Consultation for Disordered Puberty: What Do Adolescent Medicine Patients Teach Us?

The period of adolescence is not only marked by important growth and pubertal events, but is also characterized by important psychosocial changes driven by a search for autonomy and the construction of one's identity. It can thus be easily understood that puberty disorders interfere heavily with these process, requiring from the endocrinologist not only medical knowledge, but also a great deal of emotional and psychological skills. They must progressively move from an educational approach that heavily involves the parents to one of shared information and decision making that places the young patient at the center of the therapeutic process. This can be achieved in several ways: respecting the affective and cognitive development of the adolescent; securing his privacy and (if requested by him) confidentiality; exploring his self-image and self-esteem and adapting the therapeutic process to the patient's expectations; reviewing the teenager's lifestyle, including the issue of sexuality and sexual behavior, and involving him in any therapeutic choice that has to be made, even if it does not match with the parents' expectations. The skills required for this respectful and holistic follow-up often exceed the abilities of any physician; it is thus suggested that a team approach involving a clinical nurse and/or a psychologist and/or social worker(s) be set up whenever possible.

BD-US: les comics vus par l'Europe

Cet ouvrage réunit des spécialistes de l'étude de la bande dessinée qui proposent une série d'éclairages sur la manière dont les productions culturelles européennes ont diffusé, exploité, reformulé ou détourné l'imaginaire et le langage des comics venus d'outre-Atlantique. L'approche se veut résolument comparative, interculturelle et intermédiale : les chercheurs abordent autant Edgar P. Jacobs ou les récents albums de Serge Lehman que les séries TV de science-fiction britanniques ou les films d'Alain Resnais, et se proposent d'interroger la réception et les réappropriations de motifs et genres populaires situés au croisement d'influences et de références diverses. La production américaine est ainsi discutée dans toute sa richesse, des super-héros à l'underground, à travers des (re)lectures proposées en Europe.

Social Preferences and Transport Policy: The case of US speed limits

This article, in reviewing the longrunning US debate on speed limits, illustrates how a different valuation of the trade-off between private mobility needs and safety concerns can shape transport policies. It is argued that the regulatory decentralization debate, together with the speed limit in force in each state, obey the social preferences and valuation given to this tradeoff. Such a view is consistent with evidence that higher speed limits are to be found in states with greater private mobility needs, even though their fatality rates might be among the highest in the country. By contrast, lower speed limits and supporters of a low national speed limit are to be found in states that show a greater concern for safety outcomes and which are less dependent on private mobility. By reviewing these events and examining the role played by the main actors and analyzing their motivations, the article identifies important lessons for similar future discussions on transport policy.

Multicointegration, polynomial cointegration and I(2) cointegration with structural breaks. An application to the sustainability of the US external deficit

In this paper we model the multicointegration relation, allowing for one structural break. Since multicointegration is a particular case of polynomial or I(2) cointegration, our proposal can also be applied in these cases. The paper proposes the use of a residualbased Dickey-Fuller class of statistic that accounts for one known or unknown structural break. Finite sample performance of the proposed statistic is investigated by using Monte Carlo simulations, which reveals that the statistic shows good properties in terms of empirical size and power. We complete the study with an empirical application of the sustainability of the US external deficit. Contrary to existing evidence, the consideration of one structural break leads to conclude in favour of the sustainability of the US external deficit.

Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data

During the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions. Methods: Cubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations. Results: We started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975–79, Catalonia 1980–89) and after (USA and Catalonia 1990–2001). Survival in Catalonia in the 1980–89 period was worse than in the USA during 1975–79, but the differences disappeared in 1990–2001. Conclusion: Our results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia

Parâmetros r e R obtidos de programa interlaboratorial: como usá-los

Intralaboratorial and interlaboratorial variabilities can be obtained by conducting an specially designed interlaboratory program. Using the analysis of variance technique one can calculate the r (repeatability) and R (reproducibility) indexes that can help participant laboratories to monitor their routine quality control procedures. An example is described using data obtained from an interlaboratory program where twelve laboratories determined total iron content in silicon metal sample by using flame atomic absorption spectrometry.

Partie orientale de la Lapponie suèdoise. Tirée de celles d’Andr Burae(us) et de Isaac Massa. Par le Sr. Sanson geogr’ ord:re du roy

1 kartta : vär. ; 43,8 x 54,8 cm, lehti 46 x 56,7 cm.

Determinants of credit default swap spread, the effect of the financial crisis in the us markets

The purpose of this study is to define what determinants affect the Credit spread. There are two theoretical frameworks to study this: structural models and reduced form models. Structural models indicate that the main determinants are company leverage, volatility and risk-free interest rate, and other market and firm-specific variables. The purpose is to determine which of these theoretical determinants can explain the CDS spread and also how these theoretical determinants are affected by the financial crisis in 2007. The data is collected from 30 companies in the US Markets, mainly S&P Large Cap. The sample time-frame is 31.1.2004 – 31.12.2009. Empirical studies indicate that structural models can explain the CDS spreads well. Also, there were significant differences between bear and bull markets. The main determinants explaining CDS spreads were leverage and volatility. The other determinants were significant, depending on the sample period. However, these other variables did not explain the spread consistently.

Quais as características propostas pelo BIRADS-US que melhor diferenciam nódulos malignos dos benignos?

OBJETIVO: analisar qual das características propostas pelo BIRADS-US tem maior impacto na diferenciação das lesões benignas das malignas. MÉTODOS: estudamos as características ultra-sonográficas do BIRADS em 384 nódulos submetidos à biópsia percutânea no período de fevereiro de 2003 a dezembro de 2006. Utilizou-se, para o exame, o aparelho Logic 5, com transdutor linear multifreqüencial de 7,5-12 MHz. A análise ultra-sonográfica do nódulo foi baseada no BIRADS-US levando em conta: forma, orientação, margem, limites da lesão, ecogenicidade, características acústicas posteriores, o tecido circunjacente e a presença de calcificações. Estes dados foram submetidos à análise estatística com modelo de regressão logística. Para o estudo de associação entre estas variáveis utilizamos o teste do c² e também calculamos a sensibilidade e a especificidade das variáveis "tecido ao redor", "calcificações", "efeito posterior", "limite da lesão" e "orientação". RESULTADOS: as lesões benignas representaram 42,4% e as malignas, 57,6%. A análise por regressão logística encontrou odds ratio (OR) aumentado para câncer de 7,7 vezes quando o tecido ao redor esteve alterado, de 6,2 vezes quando houve presença das microcalcificações no interior das lesões, de 1,9 quando o efeito acústico foi sombra, de 25,0 vezes quando houve o halo ecogênico e de 7,1 vezes quando a orientação foi não paralela. CONCLUSÕES: dentre as características estudadas, o limite da lesão, representado pela presença ou não do halo ecogênico, é o mais importante diferenciador das massas benignas das malignas.

Hintaluettelo US-renkaita

kuv., 12 x 15 cm

Prislista US-ringar

kuv., 11 x 15 cm