Iowa Natural Resources, Agency Performance Plan, FY2013

The work of the Department of Natural Resources impacts the lives of all Iowans. Iowans deserve a clean environment and quality natural areas for public use and enjoyment. This report reflects the progress made during fiscal year 2013 (FY13) toward our goals and provides information regarding the condition of our state’s natural resources and the effectiveness of our programs. In FY13, we continued to improve collaboration with other executive branch agencies. The DNR and DOT work very closely on the issuance of permits needed for road and bridge constructions, but recently we have also been working together to meet the administrative needs of the agencies. The DNR is working closely with the DOT to adopt an Electronic Records Management System used by the DOT. This system will improve accessibility to public documents and reduce the amount of paper files retained in storage. The DNR also continues to improve collaboration with other agencies, such as the Iowa Economic Development Authority as we work closely with them on business development in the state. The DNR strives to continually improve our customer service and how we can meet Iowan’s needs. As an example, the online reservation system for campground reservations has grown over the past eight years so that now 88% of the camping reservations are made online. The DNR continues to improve our online presence and accessibility. In FY13 the Iowa Legislature approved paying off the State’s bond debt used to construct Honey Creek Resort State Park. By removing this debt, the DNR will be able to focus more on the future of the Resort, rather than the past debt. Finally, in August of 2012, the DNR was faced with a tragic accident, where a seasonal parks employee died after rolling a mower into a lake. This incident has caused us to establish a Safety Program at the DNR and to review all of our departmental safety trainings, programs, and equipment. By focusing on our employee’s safety and well being, it is another way that we can demonstrate that at the DNR, our employees are our greatest asset.

Patient expectations at a multicultural out-patient clinic in Switzerland.

BACKGROUND: Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. OBJECTIVES: The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. METHODS: Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. RESULTS: We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. CONCLUSIONS: Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication training.

Local Public-Services Provision under Public-Private Partnerships : Contractual Design and Contracting Parties Incentives

When deciding to resort to a PPP contract for the provision of a local public service, local governments have to consider the demand risk allocation between the contracting parties. In this article, I investigate the effects of demand risk allocation on the accountability of procuring authorities regarding consumers changing demand, as well as on the cost-reducing effort incentives of the private public-service provider. I show that contracts in which the private provider bears demand risk motivate more the public authority from responding to customer needs. This is due to the fact that consumers are empowered when the private provider bears demand risk, that is, they have the possibility to oust the private provider in case of non-satisfaction with the service provision, which provides procuring authorities with more credibility in side-trading and then more incentives to be responsive. As a consequence, I show that there is a lower matching with consumers' preferences over time when demand risk is on the public authority rather than on the private provider, and this is corroborated in the light of two famous case studies. However, contracts in which the private provider does not bear demand risk motivate more the private provider from investing in cost-reducing efforts. I highlight then a tradeoff in the allocation of demand risk between productive and allocative efficiency. The striking policy implication of this article for local governments would be that the current trend towards a greater resort to contracts where private providers bear little or no demand risk may not be optimal. Local governments should impose demand risk on private providers within PPP contracts when they expect that consumers' preferences over the service provision will change over time.

The economics of infertility

Infertility is a growing issue that affects thousands of Spanish couples; increasingly there are more and more people who cannot raise a family by themselves. Instead they have to resort to ART, adoption -local or international- or surrogacy abroad, a practice that many couples consider but that isn’t legalized in Spain. In this paper we have broken down each option in detail by analysing the market, differentiating its variants and specific steps, calculating its “price” and suggesting possible improvements that could be made from an economic perspective. We end our paper with the “SWOT” analysis of a hypothetical surrogacy market in Spain by calculating an estimated price, using the US as a reference, and the degree of acceptance it would have, based on the results of random surveys.

French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering.

OBJECTIVE: Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially "existential suffering." This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable). METHODS: We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians. RESULTS: 74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000). Significance of the results: The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.

Infirmier en psychiatrie de liaison : développement de la supervision en milieu somatique [Liaison psychiatry nurse: The development of supervision in somatic medicine].

BACKGROUND: Over the years, somatic care has become increasingly specialized. Furthermore, a rising number of patients requiring somatic care also present with a psychiatric comorbidity. As a consequence, the time and resources needed to care for these patients can interfere with the course of somatic treatment and influence the patient-caregiver relationship. In the light of these observations, the Liaison Psychiatry Unit at the University Hospital in Lausanne (CHUV) has educated its nursing staff in order to strengthen its action within the general care hospital. What has been developed is a reflexive approach through supervision of somatic staff, in order to improve the efficiency of liaison psychiatry interventions with the caregivers in charge of patients. The kind of supervision we have developed is the result of a real partnership with somatic staff. Besides, in order to better understand the complexity of interactions between the two systems involved, the patient's and the caregivers', we use several theoretical references in an integrative manner. PSYCHOANALYTICAL REFERENCE: The psychoanalytical model allows us to better understand the dynamics between the supervisor and the supervised group in order to contain and give meaning to the affects arising in the supervision space. "Containing function" and "transitional phenomena" refer to the experience in which emotions can find a space where they can be taken in and processed in a secure and supportive manner. These concepts, along with that of the "psychic envelope", were initially developed to explain the psychological development of the baby in its early interactions with its mother or its surrogate. In the field of supervision, they allow us to be aware of these complex phenomena and the diverse qualities to which a supervisor needs to resort, such as attention, support and incentive, in order to offer a secure environment. SYSTEMIC REFERENCE: A new perspective of the patient's complexity is revealed by the group's dynamics. The supervisor's attention is mainly focused on the work of affects. However, these are often buried under a defensive shell, serving as a temporary protection, which prevents the caregiver from recognizing his or her own emotions, thereby enhancing the difficulties in the relationship with the patient. Whenever the work of putting emotions into words fail, we use "sculpting", a technique derived from the systemic model. Through the use of this type of analogical language, affects can emerge without constraint or feelings of danger. Through "playing" in that "transitional space", new exchanges appear between group members and allow new behaviors to be conceived. In practice, we ask the supervisee who is presenting a complex situation, to design a spatial representation of his or her understanding of the situation, through the display of characters significant to the situation: the patient, somatic staff members, relatives of the patient, etc. In silence, the supervisee shapes the characters into postures and arranges them in the room. Each sculpted character is identified, named, and positioned, with his or her gaze being set in a specific direction. Finally the sculptor shapes him or herself in his or her own role. When the sculpture is complete and after a few moments of fixation, we ask participants to express themselves about their experience. By means of this physical representation, participants to the sculpture discover perceptions and feelings that were unknown up to then. Hence from this analogical representation a reflection and hypotheses of understanding can arise and be developed within the group. CONCLUSION: Through the use of the concepts of "containing function" and "transitional space" we position ourselves in the scope of the encounter and the dialog. Through the use of the systemic technique of "sculpting" we promote the process of understanding, rather than that of explaining, which would place us in the position of experts. The experience of these encounters has shown us that what we need to focus on is indeed what happens in this transitional space in terms of dynamics and process. The encounter and the sharing of competencies both allow a new understanding of the situation at hand, which has, of course, to be verified in the reality of the patient-caregiver relationship. It is often a source of adjustment for interpersonal skills to recover its containing function in order to enable caregiver to better respond to the patient's needs.

08009-005 Storm Lake Watershed Final Report

Storm Lake, the state's fourth largest natural lake, has been the centerpiece of significant economic development, including a resort, water park, and state marina. While there have been considerable improvements to the lake's water quality through a major on-going lake restoration program and watershed project, the Little Storm Lake area still needs to be addressed. Little Storm Lake is a 190 acre area on the nmihwest side of Storm Lake. The water level in both areas is based on the dam height located on the southeast corner of Storm Lake. Approximately 70% of the water from the watershed flows through Little Storm Lake. Little Storm Lake originally had the ability to remove much of the sediment and nutrients from incoming waters. However, due to degradation, proper wetland function has been compromised. Under normal hydrologic conditions Little Storm Lake has the potential to function as a sediment trap for Storm Lake, but tllis capacity is overwhelmed during high flows. Little Storm Lake is at or near its sediment trapping capacity, which results in higher sediment transport into Storm Lake. Resuspension of sediments due to wind and other in-lake dynamics, such as rough fish, further exacerbate the total turbidity from suspended sediment and results in movement of sediment from Little Storm Lake into Storm Lake. This project includes a fish barrier and water retention structure between Little Storm Lake and Storm Lake and the construction of a pumping station and associated equipment. The project involves periodic dewatering of Little Storm Lake during years of favorable climatological conditions to consolidate the sediments and revegetate the area. Construction of the fish banier would aid restoration efforts by preventing rough fish from destroying the vegetation and would decrease recruitment of rough fish by limiting their spawning area. In the future, if the diminished trapping capacity of Little Storm Lake still results in sediment moving into Storm Lake, a dredging project would be initiated to deepen Little Storm Lake.

Résistance aux antibiotiques chez les pneumocoques.

In 1875, 7 years prior to the description of the Koch bacillus, Klebs visualized the first Streptococcus pneumoniae in pleural fluid. Since then, this organism has played a decisive role in biomedical science. From a biological point of view, it was extensively involved in the development of passive and active immunization by serotherapy and vaccination respectively. Genetic transformation was also first observed in S. pneumoniae, leading to the discovery of DNA. From a clinical point of view, S. pneumoniae is today still a prime cause of otitis media in children and of pneumonia in all age groups, as well as a predominant cause of meningitis and bacteremia. In adults, bacteremia still has a mortality of over 25%. Although S. pneumoniae remained very sensitive to penicillin for many years, penicillin-resistant strains have emerged and increased dramatically over the last 15 years. During this period the frequency of penicillin-resistant isolates has increased from < or = 1% to frequencies varying from 20 to 60% in geographic areas as diverse as South Africa, Spain, France, Hungary, Iceland, Alaska, and numerous regions of the United States and South America. In Switzerland, the current frequency of penicillin-resistant pneumococci ranges between 5 and > or = 10%. The increase in penicillin-resistant pneumococci correlates with the intensive use of beta-lactam antibiotics. The mechanism of resistance is not due to bacterial production of penicillinase but to an alteration of the bacterial target of penicillin, the so-called penicillin-binding proteins. Resistance is subdivided into (1) intermediate level resistance (minimal inhibitory concentration [MIC] of penicillin of 0.1-1 mg/l) and (2) high level resistance (MCI > or = 2 mg/l). The clinical significance of intermediate resistance remains poorly defined. On the other hand, highly resistant strains have been responsible for numerous therapeutic failures, especially in cases of meningitis. Antibiotics recommended against penicillin-resistant pneumococci include cefotaxime, ceftriaxone, imipenem and in some instances vancomycin. However, penicillin-resistant pneumococci tend to present cross-resistances to all the antibiotics of the beta-lactam family and could even become resistant to the last resort drugs mentioned above. Thus, the explosion of resistance to penicillin in pneumococci is a ubiquitous phenomenon which must be fought against by (1) avoiding excessive use of antibiotics, (2) the practice of microbiological sampling of infected foci before treatment, (3) the systematic surveillance of resistance profiles of pneumococci against antibiotics and (4) adequate vaccination of populations at risk.

Relaciones de complacencia y deberes para con los invitados

En la STS, 1a, 17.7.2007 (RJ 2007\4895, MP: Francisco Marín Castán), el Tribunal Supremo sostiene que los daños que sufre una amiga de los demandados en el inmueble de éstos al tropezar con un juguete abandonado en el suelo del pasillo, insuficientemente iluminado, no son indemnizables, porque dada la especial relación de confianza entre las partes, ese nivel extremo de diligencia no es exigible. El Tribunal parece aplicar al caso un patrón de diligencia quam in suis, la que despliega uno en sus propios asuntos, que permitiría limitar la responsabilidad a los casos de dolo o culpa grave. El trabajo comenta la sentencia y presenta, además, la clasificación entre invitee, licensee y trespasser que el Common Law norteamericano ha utilizado tradicionalmente para delimitar los niveles de cuidado de propietarios (o poseedores) de inmuebles y que el borrador No. 6 del Restatement (Third) of Torts, de 12.9.2007, ha simplificado, añadiendo a la regla tradicional de No Duty to Trespasser la de una negligencia simple para los Innocent Trespasser.

Estacions termals en zones rurals, serveis associats i titulacions oficials

El turisme rural, l’esport i la salut han adquirit de forma progressiva en els últims anys una importància cada vegada més gran. Una part creixent de la població ha anat incorporant de mica en mica dies de descans i repòs durant tot l’any. Aquesta realitat és deguda, parcialment, a l’augment del temps lliure i a la consideració del seu gaudi com un element per a la millora de la qualitat de vida. El turisme rural, a causa del canvi de valors experimentat en la societat contemporània, s’interrelaciona amb altres productes, com ara el turisme termal i les activitats esportives realitzades en contacte amb la natura, igual que amb altres serveis del sector del lleure, com ara l’espectacle, el joc, la cultura, etc. Aquesta situació determina la necessitat de plantejar sistemes de gestió professionals i aplicar estratègies que permetin de generar factors competitius i diferenciadors. Les empreses turístiques que han adoptat el paradigma empresarial de la gestió de qualitat total es caracteritzen per oferir qualitat de servei, i per assolir aquesta qualitat cal disposar d’un equip d’especialistes altament qualificats i experimentats. El propòsit d’aquest treball és analitzar les titulacions oficials relacionades amb les estacions termals en zones rurals i els serveis associats.

Estaciones termales en zonas rurales, servicios asociados y titulaciones oficiales

El turismo rural, el deporte y la salud han venido adquiriendo de forma progresiva en los últimos años una importancia cada vez mayor. Una parte creciente de la población ha ido incorporando paulatinamente días de descanso y reposo durante todo el año. Esta realidad es debida, en parte, al aumento del tiempo libre y a la consideración de su disfrute como un elemento para la mejora de la calidad de vida. El turismo rural, debido al cambio de valores sufrido en la sociedad contemporánea, se interrelaciona con otros productos como el turismo termal y las actividades deportivas realizadas en contacto con la naturaleza, al igual que con otros servicios del sector ocio, como pueden ser el espectáculo, el juego, la cultura, etc. Esta situación determina la necesidad de plantear sistemas de gestión profesionales y aplicar estrategias que permitan generar factores competitivos y diferenciadores. Las empresas turísticas que han adoptado el paradigma empresarial de la gestión de calidad total se caracterizan por ofrecer calidad de servicio, y para alcanzar dicha calidad es necesario disponer de un equipo de especialistas altamente cualificados y experimentados. El propósito de este trabajo es analizar las titulaciones oficiales relacionadas con las estaciones termales en zonas rurales y los servicios asociados.

Evaluación de un artículo científico

El proceso de revisión y evaluación de manuscritos, conocido como arbitraje científico o peer review, supone actualmente un paso que se considera necesario para la divulgación de los avances científicos de una determinada disciplina. Cuando una revista recibe un artículo, sus editores recurren a revisores expertos que, después de la lectura detenida del manuscrito, evalúan la idoneidad de su publicación, en este trabajo se describe el proceso editorial de un artículo y se muestran los ítems por los cuales se evalúan los artículos.

Using vegetation to characterize the avalanche to Canal del Roc Roig, Vall de Núria (Eastern Pyrenees, Spain)

Avalanche hazard maps of high accuracy are difficult to produce. For land-use planning and management purposes, a good knowledge of extreme run-out zones and frequencies of avalanches is required. In the present work, vegetation recognition (especially focused on Pinus uncinata trees) and dendrochronological techniques are used to characterize avalanches that have occurred in historical times, helping to determine both the extent of large or extreme avalanches and their occurrence in time. Vegetation was studied at the Canal del Roc Roig (eastern Pyrenees, Spain) avalanche path. The avalanches descending this path affect the railway that reaches the Vall de Núria resort and the run-up to the opposite slope. During winter 1996, two important avalanches affecting this path were well documented. These are compared with the results of the vegetation study, consisting of an inventory of flora, the recording of vegetation damages along eight transverse profiles at different altitudes on the path and a dendrochronological sampling campaign. The data obtained contributed to a characterization of the predominant snow accumulation in the starting zone, the 1996 avalanches and the range of frequencies of large avalanches. Also, traces of avalanches that increase the path mapped in the avalanche paths map published by the Institut Cartogràfic de Catalunya in 2000 were identified, improving the initial existing information.

Using vegetation to characterize the avalanche to Canal del Roc Roig, Vall de Núria (Eastern Pyrenees, Spain)

Avalanche hazard maps of high accuracy are difficult to produce. For land-use planning and management purposes, a good knowledge of extreme run-out zones and frequencies of avalanches is required. In the present work, vegetation recognition (especially focused on Pinus uncinata trees) and dendrochronological techniques are used to characterize avalanches that have occurred in historical times, helping to determine both the extent of large or extreme avalanches and their occurrence in time. Vegetation was studied at the Canal del Roc Roig (eastern Pyrenees, Spain) avalanche path. The avalanches descending this path affect the railway that reaches the Vall de Núria resort and the run-up to the opposite slope. During winter 1996, two important avalanches affecting this path were well documented. These are compared with the results of the vegetation study, consisting of an inventory of flora, the recording of vegetation damages along eight transverse profiles at different altitudes on the path and a dendrochronological sampling campaign. The data obtained contributed to a characterization of the predominant snow accumulation in the starting zone, the 1996 avalanches and the range of frequencies of large avalanches. Also, traces of avalanches that increase the path mapped in the avalanche paths map published by the Institut Cartogràfic de Catalunya in 2000 were identified, improving the initial existing information.

Brandin vahvistaminen matkailualalla

Tutkimuksen tavoitteena on selvittää brandin vahvistamista palvelualalla. Palvelubrandit eivät periaatteellisesti eroa varsinaisten tuotebrandien luomisesta ja vahvistamisesta. Käytännössä kuitenkin palvelubrandien kehittämisessä yrityksen henkilöstön palveluvalmius on keskeisin asiakkaan palvelukokemukseen vaikuttava tekijä. Henkilöstön palvelukykyyn ja –haluun vaikutetaan yrityksen avoimella, suunnitellulla ja tehokkaalla sisäisellä viestinnällä ja markkinoinnilla. Palveluyritykseen tulisi luoda ”asiakasta ilahduttava palvelukulttuuri”. Tutkimusmetodi on kvalitatiivinen ja yritysesimerkkinä on Katinkullan lomakeskus. Tutkimuksessa palvelubrandia tarkastellaan seuraavista neljästä brandiomaisuuden keskeisestä näkökulmasta: brandin tunnettuus, jonka tärkeä tekijä on mainonta. Brandin identiteettiin kuuluvat palvelutuote, sen persoona sekä brandin symboli. Brandin laadun tekijöitä ovat hinnoittelu, palvelupuitteet sekä itse palveluprosessi. Ne luovat asiakkaille odotuksia, joiden täyttyminen näkyy asiakastyytyväisyytenä. Se puolestaan johtaa neljänteen brandiomaisuuden tekijään eli asiakasuskollisuuteen.