The influence of medical enduring power of attorney and advance directives on decision making by Australian intensive care doctors

OBJECTIVE: Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans.
DESIGN: We surveyed Australian intensive care doctors, using a hypothetical clinical scenario, to evaluate how potential end-of-life treatment decisions might be influenced by advance planning - the appointment of a medical enduring power of attorney (MEPA) or an advance care plan (ACP). Using open-ended questions we sought to explore the reasoning behind the doctors' decisions.
RESULTS: 275 surveys were returned (18.3% response rate). We found that opinions expressed by an MEPA and ACP have some influence on treatment decisions, but that intensive care doctors had major reservations. Most did not follow the request for palliation made by the MEPA in the hypothetical scenario.
CONCLUSIONS: Many intensive care doctors believe end-of-life decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.

The promised LAN: the transformative power of information and communications technology in developing countries

Este tese analise as implicações dos investimentos em tecnologia de informação e comunicação (ICT) em países ainda em desenvolvimento, especialmente em termos de educação, para estimular a implementação de uma infra-estrutura mais moderna em vez da continuação do uso de métodos tradicionais. Hoje, como o interesse e os investimentos em ICT estão crescendo rapidamente, os módulos e as idéias que existem para medir o estado de ICT são velhos e inexatos, e não podem ser aplicados às culturas de países em desenvolvimento. Políticos e investidores têm que considerar estes problemas quando estão pensando em investimentos ou socorros para programas em ICT no futuro, e investigadores e professores precisam entender os fatores importantes no desenvolvimento para os ICTs e a educação antes de começar estudos nestes países. Este tese conclue que investimentos em tecnologias móbeis e sem fios ajudarem organizações e governos ultrapassar a infra-estrutura tradicional, estreitando a divisão digital e dando o resulto de educação melhor, alfabetização maior, e soluções sustentáveis pelo desenvolvimento nas comunidades pobres no mundo de países em desenvolvimento.

Biodegradability of commercial and weathered diesel oils

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The performance of Chinese and Brazilian exports to Latin America, 1994-2009

Includes bibliography

An assessment of fiscal and regulatory barriers to deployment of energy efficiency and renewable energy technologies in Curaçao

The current energy systems within Curaçao depend primarily on high cost, imported fossil fuels, and typically constitute power sectors that are characterized by small, inefficient generation plants which result in high energy prices. As a consequence of its dependence on external fuel supplies, Curaçao is extremely vulnerable to international oil price shocks, which can impact on economic planning and foreign direct investment within their industrial sectors. The ability of the successive governments to source capital for economic stimulation and social investment is therefore significantly challenging. Additionally, there is over-dependence on two of the most climate-sensitive economic sectors, namely the tourism and fisheries sectors, but the vulnerabilities of the country to the effects of climate change make adaptation difficult and costly. It is within this context that this report focuses on identification of the fiscal and regulatory barriers to implementation of energy efficiency and renewable energy technologies in Curaçao with a view of making recommendations for removal of these barriers. Consultations with key Government officials, the private sector as well as civil society were conducted to obtain information and data on the energy sector in the country. Desktop research was also conducted to supplement the information gathered from the consultations. The major result of the assessment is that Curaçao is at an early stage in the definition of its energy sector. Despite some infrastructural legacies of the pre-independence era, as well as a number of recent developments including the modernization and expansion of its windfarms and completion of a modern Electricity Policy, there are still a number of important institutional and policy gaps within the energy sector in Curaçao. The most significant deficiency is the absence of a ministry or Government agency with portfolio responsibility for the energy sector as a whole; this has: limited the degree to which the activities of energy sector stakeholders are coordinated and retarded the development and implementation of a comprehensive national energy policy. The absence of an energy policy, which provides the framework for energy planning, increases investor risk. Also, the lack of political continuity that has emanated from the frequent changes in Government administrations is a concern among stakeholders and has served to reduce investor confidence in particular, and market confidence in general.

Effectiveness of immediate bonding of etch-and-rinse adhesives to simplified ethanol-saturated dentin

This study examined the immediate bond strength of etch-and-rinse adhesives to demineralized dentin saturated with either water or absolute ethanol. The research hypothesis was that there would be no difference in bond strength to dentin between water or ethanol wet-bonding techniques. The medium dentin of 20 third molars was exposed (n = 5). The dentin surface was then acid-etched, left moist and randomly assigned to be saturated via either water wet-bonding (WBT) or absolute ethanol wet-bonding (EBT). The specimens were then treated with one of the following etch-and-rinse adhesive systems: a 3-step, water-based system (Adper Scotchbond Multipurpose, or SBMP) or a 2-step, ethanol/water-based system (Adper Single Bond 2, or SB). Resin composite build-ups were then incrementally constructed. After water storage for 24 h at 37 degrees C, the tensile strength of the specimens was tested in a universal testing machine (0.5 mm/min). Data were analyzed by two-way ANOVA and Tukey's test (alpha = 5%). The failure modes were verified using a stereomicroscope (40x). For both adhesives, no significant difference in bond strength was observed between WBT and EBT (p > 0.05). The highest bond strength was observed for SB, regardless of the bonding technique (p < 0.05). No significant interaction between adhesives and bonding techniques was noticed (p = 0.597). There was a predominance of adhesive failures for all tested groups. The EBT and WBT displayed similar immediate bond strength means for both adhesives. The SB adhesive exhibited higher means for all conditions tested. Further investigations are needed to evaluate long-term bonding to dentin mediated by commercial etch-and-rinse adhesives using the EBT approach.

The twofold role of Cloud Computing in Digital Forensics: target of investigations and helping hand to evidence analysis

This PhD thesis discusses the impact of Cloud Computing infrastructures on Digital Forensics in the twofold role of target of investigations and as a helping hand to investigators. The Cloud offers a cheap and almost limitless computing power and storage space for data which can be leveraged to commit either new or old crimes and host related traces. Conversely, the Cloud can help forensic examiners to find clues better and earlier than traditional analysis applications, thanks to its dramatically improved evidence processing capabilities. In both cases, a new arsenal of software tools needs to be made available. The development of this novel weaponry and its technical and legal implications from the point of view of repeatability of technical assessments is discussed throughout the following pages and constitutes the unprecedented contribution of this work

Differences in the EEG profiles of early and late responders to antipsychotic treatment in first-episode, drug-naive psychotic patients

The aim of this study was to search for differences in the EEG of first-episode, drug-naive patients having a schizophrenic syndrome which presented different time courses in response to antipsychotic treatment. Thirteen patients who fulfilled DSM-IV diagnosis for schizophrenia or schizophreniform disorder participated in this study. Before beginning antipsychotic treatment, the EEG was recorded. On the same day psychopathological ratings were assessed using the ADMDP system, and again after 7 and 28 days of treatment. The resting EEG (19 leads) was subject to spectral analysis involving power values for six frequency bands. The score for the schizophrenic syndrome was used to divide the patients into two groups: those who displayed a clinically meaningful improvement of this syndrome (reduction of more than 30%) after 7 days of treatment (early responders, ER) and those who showed this improvement after 28 days (late responders. LR). Analysis of variance for repeated measures between ER, LR and their matched controls with the 19 EEG leads yielded highly significant differences for the factor group in the alpha2 and beta2 frequency band. No difference was found between the slow-wave frequency bands. Compared to controls the LR group showed significantly higher alpha2 and beta2 power and, in comparison to the ER group, significantly higher alpha2 power. There were no significant differences between the ER and the control group. These findings point to differences in brain physiology between ER and LR. The implications for diagnosis and treatment are discussed.

Antibody Responses of Vaccinated and Nonvaccinated Calves to Haemophilus somnus

Respiratory disease resulting from infection of calves with Haemophilus somnus (H. somnus) is an annual occurrence in fall calves at the McNay Farm. Previous observations of skin test reactivity to H. somnus antigens suggested a role for this phenomenon in the pathogenesis of the disease. Groups of calves, about 90 days of age, were vaccinated with four different commercial H. somnus vaccines, and serum levels of H. somnus antibodies were determined. Antibodies of the IgG and IgE classes were detected with ELISA procedures conducted on sera collected before and after vaccination. Most of the calves had detectable H. somnus IgE class antibodies at the start of the experimentation but IgG class antibodies were minimal. Antibodies of both classes increased in nonvaccinated and vaccinated calves during the 30 day period of experimentation. However, the level of IgE class antibodies in vaccinates was lower than in controls suggesting that vaccination may limit the IgE response.

The power of emotional valence – from cognitive to affective processes in reading

The comprehension of stories requires the reader to imagine the cognitive and affective states of the characters. The content of many stories is unpleasant, as they often deal with conflict, disturbance or crisis. Nevertheless, unpleasant stories can be liked and enjoyed. In this fMRI study, we used a parametric approach to examine (1) the capacity of increasing negative valence of story contents to activate the mentalizing network (cognitive and affective theory of mind, ToM), and (2) the neural substrate of liking negatively valenced narratives. A set of 80 short narratives was compiled, ranging from neutral to negative emotional valence. For each story mean rating values on valence and liking were obtained from a group of 32 participants in a prestudy, and later included as parametric regressors in the fMRI analysis. Another group of 24 participants passively read the narratives in a three Tesla MRI scanner. Results revealed a stronger engagement of affective ToM-related brain areas with increasingly negative story valence. Stories that were unpleasant, but simultaneously liked, engaged the medial prefrontal cortex (mPFC), which might reflect the moral exploration of the story content. Further analysis showed that the more the mPFC becomes engaged during the reading of negatively valenced stories, the more coactivation can be observed in other brain areas related to the neural processing of affective ToM and empathy.

Adaptation and maladaptation of heart and skeletal muscle to different diets in a rodent model of human obesity

Obesity and diabetes are metabolic disorders associated with fatty acid availability in excess of the tissues' capacity for fatty acid oxidation. This mismatch is implicated in the pathogenesis of cardiac contractile dysfunction and also in skeletal muscle insulin resistance. My dissertation will present work to test the overall hypothesis that "western" and high fat diets differentially affect cardiac and skeletal muscle fatty acid oxidation, the expression of fatty acid responsive genes, and cardiac contractile function. Wistar rats were fed a low fat, "western," or high fat (10%, 45%, or 60% calories from fat, respectively) diet for acute (1 day to 1 week), short (4 to 8 weeks), intermediate (16 to 24 weeks), or long (32 to 48 weeks) term. With high fat diet, cardiac oleate oxidation increased at all time points investigated. In contrast, with western diet cardiac oleate oxidation increased in the acute, short and intermediate term, but not in the long term. Consistent with a maladaptation of fatty acid oxidation, cardiac power (measured ex vivo) decreased with long term western diet only. In contrast to the heart, soleus muscle oleate oxidation increased only in the acute and short term with either western or high fat feeding. Transcript analysis revealed that several fatty acid responsive genes, including pyruvate dehydrogenase kinase 4, uncoupling protein 3, mitochondrial thioesterase 1, and cytosolic thioesterase 1 increased in heart and soleus muscle to a greater extent with high fat diet, versus western diet, feeding. In conclusion, the data implicate inadequate induction of a cassette of fatty acid responsive genes in both the heart and skeletal muscle by western diet resulting in impaired activation of fatty acid oxidation, and the development of cardiac dysfunction. ^

THE EFFECTS OF COST-SHARING ON USE OF SERVICES AND CONSUMER CHARACTERISTICS IN A STATE'S CRIPPLED CHILDREN'S DIVISION

The present study analyzed some of the effects of imposing a cost-sharing requirement on users of a state's health service program. The study population consisted of people who were in diagnosed medical need and included, but was not limited to, people in financial need.^ The purpose of the study was to determine if the cost-sharing requirement had any detrimental effects on the service population. Changes in the characteristics of service consumers and in utilization patterns were analyzed using time-series techniques and pre-post policy comparisons.^ The study hypotheses stated that the distribution of service provided, diagnoses serviced, and consumer income levels would change following the cost-sharing policy.^ Analysis of data revealed that neither the characteristics of service users (income, race, sex, etc.) nor services provided by the program changed significantly following the policy. The results were explainable in part by the fact that all of the program participants were in diagnosed medical need. Therefore, their use of "discretionary" or "less necessary" services was limited.^ The study's findings supported the work of Joseph Newhouse, Charles Phelps, and others who have contended that necessary service use would not be detrimentally affected by reasonable cost-sharing provisions. These contentions raise the prospect of incorporating cost-sharing into programs such as Medicaid, which, at this writing, do not demand any consumer payment for services.^ The study concluded with a discussion of the cost-containment problem in health services. The efficacy of cost-sharing was considered relative to other financing and reimbursement strategies such as HMO's, self-funding, and reimbursement for less costly services and places of service. ^

The power of language and the language of power in M. T. Anderson’s Feed and Gary Stheyngart’s Super Sad True Love Story. A comparative analysis

The aim of my dissertation is to analyze how selected elements of language are addressed in two contemporary dystopias, Feed by M. T. Anderson (2002) and Super Sad True Love Story by Gary Shteyngart (2010). I chose these two novels because language plays a key role in both of them: both are primarily focused on the pervasiveness of technology, and on how the use/abuse of technology affects language in all its forms. In particular, I examine four key aspects of language: books, literacy, diary writing, as well as oral language. In order to analyze how the aforementioned elements of language are dealt with in Feed and Super Sad True Love Story, I consider how the same aspects of language are presented in a sample of classical dystopias selected as benchmarks: We by Yevgeny Zamyatin (1921), Brave New World by Aldous Huxley (1932), Animal Farm (1945) and Nineteen Eighty-Four (1949) by George Orwell, Fahrenheit 451 by Ray Bradbury (1952), and The Handmaid's Tale by Margaret Atwood (1986). In this way, I look at how language, books, literacy, and diaries are dealt with in Anderson’s Feed and in Shteyngart’s Super Sad True Love Story, both in comparison with the classical dystopias as well as with one another. This allows for an analysis of the similarities, as well as the differences, between the two novels. The comparative analysis carried out also takes into account the fact that the two contemporary dystopias have different target audiences: one is for young adults (Feed), whereas the other is for adults (Super Sad True Love Story). Consequently, I also consider whether further differences related to target readers affect differences in how language is dealt with. Preliminary findings indicate that, despite their different target audiences, the linguistic elements considered are addressed in the two novels in similar ways.

H. Campbell & Co.'s hand-book for business men; or, Legal and financial directory, containing a catalogue of responsible lawyers located in all the important cities and towns of the United States and Canada, for the collection of claims and the expeditious transaction of all legal business. Also, a list of banks and bankers, together with a compilation of laws and facts important to every business man.

Wanting: p. 55-88, 147-188.

Changing the Interface of Family and Consumer Sciences at Florida International University

The need to change the interface of the Family and Consumer Sciences (FCS) Program at Florida International University (FlU) has evolved because of changes in our family structure, culture, resources, educational reform, new knowledge in basic disciplines and applied research.