A new approach in the treatment of high flow native AV fistula: the open-pore external scaffolding prosthesis

Objective: The vascular access steal syndrome is a complication occurring in 1-6% after native arterio-venous (AV) fistulas, often due to huge diameter of the vein. This results in very high flow, which could also be responsible for cardiac overload. The aim of this study is to evaluate the efficiency of a new approach in the treatment of this pathology using open-pore external scaffolding prosthesis.Methods: This a retrospective review of all patients presenting symptomatic high flow after native AV fistula between January 2007 and December 2009 in 3 vascular centers. Pre-operative duplex exam confirmed the diagnosis of high flow. The operation consisted in preparation of the whole fistula, measurement of the flow and section on the venous side. The vein was wrapped with this 6 to 8 mm open-pore external scaffolding prosthesis (ProVena, BBraun, Germany) according to its diameter and to the flow and then sutured. Measurement of the flow was repeated. Patients were followed by duplex exam at 1 week and at 1, 3, 6 and 12 months. Procedural success was defined as complete implantation of the prosthesis and reduction of the flow. Primary outcomes were reduction of the flow and recovery of the symptoms and secondary endpoint was patency of the fistula.Results: During the study period, 14 patients, with a mean age of 65・8 years old, have been operated with this technique.There were 2 native forearmfistulas and 12 on the armwith a mean pre-operative flow of 2600 ml/min (1800-3800). The mode of presentation was pain in 6 patients, neurological disorders in 10 and necrosis in 4. Moreover, 3 patients had cardiac insufficiency due to high flow in the fistula. The procedure was technically successful in 100% of cases. Re-intervention was necessary in 2 patients due to hematoma. Recovery of the initial symptoms occurred in 13 patients (93%). The mean flow reduction was 1200 ml/min (600-2000). In 1 patient, a persistent steal syndrome despite flow reduction to 1400 ml/min resulted in fistula closure 2 months later. At a mean follow-up of 22 months (4-35), all remaining patients (13/14) presented a patent fistula without recurrence.Conclusion: This new approach seems to be safe and effective in the treatment of symptomatic high flow native AV fistulas by significantly reducing the flow and avoiding closure of the vascular access. Longer follow-up with more patients are necessary to evaluate the risk of recurrence.

Sistema de Informação Geográfica na Internet para apoio à gestão de Infra-estruturas, baseado em ferramentas Open Source

A gestão de infra-estruturas é um processo de coordenação, avaliação sistemática e manutenção efectiva das infra-estruturas relacionadas com os serviços básicos. A gestão eficaz de infra-estruturas exige que a disposição dos equipamentos no meio urbano seja conhecida, bem como sua relação com o uso do solo. Sendo a gestão de infra-estruturas uma questão de natureza espacial, é natural pensar na utilização de um Sistema de Informação Geográfica como ferramenta com potencial de grande utilidade, pois permite a georreferenciação de dados espaciais e sua interligação com atributos alfanuméricos, para além da realização de análises complexas e a possibilidade de simular diversos cenários de modo a propiciar uma tomada de decisão eficaz. O elevado custo das licenças e a especificidade de utilização a nível técnico, tornam-se obstáculos na criação e manutenção de dados geográficos. Contudo os recentes desenvolvimentos em tecnologias da Internet têm contribuído para o acesso, publicação, exploração e distribuição da Informação Geográfica. A utilização de SIG distribuídos na Internet (WebGIS), nomeadamente na vertente livre, pode ser uma solução adequada visto que coloca funcionalidades de SIG ao alcance de utilizadores, através de um simples browser, sem necessidade de investimentos em relação a software ou mesmo em formação técnica especializada. Assim, com este projecto pretende-se a criação de um sistema de Informação geográfico na Internet, utilizando softwares livres, que disponibiliza toda a informação geográfica e alfanumérica das infra-estruturas construídas e sob a responsabilidade do Ministério das Infra-estruturas e Economia Marítima, permitindo a visualização e a realização de pesquisas e operações de análise.

On optimal monetary and fiscal policy interactions in open economies

This paper studies monetary and fiscal policy interactions in a two country model, where taxes on firms sales are optimally chosen and the monetary policy is set cooperatively.It turns out that in a two country setting non-cooperative fiscal policy makers have an incentive to change taxes on sales depending on shocks realizations in order to reduce output production. Therefore whether the fiscal policy is set cooperatively or not matters for optimal monetary policy decisions. Indeed, as already shown in the literature, the cooperative monetary policy maker implements the flexible price allocation only when special conditions on the value of the distortions underlying the economy are met. However, if non-cooperative fiscal policy makers set the taxes on firms sales depending on shocks realizations, these conditions cannot be satisfied; conversely, when fiscal policy is cooperative, these conditions are fulfilled. We conclude that whether implementing the flexible price allocation is optimal or not depends on the fiscal policy regime.

Laparoscopic and open colorectal surgery in everyday practice : retrospective study

Résumé Introduction: La plupart des études disponibles sur la chirurgie colorectale par laparoscopie concernent des patients hautement sélectionnés. Le but de cette étude est d'analyser les résultats à court et à long terme de l'ensemble des patients traités dans un service de chirurgie générale. Méthodes: Il s'agit d'une analyse rétrospective d'un registre prospectif interne au service, dans lequel tous les patients consécutifs opérés pour la première fois du colon et du rectum entre mars 1993 et décembre 1997 ont été enregistrés. Les informations concernant le suivi ont été collectées par questionnaire. Résultats: Un total de 187 patients ont été opérés par laparoscopie et 215 patients par chirurgie ouverte durant la période d'étude. Les informations concernant le suivi ont pu être collectées dans 95% des cas avec une évolution de 1-107 mois (médiane 59 mois), respectivement de 1-104 mois (médiane 53 mois). Une conversion fut nécessaire dans 28 cas (15%) mais ceux-ci restent inclus dans le groupe laparoscopie pour l'analyse par intention de traitement. Dans le groupe laparoscopie, les opérations ont duré plus longtemps (205 vs 150 min, p<0.001) mais l'hospitalisation a été plus courte (8 vs 13 jours, p<0.001). La reprise du transit a été plus rapide après laparoscopie, mais uniquement après intervention sur le colon gauche (3 vs 4 jours, p<0.01). Cependant, la sélection préopératoire (nombre plus élevé d'urgences et de patients avec un risque anesthésiologique élevé dans le groupe de la chirurgie ouverte) a été favorable à la laparoscopie. Le taux de complications (global ainsi que pour chaque complication chirurgicale) a été similaire dans les deux groupes, avec un taux global de 20% environ. Conclusions: Malgré une sélection favorable des cas, uniquement très peu d'avantages à la laparoscopie sur la chirurgie ouverte ont pu être observés. Abstract Background: Most studies available on laparoscopic colorectal surgery focus on highly selected patient groups. The aim of the present study was to review short- and long-term outcome of everyday patients treated in a general surgery department. Methods: Retrospective review was carried out of a prospective database of all consecutive patients having undergone primary laparoscopic (LAP) or open colorectal surgery between March 1993 and December 1997. Follow-up data were completed via questionnaire. Results: A total of 187 patients underwent LAP resection and 215 patients underwent open surgery. Follow up was complete in 95% with a median of 59 months (range, 1-107 months) and 53 months (range, 1-104 months), respectively. There were 28 conversions (15%) in the LAP group and these remained in the LAP group in an intention-to-treat analysis. The LAP operations lasted significantly longer for all types of resections (205 vs 150 min, P<0.001) and hospital stay was shorter (8 vs 13 days, P<0.001). Recovery of intestinal function was faster in the LAP group, but only after left-sided procedures (3 vs 4days, P<0.01). However, preoperative patient selection (more emergency operations and patients with higher American Society of Anesthesiologists (ASA) score in the open group) had a major influence on these elements and favours the LAP group. Surprisingly, the overall surgical complication rate (including long-term complications such as wound hernia) was 20% in both groups with rates of individual complications also being comparable in both groups. Conclusion: Despite a patient selection favourable to the laparoscopy group, only little advantage in postoperative outcome could be shown for the minimally invasive over the open approach in the everyday patient.

Organização e Publicação dos Termos do Website da ANACOM sob uma Perspetiva Linked Open Data

O propósito da Web Semântica é conseguir uma Web de dados totalmente ligada, isto é, numa perspetiva Linked Open Data. A Web Semântica deve garantir (estabelecendo padrões tecnológicos, vocabulários, linguagens lógicas, etc.) que os conteúdos publicados na Websejam inteligíveis quer por agentes humanos, quer por agentes máquina. Esta dissertação tem como objetivo responder à um problema delimitado, propondo uma solução no quadro da Web Semântica e suas tecnologias. Partindo-se de uma lista de termos em linguagem natural utilizados no Website da ANACOM (Autoridade Nacional de Comunicações), propomos uma organização de acordo com metodologias de construção de ontologias e vocabulários. Inspirámo-nos em duas metodologias, o Ontology Development 101 e o Process and Methodology for Core Vocabularies. O vocabulário controlado resultante, tem como base tecnológica o modelo de organização de conhecimento, recomendado pelo W3C (World Wide Web Consortium), o SKOS (Simple Knowledge Organization System). Trata-sede uma tecnologia standard da W3C desde 2009, utilizada na criação de tesauros,esquemas de classificação, taxonomias, glossários e outros tipos de vocabulários controlados. Como resultado da nossa intervenção, conseguimos organizar e codificar em SKOS, cerca de cinco centenas de termos identificados no Website da ANACOM. Para além da proposta do vocabulário controlado, passámos em revista às tecnologias e teorias que sustentam a temática da Web Semântica.

A structural model of Australia as a small open economy

This paper sets up and estimates a structuralmodel of Australia as a small open economyusing Bayesian techniques. Unlike other recentstudies, the paper shows that a small microfoundedmodel can capture the open economydimensions quite well. Specifically, the modelattributes a substantial fraction of the volatilityof domestic output and inflation to foreigndisturbances, close to what is suggested by unrestrictedVAR studies. The paper also investigatesthe effects of various exogenous shockson the Australian economy.

A medium-scale open economy model of Australia

We estimate an open economy dynamic stochastic general equilibrium (DSGE)model of Australia with a number of shocks, frictions and rigidities, matching alarge number of observable time series. We find that both foreign and domesticshocks are important drivers of the Australian business cycle.We also find that theinitial impact on inflation of an increase in demand for Australian commoditiesis negative, due to an improvement in the real exchange rate, though there is apersistent positive effect on inflation that dominates at longer horizons.

Monetary policy and exchange rate volatility in a small open economy

We lay out a small open economy version of the Calvo sticky price model, and show how the equilibrium dynamics can be reduced to simple representation in domestic inflation and the output gap. We use the resulting framework to analyze the macroeconomic implications of three alternative rule-based policy regimes for the small open economy: domestic inflation and CPI-based Taylor rules, and an exchange rate peg. We show that a key difference amongthese regimes lies in the relative amount of exchange rate volatility that they entail. We also discuss a special case for which domestic inflation targeting constitutes the optimal policy, and where a simple second order approximation to the utility of the representative consumer can be derived and used to evaluate the welfare losses associated with the suboptimal rules.

How do very open economies adjust to large immigration flows? Recent evidence from Spanish regions

In recent years, Spain has received unprecedented immigration flows. Between 2001 and 2006 the fraction of the population born abroad more than doubled, increasing from4.8% to 10.8%. For Spanish provinces with above-median inflows (relative to population),immigration increased by 24% the number of high school dropouts while only increasingcollege graduates by 11%. We study different channels by which regional labor markets haveabsorbed the large increase in relative supply of low educated workers. We identify theexogenous supply shock using historical immigrant settlement patterns by country of origin.Using data from the Labor Force Survey and the decennial Census, we find a large expansion ofemployment in high immigration regions. Disaggregating by industry, the absorption operatedthrough large increases in the share of low-educated workers, compared to the same industry inlow-immigration regions. We do not find changes in sectoral specialization. Overall, andperhaps surprisingly, the pattern of absorption is very similar to the one found in the US.

Which inflation to target? A small open economy with sticky wages indexed to past inflation

In a closed economy context there is common agreement on price inflation stabilization being one of the objects of monetary policy. Moving to an open economy context gives rise to the coexistence of two measures of inflation: domestic inflation (DI) and consumer price inflation (CPI). Which one of the two measures should be the target variable? This is the question addressed in this paper. In particular, I use a small open economy model to show that once sticky wages indexed to past CPI inflation are introduced, a complete inward looking monetary policy is no more optimal. I first, derive a loss function from a secondorder approximation of the utility function and then, I compute the fully optimalmonetary policy under commitment. Then, I use the optimal monetary policy as a benchmark to compare the performance of different monetary policy rules. The main result is that once a positive degree of indexation is introduced in the model the rule performing better (among the Taylor type rules considered) is the one targeting wage inflation and CPI inflation. Moreover this rule delivers results very close to the one obtained under the fully optimal monetary policy with commitment.

What is the importance of open habitat in a predominantly closed forest area to the dung beetle (Coleoptera, Scarabaeinae) assemblage?

What is the importance of open habitat in a predominantly closed forest to the dung beetle assemblage? The Atlantic Forest in Brazil is one of the most highly disturbed ecosystems and is mainly represented by fragmented areas. However, in places where human disturbances have ceased, certain areas are showing a natural regeneration pattern. The aim of the present study was to determine how the dung beetle assemblage responds to distinct habitat structures in a fragment of Atlantic Forest. For such, open and closed forest areas were sampled in a fragment of the Atlantic Forest in the northeastern region of Brazil. Pitfall traps baited with excrement and carrion were used to collect the beetles. A total of 7,267 individuals belonging to 35 species were captured. Canthon chalybaeus and C. mutabilis were restricted to open areas. Nearly 90% of the individuals of C. aff. simulans and Deltochilum aff. irroratum were identified in these areas. A higher percentage (> 50%) of Canthon staigi, Dichotomius aff. depressicolis and D. aff. sericeus occurred in closed areas. Abundance differed between areas, with higher values in closed areas. Richness was not influenced by the habitat structure. NMDS ordination exhibited the segregation of areas and ANOSIM confirmed that this variable explained the assemblage of dung beetle species. The findings of the present study validate that open areas are associated to more restrictive conditions, limiting a higher abundance of dung beetle. Although situated near preserved fragments, the studied open areas increase the heterogeneity of the general landscape.

Open Door Newsletter of the Library, Winter 2007

The Open Door newsletter is produced by the Iowa Commission for the Blind. It is published twice a year with information about the library programs and what is going on.

Open Door Newsletter of the Library, Spring 2008

The Open Door newsletter is produced by the Iowa Commission for the Blind. It is published twice a year with information about the library programs and what is going on.