Immunoscintigraphie avec tomographie d'émission dans les cancers de la thyroïde

Immunoscintigraphy (IS) consists of in vivo body structure imaging using a specific labelled antibody to an antigen concentrated in the structure under study. Technically, the image contrast is better when IS is performed with a computerized emission tomography system. High concentrations of carcinoembryonic antigen (CEA) have been reported in medullary thyroid carcinoma and thyroglobulin (Tg) is a marker for differentiated thyroid carcinoma. We used injections of 131-I labelled monoclonal antibodies to CEA and Tg to detect thyroid tumours. A feasibility trial using anti-CEA antibodies gave very encouraging results. However, only tumours larger than 10 cm3 could be detected. Contradictory results were obtained using anti-Tg antibodies but this data must be considered as preliminary. Various means of improving the method and the concept of accessibility of the antigen to the antibody in vivo are discussed. This study shows IS to be a promising experimental technique. Further studies are required to define its clinical indications before it can be advocated for routine use.

Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series.

OBJECTIVES: The aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland. METHODS: A retrospective consecutive case series was performed. We included all highly frequent users, defined as patients attending the ED 12 times or more within a calendar year (1 January 2009 to 31 December 2009). We collected their characteristics and calculated a score of accumulation of risk factors of vulnerability. RESULTS: Highly frequent users comprised 0.1% of ED patients, and they accounted for 0.8% of all ED attendances (23 patients, 425 attendances). Of all highly frequent users, 87% had a primary care practitioner, 82.6% were unemployed, 73.9% were socially isolated, and 60.9% had a mental health or substance use primary diagnosis. One-third had attempted suicide during study period, all of them being women. They were often admitted (24.0% of attendances), and only 8.7% were uninsured. On average, they cumulated 3.3 different risk factors of vulnerability (SD 1.4). CONCLUSION: Highly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.

Mission-Oriented Dust Control and Surface Improvement Processes for Unpaved Roads, HR-194, 1981

Six subject areas prompted the broad field of inquiry of this mission-oriented dust control and surface improvement project for unpaved roads: • DUST--Hundreds of thousands of tons of dust are created annually by vehicles on Iowa's 70,000 miles of unpaved roads and streets. Such dust is often regarded as a nuisance by Iowa's highway engineers. • REGULATIONS--Establishment of "fugitive dust" regulations by the Iowa DEQ in 1971 has created debates, conferences, legal opinions, financial responsibilities, and limited compromises regarding "reasonable precaution" and "ordinary travel," both terms being undefined judgment factors. • THE PUBLIC--Increased awareness by the public that regulations regarding dust do in fact exist creates a discord of telephone calls, petitions, and increasing numbers of legal citations. Both engineers and politicians are frustrated into allowing either the courts or regulatory agencies to resolve what is basically a professional engineering responsibility. • COST--Economics seldom appear as a tenet of regulatory strategies, and in the case of "fugitive dust," four-way struggles often occur between the highway professions, political bodies, regulatory agencies, and the general public as to who is responsible, what can be done, how much it will cost, or why it wasn't done yesterday. • CONFUSION--The engineer lacks authority, and guidelines and specifications to design and construct a low-cost surf acing system are nebulous, i.e., construct something between the present crushed stone/gravel surface and a high-type pavement. • SOLUTION--The engineer must demonstrate that dust control and surface improvement may be engineered at a reasonable cost to the public, so that a higher degree of regulatory responsibility can be vested in engineering solutions.

Rate of undesirable events at beginning of academic year: retrospective cohort study.

OBJECTIVE: To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year. DESIGN: Retrospective cohort study using administrative and patient record data. SETTING: University affiliated hospital in Melbourne, Australia. PARTICIPANTS: 19,560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000). MAIN OUTCOME MEASURES: Absolute event rates, absolute rate reduction, and rate ratios of undesirable events. RESULTS: The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82%), inadequate oxygenation of the patient (66%), vomiting/aspiration in theatre (53%), and technical failures of tracheal tube placement (49%). CONCLUSIONS: The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase.

2007-2008 Academic Year Iowa Community Colleges Tuition and Fees Report, July 2007

This document shows the tuition and fees charged by the 15 community colleges. It includes comparisons to the regents institutions and to national data.

2004-2005 Academic Year Iowa Community Colleges Tuition and Fees Report, November 2004

This document shows the tuition and fees charged by the 15 community colleges. It includes comparisons to the regents institutions and to national data.

2006-2007 Academic Year Iowa Community Colleges Tuition and Fees Report, July 2006

This document shows the tuition and fees charged by the 15 community colleges. It includes comparisons to the regents institutions and to national data.

Pathways for Academic Career and Employment (PACE) Program, FY 2014 Report,

The pathways for academic career and employment program (PACE) is established to provide funding to community colleges for the development of projects that will lead to gainful, quality, in-state employment for members of target populations by providing them with both effective academic and employment training to ensure gainful employment and customized support services.