Gift of Peace of Mind-The For yourself For your Family, 2000, Large Print Edition

The purpose of this booklet is to educate the public about advance directives. By doing so, we hope to increase the use of advance directives, as well as the quality and accuracy of the documents themselves. The reader is led through a series of steps that ultimately lead to filling out the advance directive documents in an informed manner.

Executive Order Number Forty-Four, September 2005

Excecutive order signed by Governor Thomas Vilsck. Directs the Department of Human Services to comply with all directives from the federal government arising from Hurricane Katrina insofar as those directives concern public welfare programs administered by DHS, declares that any evacuee shall be deemed a resident of the State of Iowa for purposes of obtaining eligibility for the food stamp, family investment and Medicaid programs, and DHS should process applications in an expedited and flexible manner.

Psychological transformations in kidney transplantation: A prospective qualitative study

The aim of this IRB-approved study was to prospectively analyze psychological transformations in ESRD patients before and after transplantation (KT). Semi-structured interviews were conducted in 30 patients (mean age = 53±10) after their inclusion on the waiting-list (Gr. A). Follow-up interviews were performed 6 months later in 15 patients still awaiting KT (Gr. B6), and in 15 patients 6 months (Gr. C6) and 12 months (Gr. C12) after KT. Qualitative analysis was performed. Gr: A:All patients underlined loss of freedom, 87% devoted much energy to maintain normality, 57% modified medical directives. All reported emotional fragility related to dialysis and loss of quality of life (QOL), negative (43%) or suicidal thoughts (20%). Professional stigma was underlined (26%). Gr: B6:40% reported no change, 60% mentioned increase of illness intrusiveness, 46% dialysis side-effects, 40% communication problems, 33% tension with medical staff and waiting list handling. Fear of emotional breakdown (40%), couple problems (47%) and worsened professional difficulties (20%) were reported. Gr: C6:All patients mentioned improved QOL and freedom recovery (87%). All expressed concerns about possible acute rejection, 73% were anxious about laboratory results, 93% experienced dependence to immunosuppressants, 47% reported difficulties in handling medication, 21% feared to forget them, 47% were concerned about side-effects, 67% had resumed work but medical constraints led to professional tension (40%). Gr: C12:All mentioned recovered QOL. Medical controls were accepted as a routine (87%) and adherence to medication was mandatory (100%). All mentioned the limited long-term graft survival and 47% were anxious about possible return to dialysis, especially younger patients (27%). Positive identity and existential changes were reported (60%). This prospective qualitative study identifies psychological modifications in the course of KT. It provides a basis to adequately address concerns, but it shows also that KT is clearly associated with positive psychological transformations.

Spanish auditors and the 'true and fair view'

In 1990 a new Spanish 'Plan General de Contabilidad' (PGC) implementedthe requirements of the EU 4th and 7th Directives in Spain. Included in the PGC is the requirement, derived from the 4th Directive, that accounts should present a 'true and fair view', in Spanish 'imagen fiel'. Where the term has been used in English speaking jurisdictions it has proved to have a variety of shades of meaning, and to have had strikingly different impact in different countries. Within the European Union the term has been seen as a 'Trojan horse', inserted into the 4th Directive to inject an Anglo-Saxon approach of flexibility and judgement dependent accounting into a Continental European accounting tradition of detailed prescription and uniformity. In this paper we report on a survey of the views and experience of Spanish auditors relating to 'imagen fiel'. Specifically, we:1) Review the English language literature on 'true and fair view' to identify the key areas of controversy.2) Consider the significance of the 'true and fair view' within the EU 4th Directive.3) Report on the experience of Spanish auditors in working with this concept, their views on the value of the term, and their experience in use of the true and fair view 'override'.

A portrait of the Spanish accounting community

This study presents a portrait of the Spanish academic accountingcommunity in 1995, based upon a questionnaire circulated to Spanishaccounting academics in 1995 and upon an analysis of authorship andcitations in the main Spanish accounting journals. The approach tothese analyses is grounded in similar studies which have been carriedout in the United States, Spain and elsewhere. but the combination oftechniques used in this study is particularly broad in range.The results of the study are used to describe a range ofcharacteristics of Spanish accounting academics, for example,publications records and length of academic experience. The analysisof publications produces a ranking by institutional affiliation ofthe most significant contributors to current debates on accounting.Citation analysis is used to identify the range and extent ofinternational influences upon the Spanish academic accountingcommunity, and to provide an additional ranking by institutionalaffiliation of the most frequently cited sources A significantfinding was that the nature and extent of international influence hadchanged very little over the ten year period since Spain entered theEuropean Union and started to implement European Directives.Perceptions of journal quality were elicited by questionnaire. Fortyfive journals, Spanish and international are included in a listranked for perceived importance as outlets for publication. and assources of support for teaching and research. The results of thisexercise show that Spanish journals were ranked low relative tojournals published in the United Kingdom and United States.Finally the study examines the extent of purpose upon Spanishaccounting academies to publish, by presenting results of a questionabout criteria for promotion, and also by examining and increasingtendency to publish co-authored work.

Concepções, Práxis e Tendências de Desenvolvimento Curricular no Ensino Superior Público em Cabo Verde: um Estudo de Caso Sobre a Universidade de Cabo Verde

A tese enquadra-se nas discussões sobre as concepções do currículo, como problemática central nos processos de educação e formação, e o papel da Universidade ao longo dos tempos, mormente nos contextos actuais da globalização, conferindo especial relevo às concepções, práxis e tendências que caracterizam a experiência de desenvolvimento curricular na Universidade de Cabo Verde (Uni-CV), desde a sua criação, em Novembro de 2006, no seguimento de um percurso de quase três décadas do ensino superior público cabo-verdiano Com o enquadramento teórico da problemática da investigação faz-se uma ampla cartografia da literatura relevante no campo científico dos estudos curriculares, numa abordagem que patenteia a diversidade de conceptualizações do currículo e do desenvolvimento curricular, os principais traços característicos das teorias curriculares que se têm sucedido e ou que rivalizam na busca de hegemonia no sector da educação, bem como as políticas educativas e curriculares que vêm sendo concebidas e realizadas à escala global, dispensando atenção particular às dimensões instituinte e instituída do processo curricular. Ainda que fortemente condicionado pelas concepções e políticas de globalização da educação, a tendência para a uniformização educativa e curricular não constitui uma inevitabilidade, demonstrando-se, pelo contrário, que o processo de desenvolvimento curricular deixa espaços de apropriação e inovação ao nível das instituições educativas, atendendo à diversidade de contextos, expectativas e perspectivas inerentes à dinâmica da realização do currículo. Ainda no plano teórico, ao analisar-se a evolução do conceito ou ideia de Universidade, desde a sua génese até aos tempos actuais, coloca-se em relevo a natureza específica da instituição no âmbito do ensino superior, patenteando o modo como, nos diferentes contextos, a mesma tem procurado afirmar a centralidade do conhecimento e do currículo no cumprimento da sua missão, a despeito de factores e condicionalismos diversos, de entre os quais releva o tipo de relacionamento predominante entre a Universidade, o Estado e o mercado, no âmbito do qual se deve entender a complexidade da crise institucional, na triplicidade das suas manifestações (crise de legitimidade, de hegemonia e de identidade) que atravessa a academia, com reflexos ao nível das tendências para o condicionamento da autonomia, missão e funções da academia, assim como da própria natureza do conhecimento universitário. Na procura de saídas para a crise, que é global e, como tal, se reflecte nas universidades do continente africano, em que se insere Cabo Verde, a Universidade é desafiada a afirmar a sua especificidade institucional, enquanto promotora da alta cultura e da capacidade de pensamento de longo prazo, conciliando, deste modo, as suas funções essenciais ou simbólicas com as que se prendem com a satisfação das necessidades imediatas ou de curto prazo da economia e do mercado. Com base nos pertinentes subsídios teóricos, os estudos empíricos desenvolvem-se segundo a abordagem metodológica de estudo de caso, em que a análise documental e as técnicas de investigação qualitativa e quantitativa permitiram consolidar as evidências sobre: (i) os antecedentes da criação da Uni-CV, através do mapeamento do percurso académico e curricular dos diversos estabelecimentos públicos de ensino superior que precederam a universidade pública, legando a esta o seu património científico, tecnológico e logístico, com as inerentes potencialidades e limitações; (ii) o processo de institucionalização da Uni-CV, com a referencialização das opções estruturantes da organização e gestão da Universidade assim como da política educativa e curricular da Universidade; (iii) a experiência multifacetada de desenvolvimento curricular na novel instituição durante os cinco primeiros anos de funcionamento (2006-2011), correlacionando opções e práxis e evidenciando tendências da sua evolução. Da análise interpretativa dos estudos empíricos realizados, mediante a triangulação dos dados de arquivo e de perspectiva, resulta que a Uni-CV, não obstante as fragilidades persistentes no processo de seu desenvolvimento institucional, tem cumprido a sua missão de forma satisfatória, facto que fica a dever-se quer à adequação das opções, normas e directivas conformadoras da dimensão instituinte do processo curricular, quer ao esforço de realização das prescrições curriculares, sendo, todavia, evidentes os desafios a serem vencidos tendo em vista a consecução da almejada excelência académica, que os Estatutos propugnam, e que passa, nomeadamente, pela melhoria do nível da qualificação do seu corpo docente, pela implementação ou funcionamento efectivo de alguns dos órgãos da academia e pela afirmação da investigação científica como função incontornável para o desempenho cabal das funções de ensino e extensão. De entre as conclusões, sustenta-se que, no processo de integração de Cabo Verde nas redes internacionais de investigação e excelência científica e tecnológica, como, de resto, propugnam os Estatutos da Uni-CV, deve atender-se à especificidade deste pequeno país do Atlântico Médio, tendo em conta as suas fragilidades estruturais, pelo que se impõe algum distanciamento crítico em relação à incorporação de certas opções de política educativa e curricular que emanam de instâncias internacionais, independentemente do seu carácter inovador ou mesmo da sua possível consistência científica e técnica, comprovada em outros contextos.

Parallelizing remote sensing image geometric correction

Remote sensing spatial, spectral, and temporal resolutions of images, acquired over a reasonably sized image extent, result in imagery that can be processed to represent land cover over large areas with an amount of spatial detail that is very attractive for monitoring, management, and scienti c activities. With Moore's Law alive and well, more and more parallelism is introduced into all computing platforms, at all levels of integration and programming to achieve higher performance and energy e ciency. Being the geometric calibration process one of the most time consuming processes when using remote sensing images, the aim of this work is to accelerate this process by taking advantage of new computing architectures and technologies, specially focusing in exploiting computation over shared memory multi-threading hardware. A parallel implementation of the most time consuming process in the remote sensing geometric correction has been implemented using OpenMP directives. This work compares the performance of the original serial binary versus the parallelized implementation, using several multi-threaded modern CPU architectures, discussing about the approach to nd the optimum hardware for a cost-e ective execution.

Syndrome métabolique et antipsychotiques atypiques : recommandations et prise en charge clinique

L'introduction des antipsychotiques atypiques (AA) avec leurs effets secondaires métaboliques a attiré une plus grande attention sur le risque iatrogène éventuel de maladies cardiovasculaires dans la population des patients atteints de schizophrénie ou de trouble bipolaire. À cet égard, l'analyse du rapport risque/bénéfice dans l'utilisation des ces médicaments se révèle souvent délicate, nécessitant la coordination de plusieurs savoirs et ressources des réseaux somatiques et psychiatriques. Dans cet article, les auteurs présentent une revue sur le syndrome métabolique (SM) et la maladie cardiovasculaire (MCV) dans la population psychiatrique. Sur la base des dernières recommandations internationales, ils proposent des directives de prise en charge des effets secondaires, notamment métaboliques, à l'introduction d'un AA.

Étude rétrospective de la qualité de la chirurgie oncologique pédiatrique dans un centre académique suisse

Introduction : Il essentiel pour les patients, mais aussi pour l'utilisation appropriée des ressources médicales et financières, que les centres pédiatriques oncologiques de moindre envergure répondent de manière adéquate aux normes de soins et atteignent des résultats comparables à ceux des grands centres. Étant donné que l'impact économique des soins de santé est devenu un important modulateur des décisions politiques, il est urgent que les institutions abordent le sujet de la qualité en chirurgie pédiatrique oncologique, et fournissent des éléments pour appuyer ou modifier les lignes directrices existantes Patients et méthode : Par cette étude monocentrique rétrospective de 13 ans, nous avons analysé la qualité de la chirurgie pédiatrique de tumeurs abdominales ou thoraciques du Département Médico-Chirurgical du CHUV pratiquée sur 48 enfants. Afin d'y parvenir, nous avons choisi et analysé deux indicateurs de la qualité de ces soins. Le premier est la conformité de la pratique de ce service, avec les directives des protocoles de traitements internationaux. Le second paramètre étudié est la mesure du taux d'événements indésirables liés à la chirurgie du cancer observés dans notre population de patients. Résultats : La conformité avec les protocoles de traitement est très élevée avec un taux de 96%. L'incidence des événements indésirables liés à la chirurgie est de 34 patients sur 48 (66%). Les complications graves sont rares, avec 85% ne nécessitant pas plus qu'un traitement médical simple. Aucune mortalité chirurgicale n'a été identifiée. Conclusion : Nos données suggèrent que la planification méticuleuse de la chirurgie et l'exécution de celle-ci par des chirurgiens dédiés à l'oncologie pédiatrique, ainsi qu'une étroite collaboration avec des oncologues pédiatres sont des conditions essentielles à la qualité des soins apportés à ces patients. Dans ces conditions, même un centre d'oncologie pédiatrique de moindre envergure peut répondre aux normes établies par les grands centres internationaux.

Patients' right to information: a review of the regulatory and ethical framework

[eng] Aim: The paper examines the current situation of recognition of patients' right to information in international standards and in the national laws of Belgium, France, Italy, Spain (and Catalonia), Switzerland and the United Kingdom.Methodology: International standards, laws and codes of ethics of physicians and librarians that are currently in force were identified and analyzed with regard to patients' right to information and the ownership of this right. The related subjects of access to clinical history, advance directives and informed consent were not taken into account.Results: All the standards, laws and codes analyzed deal with guaranteeing access to information. The codes of ethics of both physicians and librarians establish the duty to inform.Conclusions: Librarians must collaborate with physicians in the process of informing patients.

El dret a la informació del pacient: una aproximació legal i deontològica

[eng] Aim: The paper examines the current situation of recognition of patients' right to information in international standards and in the national laws of Belgium, France, Italy, Spain (and Catalonia), Switzerland and the United Kingdom.Methodology: International standards, laws and codes of ethics of physicians and librarians that are currently in force were identified and analyzed with regard to patients' right to information and the ownership of this right. The related subjects of access to clinical history, advance directives and informed consent were not taken into account.Results: All the standards, laws and codes analyzed deal with guaranteeing access to information. The codes of ethics of both physicians and librarians establish the duty to inform.Conclusions: Librarians must collaborate with physicians in the process of informing patients.

Alternatives to Guardianship and Conservatorship for Adults in Iowa, Revised 2006

Independence, respect, and equality are values important to all people. These values help define the concepts of autonomy (independence and freedom) and self-determination (the right to make decisions for one’s self). Because these rights are so valued in our society and are something that most of us would value for ourselves, the “least restrictive alternative” should always be considered before taking away a person’s civil and legal rights to make decisions for him or herself. The least restrictive alternative is an option, which allows a person to keep as much autonomy, and self-determination as possible while providing only the level of protection and supervision that is necessary. Some examples may include: representative payee for certain government benefit checks, joint bank accounts or advance directives for health care.

Literature review on advance care planning of nursing home residents

Aim: Conduct a search and analytic review of literature regarding attributes of Advance Care Planning (ACP) and Advance Directive in order to identify the experiences and the best care strategies for older adults resident in nursing homes or long term institutions. Methodology: An extensive electronic search was undertaken in the following databases: Pubmed (via Ovid search), Cumulative Index of Nursing and Allied Health (CINAHL, via EBHOST), psychINFO and Cochrane. After analyzing and eliminating duplicates and professional's point of view (19), 144 titles were considered relevant: 28 opinion papers, 94 descriptive/qualitative studies or predictive studies, 17 experimental and five systematic reviews. Most of them were produced in North America and only 10 were in French. Results: With regard to European experiences, studies are scarce and further research could benefit from North American evidence. Contrary to Europe, nurses in North America play a major role in the process of care planning. The major findings were related to the poor efficacy of the completion of Advance Directives, even in presence of a substantial variety of implementation strategies. The evidence supports interventions that conceptualize ACP as a process, with an emphasis on the ascertainment of patients' values and beliefs and the necessity to include the family or loved ones from the beginning of the process in order to favor the expression and sharing of one's life perspectives and priorities in care. The most relevant findings were associated with the conceptualization of the ACP as a change in health behaviors which needs an involvement in different stages to overcome a variety of barriers. Conclusion: Rigorous research in ACP for the older adults in Swiss nursing homes that promote respect and dignity in this frail population is needed. How to best achieve patients and families goals should be the focus of nursing intervention and research in this domain.

El derecho a la información del paciente: una aproximación legal y deontológica

[eng] Aim: The paper examines the current situation of recognition of patients' right to information in international standards and in the national laws of Belgium, France, Italy, Spain (and Catalonia), Switzerland and the United Kingdom.Methodology: International standards, laws and codes of ethics of physicians and librarians that are currently in force were identified and analyzed with regard to patients' right to information and the ownership of this right. The related subjects of access to clinical history, advance directives and informed consent were not taken into account.Results: All the standards, laws and codes analyzed deal with guaranteeing access to information. The codes of ethics of both physicians and librarians establish the duty to inform.Conclusions: Librarians must collaborate with physicians in the process of informing patients.

Prescriptions de protection incendie en Suisse : étude de leur domaine d'application et de leur respect par l'investigation d'incendies

Avant - Propos Le feu et la protection incendie Quel que soit l'usage d'un bâtiment, chaque étape de la construction est soumise à l'application de normes. Certaines, utilisées par les architectes et les ingénieurs, concernent le gros oeuvre ; en simplifiant leur rôle, elles assurent la solidité et la stabilité de l'immeuble. Si celui-ci est ouvert au public, des aménagements particuliers concernant la sécurité des personnes sont imposés. D'autres comme les prescriptions sur les installations électriques intérieures, précisent la manière de construire une alimentation, le type de matériel utilisable en fonction du courant et de la tension, les sécurités destinées à éviter toute détérioration des circuits et tout risque d'électrocution, etc. Enfin, les prescriptions en matière de protection incendie jouent évidemment un rôle préventif et, dans le domaine judiciaire, servent de références pour qualifier une éventuelle infraction ; elles évitent qu'une source de chaleur installée dans un bâtiment - tel qu'un appareil de chauffage ou des plaques de cuisson - ou susceptible d'apparaître consécutivement à l'usure d'un matériau ou à son vieillissement - disparition d'un isolant thermique, défaut d'étanchéité d'un conduit transportant les gaz chauds de combustion, par exemple - ne communiquent une partie de l'énergie calorifique dégagée à un combustible et ne l'enflamme. Le concept de protection incendie implique d'exposer et de développer les principales notions relatives à l'inflammation d'un matériau, à sa combustion ainsi qu'au transport de l'énergie calorifique. Fréquemment, le milieu dans lequel le générateur de chaleur est installé joue un rôle dans la phase d'allumage de l'incendie. Il est évident que les prescriptions de protection incendie s'appliquent à chaque élément de construction et, par conséquent, doivent être respectées par toute personne participant à la réalisation d'un ouvrage : le chauffagiste, l'électricien, l'installateur sanitaire, le constructeur de cuisine, mais également le maçon qui construit la cheminée, le peintre et le décorateur qui posent des revêtements ou des garnitures inflammables, le menuisier qui utilise le bois pour dissimuler des conduites de fumée, etc. Dès lors, tout sinistre, hormis celui qui est perpétré délibérément, ne peut s'expliquer que par : - le non-respect ou le défaut d'application d'une prescription de protection incendie; - une lacune de la norme qui ignore une source d'échauffement et/ou un mode de transfert de l'énergie calorifique. Le but premier de ce travail consiste à : - analyser les sinistres survenus durant les années 1999 à 2005 dans plusieurs cantons suisses qui ont fait l'objet d'une investigation de la part d'un service technique de la police ou d'un expert ; - examiner les éléments retenus pour expliquer la cause de l'incendie à la norme afin de répondre à la question : « l'application d'une ou de plusieurs directives lors de l'installation ou de l'utilisation du générateur d'énergie calorifique aurait-elle évité à ce dernier de communiquer une partie de la chaleur dégagée à un combustible et à l'enflammer ? » Le second objectif visé est d'apporter une solution à la question précédente : - si la norme existe, c'est un défaut d'installation ou d'utilisation de la source de chaleur qui est à l'origine de l'incendie. Il importe donc de connaître la raison pour laquelle la prescription a été ignorée ou appliquée de manière erronée ou lacunaire; - si la norme n'existe pas, ce sont les prescriptions en matière de protection incendie qui doivent être complétées. Le chapitre suivant abordera ces thèmes en proposant divers postulats destinés à évaluer l'efficacité actuelle du concept de protection incendie en Suisse.