Report on the IowaCare program administered by the Iowa Medicaid Enterprise, a division of the Department of Human Services, for the period July 1, 2009 through June 30, 2012

Report on the IowaCare program administered by the Iowa Medicaid Enterprise, a division of the Department of Human Services, for the period July 1, 2009 through June 30, 2012

New Avenues for Theoretical Contributions in Enterprise Architecture Principles - A Literature Review

Enterprise Architecture (EA), which has been approached by both academia and industry, is considered comprising not only architectural representations, but also principles guiding architecture's design and evolution. Even though the concept of EA principles has been defined as the integral part of EA, the number of publications on this subject is very limited and only a few organizations use EA principles to manage their EA endeavors. In order to critically assess the current state of research and identify research gaps in EA principles, we focus on four general aspects of theoretical contributions in IS. By applying these aspects to EA principles, we outline future research directions in EA principles nature, adoption, practices, and impact.

Pela integração da inteligência competitiva nos Enterprise Information Systems (EIS)

O objetivo deste artigo é evidenciar a importância da integração de um módulo de inteligência competitiva (coleta, organização e difusão da informação externa) nos sistemas de informações para o apoio à decisão das empresas, enriquecendo assim os Enterprise Information Systems (EIS). É a efetividade do gerente na busca da identificação ou da antecipação de problemas ou oportunidades, em um cenário de cada vez maiores pressões internas e principalmente externas. O propósito maior é fornecer amplo ambiente de oferta de informações internas e externas, formais e informais, informações sobre as percepções do mercado, informações envolvidas em análises e simulações, enfim, um ambiente integrador das informações disponíveis e relevantes para o sucesso da organização e que crie condições de proatividade para os usuários.

Parésie trochléaire transitoire comme signe neurologique inaugural d'une panartérite noueuse [Transient trochlear nerve palsy as the presenting neurological sign of panarteritis nodosa]

INTRODUCTION: Panarteritis nodosa (PAN) is a systemic vasculitis affecting small and medium-sized arteries. Neuro-ophthalmological complications of PAN are rare but numerous, and may affect the eye, the visual and the oculomotor pathways. Such complications occur mainly in patients previously diagnosed with PAN. OBSERVATION: A 51-year-old woman presented with an isolated right trochlear (IV) palsy, in the setting of headaches and fluctuating fever of unknown etiology. Erythrocyte sedimentation rate was 13 mm and full blood cell count was normal. Previous chest X-ray and blood studies were negative for an infection or inflammation. Orbital and cerebral CT scan was normal. Spontaneous recovery of diplopia ensued over four days. Two days later, paresthesia and sensory paresis of the dorsal portion of the left foot were present. Lumbar puncture revealed 14 leucocytes (76 percent lymphocytes) with elevated proteins, but blood studies and serologies were negative. A diagnosis of undetermined meningo-myelo-radiculoneuritis was made. Because of a possible tick bite six weeks previously the patient was empirically treated with 2 g intravenous ceftriaxone for 3 weeks. Fever rapidly dropped. Six weeks after the onset of diplopia, acute onset of blindness in her right eye, diffuse arthralgias and fever motivated a new hospitalization. There was a central retinal artery occlusion of the right eye. Blood studies now revealed signs of systemic inflammation (ESR 30 mm, CRP 12 mg/L, ANA 1/80, pANCA 1/40, leucocytosis 12.4 G/L, Hb 111 g/L, Ht 33 percent). Biopsy of the left sural nerve revealed arterial fibrinoid necrosis. A diagnosis of PAN was made. CONCLUSIONS: Transient diplopia can be the heralding symptom of a systemic vasculitis such as PAN, giant cell arteritis and Wegener granulomatosis. In this patient the presence of accompanying systemic symptoms raised a suspicion of systemic inflammation, but the absence of serologic and imaging abnormalities precluded a specific diagnosis initially. A few weeks later, the presence of a second ischemic event (retinal) and positive blood studies led to a further diagnostic procedure. Oculomotor and abducens palsies have rarely been reported in association with PAN. We report the first case of trochlear nerve paresis as the inaugural neurological sign of PAN. This case highlights the importance of considering inflammatory systemic disorders in patients with acute diplopia particularly when they are young, lack vascular risk factors or cause, and complain of associated systemic symptoms.

Marine and transitional Middle/Upper Eocenen units of the Southeastern Pyrenean Foreland Basin (NE Spain)

The stratigraphic basis of this work has allowed the use of larger foraminifers in the biostratigraphic characterisation of the new Shallow Benthic Zones (SBZ). This part of the volume presents a description of the sedimentary cycles formed by the transgressive-regressive systems of the Lutetian and Bartonian in the southeastern sector of the Ebro Foreland Basin. Concerning the Lutetian deposits studied in the Amer-Vic and Empordà areas, four sedimentary cycles have been characterised. The first and second are found within the Tavertet/Girona Limestone Formation (Reguant, 1967; Pallí, 1972), while the third and fourth cycles cover the Coll de Malla Marl Formation (Clavell et al., 1970), the Bracons Formation (Gich, 1969, 1972), the Banyoles Marl Formation (Almela and Ríos, 1943), and the Bellmunt Formation (Gich, 1969, 1972). In the Bartonian deposits studied in the Igualada area, two transgressive-regressive sedimentary cycles have been characterised in the Collbàs Formation (Ferrer, 1971), the Igualada Formation (Ferrer, 1971), and the Tossa Formation (Ferrer, 1971). The Shallow Benthic Zones (SBZs) recognised within the Lutetian are the following: SBZ 13, from the Early Lutetian, in the transgressive system of the first cycle; SBZ 14, from the Middle Lutetian, in the second cycle and the lower part of the transgressive system of the third cycle; SBZ 15, from the Middle Lutetian, in the remaining parts of the third system; SBZ 16, from the Late Lutetian, throughout the fourth cycle. The association of larger foraminifers in the first and second cycles of the Bartonian in the Igualada area has been used as the basis for the definition of SBZs 17 and 18 recognised in the Bartonian of the western Tethys.

An inventory of the marine and transitional Middle/Upper Eocene deposits of the Southeastern Pyrenean Foreland Basin (NE Spain)

In the southeastern Ebro Foreland Basin, the marine deposits of Lutetian and Bartonian age show excellent outcrop conditions, with a great lateral and horizontal continuity of lithostratigraphic units. In addition, the rich fossil record -mainly larger foraminifers-, provides biostratigraphic data of regional relevance for the whole Paleogene Pyrenean Basin, that can be used for the Middle Eocene biocorrelation of the western Tethys. This contribution is a sedimentary and biostratigraphic synthesis of the basic outcrops and sections of the Lutetian andBartonian marine and transitional deposits in the southeastern sector of the Ebro Foreland Basin.

Evidence for middle Cretaceous accretion at Santa Elena Peninsula (Santa Rosa Accretionary Complex), Costa Rica

An oceanic assemblage of alkaline basalts, radiolarites and polymictic breccias forms the tectonic substratum of the Santa Elena Nappe, which is constituted by extensive outcrops of ultramafic and mafic rocks of the Santa Elena Peninsula (NW Costa Rica). The undulating basal contact of this nappe defines several half-windows along the south shores of the Santa Elena Peninsula. Lithologically it is constituted by vesicular pillowed and massive alkaline basaltic flows, alkaline sills, ribbon-bedded and knobby radiolarites, muddy tuffaceous and detrital turbidites, debris flows and polymictic breccias and megabreccias. Sediments and basalt flows show predominant subvertical dips and occur in packages separated by roughly bed-parallel thrust planes. Individual packages reveal a coherent internal stratigraphy that records younging to the east in all packages and shows rapid coarsening upwards of the detrital facies. Alkaline basalt flows, pillow breccias and sills within radiolarite successions are genetically related to a mid-Cretaceous submarine seamount. Detrital sedimentary facies range form distal turbidites to proximal debris flows and culminate in megabreccias related to collapse and mass wasting in an accretionary prism. According to radiolarian dating, bedded radiolarites and soft-sediment- deformed clasts in the megabreccias formed in a short, late Aptian to Cenomanian time interval. Middle Jurassic to Lower Cretaceous radiolarian ages are found in clasts and blocks reworked from an older oceanic basement. We conclude that the oceanic assemblage beneath the Santa Elena Nappe does not represent a continuous stratigraphic succession. It is a pile of individual thrust sheets constituting an accretionary sequence, where intrusion and extrusion of alkaline basalts, sedimentation of radiolarites, turbidites and trench fill chaotic sediments occurred during the Aptian-Cenomanian. These thrust sheets formed shortly before the off-scraping and accretion of the complex. Here we define the Santa Rosa Accretionary Complex and propose a new hypothesis not considered in former interpretations. This hypothesis would be the basis for further research.

Relation between high-sensitivity C-reactive protein and cardiovascular and renal markers in a middle-income country in the African region.

BACKGROUND: High-sensitivity C-reactive protein (hs-CRP) is associated with several cardiovascular risk factors (CVRF) and with renal function markers. However, these associations have not been examined in populations in the African region. We analyzed the distribution of hs-CRP and the relationship with a broad set of CVRF, renal markers and carotid intima-media thickness (IMT), in the Seychelles (African region). METHODS: We conducted a survey in the population aged 25-64years (n=1255, participation rate: 80.2%). Analyses were restricted to persons of predominantly African descent (n=1011). RESULTS: Mean and median hs-CRP serum concentrations (mg/l) were 3.1 (SD 7.6) and 1.4 (IQR 0.7-2.9) in men and 4.5 (SD 6.7) and 2.2 (IQR 1.0-5.4) in women (p<0.001 for difference between men and women). hs-CRP was significantly associated with several conventional CVRF, and particularly strongly with markers of adiposity. With regards to renal markers, hs-CRP was strongly associated with cystatin C and with microalbuminuria but not with creatinine. hs-CRP was not associated with IMT. CONCLUSIONS: Serum concentration of hs-CRP was significantly associated with sex, several CVRF and selected renal function markers, which extends similar findings in Europe and in North America to a population in the African region. These findings can contribute to guide recommendations for the use of hs-CRP in clinical practice in the region.

Report on a review of the Central Procurement Enterprise (CPE) of the Iowa Department of Administrative Services for the period July 1, 2009 through March 31, 2013

Report on a review of the Central Procurement Enterprise (CPE) of the Iowa Department of Administrative Services for the period July 1, 2009 through March 31, 2013