de um caso clínico de Linfoma T Angioimunoblástico e suas particularidades transfusionais. Métodos: Observação, exame objectivo e recolha de história clínica junto da doente. Consulta de registos clínicos no programa Sorian e recolha de dados analíticos relevantes nos programas WebAppolo, ASIS e registos de estudos pré-transfusionais realizados no SSMT. Recolha de dados, telefonicamente, junto do IPST, relativamente aos estudos pré-transfusionais realizados no mesmo. Resultados: Doente do sexo feminino, 72 anos, autónoma, sem antecedentes transfusionais, apresentava em consulta de ambulatório queixas de dor abdominal difusa, com três dias de evolução, sem alterações do trânsito intestinal. Exame objectivo sem alterações relevantes. Analiticamente apresentava Hb 11.1 g/dL. Realizou TC abdominal que mostrou “expressão quística parapiélica bilateral, adenomegálias ileo-pélvicas, pequenas adenopatias periaórticas e densificação retroperitoneal”. Duas semanas mais tarde inicia quadro de cansaço para pequenos esforços, associado a anorexia, perda de peso e palidez cutânea, pelo que recorre ao Serviço de Urgência. Apresentava-se hemodinamicamente estável, pálida, com sudorese, apirética, polipneica. Sat O2-97% com 2L/min de O2. Ligeira dor à palpação abdominal nos quadrantes inferiores, sem defesa. Analiticamente: Hb 3.1 g/dL normocitica/normocrómica. Não reunia critérios de anemia hemolítica. Foram requisitadas duas Unidades (U) de Concentrado Eritrocitário (CE). No estudo pré-transfusional, método em gel, encontrou-se: PAI positiva – Poliaglutinação (3+) tanto em meio de LISS/Coombs como enzimático. TAD positivo (Poliespecífico 4+; Monoespecíficos - IgG 4+; IgM 3+; C3c 3+; C3d 4+; Título de IgG 1:100); Provas de compatibilidade (PC), com várias unidades de CE, positivas (de pelo menos 2+) . Foi decidido protelar a transfusão por estabilidade hemodinâmica da doente. No dia seguinte por valor de Hb 2.6g/dL e agravamento do estado clínico, realizou, após administração de Hidrocortisona 200 mg e Clemastina 2mg, transfusão de 1 U de CE compatibilizada no IPST (PC positiva 1+, método em tubo). A transfusão decorreu sem intercorrências, no controlo pós-transfusional (CPT) - Hb 4.0g/dL, com melhoria franca da sintomatologia. Inicia corticoterapia (Prednisolona 1 mg/Kg/dia). Foi de novo transfundida dois dias mais tarde, Hb 3,7 g/dL, tendo sido enviada Unidade do (1U CE - IPST - PC negativa) . Não se registaram intercorrências, CPT - Hb 5.4g/dL. Após 8 dias de Internamento, e a realização de diversos MCDTs foi diagnosticado um Linfoma T Angioimunoblástico. Conclusão: O Linfoma T Angioimunoblástico pode apresentar-se com um quadro clínico inicial de anemia grave, de instalação rápida, que pelas suas características imunologicas, pode obrigar ao adiamento da transfusão. REFERÊNCIAS BIBLIOGRÁFICAS 1- Zão, I., Dias, M., Castro, M., Coutinho, R., Cabral, R., Regadas, L., Casais, C., Xavier, L., Gonçalves, C., Mota, A., Pinho, L., Coutinho, J., . Manifestações auto-imunes do linfoma T angioimunoblástico . , 2017, Reunião Anual SPH, PO47 2- Xu, B., Liu. P., No Survival Improvement for Patients with Angioimmunoblastic T-Cell Lymphoma over the Past Two Decades: A Population-Based Study of 1207 Cases, 2014, PLOS ONE, Volume 9, Issue 3; e92585info:eu-repo/semantics/publishedVersio

Lúpus neonatal

O lúpus eritematoso neonatal (LEN), uma doença imunológica rara, pode manifestar-se por bloqueio cardíaco congénito, erupção cutânea e alterações laboratoriais. Apresenta-se o caso de uma criança com diagnóstico pré-natal de bradidisrritmia, sem cardiopatia estrutural. No primeiro dia de vida, apresentava bradicardia e no electrocardiograma bloqueio aurículo-ventricular (BAV) de segundo grau tipo Mobitz II e bloqueio completo de ramo esquerdo. Permaneceu assintomática e o BAV reverteu espontaneamente, tendo tido alta no sétimo dia de vida. No terceiro mês de vida apareceu com erupção cutânea, cansaço e sudorese durante as mamadas. Foi diagnosticado BAV completo, pelo que colocou pacemaker obtendo melhoria clínica. Os anticorpos anti-Ro foram positivos na mãe e no recém-nascido e a biópsia cutânea foi sugestiva de LEN. Fez corticoterapia tópica com regressão das lesões cutâneas. Apesar do BAV congénito ser considerado permanente pode existir regressão para ritmo sinusal e, posteriormente, recorrência. É essencial uma vigilância a longo prazo

Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function

Background: Several studies have reported that morbid obesity is associated with increased thyroid-stimulating hormone (TSH) levels. However, it is not clear what is the impact of bariatric surgery on postoperative thyroid function. The aim of this study was to evaluate the effect of weight loss after bariatric surgery on TSH levels in euthyroid patients with morbid obesity. Methods: We performed a retrospective observational study of 949 euthyroid patients (86.1% female; age 42.0 ± 10.3 years, BMI 44.3 ± 5.7 kg/m2) with morbid obesity submitted to bariatric surgery (laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, or sleeve gastrectomy). Patients were subdivided in two groups: normal TSH group (TSH <2.5 mU/L) and high-normal TSH group (TSH ≥2.5 mU/L). The impact of anthropometric parameters, comorbidities, TSH, free thyroxine (FT4), free triiodothyronine (FT3), type of surgery, and excessive body weight loss (EBWL) on TSH variation 12 months after surgery was evaluated. Results: The high-normal TSH group (24.3% of patients) included more women, presented a higher BMI, higher systolic blood pressure, and higher FT3 levels. There was a significant decrease of TSH 12 months after surgery that was more marked in the high-normal TSH group (normal TSH group: 1.57 ± 0.49 to 1.53 ± 0.69 mIU/L, p = 0.063; high-normal TSH group: 3.23 ± 0.59 to 2.38 ± 0.86 mIU/L, p < 0.001). In a multivariate analysis, after adjusting for relevant covariates, EBWL, baseline BMI, and baseline FT3 were significantly associated with TSH decrease 12 months after bariatric surgery. Conclusion: Bariatric surgery promotes a decrease of TSH that is significantly greater in patients with high-normal TSH and is independently associated with EBWL after surgery

Why place matters in residential care: the mediating role of place attachment in the relation between adolescents’ rights and psychological well-being

Little evidence exists on the relationship between rights’ perceptions and well-being outcomes during the adolescence, and particularly in care, as well as on the mediating role of place attachment. Young people in residential care are psychologically and socially vulnerable, showing greater difficulties than their peers do in the family. Youth’s rights fulfilment in residential care may positively affect their psychological functioning together with positive attachments to this place. A sample of 365 adolescents in residential care settings (M = 14.71, SD = 1.81) completed a set of self-reported measures, specifically, the Rights perceptions scale, the Place attachment scale and Scales of psychological well-being. Results revealed significant mediating effects of place attachment (Global scale and subscales of Friends Bonding and Place Dependence) on the relationship between Participation and Protection rights in residential care and Psychological well-being (Positive Relations with others, Personal Growth and Self-Acceptance). The positive role of rights fulfilment in residential care, specifically participation opportunities, as well as the role of youth’s attachment to the care setting are discussed based on previous evidence and theoretical assumptions. A set of practical implications is described.info:eu-repo/semantics/acceptedVersio