Time and travel costs incurred by women attending antenatal tests: A costing study

OBJECTIVE: to estimate the costs to women, their friends and family for different antenatal tests in the Down's syndrome (DS) screening pathway. DESIGN: questionnaire-based costing study. SETTING: eight maternity clinics across the UK. PARTICIPANTS: pregnant women (n=574) attending an appointment for DS screening, NIPT or invasive testing between December 2013 and September 2014. MEASUREMENTS: using data collected from the questionnaires we calculated the total costs to women by multiplying the time spent at the hospital and travelling to and from it by the opportunity costs of the women and accompanying person and adding travel and childcare costs. Assumptions about the value of opportunity costs were tested in one-way sensitivity analyses. The main outcome measure was the mean cost to the women and friends/family for each test (DS screening, NIPT, and invasive testing). FINDINGS: mean costs to women and their family/friend were £33.96 per visit, of which £22.47 were time costs, £9.15 were travel costs and £2.34 were childcare costs. Costs were lowest for NIPT (£22), £32 for DS screening (£44 if combined with NIPT), and highest for invasive testing (£60). Sensitivity analysis revealed that variations around the value of leisure time opportunity costs had the largest influence on the results. KEY CONCLUSIONS: there are considerable costs to women, their friends and family when attending different tests in the DS screening pathway. IMPLICATIONS FOR PRACTICE: when assessing the cost-effectiveness of changes to this pathway, costs to women should be considered

Maternal and Cord Serum Cytokine Changes with Continuous and Intermittent Labor Epidural Analgesia: A Randomized Study

Background. Maternal fever during labor epidural analgesia (LEA) may cause increased maternal and cord serum inflammatory cytokines. We report the effects of intermittent and continuous LEA on these cytokines. Methods. Ninety-two women were randomly assigned to continuous (CLEA) or intermittent (ILEA) groups, 46 in each. Maternal temperature was checked and blood drawn at epidural insertion (baseline) and four-hourly until 4 h postpartum (4 PP). Cord blood was drawn after placental delivery. Interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), granulocyte macrophage-colony stimulating factor (GM-CSF), and tumor necrosis factor-α (TNF-α) were measured and analyzed according to group randomization, and then combined and reanalyzed as febrile (temperature ≥38°C) or afebrile groups. Results. Significant intragroup changes from baseline were noted in some groups. Data are pg/mL, median (Q1/Q3). IL-6 rose at all time points in all groups. CLEA: baseline: 18.5 (12.5/31.1), 4 h: 80.0 (46.3/110.8), 8 h: 171.9 (145.3/234.3), and 4 PP: 81 (55.7/137.4). ILEA: baseline: 15.7 (10.2/27.1), 4 h: 68.2 (33.3/95.0), 8 h: 125.0 (86.3/195.0), and 4 PP: 70.2 (54.8/103.6). Febrile group: baseline: 21.6 (13.8/40.9), 4 h: 83.9 (47.5/120.8), 8 h: 186.7 (149.6/349.9), and 4 PP: 105.8 (65.7/158.8). Afebrile group: baseline: 10.9 (2.1/17.4), 4 h: 38.2 (15.0/68.2), 8 h: 93.8 (57.1/135.7), and 4 PP: 52.9 (25.1/78). IL-8 rose at all time points in CLEA: baseline: 2.68 (0.0/4.3), 4 h: 3.7 (0.0/6.5), 8 h: 6.0 (3.3/9.6), 4 PP: 5.6 (0.8/8.0), and afebrile group baseline: 2.5 (0.0/4.7), 4 h: 3.3 (0.0/6.2), 8 h: 5.3 (1.9/9.8), and 4 PP: 4.7 (0.0/7.6). It fell at 4 PP in febrile group: baseline: 4.1 (0.0/6.4), 4 h: 3.8 (0.0/6.5), 8 h: 5.2 (2.5/8.0), and 4 PP: 2.9 (0.0/4.0). GM-CSF increased at 8 h and decreased at 4 PP in ILEA baseline: 2.73 (0.0/7.2), 4 h: 2.73 (0.0/7.9), 8 h: 3.9 (2.7/11.5), and 4 PP: 2.0 (0.0/7.2). It increased at 4 h and 8 h and decreased at 4 PP in febrile group: baseline: 2.6 (0.0/4.2), 4 h: 3.2 (2.1/7.0), 8 h: 4.0 (3.2/12.3), and 4 PP: 2.4 (1.7/12.6). There were no intergroup cytokine changes in maternal or cord serum in CLEA versus ILEA or febrile versus afebrile groups. Conclusions. Some cytokines, especially IL-6, rise physiologically during labor epidural analgesia

La rotación del personal en los Gobiernos Autónomos Descentralizados Municipales y su impacto en el clima organizacional/The rotation of personnel in the Municipal Decentralized Autonomous Governments and their impact on the organizational climate

Los cambios constantes en el nivel de las organizaciones públicas hacen que estas expandan su visión y la competitividad permanente lleva a los Gobiernos Autónomos Descentralizados (GAD) Municipales a desarrollar estrategias para alcanzar sus objetivos, es así como, la contratación y la continuidad de los despidos del personal representa un problema de gran magnitud para las instituciones, pues sin duda, limita el desarrollo eficiente que se desearía tener, ya que la productividad de la institución se ve significativamente afectada, evidenciándose un mal clima organizacional, restando la eficiencia eficacia y efectividad en los procesos, influyendo directamente en los resultados Esta investigación determina un análisis de las causas del clima organizacional en una institución pública. Debido a la alta tasa de rotación evidenciada dentro de los municipios según se constata en las encuestas realizadas, principalmente en el personal operativo, que son aquellos que trabajan directamente con los usuarios y pueden tener los efectos causados por el servicio ofrecido. En consecuencia, esta investigación conlleva aumentar el servicio al usuario proporcionado por los colaboradores públicos. Y una relación muy estrecha entre el clima organizacional medido y la rotación de personar también se define al analizar la premisa de que si el clima organizacional mejora la rotación de personal se reducirá el malestar entre compañeros de trabajo, ya que puede haber razones que no se conocen o están fuera del control y, por lo tanto, no se pueden mejorar el lineamiento de prestigio institucional. Constant changes at the level of public organizations mean that they expand their vision and permanent competitiveness leads the Municipal Autonomous Decentralized Governments (GAD) to develop strategies to achieve their objectives, such as hiring and continuity of layoffs The staff represents a problem of great magnitude for the institutions, because without a doubt, it limits the efficient development that one would like to have, since the productivity of the institution is significantly affected, evidencing a bad organizational climate, subtracting the efficiency effectiveness and effectiveness in the processes, directly influencing the results This research determines an analysis of the causes of the organizational climate in a public institution. Due to the high rate of turnover evidenced within the municipalities as found in the surveys carried out, mainly in the operating personnel, which are those that work directly with users and can have the effects caused by the service offered. Consequently, this research entails increasing the user service provided by public collaborators. And a very close relationship between the measured organizational climate and the turnover of people is also defined when analyzing the premise that if the organizational climate improves staff turnover, discomfort among coworkers will be reduced, since there may be reasons that are not they know or are out of control and, therefore, the institutional prestige guidelines can not be improved. Palabras Clave: desempeño, talento humano, rotación, clima laboral, decisiones. Keywords: performance, human talent, rotation, labor climate, decisions

Tourist spaces and tourism policy in Spain and Portugal

Advances in Cultura, Tourism and Hospitality Research;10, 235-249This study analyses the relationship between the development of the tourism policy of Spain and Portugal and their effects on regional imbalances. Despite the proximity of the two countries and their specialisation in tourism, there are few comparative studies on tourism of the two Iberian countries. The study focuses on the two major phases of tourism policy: the period of mass tourism and post-Fordist stage. In the conclusions we refer the debate on the existence of a model of development based on tourism to the Latin countries of Southern Europe and we note the export process of the Spanish low-cost tourism model to other countries.Financiado por el Gobierno de España, Programa Fundamental de Investigación, Proyecto de I+D (CSO2012-30840) "Geografías de la crisis: análisis de los territorios urbanos y turísticos de las Islas Baleares, Costa del Sol y principales destinos del Caribe y América Central"

Nambu-Poisson manifolds and associated n-ary Lie algebroids

We introduce an n-ary Lie algebroid canonically associated with a Nambu-Poisson manifold. We also prove that every Nambu-Poisson bracket defined on functions is induced by some differential operator on the exterior algebra, and characterize such operators. Some physical examples are presented

Genome-wide association analysis and accuracy of genome-enabled breeding value predictions for resistance to infectious hematopoietic necrosis virus in a commercial rainbow trout breeding population

International audienceAbstractBackgroundInfectious hematopoietic necrosis (IHN) is a disease of salmonid fish that is caused by the IHN virus (IHNV). Under intensive aquaculture conditions, IHNV can cause significant mortality and economic losses. Currently, there is no proven and cost-effective method for IHNV control. Clear Springs Foods, Inc. has been applying selective breeding to improve genetic resistance to IHNV in their rainbow trout breeding program. The goals of this study were to elucidate the genetic architecture of IHNV resistance in this commercial population by performing genome-wide association studies (GWAS) with multiple regression single-step methods and to assess if genomic selection can improve the accuracy of genetic merit predictions over conventional pedigree-based best linear unbiased prediction (PBLUP) using cross-validation analysis.ResultsTen moderate-effect quantitative trait loci (QTL) associated with resistance to IHNV that jointly explained up to 42% of the additive genetic variance were detected in our GWAS. Only three of the 10 QTL were detected by both single-step Bayesian multiple regression (ssBMR) and weighted single-step GBLUP (wssGBLUP) methods. The accuracy of breeding value predictions with wssGBLUP (0.33–0.39) was substantially better than with PBLUP (0.13–0.24).ConclusionsOur comprehensive genome-wide scan for QTL revealed that genetic resistance to IHNV is controlled by the oligogenic inheritance of up to 10 moderate-effect QTL and many small-effect loci in this commercial rainbow trout breeding population. Taken together, our results suggest that whole genome-enabled selection models will be more effective than the conventional pedigree-based method for breeding value estimation or the marker-assisted selection approach for improving the genetic resistance of rainbow trout to IHNV in this population

Global Research Alliance N2O chamber methodology guidelines: Recommendations for deployment and accounting for sources of variability

Adequately estimating soil nitrous oxide (N2O) emissions using static chambers is challenging due to the high spatial variability and episodic nature of these fluxes. This paper discusses how static chamber N2O experiments can be designed, and protocols implemented, to better account for this variability and reduce the uncertainty of N2O emission estimates. It is part of a series of papers in this special issue, each discussing a particular aspect of N2O chamber methodology. Aspects of experimental design and sampling affected by spatial variability include site selection, and chamber layout, size and areal coverage. Where used, treatment application adds a further level of spatial variability. Time of day, frequency and duration of sampling (both in terms of individual chamber closures and overall experiment duration) affect the temporal variability captured. In addition, we present best practice recommendations for experimental chamber installation and sampling protocols to minimise the introduction of further uncertainty. To obtain the best N2O emission estimates, resources should be allocated to minimise the overall uncertainty in line with experiment objectives. In some cases, this will mean prioritising individual flux measurements and increasing their accuracy and precision by, for example, collecting ≥4 headspace samples during each chamber closure. However, where N2O fluxes are exceptionally spatially variable, for example, in heterogeneous agricultural landscapes, such as uneven and woody grazed pastures, using available resources to deploy more chambers with fewer headspace samples per chamber may be beneficial. Similarly, for particularly episodic N2O fluxes, generated for example by irrigation or freeze-thaw cycles, increasing chamber sampling frequency will improve the accuracy and reduce the uncertainty of temporally interpolated N2O fluxe

The role of histidine residues in modulation of the rat P2X 2 purinoceptor by zinc and pH

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65774/1/jphysiol.2001.013244.pd