Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score.

ABSTRACT: BACKGROUND: Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care. METHODS: Data were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group. RESULTS: The coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increases with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774) revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81) with a sensitivity of 85.6% and a specificity of 47.2%. CONCLUSIONS: This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

Previsió d'impactes en el medi físic, derivats de l'explotació de les formacions geològiques d'interés per a la producció d'àrids, a la zona del curs mitjà del Riu Fluvià (La Garrotxa)

Potential mining of the pliocene and quaternary geological formations for the aggregate production along the medium course of the Fluvil river is likely to be carried out through gravel pits. The most significant environmental impacts are envisaged to occur during site preparation and extraction of aggregate. Several environmental impacts types have been considered: variation of water table, reduction of soil and vegetation, development of unbalanced land-forms and deterioration of landscape

Los objetivos y plan de los experimentos de campo en la industria azucarera filipina

Muestra las investigaciones realizadas en la industria azucarera con el objetivo de reducir costos en relación a los sembríos y preparación del suelo y de esa formar generar mayor ganancias en el sector. Analiza la utilización de los tipos de abono que se encuentran en el mercado y selecciona los más adecuados para la producción del azúcar.

Estudio sobre la industria pesquera

Comenta sobre las formas adecuadas de investigación en relación a las actividades de la pesca y la industria del sector, analizando el comercio y la venta de pescado en el país, ya sea para consumo humano directo o procesado. Es por eso que se identifica mayores recursos (económicos y humanos) para realizar investigaciones en el Perú.

Sovereign debt markets in turbulent times: Creditor discrimination and crowding-out effects

In 2007, countries in the Euro periphery were enjoying stable growth, low deficits, and lowspreads. Then the financial crisis erupted and pushed them into deep recessions, raising theirdeficits and debt levels. By 2010, they were facing severe debt problems. Spreads increased and,surprisingly, so did the share of the debt held by domestic creditors. Credit was reallocatedfrom the private to the public sectors, reducing investment and deepening the recessions evenfurther. To account for these facts, we propose a simple model of sovereign risk in which debtcan be traded in secondary markets. The model has two key ingredients: creditor discriminationand crowding-out effects. Creditor discrimination arises because, in turbulent times, sovereigndebt offers a higher expected return to domestic creditors than to foreign ones. This providesincentives for domestic purchases of debt. Crowding-out effects arise because private borrowingis limited by financial frictions. This implies that domestic debt purchases displace productiveinvestment. The model shows that these purchases reduce growth and welfare, and may lead toself-fulfilling crises. It also shows how crowding-out effects can be transmitted to other countriesin the Eurozone, and how they may be addressed by policies at the European level.

Voyages astraux et hors du corps. Héautoscopie, extase et hallucinations expérientielles d'origine épileptique [Astral and out-of-body voyages. Heautoscopy, ecstasis and experimental hallucinations of epileptic origin]

We report a 38 year-old patient who had temporoparietal epilepsy and unusual ictal "out of body" experiences that remained undiagnosed for more than ten years, until her admission for a motor seizure of the left hemibody. Out of body episodes were experienced as intense and ecstatic astral journeys. EEG showed a bilateral extension of epileptiform abnormalities to the parietal regions, predominantly on the right side. We discuss the various forms of heautoscopy and their putative mechanisms. We suggest that a disturbance in representing space in independent extrapersonal and personal coordinates might be as crucial as the elusive hypothesis of a body schema disorder. Combined involvement of the parietal neocortex and temporolimbic structures might allow those experiences to gain a subjective vividness which appears to be indissociable from normal conscious experiences.

Automatització d'una planta de processos químics

Resum L’any 1969 es van començar a comercialitzar els sistemes digitals programables coneguts com autòmats programables o PLC’s, utilitzats per controlar qualsevol tipus de procés industrial. Al llarg de tots aquests anys, aquests sistemes i tota la tecnologia en general han evolucionat molt, i només és qüestió de temps que la tecnologia que utilitzem avui en dia quedi obsoleta i substituïda per una de millors característiques i amb més avantatges. Aquest és el motiu de l’elaboració d’aquest treball, que com a objectiu pretén modernitzar un procés de fabricació d’una industria química que ha quedat molt limitat a causa de l’antiguitat de la instal•lació. Per dur a terme aquesta modernització, s’introdueixen sistemes de control amb majors prestacions, s’utilitzen xarxes de comunicacions per facilitar el muntatge elèctric de la instal•lació i un sistema de supervisió i adquisició de dades per poder obtenir un control més estricte del procés de fabricació i de tots els factors que intervenen. El funcionament del procés de fabricació és que a partir d’unes matèries primeres líquides emmagatzemades en dipòsits, es dosifiquin aquestes matèries en l’ordre i la quantitat desitjada dins un o diversos recipients per barrejar-les i aplicar els tractaments que siguin necessaris. Tot aquest procés està controlat per un autòmat programable, i disposa de diferents terminals operadors per poder interactuar amb el sistema. També té implementat un sistema SCADA en diversos ordinadors per aportar una visió general de la planta en temps real, un registre de dades dels paràmetres que es controlen i alhora serveix per enllaçar amb la xarxa d’ordinadors existent. Com annex d’aquest treball, es presenten els esquemes elèctrics i el programa de l’autòmat programable per veure totes les característiques elèctriques dels dispositius i el mètode de funcionament del procés. S’ha aconseguit donar un salt tecnològic i poder gaudir de tots els avantatges que ofereixen les noves tecnologies, que com a resultat s’ha optimitzat i millorat el procés de fabricació. De totes les conclusions, la més destacada és la d’haver dissenyat un sistema de control basat en una estructura descentralitzada molt flexible, que es pot expandir i adaptar fàcilment als possibles canvis.

Report on a review of the Transportation Enhancement Program of the Iowa Department of Transportation for projects closed out during the period July 1, 2007 through June 30, 2009

Report on a review of the Transportation Enhancement Program of the Iowa Department of Transportation for projects closed out during the period July 1, 2007 through June 30, 2009

Stand Out In A Crowd! Merchandising Your Job Talents,

You want a job. And you believe that somewhere, some employer has precisely the job you want - one that fully utilizes your knowledge and abilities and provides challenge and opportunities for advancement. To find that job, you need to perform a well-planned job search. You have a product to sell - your knowledge, skills and experience . . . YOURSELF! What you need to know is how to market yourself most effectively. Whether you are just out of school and ready to start your career or looking for a new position after 20 years of experience, some of the techniques presented in this booklet may help you. NOTE: ENGLISH

La industria editorial frente al libro electrónico

El libro, la lectura y la industria editorial están experimentando cambios motivados por el progreso tecnológico. Los contenidos se han desvinculado del soporte y, en consecuencia, la industria editorial ha necesitado transformar su estructura logística, basada hasta hace poco en la distribución física. La impresión digital y las librerías virtuales cubren nuevas necesidades: han aumentado las posibilidades de visibilidad y de difusión de la producción editorial, y han eliminado barreras geográficas y físicas.

Report to the Governor and General Assembly on the Status of Out-of School Arts Programming for Youth, December 2006

In the 2006 Iowa General Assembly, House File 2797 called for a study on the status of afterschool arts programs and appropriated $5,000 for the study. In accordance with the legislation, the Iowa Arts Council, who received the charge, contracted with the Iowa Afterschool Alliance to form a Resource Group of out-of-school arts providers and experts to develop and oversee the study, review its results, and make recommendations for the expansion of arts programs that operate outside the normal school day. As a part of its charge in HF 2797, the Iowa Arts Council also documented a sampling of out-of-school arts programs statewide. Five are featured in this report.

Evidence on the complex link between

Most studies analysing the infrastructure impact on regional growth show a positive relationship between both variables. However, the public capital elasticity estimated in a Cobb-Douglas function, which is the most common specification in these works, is sometimes too big to be credible, so that the results have been partially desestimated. In the present paper, we give some new advances on the real link between public capital and productivity for the Spanish regions in the period 1964-1991. Firstly, we find out that the association for both variables is smaller when controlling for regional effects, being industry the sector which reaps the most benefits from an increase in the infrastructural dotation. Secondly, concerning to the rigidity of the Cobb-Douglas function, it is surpassed by using the variable expansion method. The expanded functional form reveals both the absence of a direct effect of infrastructure and the fact that the link between infrastructure and growth depends on the level of the existing stock (threshold level) and the way infrastructure is articulated in its location relative to other factors. Finally, we analyse the importance of the spatial dimension in infrastructure impact, due to spillover effects. In this sense, the paper provides evidence of the existence of spatial autocorrelation processes that may invalidate previous results.

Integración económica y localización industrial. Cataluña, la fábrica de España: ¿cuándo y por qué?

En este artículo se analizan los determinantes de la localización de la actividad industrial en España durante la segunda mitad del siglo XIX. El objetivo es estudiar la existencia de cambios en los factores explicativos de la localización, con el fin de identificar los efectos de la integración económica sobre la geografía industrial española. Para hacerlo, en primer lugar se analiza la literatura histórica existente. En segundo lugar, se describen las teorías que explican la localización de l'actividad. En tercer lugar, se realiza un análisis empírico de la localización y la concentración de la industria española al siglo XIX. A continuación, se propone un estudio econométrico de los determinantes de la localización industrial en dos cortes temporales, 1856 y 1893. Los resultados son consistentes con las teorías del comercio. Durante el decurso de la segunda mitad del siglo XIX, España paso a ser una economía integrada, la movilidad del trabajo y del capital se vio favorecida y como resultado, las diferencias relativas en las dotaciones de factores perdieron importancia en la explicación de las pautas de especialización industrial. Por el contrario, la integración económica favoreció la significación relativa de las economías de escala o de la proximidad a los mercados como elementos explicativos de la localización de la industria, favoreciendo, de esta manera, la aglomeración de la actividad industrial

Evidence on the complex link between

Most studies analysing the infrastructure impact on regional growth show a positive relationship between both variables. However, the public capital elasticity estimated in a Cobb-Douglas function, which is the most common specification in these works, is sometimes too big to be credible, so that the results have been partially desestimated. In the present paper, we give some new advances on the real link between public capital and productivity for the Spanish regions in the period 1964-1991. Firstly, we find out that the association for both variables is smaller when controlling for regional effects, being industry the sector which reaps the most benefits from an increase in the infrastructural dotation. Secondly, concerning to the rigidity of the Cobb-Douglas function, it is surpassed by using the variable expansion method. The expanded functional form reveals both the absence of a direct effect of infrastructure and the fact that the link between infrastructure and growth depends on the level of the existing stock (threshold level) and the way infrastructure is articulated in its location relative to other factors. Finally, we analyse the importance of the spatial dimension in infrastructure impact, due to spillover effects. In this sense, the paper provides evidence of the existence of spatial autocorrelation processes that may invalidate previous results.