"INTERMED": a method to assess health service needs. I. Development and reliability.

The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational purposes. First, a feasibility study (N = 21 patients) was conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Averaged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes; as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study 1 revealed that on most items there was considerable agreement; some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was more susceptible to differences. Some improvements--mainly of the anchor points--were specified which may further enhance interrater reliability. The INTERMED proves to be a reliable method for classifying patients' care needs, especially when used by experienced raters scoring by patient interview. It can be a useful tool in assessing patients' care needs, as well as the level of needed adjustment between general and mental health service delivery. The INTERMED is easily applicable in the clinical setting at low time-costs.

Anàlisi sòcio-demogràfica del reagrupament familiar a Catalunya 2004-2010

Aquest treball parteix de l’anàlisi de les dades sobre informes d’adequació de l’habitatge per a l’obtenció d’una autorització de reagrupament familiar realitzats per l’Ajuntament de Barcelona des de 2005 fins 2009, i del registre administratiu de les sol•licituds de reagrupament familiar presentades a les quatre subdelegacions del Govern a Catalunya des de 2004 fins 2010. Per a procedir a la seva anàlisi s’ha hagut de fer un important treball de depuració, harmonització i anonimització d’unes dades procedents de registres administratius no pensades per la seva explotació estadística. L’anàlisi demogràfica ha posat en relleu la importància dels rols de gènere en les estratègies familiars que acabaran conformant el perfil sociodemogràfic tant de les persones reagrupades com de les reagrupadores. També s’ha pogut veure com no hi ha una relació directa entre les persones estrangeres residents en cada municipi i les pautes de reagrupament familiar. La davallada del reagrupament familiar és deguda en bona part a la crisi econòmica, no obstant per a entendre la seva evolució en conjunt cal tenir en compte a més els factors legislatius (la Normalització del 2005 que explica el creixement de 2006 i 2007, però també l’entrada dels romanesos a la UE en 2007), així com la pròpia dinàmica familiar de la població immigrada, amb un esgotament del potencial reagrupadors per a les nacionalitats que precisament protagonitzaren el boom migratori (llatinoamericans). La legislació en matèria de reagrupament familiar s’ha basat en tres principis que han tingut un efecte indubtable i de vegades contrari a l’esperat: 1) la discriminació entre raons econòmiques i familiars en les migracions; 2) La restricció del dret de reagrupar a la definició nuclear de la família; i, 3) L’assumpció de la formació pre-migratòria de la família a reagrupar. Els resultats d’aquest informe aporten indicis que aquesta aproximació apriorística ha tingut efectes perversos, començant pel volum considerable de reagrupacions de facto.

The roots of success: industrial growth in Italy reconsidered, 1911- 1951

This article reconsiders the growth of Italian industry from the First World War to the eve of the economic miracle, with the aid of sector-specific new value-added series, at three different price-bases. The new estimates reduce growth during the First World War, making the Italian case comparable to the other belligerent countries, while improving the performance of the 1920s. The 1929 crisis looks more profound than before, while the recovery after 1933 is now stronger. During the 1920s and the 1930s, a significant shift from traditional to more advanced activities took place: when confronted with the rest of Europe, the interwar period was a relative success, which laid the ground for the following economic boom.

Les métamorphoses d'Ovide , en latin et françois, divisées en XV livres. Avec de nouvelles explications historiques... sur toutes les fables, chacune selon son sujet, de la traduction de M. Pierre Du Ryer,...

[Les métamorphoses (français-latin). 1702]

Iowa Workforce, Today and Tomorrow, 2004

Demographic and employment information are used by economic developers, market researchers, counselors and curriculum developers for educational institutions, academic researchers, government planners, and private businesses. Occupational information on employment and wages also provides guidance for students making their first career choices and older workers considering a change of profession. In the last decade, Iowans have grown older and more diverse. The median age (2000) stood at 36.6 years, with 38 counties recording a median age of 40 or above. In the last decade, Hispanics accounted for a third of Iowa’s population growth. The most highly educated Iowans were Asians, with 43 percent earning a minimum of a bachelor’s degree. The Iowa labor force has been growing erratically since 1980, but still reached a record 1,663,000 in 2002 before inching downward. In the next 25 years, the labor force will see dramatic changes with the impending retirement of the baby boom generation and the influx of new immigrants and younger college-educated workers. While Iowa nonfarm employment declined by 7,000 workers during 2003, it did show improvement in the second half of the year. In a prosperous year, the Iowa economy generates an average of 2,500 jobs per month. This number was negative during the recession and has been below average this year. National economic events will continue to have a strong impact on Iowa job growth. Occupations requiring higher education are among the higher-paying Iowa jobs. Computer software engineers, computer support specialists, and customer service representatives are expected to be among the faster-growing occupations. Also, the aging population will bring opportunities for workers in healthcare. Occupations requiring higher education are among the higher-paying Iowa

The A-kinase anchoring protein (AKAP)-Lbc-signaling complex mediates alpha1 adrenergic receptor-induced cardiomyocyte hypertrophy.

In response to various pathological stresses, the heart undergoes a pathological remodeling process that is associated with cardiomyocyte hypertrophy. Because cardiac hypertrophy can progress to heart failure, a major cause of lethality worldwide, the intracellular signaling pathways that control cardiomyocyte growth have been the subject of intensive investigation. It has been known for more than a decade that the small molecular weight GTPase RhoA is involved in the signaling pathways leading to cardiomyocyte hypertrophy. Although some of the hypertrophic pathways activated by RhoA have now been identified, the identity of the exchange factors that modulate its activity in cardiomyocytes is currently unknown. In this study, we show that AKAP-Lbc, an A-kinase anchoring protein (AKAP) with an intrinsic Rho-specific guanine nucleotide exchange factor activity, is critical for activating RhoA and transducing hypertrophic signals downstream of alpha1-adrenergic receptors (ARs). In particular, our results indicate that suppression of AKAP-Lbc expression by infecting rat neonatal ventricular cardiomyocytes with lentiviruses encoding AKAP-Lbc-specific short hairpin RNAs strongly reduces both alpha1-AR-mediated RhoA activation and hypertrophic responses. Interestingly, alpha1-ARs promote AKAP-Lbc activation via a pathway that requires the alpha subunit of the heterotrimeric G protein G12. These findings identify AKAP-Lbc as the first Rho-guanine nucleotide exchange factor (GEF) involved in the signaling pathways leading to cardiomyocytes hypertrophy.

X-Munich : cas pràctic

Berneda S.A. és una “pime” familiar catalana no cotitzada que es va fundar l’any 1939. També coneguda per ser l’empresa posseïdora de la marca X-Munich, destaca per la seva capacitat d’autofinançament.Al llarg de la seva història Berneda S.A. ha sabut guanyar-se el mercat en diverses etapes i, tot i haver viscut períodes de menys facturació, des de l’any 2007 ha gaudit d’un boom de les seves vendes al mercat espanyol. Part d’aquest creixement del volum de vendes i ingressos està relacionat també amb la seva capacitat exportadors: actualment les seves sabatilles esportives es comercialitzen, entre d’altres, a Itàlia, Holanda, Japó, Gran Bretanya i Portugal.Berneda S.A. ha aprofitat el seu avantatge competitiu, la diferenciació, per a oferir al mercat un producte diferent i posicionar-se com a una marca de referencia en el sector.

The varieties of regional change

Many metropolitan areas have experienced extreme boom-bust cycles over the past century. Some places, like Detroit, grew enormously as industrial powerhouses and then declined, while other older cities, like Boston, seem quite resilient. Education does a reasonable job of explaining urban resilience. In this paper, we present a simple model where education increases the level of entrepreneurship. In this model, human capital spillovers occur at the city level because skilled workers produce more product varieties and thereby increase labor demand. We decompose empirically the causes of the connection between skills and urban success and find that skills are associated with growth in productivity or entrepreneurship, not with growth in quality of life, at least outside of the West. We also find that skills seem to have depressed housing supply growth in the West, but not in other regions, which supports the view that educated residents in that region have fought for tougher land-use controls. We also present evidence that skills have had a disproportionately large impact on unemployment during the current recession.

Social spending and demographics: The role of public policies in the intergenerational redistribution of income. Empirical evidence from Spain and Catalonia

The demographic shift underway in Southern Europe requires a revision of some of the fundamental principles of the traditional welfare state. We analyze the evolution of several aspects of welfare and social expenditure over the last two decades. We find that in the context of the present demographic changes and real estate boom current social and pension policy leads to a new distribution of benefits and burdens which is highly intergenerationally unequal. We argue for a revised definition of public policy based on Musgrave's proposition as a possible rule for an intergenerationally fair distribution.

Life expectancy with and without disability

Average life expectancy reached 78.8 years in Europe in 2002 (WHO 2003); most Europeans can, therefore, now anticipate living well past 75 years of age. Projections in industrialized nations suggest a continuing mortality decline in the next decades 1 while birth rates will probably continue to decline, resulting in further ageing of these nations. As those aged 80 years and over are the fastest expanding segment of the older population, concerns are growing about a potential dramatic increase in the number of disabled persons. The ageing of the population and the related increase in chronic disease burden have already had major impacts on most Western health-care systems, and will probably further affect these systems in the future as the baby-boom generation becomes older. For instance, in Switzerland, it is estimated that costs due to long-term care could more than double by 2030, from 6.5 to 15.3 billion SFr.2 Similar trends are expected in most European countries. As a consequence, postponement of the onset of disability, with a compression of functional dependency into a shorter period towards the end of life, is becoming a major goal. To successfully achieve this goal and improve the control of growing health and social care expenditures, various strategies of health promotion and disease prevention are developed and tested. Although several of these experiences had some effects on functional decline and institutional placement, they have not been shown to be cost-effective. Additional strategies are, therefore, needed to prevent or delay the onset of disability in older persons, reduce functional impairment, and face the challenge of an increasing disabled elderly population.

Enhanced generation of specific tumor-reactive CTL in vitro by selected Melan-A/MART-1 immunodominant peptide analogues.

The Melan-A/MART-1 gene, which is expressed by normal melanocytes as well as by most fresh melanoma samples and melanoma cell lines, codes for Ags recognized by tumor-reactive CTL. HLA-A*0201-restricted Melan-A-specific CTL recognize primarily the Melan-A(27-35) (AAGIGILTV) and the Melan-A(26-35) (EAAGIGILTV) peptides. The sequences of these two peptides are not necessarily optimal as far as binding to HLA-A*0201 is concerned, since both lack one of the dominant anchor amino acid residues (leucine or methionine) at position 2. In this study we introduced single amino acid substitutions in either one of the two natural peptide sequences with the aim of improving peptide binding to HLA-A*0201 and/or recognition by specific CTL. Surprisingly, analogues of the Melan-A(27-35) peptide, which bound more efficiently than the natural nonapeptide to HLA-A*0201, were poorly recognized by tumor-reactive CTL. In contrast, among the Melan-A(26-35) peptide analogues tested, the peptide ELAGIGILTV was not only able to display stable binding to HLA-A2.1 but was also recognized more efficiently than the natural peptide by two short-term cultured tumor-infiltrated lymph node cell cultures as well as by five of five tumor-reactive CTL clones. Moreover, in vitro generation of tumor-reactive CTL by stimulation of PBMC from HLA-A*0201 melanoma patients with this particular peptide analogue was much more efficient than that observed with either one of the two natural peptides. These results suggest that the Melan-A(26-35) peptide analogue ELAGIGILTV may be more immunogenic than the natural peptides in HLA-A*0201 melanoma patients and should thus be considered as a candidate for future peptide-based vaccine trials.

Immigration and housing booms: Evidence from Spain

We estimate empirically the effect of immigration on house prices and residentialconstruction activity in Spain over the period 1998-2008. This decade is characterized by both aspectacular housing market boom and a stunning immigration wave. We exploit the variation inimmigration across Spanish provinces and construct an instrument based on the historicallocation patterns of immigrants by country of origin. The evidence points to a sizeable causaleffect of immigration on both prices and quantities in the housing market. Between 1998 and2008, the average Spanish province received an immigrant inflow equal to 17% of the initialworking-age population. We estimate that this inflow increased house prices by about 52% andis responsible for 37% of the total construction of new housing units during the period. Thesefigures imply that immigration can account for roughly one third of the housing boom, both interms of prices and new construction.

GESTÃO E AVALIAÇÃODE DESEMPENHO NA SHELL CABO VERDE, SARL

Cabo Verde foi alcandorado a PDM recentemente o que traz novos e grandes desafios para o seu processo de desenvolvimento. O país que tem as suas vulnerabilidades decorrentes do seu frágil tecido produtivo e da sua reduzida dimensão, para além da escassez de recursos naturais, enfrenta ainda o desafio da insularidade. Assim terá que ancorar-se em primeiro lugar nos seus recursos humanos, para enfrentar esses desafios. A questão da gestão de desempenho e recompensa começa a emergir-se no sector empresarial quer privado quer estatal, como um processo fundamental para se alcançar a excelência operacional, fundamental para enfrentar a competição nos dias de hoje. O presente estudo focou o sistema de avaliação de desempenho na Shell Cabo Verde uma filial do Grupo Shell, que é uma multinacional com uma história rica e com forte experiência no mercado Global. Procurou-se, através de um estudo de caso, fazer o levantamento e o enquadramento teórico do sistema e analisar até que ponto o mesmo tem potenciado a melhoria do desempenho organizacional através do alinhamento dos objectivos individuais e da organização. Cape Verde has recently been upgraded to a Medium Development Country condition which brings along new great challenges to its development process. The country has already its vulnerabilities due to its week productive tissue and its small dimension and beyond the lack of natural resources it has to deal with the challenge of insularity. Thus it has to anchor itself firstly in its human resources to face the challenges. The performance and reward management starts to emerge in both private’s and State’s entrepreneur sector, as a fundamental process to achieve the operational excellence in order to face the competitiveness now-a-days. This study focused the performance evaluation used in Shell Cape Verde, a company that belongs to the multinational Shell with a rich global market experience. We tried, through a case study, to understand the theoric contents of the system and analyze at what point it has enhanced the improvement of the organizational performance through the alignment of individual objectives and organizational objectives.

The macroeconomic effects of German unification: Real adjustments and the welfare state

We study the effects of German unification in a model with capital accumulation, skill differences and a welfare state. We argue that this event is similar to a mass migration of low-skilled agents holding no capital into a foreign country. Absent a welfare state, we observe an investment boom, depressed output and employment conditions. Capital owners and high-skilled agents are willing to give up to 4% of per-capita consumption to favor unification. When a welfare state exists the investment boom disappears and the recession is prolonged. Now, with unification, capital owners and high-skilled agents lose 4% of per-capita consumption.

With a bang, not a whimper: Pricking Germany's "stock market bubble" in 1927 and the slide into depression

In May 1927, the German central bank intervenedindirectly to reduce lending to equity investors.The crash that followed ended the only stockmarket boom during Germany s relative stabilization 1924-28. This paper examines thefactors that lead to the intervention as well asits consequences. We argue that genuine concernabout the exuberant level of the stock market,in addition to worries about an inflow offoreign funds, tipped the scales in favour ofintervention. The evidence strongly suggeststhat the German central bank under HjalmarSchacht was wrong to be concerned aboutstockprices-there was no bubble. Also, theReichsbank was mistaken in its belief thata fall in the market would reduce theimportance of short-term foreign borrowing,and help to ease conditions in the money market.The misguided intervention had important realeffects. Investment suffered, helping to tipGermany into depression.