The role of title insurance under recording and registration

This article outlines a transaction cost theory of title insurance andanalyses the role it plays in countries with recording and registrationof land titles. Title insurance indemnifies real estate right holdersfor losses caused by pre-existing title defects that are unknown whenthe policy is issued. It emerged to complement the errors and omissions insurance of professionals examining title quality. Poor organizationof public records led title insurers in the USA to integrate titleexamination and settlement services. Their residual claimant statusmotivates insurers to screen, cure and avoid title defects. Firmsintroducing title insurance abroad produce little information on titlequality, however. Their policies are instead issued on a casualty basis,complementing and enforcing the professional liability of conveyancers.Future development in markets with land registration is uncertainbecause of adverse selection, competitive reactions from establishedconveyancers and the ability of larger banks to self-insure title risks.

Award errors and permanent disability benefits in Spain

There is a controversial debate about the effects of permanent disability benefits on labormarket behavior. In this paper we estimate equations for deserving and receiving disabilitybenefits to evaluate the award error as the difference in the probability of receiving anddeserving using survey data from Spain. Our results indicate that individuals aged between55 and 59, self-employers or working in an agricultural sector have a probability of receiving a benefit without deserving it significantly higher than the rest of individuals. We also find evidence of gender discrimination since male have a significantly higher probability of receiving a benefit without deserving it. This seems to confirm that disability benefits are being used as an instrument for exiting the labor market for some individuals approaching the early retirement or those who do not have right to retire early. Taking into account that awarding process depends on Social Security Provincial Department, this means that some departments are applying loosely the disability requirements for granting disability benefits.

Family Development and Self-Sufficiency Program, Annual Report, 2008

Iowa’s Family Development and Self-Sufficiency (FaDSS) Grant Program was created by the 1988 Iowa General Assembly to assist Family Investment Program (FIP) families with significant or multiple barriers reach self-sufficiency. FaDSS provides services that promote, empower, and nurture families towards economic and emotional self-sufficiency. The foundation of FaDSS is regular home visits with families, using a strength-based approach. Core services include support, goal setting, and assessment. Support is given in many ways such as referrals, group activities, linking families to communities and advocacy. Assessment aids the family to identify strengths that they possess that may be used to eliminate barriers to self-sufficiency. Goal setting helps families break down goals that seem out of reach into small steps that will lead to success. Participation in FaDSS is a voluntary option for people receiving Family Investment Program (FIP) benefits.

The genome of the leaf-cutting ant Acromyrmex echinatior suggests key adaptations to advanced social life and fungus farming.

We present a high-quality (>100× depth) Illumina genome sequence of the leaf-cutting ant Acromyrmex echinatior, a model species for symbiosis and reproductive conflict studies. We compare this genome with three previously sequenced genomes of ants from different subfamilies and focus our analyses on aspects of the genome likely to be associated with known evolutionary changes. The first is the specialized fungal diet of A. echinatior, where we find gene loss in the ant's arginine synthesis pathway, loss of detoxification genes, and expansion of a group of peptidase proteins. One of these is a unique ant-derived contribution to the fecal fluid, which otherwise consists of "garden manuring" fungal enzymes that are unaffected by ant digestion. The second is multiple mating of queens and ejaculate competition, which may be associated with a greatly expanded nardilysin-like peptidase gene family. The third is sex determination, where we could identify only a single homolog of the feminizer gene. As other ants and the honeybee have duplications of this gene, we hypothesize that this may partly explain the frequent production of diploid male larvae in A. echinatior. The fourth is the evolution of eusociality, where we find a highly conserved ant-specific profile of neuropeptide genes that may be related to caste determination. These first analyses of the A. echinatior genome indicate that considerable genetic changes are likely to have accompanied the transition from hunter-gathering to agricultural food production 50 million years ago, and the transition from single to multiple queen mating 10 million years ago.

Indicators used by clinicians to assess pain in the brain injured

INTRODUCTION. The assessment of pain in critically ill brain-injured patients is challenging for health professionals. In addition to be unable to self-report, the confused and stereotyped behaviors of these patients are likely to alter their ''normal'' pain responses. Therefore, the pain indicators observed in the general critically ill population may not be appropriate. OBJECTIVES. To identify behavioral and physiological indicators used by clinicians to assess pain in critically ill brain-injured patients who are unable to self-report. METHODS.Amixed-method design was used with the first step being the combination of the results of an integrative literature review with the results of nominal groups of 12 nurses and four physicians. The second step involved a web-based survey to establish content validity. Fourteen experts (clinicians and academics) from three French speaking European countries rated the relevance of each indicator. A content validity index (CVI) was computed for each indicator (I-CVI) and for each category (S-CVI). RESULTS. The first step generated 52 indicators. These indicators were classified into six categories: facial expressions, position/movement, muscle tension, vocalization, compliance with ventilator, and physiological indicators. In the second step, the agreement between raters was high with an Intraclass Correlation Coefficient of 0.88 (95% CI 0.83-0.92). The I-CVIs ranged from 0.07 to 1. Indicators with an I-CVI below 0.5 (n = 12) were not retained, resulting in a final list of 30 indicators. The CVI for this final list was 0.75 with categories ranging from 0.67 (compliance with ventilation) to 0.87 (vocalization). CONCLUSIONS. This process identified specific pain indicators for critically ill braininjured patients. Further evaluation is in progress to test the validity and relevance of these indicators in the clinical setting.

Self-Expanding Versus Balloon-Expandable Stents in Acute Myocardial Infarction: Results From the APPOSITION II Study: Self-Expanding Stents in ST-Segment Elevation Myocardial Infarction.

OBJECTIVES: This study sought to investigate whether self-expanding stents are more effective than balloon-expandable stents for reducing stent malapposition at 3 days after implantation in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. BACKGROUND: Acute myocardial infarction is associated with vasoconstriction and large thrombus burden. Resolution of vasoconstriction and thrombus load during the first hours to days after primary percutaneous coronary intervention may lead to stent undersizing and malapposition, which may subsequently lead to stent thrombosis or restenosis. In addition, aggressive stent deployment may cause distal embolization. METHODS: Eighty patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomized to receive a self-expanding stent (STENTYS, STENTYS SA, Paris, France) (n = 43) or a balloon-expandable stent (VISION, Abbott Vascular, Santa Clara, California; or Driver, Medtronic, Minneapolis, Minnesota) (n = 37) at 9 European centers. The primary endpoint was the proportion of stent strut malapposition at 3 days after implantation measured by optical coherence tomography. Secondary endpoints included major adverse cardiac events (cardiac death, recurrent myocardial infarction, emergent bypass surgery, or clinically driven target lesion revascularization). RESULTS: At 3 days after implantation, on a per-strut basis, a lower rate of malapposed stent struts was observed by optical coherence tomography in the self-expanding stent group than in the balloon-expandable group (0.58% vs. 5.46%, p < 0.001). On a per-patient basis, none of the patients in the self-expanding stent group versus 28% in the balloon-expandable group presented ≥5% malapposed struts (p < 0.001). At 6 months, major adverse cardiac events were 2.3% versus 0% in the self-expanding and balloon-expandable groups, respectively (p = NS). CONCLUSIONS: Strut malapposition at 3 days is significantly lower in ST-segment elevation myocardial infarction patients allocated to self-expanding stents when than in those allocated to balloon-expandable stents. The impact of this difference on clinical outcome and the risk of late stent thrombosis need to be evaluated further. (Randomized Comparison Between the STENTYS Self-expanding Coronary Stent and a Balloon-expandable Stent in Acute Myocardial Infarction [APPOSITION II]; NCT01008085).

From current immunosuppressive strategies to clinical tolerance of allografts.

In order to prevent allograft rejection, most current immunosuppressive drugs nonspecifically target T-cell activation, clonal expansion or differentiation into effector cells. Experimental models have shown that it is possible to exploit the central and peripheral mechanisms that normally maintain immune homeostasis and tolerance to self-antigens, in order to induce tolerance to alloantigens. Central tolerance results from intrathymic deletion of T cells with high avidity for thymically expressed antigens. Peripheral tolerance to nonself-molecules can be achieved by various mechanisms including deletion of activated/effector T cells, anergy induction and active regulation of effector T cells. In this article, we briefly discuss the pathways of allorecognition and their relevance to current immunosuppressive strategies and to the induction of transplantation tolerance (through haematopoietic mixed chimerism, depleting protocols, costimulatory blockade and regulatory T cells). We then review the prospect of clinical applicability of these protocols in solid organ transplantation.

The experience of transplantation for patients and their significant ones: A difficult encounter of two worlds

Objectives This paper reports on a longitudinal qualitative study exploring concerns of 60 patients before and after transplantation. Methods Semi-structured interviews were conducted without time constraints in a protected space out of the hospital. Qualitative analysis was performed. Results Prior to transplantation, all patients talked freely about negative feelings, stigmatisation, being misunderstood by others, loneliness and culpability caused by increasing physical dependency or abandoned roles. They mentioned alternative ways to cope (magic, spirituality), and even expressed their right to let go. In a subset of 13 patients, significant ones allowed themselves in the interview, or were integrated on the request of the patients. In this modified setting, two illness-worlds were confronted. If common themes were mentioned (e.g., modified life plans, restricted space, physical and psychological barriers), they were experienced differently. Fear of transplantation or guilt towards the donors was overtly expressed, often for the first time. Mutual hiding of anxiety in order to protect loved ones or to prevent loss of control was disclosed. The significant ones talked about accumulated stress and exhaustion related to the physical degradation of the patient, fear of the unpredictable evolution of illness and financial problems, and stressed their difficulty to adapt adequately to the fluctuating state of the patient. After transplantation, other themes emerged, where difficulty in disclosure was observed: intensive care and near death experiences, being a transplanted person, debt to the donor and his/her family, fear of rejection. Conclusions With the self-imposed strategy of hiding concerns to protect one another, a discrepancy between two illness-worlds was created. When concerns were confronted during the interviews, a new mutual understanding emerged. Patients and their families stated the need for sharing concerns in the course of illness.

Les règles n'ont plus la cote: une question de contraception ou de choix [To bleed or not--a new dogma or a real choice in contraception?]

On en parle ! Il est question de la suppression des règles par l'administration de contraceptifs oestro-progestatifs (pilule, patch ou anneau vaginal) en cycles longs (cycles prolongés ; cycles étendus ; extended cycles) entraînant des périodes d'aménorrhée, rythmées par des intervalles libres de sept jours sans administration hormonale. L'indication à ce mode de prescription est presque unanimement reconnue pour le traitement des pathologies bénéficiant de la suppression des règles et des fluctuations hormonales inhérentes à l'activité ovarienne. Ce traitement suscite cependant également de l'intérêt pour une indication du type mode de vie. Les modalités thérapeutiques, les avantages et inconvénients sont examinés à la lumière de l'attente des femmes et de leur droit au choix éclairé et libre. Let's talk about it ! Suppression of menstruation, by extending the duration of contraceptives containing estro-progestins (oral contraception, patch or vaginal ring) to long cycles, is a new approach in the field of contraception. These extended cycles aim at obtaining prolonged amenorrhea, interrupted periodically by a free interval of 7 days without hormone intake and thus causing breakthrough bleeding. Pathologies, which are supposed to get some benefit from the suppression of menstruation and of hormone level variations related to ovarian activity, are widely recognized as an indication. Some interest is also coming up for so called life style indications. Treatment issues, advantages and disadvantages are examined in the light of women's expectations and right to access to informed consent and independent choice.

Dpp/BMP signaling in flies: From molecules to biology.

Decapentaplegic (Dpp), the fly homolog of the secreted mammalian BMP2/4 signaling molecules, is involved in almost all aspects of fly development. Dpp has critical functions at all developmental stages, from patterning of the eggshell to the determination of adult intestinal stem cell identity. Here, we focus on recent findings regarding the transcriptional regulatory logic of the pathway, on a new feedback regulator, Pentagone, and on Dpp's roles in scaling and growth of the Drosophila wing.

Loukatun suostumuksesta potilaan itsemääräämisoikeuteen

Ylänimeke: Oppirakennelmia ja periaatteita

Influència de l'educació sanitària en l'adaptació dels pacients ostomitzats a la nova situació produïda per l'ostomia digestiva

Introducció: Les persones ostomitzades presenten una sèrie de canvis de tipus fisiològic, psicològic i social, els quals els obliga a adaptar-se a la seva vida diària. Per adaptar-se a aquesta nova situació utilitzen una sèrie d'estratègies d'afrontament, sent l'acceptació el producte final. Per a que les estratègies adoptades siguin les més efectives, han de rebre una educació sanitària adequada.Contràriament, l'escassetat d'educació sanitària o l'educació sanitària inadequada que reben aquests pacients és un problema real que ens trobem en l'actualitat.Objectiu: Conèixer si l'educació sanitària rebuda pels pacients ostomitzats, té influencia en la seva adaptació a la nova situació produïda per l'ostomia digestiva.Metodologia: Estudi qualitatiu fenomenològic, on les dades es recolliran a través d'entrevistessemiestructurades a pacients amb ostomia digestiva, els quals van rebre l'alta hospitalària fa almenys 2 mesos. Les entrevistes seran gravades, transcrites i analitzades, utilitzant en aquest últim pas la triangulació d'investigadors. La mostra serà de tipus intencional, la seleccionaré a l'Hospital Universitàri de Bellvitge entre els pacients que acudeixen a la consulta de la infermera estomaterapeuta, i el seu tamany estarà definit per la saturació teòrica. L'estudi estarà reglat en tot moment pel dret a la intimitat, incloent en aquest l'anonimat i la confidencialitat, i el dret a la lliure decisió.Consideracions finals: Inclou una explicació argumentada sobre els meus punts febles i forts del treball, una reflexió sobre la satisfacció amb les competències que he adquirit i finalment una autoavaluació dels resultats del meu aprenentatge.

CD4+CD25+Foxp3+ regulatory T cells: from basic research to potential therapeutic use.

Regulatory T cells control immune responses to self- and foreign-antigens and play a major role in maintaining the balance between immunity and tolerance. This article reviews recent key developments in the field of CD4+CD25+Foxp3+ regulatory T (TREG) cells. It presents their characteristics and describes their range of activity and mechanisms of action. Some models of diseases triggered by the imbalance between TREG cells and effector pathogenic T cells are described and their potential therapeutic applications in humans are outlined.

Response to the comments on "The formation of Pangea" by D.A. Ruban

The Variscan structures of the Caucasus region are still quite difficult to decipher, they certainly deserved some in depth investigations in the future. Thus, it is right to question any paleogeographic models proposed in that area, as made by D.A. Ruban. We present here the arguments that we used to decide on the distribution of the terranes in that region. The Transcaucasus massif is regarded as pertaining to the Galatian super-terrane, whereas, the Great Caucasus terrane belongs to the Hanseatic ribbon terrane. The latter was a part of Hunia, detached from Laurussia in the Devonian.

Residents' Rights

Resident rights are guaranteed by the federal Nursing Home Reform Law of 1987, which requires nursing facilities to promote and protect the rights of each resident and places a strong emphasis on individual dignity and self-determination. Residents’ rights include, but are not limited to: • Being treated with respect and dignity • Being free from abuse and chemical and physical restraints • Participating in one’s own care and treatment • Being ensured information is being kept confidential • Managing one’s own finances • Being free to voice grievances, without fear of retaliation • Being able to associate and communicate privately with any person • Being able to send and receive personal mail • Making independent choices • Being able to apply for state and federal assistance without discrimination • Being informed of rights, services available and all charges prior to admission • Being given advance notice of a transfer or discharge