Pension systems in East Asia and the Pacific : challenges and opportunities

With the recovery from the recent crisis, countries of the East Asia and Pacific region are rethinking their financial, and social policy, including old-age protection. Population aging, in combination with ongoing urbanization, and economic transformation, will place increasing pressure on traditional family care arrangements. Coverage under formal pension systems is generally low, and the absence of social safety nets for the needy elderly, poses risks in the face of breaks in the economic growth path. In addition to common systemic challenges, formal old-age income support systems confront issues specific to their design type: 1) The national provident fund, and social security systems with reserve funds, have demonstrated problems with investment policy, and performance, governance and management. 2) In the established market economies, social security systems are fiscally unsustainable in the long run, and often have a weak benefit-contribution link. 3) These types of systems encounter additional problems in transition economies, including low contribution collection from previously socialized enterprises. Options addressed by the paper involve the adoption of an integrated view on retirement income provision, averting fiscal un-sustainability, and, integrating public, and private sector pensions. Additionally, moving toward a multi-pillar structure with prudent coverage extension, and, fostering financial markets, to allow decentralized pension funds management, are also suggested.Health Economics&Finance,Public Sector Economics,Pensions&Retirement Systems,Environmental Economics&Policies,Banks&Banking Reform

A qualitative study of music teachers' beliefs about the teaching of composition

While research has touted the educational benefits of music composition in the classroom, studies have also revealed the numerous difficulties teachers encounter in its inclusion. From lack of time and materials to lack of training and confidence, teachers have struggled to incorporate composition in their lessons. At the same time, a body of research also has suggested that what teachers believe about a subject can have significant bearing on what they teach and how they teach it. This multi-case study looked at three teachers to investigate what they believed about music composition, where those beliefs originated and how those beliefs may be expressed in their classrooms and use of composition. The results revealed the significance of early music influences with family and church music directors, a strong connection to identity through music, and the importance of the sharing and peer teaching of music. There was a distinct bias for European forms and standard notation that eclipsed other ways of knowing, understanding, and expressing music. Other than jazz, forms of improvisation were often viewed as childish or primitive. The teachers most likely to find success in the use of composition in the classroom were flexible, and able to align their beliefs about music education, the efficacy of their students and themselves, with their beliefs about composition and what it can offer

Proactive palliative care in the intensive care units of an academic hospital

Palliative care (PC) is a specialty that improves the quality of care often for terminally ill patients and their family members by providing physical, psychosocial, and spiritual pain and symptom management. PC assists patients in decision making about their goals of care. These goals of care discussions help the treating physicians to better plan more appropriate treatment options specifically tailored for each patient based on their preferences. Due to the illness severity of the patients, approximately 20% of all hospital deaths occur in the intensive care unit (ICU). Recognition of and advocacy for integrating PC in the ICU have increased in the last decade following many studies which have shown the positive effects of PC for critically ill patients and their family members. This was a single-center retrospective study conducted at an academic hospital that examined the effects of a proactive PC intervention and the clinical outcomes on patients who died in the medical and neurological ICUs (MICU and NICU), since the majority of ICU deaths occurred in these two units. This study was a quality improvement project that examined only patients who died, in order to make a similar comparison between patients who ultimately had the same clinical outcome. This pre-intervention (phase 1) and post-intervention three phase analysis measured the effectiveness of a screening tool (phase 2), and a daily ICU huddle (phase 3) compared to the pre-intervention phase. The study analyzed the impact the interventions had on clinical measurable outcomes such as 1) day of PC consultation after ICU admission and after meeting criteria, 2) day of meeting criteria for PC based on a screening tool, 3) hospital and ICU lengths of stay, 4) direct cost per discharge, and 5) the average number of PC consultations per month. Electronic database review of all MICU and NICU patients who died from July 2010 to December 2011 and April 2013 to October 2014 were performed. Comparisons were made between patients who received a PC consultation and those who received usual care, from both pre-intervention and post-intervention phases. A total of 888 patients were included and analyzed in this study. The intervention reduced the average day of PC consultation after ICU admission from 9.55 in phase 1 to 4.95 in phase 2 and to 4.75 in phase 3 after the addition of the daily huddle. The average day of PC consultation after meeting criteria in the ICU was also reduced from 8.0 to 3.08 then to 2.18, respectively. The average number of PC consultations per month increased from 10.6 to 12.8 to 17.7 in the three respective phases. The cost per discharge was not significantly different from patients who received a PC consultation and for patients who received usual care. PC service did not reduce the length of stay for patients when compared to patients who received usual care. The sensitivity and specificity of the screening tool in phase 2 were 66.2% and 70.8%, respectively. The sensitivity and specificity of the screening tool with daily huddle in phase 3 were 65.7% and 62.5%, respectively. Proactive screening for PC eligibility and discussion of that eligibility with the critical care team improves access to PC in the ICU. The screening tool and daily ICU huddle helped critical care physicians identify the group of patients most appropriate for PC consultation. The analysis suggests that the critical care physicians were able to accurately discriminate which end-of-life patients they could manage on their own. However, the low sensitivity and specificity of the screening tool suggests that there is still significant room for refinement in order for the screening tool to be more discriminatory and effective. Further research is needed to confirm these findings

Testosterone replacement therapy

Physicians and scientists have suspected that the testes secrete a substance into the body that causes male secondary sexual characteristics for hundreds of years. However, testosterone was not synthesized until 1935 and it was not until the 1940's when scientists could accurately measure the amount of this hormone in the blood. Since then, scientists have been able to make correlations between the levels of testosterone in the body and men's health Scientists have long observed higher levels of testosterone to be associated with an increase in levels of Hematocrit (Hct). As a result, Testosterone Replacement Therapy (TRT) has been used to treat anemia associated with chronic diseases. In recent years, prescription sales for testosterone have sky rocketed due to new clinical uses such as androgen deficiency in older men. In fact, the rate of prescription for testosterone products has increased by over 170% in the previous five years. Long-term data shows that the level of testosterone in the male body begins to decrease at about the age of 30. As the life expectancy of the general population continues to increase, TRT may be a viable option for older men with low testosterone to increase the quality and duration of life. However, an increase in Hct continues to be a major side effect of TRT. New research is beginning to make clear the mechanism by which testosterone affects erythropoeisis. New research suggests TRT suppresses hepcidin and leads to an increase in the rate of iron (Fe) retention in red blood cells (RBCs). Inter-individual differences in the pharmacogenetic effects of TRT have been observed. In the future TRT could be genetically tailored based on the individuals DNA. In this case, the optimal dose of testosterone can be given to maximize benefits and reduce side effects. Here, the risks and benefits associated with TRT and a review of the updated Clinical Guidelines for its use will be presented. The effects of TRT on erythropoeisis will be investigated via a review of the literature. The main objective of this review is to provide a general understanding of TRT and a major side effect of its use, excessive erythropoeisis

Competencias de liderazgo y engagement en los colaboradores de la distribuidora Fármacos del Norte SAC - Trujillo 2021

La competencia de liderazgo es una habilidad fundamental en la actualidad que un Gerente debe poseer para que pueda tener éxito; por otro lado, el Engagement es el compromiso que tiene el colaborador con la empresa para que esta pueda lograr sus objetivos. La presente investigación tiene como objetivo determinar la relación entre las competencias de liderazgo y su relación con el engagement en los colaboradores de la Distribuidora Fármacos del Norte SAC - Trujillo 2021. El tipo de estudio fue correlacional, empleándose un diseño no experimental, transversal, para el cual se trabajó con una muestra de 19 colaboradores de la Distribuidora Fármacos del Norte SAC, aplicándose un muestreo no probabilístico; asimismo la técnica utilizada fue la encuesta y los instrumentos fueron los cuestionarios para medir las competencias de liderazgo y el engagement, validados por expertos en el tema. De modo que, al correlacionar las dimensiones gestión del cambio, visión etratégica, orientación de resultados, calidad en la toma de decisiones y gerencia de personas de la variable competencias de liderazgo con la variable engagement los resultados señalan que ambas variables logran relacionarse de forma positiva y fuerte entre sí. Dicha relación se obtiene del resultado de la prueba Chi-Cuadrado, presentando un valor p de 0.000, el cual es menor al p valor de 0.05; por ende, se rechaza la hipótesis nula en favor de la alterna, lo que demuestra que a medida que se incrementen las competencias de liderazgo, el engagement también lo hará o a menor índice de liderazgo, menor será el índice de engagement en los colaboradores de la Distribuidora Fármacos del Norte SAC – Trujillo, 2021.Leadership competency is a fundamental skill today that a Manager must possess in order to be successful; On the other hand, Engagement is the commitment that the collaborator has with the company so that it can achieve its objectives. The objective of this research is to determine the relationship between leadership skills and their relationship with employee engagement at the Fármacos del Norte SAC - Trujillo 2021 Distributor. The type of study was correlational, using a non-experimental, cross-sectional design to which worked with a sample of 19 employees of the Fármacos del Norte SAC Distributor, applying a non-probabilistic sampling; Likewise, the technique used was the survey and the instruments were the questionnaires to measure leadership skills and engagement, validated by experts in the field. So, when correlating the dimensions of change management, strategic vision, results orientation, quality in decision-making and people management of the leadership competencies variable with the engagement variable, the results indicate that both variables manage to relate positively. and strong with each other. Said relationship is obtained from the result of the Chi-Square test, presenting a p value of 0.000, which is less than the p value of 0.05; therefore, the null hypothesis is rejected in favor of the alternative, which shows that as leadership competencies increase, engagement will also do so, or the lower the leadership index, the lower the engagement index in the collaborators of the company. Distributor Fármacos del Norte SAC – Trujillo, 2021.Tesi

Optimized Spectrometers Characterization Procedure for Near Ground Support of ESA FLEX Observations: Part 1 Spectral Calibration and Characterisation

The paper presents two procedures for the wavelength calibration, in the oxygen telluric absorption spectral bands (O2-A, λc = 687 nm and O2-B, λc = 760.6 nm), of field fixed-point spectrometers used for reflectance and Sun-induced fluorescence measurements. In the first case, Ne and Ar pen-type spectral lamps were employed, while the second approach is based on a double monochromator setup. The double monochromator system was characterized for the estimation of errors associated with different operating configurations. The proposed methods were applied to three Piccolo Doppio-type systems built around two QE Pros and one USB2 + H16355 Ocean Optics spectrometers. The wavelength calibration errors for all the calibrations performed on the three spectrometers are reported and potential methodological improvements discussed. The suggested calibration methods were validated, as the wavelength corrections obtained by both techniques for the QE Pro designed for fluorescence investigations were similar. However, it is recommended that a neon emission line source, as well as an argon or mercury-argon source be used to have a reference wavelength closer to the O2-B feature. The wavelength calibration can then be optimised as close to the O2-B and O2-A features as possible. The monochromator approach could also be used, but that instrument would need to be fully characterized prior to use, and although it may offer a more accurate calibration, as it could be tuned to emit light at the same wavelengths as the absorption features, it would be more time consuming as it is a scanning approach

Virgin River multi-objective optimization: maximizing endangered fish habitat and minimizing costs

This paper discusses a comparative analysis of hypothetical operational scenarios by the use of dynamic temperature and fish habitat modelling in a multi-objective framework in the Virgin River Basin, Utah. Results were compared on the basis of quantified fish habitat, operational costs, and hydropower revenue. The modelling framework, the Virgin River Operation Optimization Model, is considered as a basin-level planning model. The optimization objectives were to minimize net river system operational cost of the Washington County Water Conservation District and maximize endangered fish habitat. Considerations included infrastructure alternatives to increase flow and cold water discharges as well as demand reductions. Given the nature of the problem, an optimization procedure was developed to approximate a Pareto front or trade-off surface for the two management objectives. This trade-off surface approximation is desired to help users compare the merits of any particular solution. The relative differences between alternatives elucidated sensitivities to the system responses along the approximated Pareto front. Limitations to the methods are discussed and recommendations for future work are provided

Understanding Spatial and Spectral Morphologies of Ultracompact H II Regions

The spatial morphology, spectral characteristics, and time variability of ultracompact H II regions provide strong constraints on the process of massive star formation. We have performed simulations of the gravitational collapse of rotating molecular cloud cores, including treatments of the propagation of ionizing and non-ionizing radiation. We here present synthetic radio continuum observations of H II regions from our collapse simulations, to investigate how well they agree with observation, and what we can learn about how massive star formation proceeds. We find that intermittent shielding by dense filaments in the gravitationally unstable accretion flow around the massive star leads to highly variable H II regions that do not grow monotonically, but rather flicker, growing and shrinking repeatedly. This behavior appears able to resolve the well-known lifetime problem. We find that multiple ionizing sources generally form, resulting in groups of ultracompact H II regions, consistent with observations. We confirm that our model reproduces the qualitative H II region morphologies found in surveys, with generally consistent relative frequencies. We also find that simulated spectral energy distributions (SEDs) from our model are consistent with the range of observed H II region SEDs, including both regions showing a normal transition from optically thick to optically thin emission, and those with intermediate spectral slopes. In our models, anomalous slopes are solely produced by inhomogeneities in the H II region, with no contribution from dust emission at millimeter or submillimeter wavelengths. We conclude that many observed characteristics of ultracompact H II regions appear consistent with massive star formation in fast, gravitationally unstable, accretion flows.Comment: ApJ in pres