La incidencia de las tecnologías de la información y comunicación en los programas de formación continuada de jueces y magistrados

[spa] Los programas de formación continuada a distancia para jueces presentan problemas de ejecución debido de un lado a la dispersión geográfica de los destinatarios y de otra, a la necesidad de alcanzar cierto nivel de competencias tanto para su uso como para su diseño. En este contexto cobran especial significación la determinación de los objetivos así como el diseño curricular del programa que se pretende ejecutar.

Implementation of guidelines on delirium in a General Hospital: a before-after study of their impact on caregivers' knowledge and clinical skills

INTRODUCTION: Delirium is a highly prevalent disorder, with serious consequences for the hospitalised patient. Nevertheless, it remains under-diagnosed and under-treated. We developed evidence-based clinical practice guidelines (CPGs) focusing on prevention, screening, diagnosis, and treatment of delirium in a general hospital. This article presents the implementation process of these CPGs and a before-after study assessing their impact on healthcare professionals' knowledge and on clinical practice. METHODS: CPGs on delirium were first implemented in two wards (Neurology and Neurosurgery) of the Lausanne university hospital. Interactive one-hour educational sessions for small groups of nurses and physicians were organised. Participants received a summary of the guidelines and completed a multiple choice questionnaire, assessing putative changes in knowledge, before and three months after the educational session. Other indicators such as "diagnosis of delirium" reported in the discharge letters, and mean duration of patients' hospital stay before and after implementation were compared. RESULTS: Eighty percent of the nurses and physicians from the Neurology and Neurosurgery wards attended the educational sessions. Both nurses and physicians significantly improved their knowledge after the implementation (+9 percentage-points). Other indicators were not modified by the intervention. CONCLUSION: A single interactive intervention improved both nurses' and physicians' knowledge on delirium. Sustained and repeated interventions are probably needed to demonstrate changes in clinical practice.

County grant program for veterans : status report on the implementation of 2006 Iowa Acts, Chapter 1185, Section 34, 2007

This is an overview of the program that the General Assembly of Iowa appropriated $1 million for to the Iowa Department of Veterans Affairs with the intent to improve delivery services by the various County Commissions of Veterans Affairs to veterans in their respective counties.

Lihahygienialainsäädännön omavalvontasäädökset ja käytäntö Oy Snellman Ab:n teurastamossa ja leikkaamossa, osa I Osa 1 : Owncontrol directions in meat hygiene legislation and their practical implementation in the slaughterhouse and cutting plant of Snellman Ltd, part I

Summary: Owncontrol directions in meat hygiene legislation and their practical implementation in the slaughterhouse and cutting plant of Snellman Ltd, part I

Veterans counseling program : status report on the implementation of Iowa Code 35.12, Veterans Counseling & Outreach Program, 2008

This report gives an overview, background and progress on the implementation of the Veterans Counseling Program established pursuant to Iowa Code 35.12, as enacted by 2007 Iowa Acts, House FIle 817.

From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.

OBJECTIVES: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation. However, no studies have evaluated whether therapeutic hypothermia could be effectively implemented in intensive care practice and whether it would improve the outcome of all comatose patients with cardiac arrest, including those with shock or with cardiac arrest due to nonventricular fibrillation rhythms. DESIGN: Retrospective study. SETTING: Fourteen-bed medical intensive care unit in a university hospital. PATIENTS: Patients were 109 comatose patients with out-of-hospital cardiac arrest due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity). INTERVENTIONS: We analyzed 55 consecutive patients (June 2002 to December 2004) treated with therapeutic hypothermia (to a central target temperature of 33 degrees C, using external cooling). Fifty-four consecutive patients (June 1999 to May 2002) treated with standard resuscitation served as controls. Efficacy, safety, and outcome at hospital discharge were assessed. Good outcome was defined as Glasgow-Pittsburgh Cerebral Performance category 1 or 2. MEASUREMENTS AND MAIN RESULTS: In patients treated with therapeutic hypothermia, the median time to reach the target temperature was 5 hrs, with a progressive reduction over the 18 months of data collection. Therapeutic hypothermia had a major positive impact on the outcome of patients with cardiac arrest due to ventricular fibrillation (good outcome in 24 of 43 patients [55.8%] of the therapeutic hypothermia group vs. 11 of 43 patients [25.6%] of the standard resuscitation group, p = .004). The benefit of therapeutic hypothermia was also maintained in patients with shock (good outcome in five of 17 patients of the therapeutic hypothermia group vs. zero of 14 of the standard resuscitation group, p = .027). The outcome after cardiac arrest due to nonventricular fibrillation rhythms was poor and did not differ significantly between the two groups. Therapeutic hypothermia was of particular benefit in patients with short duration of cardiac arrest (<30 mins). CONCLUSIONS: Therapeutic hypothermia for the treatment of postcardiac arrest coma can be successfully implemented in intensive care practice with a major benefit on patient outcome, which appeared to be related to the type and the duration of initial cardiac arrest and seemed maintained in patients with shock.

Reconsidering the "policy gap":policy implementation and outcomes in Spain

By analysing entry policies and regularisation procedures in Spain from the 1990s to 2007, this article examines how the mismatch between very restrictive immigration policies and increasing foreign labour demands translated into a model of illegal migration, which in turn gave rise to the need to carry out periodical regularisation drives. This double 'policy gap' between legality and reality, and between entry policies and regularisation procedures, is explained as a policy in itself and as a way to solve in practice the apparently unsolvable dilemma between the demands for closure and the insatiable demands for foreign workers.

Basic life support teaching in the second year predraduate medical curriculum: quality of acquisition after 6 months

Purpose of the study: Basic life support (BLS) and automated externaldefibrillation (AED) represent important skills to be acquired duringpregraduate medical training. Since 3 years, our medical school hasintroduced a BLS-AED course (with certification) for all second yearmedical students. Few reports about quality and persistence over timeof BLS-AED learning are available to date in the medical literature.Comprehensive evaluation of students' acquired skills was performedat the end of the 2008 academic year, 6 month after certification.Materials and methods: The students (N = 142) were evaluated duringa 9 minutes «objective structured clinical examination» (OSCE) station.Out of a standardized scenario, they had to recognize a cardiac arrestsituation and start a resuscitation process. Their performance wererecorded on a PC using an Ambuman(TM) mannequin and the AmbuCPR software kit(TM) during a minimum of 8 cycles (30 compressions:2 ventilations each). BLS parameters were systematically checked. Nostudent-rater interactions were allowed during the whole evaluation.Results: Response of the victim was checked by 99% of the students(N = 140), 96% (N = 136) called for an ambulance and/or an AED. Openthe airway and check breathing were done by 96% (N = 137), 92% (N =132) gave 2 rescue breaths. Pulse was checked by 95% (N=135), 100%(N = 142) begun chest compression, 96% (N = 136) within 1 minute.Chest compression rate was 101 ± 18 per minute (mean ± SD), depthcompression 43 ± 8 mm, 97% (N = 138) respected a compressionventilationratio of 30:2.Conclusions: Quality of BLS skills acquisition is maintained during a6-month period after a BLS-AED certification. Main targets of 2005 AHAguidelines were well respected. This analysis represents one of thelargest evaluations of specific BLS teaching efficiency reported. Furtherfollow-up is needed to control the persistence of these skills during alonger time period and noteworthy at the end of the pregraduatemedical curriculum.

Paper 5: Surveillance of multiple congenital anomalies: implementation of a computer algorithm in European registers for classification of cases.

BACKGROUND: Surveillance of multiple congenital anomalies is considered to be more sensitive for the detection of new teratogens than surveillance of all or isolated congenital anomalies. Current literature proposes the manual review of all cases for classification into isolated or multiple congenital anomalies. METHODS: Multiple anomalies were defined as two or more major congenital anomalies, excluding sequences and syndromes. A computer algorithm for classification of major congenital anomaly cases in the EUROCAT database according to International Classification of Diseases (ICD)v10 codes was programmed, further developed, and implemented for 1 year's data (2004) from 25 registries. The group of cases classified with potential multiple congenital anomalies were manually reviewed by three geneticists to reach a final agreement of classification as "multiple congenital anomaly" cases. RESULTS: A total of 17,733 cases with major congenital anomalies were reported giving an overall prevalence of major congenital anomalies at 2.17%. The computer algorithm classified 10.5% of all cases as "potentially multiple congenital anomalies". After manual review of these cases, 7% were agreed to have true multiple congenital anomalies. Furthermore, the algorithm classified 15% of all cases as having chromosomal anomalies, 2% as monogenic syndromes, and 76% as isolated congenital anomalies. The proportion of multiple anomalies varies by congenital anomaly subgroup with up to 35% of cases with bilateral renal agenesis. CONCLUSIONS: The implementation of the EUROCAT computer algorithm is a feasible, efficient, and transparent way to improve classification of congenital anomalies for surveillance and research.

El principio del Universal Design. Concepto y desarrollos en la enseñanza superior

Los principios, las prácticas y la investigación sobre diseño universal han sidoimplantados progresivamente en diferentes ámbitos, respecto al diseño y la preparación de entornos para la atención a las necesidades de las personas con discapacidad. En el contexto internacional, este desarrollo ha estado vinculado al avance en derechos sobre igualdad de oportunidades. En el contexto legislativo español, en la Ley 51/2003 se introducen definiciones sobre «accesibilidad universal» y «diseño para todos», con lo que se genera un marco que posibilita el análisis de fuentes conceptuales y de aplicación en nuestro contexto, de las aportaciones del diseño universal, así como su consideración para la fundamentación de prácticas de innovación e investigación en nuestros ámbitos universitarios. En este trabajo, a partir de una amplia revisión de fuentes y aportaciones de gran trayectoria en este campo, se presentan y analizan distintos enfoques, a través de los cuales se están desarrollando y aplicando prácticas de diseño universal en el ámbito de la enseñanza universitaria, y se plantean sus implicaciones educativas. Este análisis permite concluir que las aplicaciones del diseño universal parecen más prometedoras para el progreso hacia metas de inclusión en el entorno universitario que una perspectiva de «adaptación curricular»; aunque se pone de manifiesto la necesidad de que la investigación que se desarrolle en nuestros contextos aporte pruebas y elementos que favorezcan su implementa- ción. Aplicar prácticas docentes y de planificación en la enseñanza universitaria con bases en el diseño universal podría contribuir a superar, eliminar o evitar en un futuro barreras en el aprendizaje, no solo limitadoras del progreso de las personas con discapacidad, sino también del conjunto del alumnado. Asimismo, las conclusiones de este trabajo plantean aplicaciones y estimaciones de nuevas muestras empíricas como puntos de partida para futuras y posibles determinaciones de enfoques conceptuales.

Implementing the Mechanistic-Empirical Pavement Design Guide: Implementation Plan, TR-509, 2005

The current 1993 American Association of State Highway and Transportation Officials (AASHTO) Pavement Design Guide is based on the empirical interpretation of the results of the 1960 AASHTO Road Test. With the release of the new Mechanistic-Empirical (M-E) Pavement Design Guide, pavement design has taken a "quantum" leap forward. In order to effectively and efficiently transition to the M-E Pavement Design Guide, state DOTs need a detailed implementation and training strategy. This document is a plan for the M-E Pavement Design Guide to be implemented in Iowa.

The Deleterious Chemical Effects of Concentrated Deicing Solutions on Portland Cement Concrete, TR-480, Implementation Guide, 2008

This research project investigated the effects of concentrated brines of magnesium chloride, calcium chloride, sodium chloride, and calcium magnesium acetate on portland cement concrete. Although known to be effective at deicing and anti-icing, the deleterious effects these chemicals may have on concrete have not been well documented. As a result of this research, it was determined that there is significant evidence that magnesium chloride and calcium chloride chemically interact with hardened portland cement paste in concrete resulting in expansive cracking, increased permeability, and a significant loss in compressive strength. Although the same effects were not seen with sodium chloride brines, it was shown that sodium chloride brines have the highest rate of ingress into hardened concrete. This latter fact is significant with respect to corrosion of embedded steel. The mechanism for attack of hardened cement paste varies with deicer chemical but in general, a chemical reaction between chlorides and cement hydration products results in the dissolution of the hardened cement paste and formation of oxychloride phases, which are expansive. The chemical attack of the hardened cement paste is significantly reduced if supplementary cementitious materials are included in the concrete mixture. Both coal fly ash and ground granulated blast furnace slag were found to be effective at mitigating the chemical attack caused by the deicers tested. In the tests performed, ground granulated blast furnace slag performed better as a mitigation strategy as compared to coal fly ash. Additionally, siloxane and silane sealants were effective at slowing the ingress of deicing chemicals into the concrete and thereby reducing the observed distress. In general, the siloxane sealant appeared to be more effective than the silane, but both were effective and should be considered as a maintenance strategy.

Review of Inconsistencies Between SUDAS and Iowa DOT Specifications Phase II: Implementation of Recommendations into SUDAS Specifications, TR-565, 2008

The current version of the SUDAS Specifications will be revised to accommodate the DOT’s utilization of SUDAS. The revisions to the SUDAS Specifications will be based upon the recommendations from Phase 1. In some instances, the recommendations will require reorganization of portions of the SUDAS Specifications. Upon incorporation of the Phase 1 recommendations, each applicable Division of the SUDAS Specifications will be updated into the active-imperative style, utilizing the 3- part specification format currently utilized by SUDAS.

Review of Inconsistencies Between SUDAS and Iowa DOT Specifications Phase II: Implementation of Recommendations into SUDAS Specifications, TR-565, Synopsis, 2008

The current version of the SUDAS Specifications will be revised to accommodate the DOT’s utilization of SUDAS. The revisions to the SUDAS Specifications will be based upon the recommendations from Phase 1. In some instances, the recommendations will require reorganization of portions of the SUDAS Specifications. Upon incorporation of the Phase 1 recommendations, each applicable Division of the SUDAS Specifications will be updated into the active-imperative style, utilizing the 3- part specification format currently utilized by SUDAS.

Implementation of a Pilot Continuous Monitoring System: Iowa Falls Arch Bridge, HR-1088, 2015

The goal of this work was to move structural health monitoring (SHM) one step closer to being ready for mainstream use by the Iowa Department of Transportation (DOT) Office of Bridges and Structures. To meet this goal, the objective of this project was to implement a pilot multi-sensor continuous monitoring system on the Iowa Falls Arch Bridge such that autonomous data analysis, storage, and retrieval can be demonstrated. The challenge with this work was to develop the open channels for communication, coordination, and cooperation of various Iowa DOT offices that could make use of the data. In a way, the end product was to be something akin to a control system that would allow for real-time evaluation of the operational condition of a monitored bridge. Development and finalization of general hardware and software components for a bridge SHM system were investigated and completed. This development and finalization was framed around the demonstration installation on the Iowa Falls Arch Bridge. The hardware system focused on using off-the-shelf sensors that could be read in either “fast” or “slow” modes depending on the desired monitoring metric. As hoped, the installed system operated with very few problems. In terms of communications—in part due to the anticipated installation on the I-74 bridge over the Mississippi River—a hardline digital subscriber line (DSL) internet connection and grid power were used. During operation, this system would transmit data to a central server location where the data would be processed and then archived for future retrieval and use. The pilot monitoring system was developed for general performance evaluation purposes (construction, structural, environmental, etc.) such that it could be easily adapted to the Iowa DOT’s bridges and other monitoring needs. The system was developed allowing easy access to near real-time data in a format usable to Iowa DOT engineers.