L'orientation du patient souffrant d'un syndrome douloureux abdominal aigu a domicile [Hospitalisation criteria for the acute abdominal pain patient seen at home or in an ambulatory setting].

Dealing at patient's home with an acute abdominal pain may be particularly challenging for the primary care physician. In such a clinical situation, the part of laboratory and radiological investigations is increasing in the diagnostic process. The decision to keep the patient at home based on a clinical evaluation alone may represent a great medical responsibility for the physician. Emergency departments (ED) are of course in charge of investigating such patients with a wide panel of investigation techniques. But these structures are chronically overcrowded resulting frequently in long and difficult periods of waiting. Based on a literature review, a description of useful clinical symptoms and signs is summarized and should help the decision process for the orientation of the patient.

A Delphi study on National PICU nursing research priorities in Australia and New Zealand.

BACKGROUND: There is a lack of evidence to direct and support nursing practice in the specialty of paediatric intensive care (PIC). The development of national PIC nursing research priorities may facilitate the process of undertaking clinical research and translating evidence into practice. PURPOSE: To (a) identify research priorities for the care of patients and their family as well as for the professional needs of PIC nurses, (b) foster nursing research collaboration, (c) develop a research agenda for PIC nurses. METHODS: Over 13 months in 2007-2008, a three-round questionnaire, using the Delphi technique, was sent to all specialist level registered nurses working in Australian and New Zealand PICUs. This method was used to identify and prioritise nursing research topics. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data. RESULTS: In Round I, 132 research topics were identified, with 77 research priorities (mdn>6, mean MAD(median) 0.68±0.01) identified in subsequent rounds. The top nine priorities (mean>6 and median>6) included patient issues related to neurological care (n=2), pain/sedation/comfort (n=3), best practice at the end of life (n=1), and ventilation strategies (n=1), as well as two priorities related to professional issues about nurses' stress/burnout and professional development needs. CONCLUSION: The research priorities identified reflect important issues related to critically ill patients and their family as well as to the nurses caring for them. These priorities can be used for the development of a research agenda for PIC nursing in Australia and New Zealand.

An agenda-setting model of electoral competition

This paper presents a model of electoral competition focusing on the formation of thepublic agenda. An incumbent government and a challenger party in opposition competein elections by choosing the issues that will key out their campaigns. Giving salience toan issue implies proposing an innovative policy proposal, alternative to the status-quo.Parties trade off the issues with high salience in voters concerns and those with broadagreement on some alternative policy proposal. Each party expects a higher probabilityof victory if the issue it chooses becomes salient in the voters decision. But remarkably,the issues which are considered the most important ones by a majority of votes may notbe given salience during the electoral campaign. An incumbent government may survivein spite of its bad policy performance if there is no sufficiently broad agreement on apolicy alternative. We illustrate the analytical potential of the model with the case of theUnited States presidential election in 2004.

The INTERNORM project : bridging two worlds of expert- and layknowledge in standardization

This paper presents a pilot project to reinforce participatory practices in standardization. The INTERNORM project is funded by the University of Lausanne, Switzerland. It aims to create an interactive knowledge center based on the sharing of academic skills and the experiences accumulated by the civil society, especially consumer associations, environmental associations and trade unions to strengthen the participatory process of standardization. The first objective of the project is action-oriented: INTERNORM provides a common knowledge pool supporting the participation of civil society actors to international standard-setting activities by bringing them together with academic experts in working groups and by providing logistic and financial support to their participation to meetings of national and international technical committees. The second objective of the project is analytical: the standardization action initiated through INTERNORM provides a research field for a better understanding of the participatory dynamics underpinning international standardization. The paper presents three incentives that explain civil society (non-)involvement in standardization that try to overcome conventional resource-based hypotheses: an operational incentive, related to the use of standards in the selective goods provided by associations to their membership; a thematic incentive, provided by the setting of priorities by strategic committees created in some standardization organization; a rhetorical incentive, related to the discursive resource that civil society concerns offers to the different stakeholders.

Setting the rules of the game: The choice of electoral systems in advanced democracies

The origins of electoral systems have received scant attention in the literature. Looking at the history of electoral rules in the advanced world in the last century, this paper shows that the existing wide variation in electoral rules across nations can be traced to the strategic decisions that the current ruling parties, anticipating the coordinating consequences of different electoral regimes, make to maximize their representation according to the following conditions. On the one hand, as long as the electoral arena does not change substantially and the current electoral regime serves the ruling parties well, the latter have no incentives to modify the electoral regime. On the other hand, as soon as the electoral arena changes (due to the entry of new voters or a change in their preferences), the ruling parties will entertain changing the electoral system, depending on two main conditions: the emergence of new parties and the coordinating capacities of the old ruling parties. Accordingly, if the new parties are strong, the old parties shift from plurality/majority rules to proportional representation (PR) only if the latter are locked into a 'non-Duvergerian' equilibrium; i.e. if no old party enjoys a dominant position (the case of most small European states)--conversely, they do not if a Duvergerian equilibrium exists (the case of Great Britain). Similarly, whenever the new entrants are weak, a non-PR system is maintained, regardless of the structure of the old party system (the case of the USA). The paper discusses as well the role of trade and ethnic and religious heterogeneity in the adoption of PR rules.

Iowa Budget Report, Building on our Progress: Protecting our Priorities, 2009

*********** Some files are large and will take time to load. *********** Seven Files: 1)Report Cover, 2)Table of Contents, 3)Statewide Financial Summaries, 4)Department Budgets, 5)Capitol Projects, 6)Associated Financial Documents, 7)Budget Report. To Members of the 82nd General Assembly, As we begin the second year of our Administration, we are pleased to submit the Fiscal Year 2009 budget for the State of Iowa pursuant to Iowa Code Section 8.21 and our constitutional authority. This budget recognizes the progress that we began last year with improvements in education, economic development, energy independence, and health care; provides funding for new policy initiatives in these areas; and is based on fiscally sound budget practices. Building on last year’s accomplishments, our Fiscal Year 2009 General Fund budget proposes an additional $75 million for increasing teachers’ salaries as part of our goal to move Iowa closer to the national average. We lay the foundation for student achievement by recommending $32.1 million for pre-school education, and we also propose $177.5 million in total for community colleges and $726.2 million in total for Regents universities. To make our State more energy independent, our General Fund budget appropriates the second-year funding of $25 million for the new Iowa Power Fund. The newly established Office of Energy Independence will soon start making awards from the Power Fund. Apart from the budget, we will be making several proposals to implement the new State energy plan. We have pledged to expand the number of Iowans who have health-care coverage. As a result, we are recommending additional funding for enrollment growth in the State Children Health Insurance Program (SCHIP). These additional funds will help the State provide coverage for another 25 percent of children who are eligible but not yet enrolled in hawk-i and the Iowa Medicaid Program. To protect the safety of Iowans, we are recommending issuance of revenue bonds for approximately $260 million in net proceeds to build a new state penitentiary in Ft. Madison, renovate and expand the Women’s Correctional Institution at Mitchellville, upgrade kitchen facilities at the Rockwell City and Mt. Pleasant Correctional Institutions, and expand Community-Based Correctional Facilities in Ottumwa, Sioux City, Waterloo, and Des Moines. Additionally, we are including funding for developing a prototype program for providing parolees and low-risk offenders with mental health and drug abuse treatment and educational services to help them make a crime-free re-entry into our communities. As part of this Capitals Budget, we also propose using $20 million for the State’s matching share for building new facilities at the Iowa Veterans Home. Iowa Budget Report iv Fiscal Year 2009 Importantly, our budget continues to fully fund our State’s Reserve Funds to help buffer Iowa from any future economic downturn. We recommend reimbursing $78.2 million to the Property Tax Credit Fund as part of our multi-year proposal to correct bad budgeting practices and eventually restore $160.0 million to this Fund. To provide more transparency, we are transferring operational expenditures in the Rebuild Iowa Infrastructure Fund to the General Fund and expenditures from the Endowment for Healthy Iowans and Healthy Iowans Tobacco Trust Funds to the General Fund. We believe that Iowa has charted a new course of becoming energy independent, providing quality pre-school education, recognizing the importance of our teachers, and providing greater health coverage for children. Our Fiscal Year 2009 budget and policy priorities reflect our continuing faith in Iowa’s ability to be the best state in the nation. We look forward to working with you in a bi-partisan and all-inclusive manner to build on our progress and protect our priorities. Sincerely, Chester J. Culver Governor Patty Judge Lt. Governor

Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care : a qualitative study

OBJECTIVES: To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme. BACKGROUND: Development and implementation of a regional diabetes programme. RESEARCH DESIGN: Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis. SETTING AND PARTICIPANTS: Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively. RESULTS: Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures. DISCUSSION AND CONCLUSIONS: Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration.

Comment on "Geochemistry, petrogenesis and tectonic setting of the Samothraki mafic suite, NE Greece: Trace-element, isotopic and zircon age constraints'' by N. Koglin, D. Kostopoulos & T. Reischmann [Tectonophysics 473, 53-68 (doi:10.1016/j.tecto.2008.10.028)]

The work by Koglin et al. (Koglin, N., Kostopoulos, D., Reichmann, T., 2009. Geochemistry, petrogenesis and tectonic setting of the Samothraki mafic Suite, NE Greece: Trace-element, isotopic and zircon age constraints. Tectonophysics 473, 53-68. doi: 10.1016/j.tecto.2008.10.028), where the authors have proposed to nullify the scenario presented by Bonev and Stampfli (Bonev, N., Stampfli, G., 2008. Petrology, geochemistry and geodynamic implications of Jurassic island arc magmatism as revealed by mafic volcanic rocks in the Mesozoic low-grade sequence, eastern Rhodope, Bulgaria. Lithos 100, 210-233) is here Put under discussion. The arguments for this proposal are reviewed in the light of available stratigraphic and radiometric age constraints, geochemical signature and tectonics of highly relevant Jurassic ophiolitic suites occurring immediately north of the Samothraki mafic suite. Our conclusion is that the weak arguments and the lack of knowledge on the relevant constraints from the regional geologic information make inconsistent the Proposal and the model of these authors. (C) 2009 Elsevier B.V. All rights reserved.

Locating emergency services with different priorities: The priority queuing covering location problem

Previous covering models for emergency service consider all the calls to be of the sameimportance and impose the same waiting time constraints independently of the service's priority.This type of constraint is clearly inappropriate in many contexts. For example, in urban medicalemergency services, calls that involve danger to human life deserve higher priority over calls formore routine incidents. A realistic model in such a context should allow prioritizing the calls forservice.In this paper a covering model which considers different priority levels is formulated andsolved. The model heritages its formulation from previous research on Maximum CoverageModels and incorporates results from Queuing Theory, in particular Priority Queuing. Theadditional complexity incorporated in the model justifies the use of a heuristic procedure.

Pitfalls in the modeling of forward-looking price setting and investment decisions

The present paper makes progress in explaining the role of capital for inflation and output dynamics. We followWoodford (2003, Ch. 5) in assuming Calvo pricing combined with a convex capital adjustment cost at the firm level. Our main result is that capital accumulation affects inflation dynamics primarily through its impact on the marginal cost. This mechanism is much simpler than the one implied by the analysis in Woodford's text. The reason is that his analysis suffers from a conceptual mistake, as we show. The latter obscures the economic mechanism through which capital affects inflation and output dynamics in the Calvo model, as discussed in Woodford (2004).

A health behaviour cross-sectional study of immigrants and non-immigrants in a Swiss urban general-practice setting.

BACKGROUND: Little is known about smoking, unhealthy use of alcohol, and risk behaviours for sexually transmitted diseases (STDs) in immigrants from developed and developing countries. METHOD: We performed a cross-sectional study of 400 patients who consulted an academic emergency care centre at a Swiss university hospital. The odds ratios for having one or more risk behaviours were adjusted for age, gender, and education level. RESULTS: Immigrants from developing countries were less likely to use alcohol in an unhealthy manner (OR = 0.35, 95% CI 0.22-0.57) or practise risk behaviours for STDs (OR = 0.31, 95% CI 0.13-0.74). They were also less likely to have any of the three studied risk behaviours (OR = 2.5, 95% CI 1.5-4.3). DISCUSSION: In addition to the usual determinants, health behaviours are also associated with origin; distinguishing between immigrants from developing and developed countries is useful in clinical settings. Surprisingly, patients from developing countries tend to possess several protective characteristics.

Measurement of ß-tryptase in postmortem serum, pericardial fluid, urine and vitreous humor in forensic setting

L'activation des mastocytes se produit dans plusieurs conditions pathologiques et est principalement observée chez des patients développant une réaction anaphylactique. Dans la pratique clinique, la mesure de l'histamine et de ses métabolites dans le plasma et dans l'urine du patient peut être effectuée et montre parfois des résultats aussi précis que la mesure de la beta-tryptase dans le sang lorsqu'il est nécessaire de confirmer une activation mastocytaire. En revanche, la mesure de la beta tryptase dans l'urine dans un but diagnostic n'a que rarement été effectuée sur des personnes vivantes et a montré des résultats contradictoires. Dans le domaine de la médecine légale, la mesure de la beta-tryptase dans un but diagnostic est effectuée dans le sérum postmortem obtenu à partir de sang prélevé au niveau fémoral. Cependant, le sang peut être partiellement ou complètement indisponible dans certains cas spécifiques, dans les autopsies de nourrissons ou de corps sévèrement mutilés par exemple. Un des buts de notre étude est d'évaluer la pertinence de la mesure de la beta-tryptase dans des échantillons biologiques alternatifs, à savoir dans l'urine, l'humeur vitrée et le liquide péricardique. Pour cela nous avons sélectionné 94 cas d'autopsies comprenant 6 cas de réaction anaphylactique suite à l'administration de produits de contraste radiologique, 10 cas d'hypothermie, 10 cas d'acidocétose diabétique, 10 cas de suicide par arme à feu, 18 cas de décès consécutif à une injection d'héroïne, 10 cas de décès traumatiques, 10 cas de mort subite avec peu ou pas d'athérosclérose coronarienne, 10 cas de décès avec une athérosclérose coronarienne sévère mais sans signe d'infarctus du myocarde et 10 cas de décès consécutif à un infarctus du myocarde avec une athérosclérose coronarienne sévère. Dans tous les cas de réaction anaphylactique suite à l'administration de produit de contraste radiologique, les concentrations de beta-tryptase, mesurées dans le sérum postmortem et dans le liquide péricardique, ont montré des valeurs plus élevées que le seuil clinique de référence (11 ng/l) et le seuil postmortem de référence (45 ng/l). La concentration de beta-tryptase mesurée dans l'urine et l'humeur vitrée a montré des valeurs inférieures au seuil clinique dans tous les cas de notre étude. La mesure de la concentration de beta tryptase dans le liquide péricardique semble donc une alternative valable à la mesure dans le sérum postmortem, lorsque le sang fémoral n'est pas disponible durant l'autopsie, afin de poser un diagnostic de réaction anaphylactique.

Updated list of ant species (Hymenoptera, Formicidae) recorded in Santa Catarina State, southern Brazil, with a discussion of research advances and priorities

Updated list of ant species (Hymenoptera, Formicidae) recorded in Santa Catarina State, southern Brazil, with a discussion of research advances and priorities. A first working list of ant species registered in Santa Catarina State, southern Brazil was published recently. Since then, many studies with ants have been conducted in the state. With data compiled from published studies and collections in various regions of the state, we present here an updated list of 366 species (and 17 subspecies) in 70 ant genera in Santa Catarina, along with their geographical distribution in the seven state mesoregions. Two hundred and seven species are recorded in the Oeste mesoregion, followed by Vale do Itajaí (175), Grande Florianópolis (150), Norte (60), Sul (41), Meio Oeste (23) and Planalto Serrano (12). The increase in the number of records since 1999 results from the use of recently adopted sampling methods and techniques in regions and ecosystems poorly known before, and from the availability of new tools for the identification of ants. Our study highlights the Meio Oeste, Planalto Serrano, Sul and Norte mesoregions, as well as the deciduous forest, mangrove, grassland and coastal sand dune ecosystems as priority study areas in order to attain a more complete knowledge of the ant fauna in Santa Catarina State.